Revista de saude publica最新文献

{"title":"Mental health during the Covid-19 pandemic: reports from health professionals in Rio de Janeiro.","authors":"Débora Castanheira, Carla Pereira, Thiago Silva Torres, Daniele Novaes, Gessica Ferreira, Thiago Jacobino, Thaís Regis Aranha Rossi, Valdilea Gonçalves Veloso","doi":"10.11606/s1518-8787.2026060006425","DOIUrl":"https://doi.org/10.11606/s1518-8787.2026060006425","url":null,"abstract":"<p><strong>Objective: </strong>To explore the perception of health professionals who worked in primary health care between 2020 and 2022, in the Manguinhos neighborhood of Rio de Janeiro, regarding the risk and protective factors for their mental health during the management of the Covid-19 pandemic.</p><p><strong>Methods: </strong>This is a qualitative study integrated into a broader investigation on testing strategies, quarantine, digital health, and telemonitoring in areas of high socioeconomic vulnerability in Brazil. Three focus groups were conducted with community health agents and ten semistructured interviews with higher education professionals. The data were collected between November 2022 and March 2023. The analysis was conducted based on the psychodynamics of work, and the procedures followed the content analysis technique.</p><p><strong>Results: </strong>The study identified several factors that contributed to high levels of stress and anxiety among health professionals who worked in family health units during the Covid-19 pandemic. The main reported factor was the constant fear of death. Additionally, work overload, lack of adequate personal protective equipment, feelings of decision-making incapacity, and absence of mental health support exacerbated the impact on the professionals' health. Among community health agents, the perception of exclusion concerning the health professionals category was particularly noted.</p><p><strong>Conclusion: </strong>The Covid-19 pandemic revealed the urgent need to prioritize the mental health of health professionals from the onset of any health crisis. Preparing for future emergencies requires proactive actions, such as equitable distribution of workload, adequate provision of personal protective equipment, and free and accessible access to specialized mental health treatment for health professionals.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 suppl 1","pages":"e12s"},"PeriodicalIF":2.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precarious work and Covid-19: repercussions on the health of primary health care workers.","authors":"Ticiane Teixeira de Mendonça, Sandra Garrido de Barros, Thais Regis Aranha Rossi, Ana Clara de Rebouças de Carvalho, Denise Nogueira Cruz, Laio Magno, Ines Dourado","doi":"10.11606/s1518-8787.2026060006692","DOIUrl":"https://doi.org/10.11606/s1518-8787.2026060006692","url":null,"abstract":"<p><strong>Objective: </strong>To analyze how the Covid-19 pandemic influenced the working conditions and health of primary health care professionals in a health district of a capital city in Northeast Brazil.</p><p><strong>Methods: </strong>This was a qualitative study using the theoretical framework of the health work process, part of the formative research of the project \"Expansion of testing, quarantine, e-health and telemonitoring strategies in the fight against Covid-19 in Brazil\" (TQT Project). Data were collected between December 2021 and March 2022 in a health district of a capital city in Northeast Brazil to support the implementation of the aforementioned project. Twenty-two interviews and three focus groups with 19 participants, all health care professionals from the health district under study, were analyzed for their content.</p><p><strong>Results: </strong>The pandemic context caused repercussions on working conditions and health, with the effects of precarious working conditions and the implementation of protective measures being highlighted as key elements in the dimension of working conditions. Mental suffering, the impact of gender issues, and post-Covid-19 conditions were identified as the main elements contributing to the illness of the professionals.</p><p><strong>Conclusion: </strong>The evidence set gathered in this study indicates that various stressors emerge or worsen intensely and inseparably among health care professionals, clearly demonstrating the relationship between the pandemic and the health-disease process of these workers. Therefore, it is imperative to reverse the situation of illness among workers in the post-pandemic period to mitigate its effects in the medium and long term.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 suppl 1","pages":"e11s"},"PeriodicalIF":2.