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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.

The present essay describes the scientific evidence on the decay of memory and focus caused due to overstimulation by digital media - herein dubbed "global forgetting". The argument put forth is that this situation is not limited to individual psychoneurological aspects, but rather to contemporary sociocultural processes comprising and fed by convergent technical, political, and economic vectors. This paper addresses the ethicality of overstimulation through the use of powerful technical devices of communicative curation, which result in the erasure of references that constitute collective identity and facilitate the acceptance of disinformation. We conceive these dynamics of erasure and the destruction of references as a positive sociotechnical process - and not merely a casual consequence. We use the emblematic case of the "people's radio" in the rise of Nazism, showing how extreme communicative events operate through the opposition of anti-versions (historical/scientific denialism) underpinned by disinformation that incites hatred (conspiracy theories) and simplifies complex scenarios in the construction of post-truths. The ethicality of contemporary digital technologies is questioned, which simultaneously cultivate the emptying of individual and collective memory through "global forgetting" with the purpose of rewriting the past and mitigating the cognitive dissonance resulting from contradictions with facts. We thus reject the notion of fortuitous forgetting as a mere gap resulting from unlinked casual psychotechnical phenomena. In summary, we point to the interconnections among "global forgetting", denialism, and post-truths, which are interdependent in terms of causalities, purposes, and dynamics.

In a country with about 20 million adult smokers, 174,000 deaths per year and BRL 153.5 billion in annual direct and indirect costs are attributable to smoking. The provision of brief advice to quit smoking by health professionals during any routine visit, as recommended by the World Health Organization, has enormous potential to reduce these numbers. For men and women aged 35 years or older, we estimated the deaths and total costs that could have been avoided if brief counseling had been offered to all smokers in Brazil in 2019 based on the most recent national data on smoking behavior and the costs of selected diseases (ischemic heart disease, stroke, chronic obstructive pulmonary disease, and lung cancer). If all 7.1 million smokers who did not receive brief counseling (49.7% of the total) had been approached, we could have had half a million more former smokers, i.e., representing a reduction of 642 deaths and saving, at the time, BRL 749.9 million. The highest numbers of deaths and cost savings would have been observed, respectively, among men for heart disease prevention and women for stroke prevention. Brazil still has a high absolute number of smokers and, therefore, the high costs associated with smoking should be analyzed using a population-based approach focused on reducing new cases and deaths from tobacco-related diseases. The resources saved by this strategy could be directed to meet the basic needs of the population, promoting health and improving quality of life.

The health crisis resulting from community transmission of COVID-19 called for the health surveillance to play a central role in facing the pandemic. This study analyzes the contributions and difficulties faced by health surveillance in the development of actions to combat the COVID-19 pandemic in Brazilian remote rural municipalities from the perspective of managers, professionals and users. This was a qualitative study of multiple cases that involved a thematic and deductive analysis of 51 interviews conducted with managers and health professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas, and 29 interviews with users, community health agents and social movements in eight remote rural municipalities. During the COVID-19 pandemic, they faced difficulties in operationalizing health surveillance and ensuring the access of patients with compromised respiratory status to health services. They needed to reorganize the health care network, establish technical cooperation, conduct inter-agency governance and seek alternatives to operationalize the local health system. The main obstacles faced in care were related to articulation between states, which were insufficient to strengthen the care and laboratory network and the logistical system. The political, structural and organizational constraints confirmed that local managers contributed to contain the risks and made an effort to establish local intersectoral arrangements and relations, integrate health surveillance with primary health care, reorganize work processes and communication with the population. Effectively and sustainably overcoming the difficulties faced by remote rural municipalities requires cooperation between states guided by the principles of comprehensiveness, intersectoriality, and social participation.

This theoretical-conceptual study aimed to develop a theoretical model to promote adequate and healthy eating in early childhood education by surveying the literature, developing a model, and evaluating its face and content validity. The axes of promoting adequate and healthy eating and the Strong Structuring Theory were adopted as theoretical-conceptual references. The proposed model consists of a visual scheme that shows actions to be developed by agents inside and outside early childhood education units. Its development presupposes intersectoral articulations and actions to encourage the adoption of healthy eating habits (inclusion of food and nutrition education as a daily and transversal practice to the curriculum, and mobilization and training on this topic with families), support for adherence to healthy eating practices (supply of human milk and adequate and healthy food and care for children with special or specific dietary needs), and protect healthy and adequate food (control the hygiene of food; accident prevention in the environments in which meals are prepared and offered; and regulation of the supply, trade, and advertising of ultra-processed foods and non-recommended preparations) along with transversal actions (training, interaction, monitoring, and evaluation). The proposed model contributes to the understanding of the topic by explaining the scope of early childhood education unit actions concerning the promotion of adequate and healthy eating.

Risky sexual behaviors, such as the nonuse of condoms, are identified in the literature as a possible outcome of excessive alcohol use. However, studies on this topic are focused on the high-risk population, namely young adults, men who have sex with men, and sex workers, which limits the analysis of life stages in this association. Thus, this study aimed to verify, for the first time, the association between heavy drinking, at global-level, and inconsistent condom use among unmarried, not cohabiting Brazilians aged 18 to 59 years in various phases of adulthood. Data were obtained from the 2019 Brazilian National Health Survey (N = 15,835). Adjusted prevalence ratios and confidence intervals were estimated using Poisson regression models stratified by sex. Heavy drinkers, unmarried, not cohabiting adults were significantly more likely to report inconsistent condom use when compared with non-heavy drinkers for all age groups and both sexes. However, significant differences were not found for this association between the phases of adulthood.