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This article analyzes the implementation of changes in national primary health care (PHC) policies in Brazil, and their repercussions in the Metropolitan Health Region I of Rio de Janeiro and in the Northern MacroRregion of Paraná between 2017 and 2022. This multicenter study adopts a comparative approach and mixed methods to identify similarities and differences between cases in three analytical axes: profile, institutional positioning, and conceptions about PHC; organizational decisions related to the work process; coverage and composition of teams. A total of 44 interviews were conducted with managers in 14 selected municipalities and secondary data were analyzed. Higher degrees in health, introduction to Public Health and short time in office, due to municipal elections, were common characteristics of the interviewees. There was convergence in the conceptions of PHC and the Family Health Strategy, as well as tensions and favorable positions for the Prevent Brazil Program, which encouraged organizational changes in the registration of the population and in the fulfillment of goals. A diverse set of strategies for monitoring, evaluation and maintenance of programs and actions was identified, as well as a reduction in the number of community health agents per team and an increase in the number of teams per basic health unit. Despite the predominance of family health teams, there were differences between the proportion of the registered population and the number of teams in the Family Health Support Center. The analysis suggests that the implementation of PHC guidelines and their repercussions are influenced by complex and interdependent factors, such as municipal capacities, intergovernmental relations, and state action within the regional context.

Temporal trends in cesarean section (C-sections) rates were analyzed in Brazil and its regions using the Robson classification system. An ecological time-series study was conducted with data from the Brazilian Ministry of Health about C-section rates from 2014 to 2022. Joinpoint models were used to estimate percentage changes in C-section rate trends in the units of analysis. C-section rate in the study period was 56.4%. Robson groups with low expected C-section values (R1 to R4) represented 46% of the total rate of C-sections, with higher rates in the R2 and R4 groups. In these groups, rates increased significantly in Brazil and all its regions during the study period. However, a significant decrease in rates was observed in the R1 and R3 groups, from 2014 to 2016 in Brazil and in the North, Northeast, and Southeast regions. Despite its larger relative size among groups and greater contributions to the total C-section rate, the R5 group had a small but significant increase in rates in the Central-West Region only. Groups with higher expected values for C-sections (R6 to R10) showed a general upward trend, except for R9. The results indicate an excess of C-sections in Brazil and its regions, especially in low obstetric risk groups. Therefore, efforts to reduce unnecessary C-sections should be based on interventions to improve labor management in nulliparous women and promote vaginal birth after the procedure.

[This corrects the article doi: 10.1590/0102-311XPT175024].

Different perspectives with regards to illness may be influenced by distinct cultures. The aim of the present study was to explore illness representations of the part of Brazilians with Alzheimer's disease (AD). A qualitative study was conducted involving 12 participants with mild and moderate AD using a semi-structured interview guide. Interpretative Phenomenological Analysis was used to guide the analysis of the participants' accounts, resulting in themes that formed five categories. The biological category (six participants) emerged from a group that acknowledged their memory deficits. Two participants from this group mentioned memory deficits and labeled their condition as a disease without the use of diagnostic labels. Three participants from this category recognized memory deficits and related their difficulties to the aging process. The psychosocial category resulted from the accounts of two participants who acknowledged memory deficits and attributed such deficits to the erosion of memory function as well as troubles with day-to-day stress. A mixed category (one participant) included biological, psychosocial, and cultural aspects. The participant labeled the disease as "Zazá", which was considered a cultural euphemism. Two additional categories were identified: one with two participants uncertain of how to make sense of their condition and the last one included one participant who was unaware of her condition. The present results show that illness representations of individuals with AD are influenced by emotional, social, and cultural contexts, and are also deeply embedded in individual coping mechanisms.

Given the centrality of comprehensive care and network organization as key outcomes of matrix support, this study aims to examine changes in the operation of the community mental health network in Itatiba, São Paulo State, Brazil, after the implementation of matrix support, focusing on three main components: (i) users' profile; (ii) identification of available therapeutic interventions; and (iii) analysis of the clinical care received by participants across the studied services. This is a repeated cross-sectional, document-based descriptive study with two measurement points (T0 and T1). Data for T0 were collected between May and July 2019, and for T1 between November and December 2021. A total of 1,958 records were analyzed at T0 and 1,431 at T1, using descriptive statistical analysis to estimate absolute and relative frequencies for each variable. The findings indicate substantial changes in referral patterns following matrix support implementation, with a decrease in spontaneous demand and a greater role of primary care in coordinating access to specialized mental health services. Improvements were also observed in clinical care, with increased attention to vital signs measurement, anamnesis, physical exams, and documentation of smoking, alcohol, and psychoactive substance use. These results suggest that matrix support contributed to a more structured and effective mental health network, enhancing integration between care levels and promoting more comprehensive and accessible care.