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the implementation of an intervention aimed at expanding Covid-19 testing, case telemonitoring and surveillance actions in Primary Health Care.","authors":"Gerluce Alves Pontes da Silva, Thais Regis Aranha Rossi, Sisse Figueiredo de Santana, Alcione Brasileiro Oliveira, Ana Maria Freire de Souza Lima, Trícia Silva Santos, Izabel Cristina Neves Ramos, Carolina Pedroza de Carvalho Garcia, Laio Magno, Inês Dourado, Lígia Maria Vieira da Silva","doi":"10.11606/s1518-8787.2026060006688","DOIUrl":"https://doi.org/10.11606/s1518-8787.2026060006688","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the degree of implementation of an intervention aimed at expanding testing, isolation, quarantine, and telemonitoring of Covid-19 cases (TQT-Covid-Strategy) in primary healthcare units within an administrative health region of a municipality in Northeastern Brazil.</p><p><strong>Methods: </strong>A decision matrix was used with dimensions and criteria derived from a logical model developed based on literature review and technical guidelines of the World Health Organization, the Brazilian Ministry of Health, and the host municipality of the administrative health region. Interviews were conducted with 121 key informants.</p><p><strong>Results: </strong>The degree of implementation in the 17 health units surveyed (12 Family Health Units and five health centers) varied according to the final classification, dimensions, and criteria. Overall, most units were considered as having the intervention partially implemented, with the highest rated dimension being \"accessibility to testing,\" implemented in 82.3% of the units, followed by the use of the \"digital platform,\" partially implemented in 15 units. The dimension with the lowest score percentage was \"monitoring cases and surveillance strategies\".</p><p><strong>Conclusions: </strong>The intervention led to significant improvements in access to testing, supported by the adoption of communication strategies that enhanced the population's adherence. Contextual, operational, technical, and acceptance factors among health professionals and users represented important challenges to implementation. To ensure sustainability and dissemination of this strategy, investments are required to strengthen Primary Health Care, including improvement in infrastructure, expansion of the health workforce, and professionals training.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 suppl 1","pages":"e13s"},"PeriodicalIF":2.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost of a healthy and sustainable basic food basket in Brazil between 2009 and 2024.","authors":"Eliseu Verly Junior, Dirce Maria Lobo Marchioni, Semíramis Martins Álvares Domene, Isabela de Albuquerque Ribeiro, Flávia Mori Sarti","doi":"10.11606/s1518-8787.2026060006878","DOIUrl":"10.11606/s1518-8787.2026060006878","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the evolution of the cost of a proposed healthy and sustainable basic food basket, nationally and for metropolitan regions, between 2009 and 2024.</p><p><strong>Methods: </strong>Food purchase data (quantities and amounts paid) from the 2008-2009 and 2017-2018 Pesquisas de Orçamentos Familiares (POF - Household Budget Surveys) were used. The food groups that make up the baskets were based on the Eat-Lancet planetary diet and official regulatory instruments. The Broad Consumer Price Index for foods and food groups was used to update the monthly prices of the items consumed by the Brazilian population in the context of the POFs that make up the proposed basic food basket. The accumulated inflation over the period was discounted to compare monetary values over time, calculating the real value of the basic food baskets.</p><p><strong>Results: </strong>The real cost of the proposed national basic food basket remained relatively stable between 2009 and 2012, showing a subsequent upward trend until early 2017, including more significant growth between 2018 and 2024. A similar pattern was observed in the basic food baskets of the metropolitan regions. The cost (adult/month) represented on average 26% of the minimum wage in force in each year of the analysis period and 19% of the national average per capita income between 2010 and 2023. The share of food groups in the cost of the proposed basket remained stable over the period.</p><p><strong>Conclusion: </strong>There has been an increase in the real cost of the proposed healthy and sustainable basic food basket at national and regional level, particularly since 2018. Moreover, the value of the healthy and sustainable basic food basket showed an upward trend in relation to the average per capita income of the population, especially since 2018.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e15"},"PeriodicalIF":2.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13073137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profile of food and beverage street vendors around private schools in Brazil.","authors":"Sabrina Gomes Ferreira Clark, Larissa Loures Mendes, Juliana Souza Oliveira, Luiza Delazari Borges, Letícia Ferreira Tavares, Paulo César Pereira de Castro Júnior, Letícia de Oliveira Cardoso, Raquel Canuto","doi":"10.11606/s1518-8787.2026060007205","DOIUrl":"https://doi.org/10.11606/s1518-8787.2026060007205","url":null,"abstract":"<p><strong>Objective: </strong>To describe the socioeconomic profile and activity of street vendors, as well as the profile of food sales, according to industrial processing, in the vicinity of private schools in Brazilian state capitals.</p><p><strong>Methods: </strong>Cross-sectional study with street vendors in the immediate vicinity of a national probability sample of Brazilian private schools. Elementary and/or high schools participating in the Food Marketing in Brazilian Schools Study were included. A previously validated questionnaire was applied to characterize workers, infrastructure and food availability. Food was classified according to the NOVA system. Comparisons between macro-regions (North, Northeast, Central-West, Southeast, and South) and sizes of point of sale (smallest: 1-3 items; intermediate: 4-13 items; largest: ≥ 14 items) were evaluated using the Kruskal-Wallis test.</p><p><strong>Results: </strong>The informal food and beverage trade in the immediate vicinity of 2,180 private schools was mapped, totaling 699 street vendors. There was a predominance of men (57.8%), black people (68.8%), those with completed secondary education (35.8%), and those who worked informally (91.4%), in carts and stalls, due to a lack of opportunity in the formal market (52.5%). The median number of ultra-processed items was about twice that of in natura, minimally processed, or processed foods and preparations based on them (2.17; 95%CI 1.90-2.45). Larger outlets concentrated more ultra-processed foods in all regions, except in the Northeast, where this predominance already occurred in intermediate-sized outlets (3.32; 95%CI 2.88-3.75). The lowest ratio of ultra-processed foods was observed in the South (0.21; 95%CI 0.05-0.37) and the highest in the Northeast (3.32; 95%CI 2.88-3.75).</p><p><strong>Conclusion: </strong>Street vending around Brazilian private schools reflects structural inequalities and expands commercially in the supply of ultra-processed foods to children and adolescents. We recommend its inclusion as an inseparable component in the evaluation of the school food environment, to support policies that reconcile income generation and the promotion of healthy eating.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e14"},"PeriodicalIF":2.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with the cost of child and adolescent mental health crisis care in Brazil.","authors":"Nathalia Nakano Telles, Heloísa Garcia Claro, José Carlos Marques de Carvalho, Márcia Aparecida Ferreira de Oliveira","doi":"10.11606/s1518-8787.2026060007306","DOIUrl":"10.11606/s1518-8787.2026060007306","url":null,"abstract":"<p><strong>Objective: </strong>To identify the sociodemographic and clinical variables that influenced the daily costs of children and adolescents who stayed overnight in Type III Centro de Atenção Psicossocial Infantojuvenil (CAPSij - Child and Adolescent Psychosocial Care Center) or in hospital reference or emergency and urgent care from the perspective of society in the year 2023.</p><p><strong>Methods: </strong>This is a retrospective cost analysis. Direct and indirect costs were collected. A mixed technique was used to measure costs, prioritizing the micro-costing approach and the bottom-up method for valuation. Factors influencing costs were evaluated using univariate statistical models.</p><p><strong>Results: </strong>The study included 399 users. The average total cost was R$ 6,704.38 (US$ 1,149.99) and the average daily cost was R$ 1,097.97 (US$ 188.33). There was statistical significance in the correlation between daily cost and age, race, diagnostic subgroup, referral to the service, and reason for seeking care. The variable with the greatest positive variation in daily cost was seeking care for drug use (R$ 125.82; US$ 21.58), while the variable with the greatest negative variation in daily cost was being referred by another service (R$ 139.86; US$ 23.99).</p><p><strong>Conclusions: </strong>To make more efficient use of available resources, it is up to the child and adolescent mental health care network to invest in the early care of children and adolescents, especially those who are most vulnerable and who may have problems with drug use, and to increasingly encourage coordination between services.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e13"},"PeriodicalIF":2.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regionalization and regulation: impact on access to cancer treatment.","authors":"Luciane Simões Duarte, Mirian Matsura Shirassu, Adeylson Guimarães Ribeiro, Cristiane Murta-Nascimento, Marcela de Araújo Fagundes, Carolina Terra de Moraes Luizaga, Victor Wünsch Filho","doi":"10.11606/s1518-8787.2026060007257","DOIUrl":"10.11606/s1518-8787.2026060007257","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of Redes Regionais de Atenção à Saúde (RRAS - Regional Health Care Network) and Oncology Regulation on geographical accessibility to oncology treatment for the main types of cancer in the state of São Paulo.