The Brazilian National Oral Health Policy has increased access to dental services for the Brazilian population. However, it is not clear whether there has been a reduction in oral health inequalities in the country. The aim of the study was to investigate the evolution of socioeconomic inequalities in oral health, the use of oral hygiene products, and the use of dental services in the adult population of Brazil between 2013 and 2019. Data from the Brazilian National Health Survey conducted in 2013 (n = 60,202) and 2019 (n = 88,531) were used to calculate the slope index of inequality (SII) and relative index of inequality (RII) in terms of schooling and family income per capita. The dependent variables were the use of a toothbrush, toothpaste, and dental floss, functional dentition, use of dental services at least once in life, use of dental services in the previous year, and use of dental services for preventive care. Inequalities in the use of oral hygiene products and the use of dental services reduced between 2013 to 2019. However, functional dentition maintained the same levels of inequality in terms of schooling (RII = 1.6) and income (RII = 1.3). Schooling inequalities in the use of preventive dental care increased (SII = 33.3 in 2013, SII = 38.9 in 2019). This study underscores the need to reorient the Brazilian National Oral Health Policy in order to reduce tooth loss and improve the use of dental services for preventive care in the most vulnerable groups. Despite improvements in the use of dental services and oral hygiene products, socioeconomic inequalities in oral health persist in Brazil.

Cancer is a global public health concern due to its high mortality rates. In Brazil, breast cancer is one of the leading causes of disease and death among women in all regions of the country, with higher mortality rates in less developed regions. Hence, this study analyzes variables associated with survival time in breast cancer patients in Campina Grande, Paraíba State, Brazil. Distributional regression models, also known as generalized additive models for location, scale, and shape (GAMLSS), were used due to their flexibility in explaining complex behaviors of a given response (for example, survival time) based on other variables. Tumor site, age, number of hormone therapy, radiotherapy and chemotherapy sessions, and molecular markers such as estrogen receptor, progesterone receptor, Ki-67 protein, p53, HER2 mutation and molecular subtype were examined. Two different GAMLSS were fitted considering Weibull and log-normal distributions, the former of which is more appropriate per the Akaike information criterion. Using a variable selection procedure specific to GAMLSS, we identified four covariates that directly affect average survival time: number of hormone therapy and chemotherapy sessions, p53 status, and estrogen receptor status. Excepting estrogen receptor status, the other covariates selected to explain average survival time were also used to explicitly explain the variability of these times.

The experience of adolescence occurs in multiple contexts mediated by the positions these individuals occupy in social structures. We aim to understand the role of interactions between social markers of difference, such as race/color, gender, and social class, in the social and affective relationships of young black women in a working-class neighborhood in Salvador, Bahia State, Brazil. This qualitative research is based on a multicenter study in five Brazilian municipalities. Data from 16 interviews from May 2021 to August 2022 and a focus group conducted with black adolescents who were aged from 15 to 19 years were included. The analysis of the empirical material had intersectionality as a theoretical framework. The experiences of black adolescents in spaces of sociability in popular neighborhoods, such as paredões and the school, were crossed by racism, sexism, and class discrimination. Affective relationships, on the other hand, were mainly marked by the intersection between racism and sexism, which and objectifies black female bodies. In this context of multiple crossings, the collective spaces of resistance in the territory emerge as powerful equipment to promote racial and gender awareness and to discuss strategies to produce equity. This context evinces that the intersection between the social markers of race/color, gender, and social class acts in the production of multiple oppressions against black and peripheral adolescents in these spaces and affective experiences.

This study aimed to analyze the coverage of cervical cancer screening in Brazil and its Federative Units (UF, acronym in Portuguese) using secondary data from the Brazilian Cancer Information System (SISCAN, acronym in Portuguese), and to compare it with the index of exam rate in females, classically used as a proxy for coverage, and to estimate the possible coverage, if the national guidelines recommended by the Brazilian Ministry of Health were properly followed by health professionals. Cytopathological tests performed between 2021 and 2023 in women up to 64 years old, registered in SISCAN and in the Outpatient Information System of the SUS (SIA/SUS, acronym in Portuguese), were selected. Coverage and ratio indicators were calculated by UF of residence. The estimated screening coverage was estimated by adding up all the tests performed in the period in women up to 64 years old and dividing by the target population (25-64 years). The estimated screening coverage for Brazil was 35.6%, which is lower than the values of the index of exam rate (47.4 and 47.8 per 100 women according to SISCAN and SIA/SUS, respectively). It was found that by directing the tests to the appropriate age group and periodicity, coverage could reach 53.9% in Brazil and exceed 70% in Espírito Santo, Paraná and Santa Catarina. It was concluded that the rate index overestimates coverage by approximately 35% and that screening coverage is far below the 70% recommended by the World Health Organization. However, the sensitization of professionals regarding the guidelines of the Brazilian Ministry of Health can change this scenario, optimizing resources and generating a positive impact on cervical cancer incidence and mortality.

This study aimed to provide a consensus-based short list of barriers and challenges to establish accessible radiotherapy services in Brazil and to discuss the managerial actions proposed to reduce the waiting time to initiate radiotherapy treatments. An e-Delphi study was made with no direct interaction between respondents. Virtual surveys were sent to physicians who had expertise in radiotherapy. A baseline list of 15 previously published barriers to radiotherapy access in low- and middle-income countries was put in topics. Participants had to rate the priority of including each of the 15 topics in future governmental interventions by using a 5-point Likert scale. Average scores for each topic were calculated and expressed as percentages. Consensus was achieved if the topic obtained a score of > 70% agreement among the participants that rated it as very high or high priority, plus being in the top five in the ranking list of importance. Four topics reached consensus. Two topics were related to costs (resources, funding models, and financial stability), one to policy environment (political instability), and one to poverty levels and planning distribution of technology. Such results form the basis for an action plan and the comprehensive priority topics should be considered in the efforts to provide better access to radiotherapy services.