</p><p><strong>Methods: </strong>A before-after study comparing the three-year periods before (2007-2009) and after (2017-2019) the policies were implemented. Data from the São Paulo Hospital Cancer Registry were used to analyze indicators of displacement and attraction of patients for surgery, radiotherapy, or chemotherapy in six types of cancer: stomach, colorectal, lung, female breast, cervix, and prostate. The RRAS were adopted as the geographical units of analysis, and inter-RRAS displacements were categorized into quartiles (< 25%, 25%-49%, 50%-74%, and ≥ 75%). Temporal analysis was carried out using thematic maps (QGIS, version 3.28) and the chi-squared test (α = 5%).</p><p><strong>Results: </strong>Approximately 25% of patients traveled for treatment. RRAS 6 (Capital), 9 (Bauru), and 13 (Ribeirão Preto) remained the centers of attraction. In the North and Northwest, RRAS 11 and 12 showed a reduction in displacements for all types of cancer; in RRAS 10, the drop occurred for colorectal and lung tumors. In the Southeast, RRAS 3 and 5 do not have qualified services, requiring displacements, while RRAS 1, 2, and 4 maintained high percentages. In the East, RRAS 14 to 17 saw a reduction in displacements, except for lung cancer. In the South, displacements increased in RRAS 7 and 8. Overall, there was a reduction in displacements for cervical and prostate cancer, and an increase for lung cancer, especially for surgery.</p><p><strong>Conclusion: </strong>The implementation of the RRAS and Oncology Regulation altered geographic accessibility in a heterogeneous way: there was an improvement in the North and Northwest, a worsening in the South, and stability in the reference centers. There is a need to improve regional planning, paying attention to territorial inequalities, the type of tumor, and the therapeutic modality.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e9"},"PeriodicalIF":2.1,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Covid-19 pandemic on tuberculosis mortality in Brazil: a time series analysis.","authors":"Bernardo Bastos Wittlin, Felipe Bezerra Pimentel Araújo, Antônio Augusto Moura da Silva","doi":"10.11606/s1518-8787.2026060007226","DOIUrl":"10.11606/s1518-8787.2026060007226","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate changes in the trend of tuberculosis mortality in Brazil over recent decades and assess the impact of the Covid-19 pandemic on this indicator.</p><p><strong>Methods: </strong>We analyzed the national and regional time series of tuberculosis mortality from 2000 to 2023 using joinpoint regression. To assess the pandemic's impact, we applied two interrupted time series (ITS) approaches: segmented linear regression and the AutoRegressive Integrated Moving Average with eXogenous variables (ARIMAX model). We also used Autoregressive Integrated Moving Average (ARIMA) modeling to estimate excess tuberculosis deaths linked to the pandemic and to forecast mortality trends through 2030.</p><p><strong>Results: </strong>An increase in tuberculosis mortality was observed starting in 2021, reaching 2.4 deaths per 100 thousand people in both 2022 and 2023 - similar to rates observed in 2011. This represents a reversal in the declining trend seen throughout the 2000s and 2010s, affecting all macroregions. The annual percentage change from 2019 to 2023 was +6.5% (95% confidence interval - 95%CI 4.42 to 9.98), contrasting with an average decline of -1.93% (95%CI -2.19 to -1.69) over the full period. Both ITS models consistently demonstrated a detrimental long-term reversal of the mortality trend after the pandemic. While a precise level change was not apparent using traditional segmented regression, the ARIMAX-based analysis successfully isolated a significant acute and lagged effect (β = +0.211; p = 0.0029). We estimated 6,540 excess tuberculosis deaths in Brazil between 2020 and 2023 (95%CI 3,950 to 9,130). The forecasting model with the pandemic effect projected higher mortality rates from 2024 to 2030, while the counterfactual scenario showed a continued decline.</p><p><strong>Conclusions: </strong>The Covid-19 pandemic had a substantial negative impact on tuberculosis mortality in Brazil, representing a setback in achieving national and global elimination targets.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e8"},"PeriodicalIF":2.1,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric validation of the Paykel Suicidal Behavior Scale in Mexican adolescents.","authors":"Marina Séris-Martínez, Fernando Austria-Corrales, Yendy Cruz Hernández, Berenice Pérez-Amezcua, Alberto Jiménez Tapia, Claudia Iveth Astudillo-García, Leonor Rivera-Rivera","doi":"10.11606/s1518-8787.2026060007086","DOIUrl":"10.11606/s1518-8787.2026060007086","url":null,"abstract":"<p><strong>Objective: </strong>To psychometrically validate the Spanish version of the Paykel Suicidal Behavior Scale in the Mexican adolescent population, and to establish an optimal cut-off point to identify risk of suicidal behavior in school contexts.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in 2022 with a non-probabilistic sample of 1,407 students from eight public high schools in the state of Morelos, Mexico. The mean age was 17 years, 58.7% were female and 41.3% were male. The students completed an online questionnaire that included the Paykel Suicidal Behavior Scale, the Center for Epidemiological Studies Depression Scale, and the Depression Anxiety and Stress Scale. A confirmatory factor analysis, item response theory, factorial invariance analysis (by sex, gender identity, and school grade), divergent validity analysis, and ROC curves were applied in this study.</p><p><strong>Results: </strong>The confirmatory factor analysis was found to be acceptable. The factor loadings ranged from 0.799 to 0.938. Item discrimination parameters were elevated (2.33 to 6.63), with difficulties ranging from 0.17 to 1.11. Factor invariance was confirmed in all subgroups. The divergent validity of the Paykel Suicidal Behavior Scale was satisfactory, as evidenced by its moderate correlations with the Epidemiological Studies Depression Scale (r = 0.507), depression (r = 0.644), anxiety (r = 0.570), and stress (r = 0.541). ROC analysis identified an optimal cutoff point of ≥ 1.0, with sensitivity of 75.93% and specificity of 76.54%.</p><p><strong>Conclusion: </strong>The Mexican version of the Paykel Suicidal Behavior Scale demonstrates robust psychometric properties, including validity, reliability, and factorial invariance in the adolescent school population. The scale's brevity, clarity, and ease of application make it an effective tool for school screening, allowing for timely detection and referral to mental health services. Its use is recommended in adolescent suicide prevention programs in educational contexts in Mexico.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e10"},"PeriodicalIF":2.1,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in time to cancer treatment initiation over a decade in Brazil.","authors":"Matheus de Abreu, Maria Emília Mota, Dandara Menezes de Araujo Oliveira, Yuri de Lima Medeiros, Maria Stella Moreira, Fábio Abreu Alves, Maria Paula Curado","doi":"10.11606/s1518-8787.2026060006943","DOIUrl":"10.11606/s1518-8787.2026060006943","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate access to treatment for cervical (CVC), colorectal (CRC), thyroid (CT), and central nervous system (CCNS) cancers that differ in incidence, prognosis, early detection program, and in their requirements for high-complexity and technologically advanced treatments.</p><p><strong>Methods: </strong>Data from Integrador RHC INCA (2013-2022) were extracted. Sociodemographic and clinic characteristics and time diagnosis-to-treatment were analyzed using multinomial logistic regression and cumulative incidence function.</p><p><strong>Results: </strong>395,225 cases of cancers were identified, CRC = 168,951, CVC = 141,189, CT = 57,755 and CCNS = 27,330. Patients with CCNS and CRC had higher cumulative probability (CPob) of treatment initiation within 60 days compared to CVC/CT. The North region was less likely to receive treatment within 30 days for all cancers (odds ratio - OR: CCNS = 0.34; CVC = 0.30; CT = 0.17; CRC = 0.49). Radiotherapy showed a lower chance of earlier treatment for all cancers (94% lower CCNS; CVC = 48%; CRC = 81%). There was a greater chance of treatment initiation within 30 days for patients with higher education for CVC (OR = 1.42); CT (OR = 2.09). White individuals demonstrated a consistently higher CPob of treatment initiation at 60 days for all cancers compared to Black (CCNS: 60% versus 49%; CVC: 37% versus 29%; CT: 32% versus 21%; CRC: 52% versus 45%). For CT, males had a higher CPob of treatment 37% in males compared to 30% in females at 60 days). For CRC, CPob of treatment initiation at 60 days was higher among individuals at younger (60% compared to 46% for those aged > 69 years) and clinical stage IV (56% compared to stage 1 - 45%).</p><p><strong>Conclusion: </strong>In Brazil, patients requiring multimodal treatments or therapies demanding technology, such as radiotherapy or chemotherapy, faced longer delays. Regional and sociodemographic disparities persist, with timely access to cancer treatment limited in socioeconomically disadvantaged regions, such as the North and Northeast, among Black patients and individuals with lower education.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e12"},"PeriodicalIF":2.1,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}