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There has been an alarming rise in suicide attempts among Indigenous people in Brazil, leading to national concerns about the provision of psychosocial care and professional support. In this study, we make an attempt to understand the perspectives of professionals in assisting Indigenous people from a specific group, the Inỹ, and identify the specific challenges of addressing issues through the mental health care system related specifically to suicide prevention. Using a qualitative approach with participant observation and semi-structured interviews, the research included Indigenous and their families assisted by three public institutions and the professionals that work in public psychosocial assistance. For this paper, we examined the tensions, conflicts, and challenges of the healthcare professionals at one of these institutions, a Psychosocial Care Center in the state of Goiás/Brazil. For data analysis, a sociocultural protocol was built to identify dialogical tensions between the different thematic fields of mental health care. The findings reveal that the theme of suicide was an important concern in the daily work with the community. Still, there were significant issues related to the assumptions, methodology, and meaning of care between the professionals and the community, on account of which the objective of the programme to address suicide attempts had not been effective or successful. The discussion of the results raises several critical questions about the possible contributions of dialogical cultural psychology in the context of Indigenous health. Also, it has important implications for the global issue of the wellbeing of Indigenous people. [ABSTRACT FROM AUTHOR]

Background: Sporotrichosis is the most common subcutaneous mycosis caused by Sporothrix spp. Traditionally, it is transmitted through injuries involving plant debris. However, over the past few decades, there has been an epidemic increase in human cases resulting from contact with infected animals, particularly cats, in various regions of Brazil. In this report, we report a notable increase in both human and animal cases within the Brazilian Amazon state. Methodology/Principal findings: An ecological study was conducted by analyzing official records of human and animal sporotrichosis diagnosed in the state of Amazon from 2020 to 2023. Data including patient demographics, clinical manifestations, mycological examination results, and species identification through PCR confirmation were evaluated. During this period, a total of 950 human cases and 2,823 animal cases of sporotrichosis were reported at an exponential rate, since no human cases were registered in 2020. The spatial and temporal dispersion of human sporotrichosis followed that of animal cases, moving from downtown areas to the periphery. Contact with infected animals was reported in 77.7% of cases, with cats being the most commonly implicated (73.5%). Only 66.7% of individuals underwent mycological examination. Among the positive cultures for Sporothrix spp., 65.4% were identified as S. brasiliensis. All patients were treated with systemic antifungals. Conclusions/Significance: This study highlights a rising incidence of sporotrichosis among animals and humans in the Brazilian Amazon region over the past four years, with S. brasiliensis being the predominant agent. Collaborative efforts involving healthcare professionals, veterinarians, and public health authorities are crucial to implement effective control measures, educate populations at risk, and promote responsible guidance for pet guardians. These measures are essential to mitigate the burden of epidemic sporotrichosis in Brazil. Author summary: Sporotrichosis is the leading subcutaneous mycosis worldwide. In the last decades, Brazil has faced an epidemic of zoonotic cases. The Brazilian Amazon region had no human cases reported in 2020, nevertheless, a striking rise in both human and animal cases was observed from 2020 to 2023, totalizing 950 human and 2,823 animal sporotrichosis. The majority of cases were reported in Manaus, the largest city in the Amazon, but cases were also documented in other populous municipalities. The study emphasizes the correlation between animal and human cases, as well as the spatial and temporal progression of the disease, moving from downtown areas to the periphery. Cats were identified as the primary reservoirs, with contact with infected animals being a significant risk factor for transmission. Urban areas, particularly domestic environments, were identified as common sites of infection. The predominant species identified was Sporothrix brasiliensis, which exhibits distinct characteristics favoring zoonotic transmission. This study emphasizes the urgent need for collaborative efforts among healthcare professionals, veterinarians, and public health authorities to implement effective control measures and mitigate the impact of the epidemic sporotrichosis in Brazil. [ABSTRACT FROM AUTHOR]

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Introduction: Sexual dysfunctions remain inadequately addressed in medical education, despite their prevalence and adverse impact on quality of life. In Brazil, there are scarce university-affiliated healthcare centers that focus on sexual health. These services play a critical role in diagnosing and managing sexual disorders and can be pivotal in the training of healthcare professionals, as well as in the advancement of research and outreach in sexual medicine. Objective: To describe the experience of establishing two sexual health centers in university-affiliated hospitals in Northeastern Brazil. Method: This is an experiential report detailing the establishment of two distinct sexual health services. Results: Both sexual health services started in different general hospitals in 2021, founded by a male and a female psychiatrists, authors of this paper. The initiative was prompted by the lack of dedicated sexual health services and the awareness of substantial patient distress stemming from sexual issues. Activities include patient consultations, case discussions, sexology seminars, and research project development, involving medical students and resident physicians, integrated into the psychiatry residency curriculum Referrals come mainly from other hospital specialties, but external referrals are also accepted. Collaboration with other healthcare professionals occurs through the analysis of clinical cases. Conclusion: The establishment of sexual health services within university-affiliated hospitals has a positive impact on patient care and contributes to the study of sexual medicine, an area often overlooked in medical education. Improvements are needed in patient recruitment, counter-referral procedures, and the systematic incorporation of medical student rotations. While these services hold promise, they require greater integration with other healthcare services and a closer collaboration with undergraduate medical education. Financing: No conflict. [ABSTRACT FROM AUTHOR]

Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such as chloroquine, plus an 8-aminoquinoline. However, 8-aminoquinolines cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, requiring prior screening to exclude those at risk. Brazil is pioneering the implementation of tafenoquine, a single-dose 8-aminoquinoline indicated for P. vivax patients with >70% of normal G6PD activity. Tafenoquine implementation in Manaus and Porto Velho, two municipalities located in the western Brazilian Amazon, included comprehensive training of healthcare professionals (HCPs) on point-of-care quantitative G6PD testing and a new treatment algorithm for P. vivax radical cure incorporating tafenoquine. Training was initially provided to higher-level facilities (phase one) and later adapted for primary care units (phase two). This study analyzed HCP experiences during training and implementation and identified barriers and facilitators. In-depth interviews and focus discussion groups were conducted 30 days after each training for a purposive random sample of 115 HCPs. Thematic analysis was employed using MAXQDA software, analyzing data through inductive and deductive coding. Analysis showed that following the initial training for higher-level facilities, some HCPs did not feel confident performing quantitative G6PD testing and prescribing the tafenoquine regimen. Modifications to the training in phase two resulted in an improvement in understanding the implementation process of the G6PD test and tafenoquine, as well as in the knowledge acquired by HCPs. Additionally, knowledge gaps were addressed through in situ training, peer communication via a messaging app, and educational materials. Training supported effective deployment of the new tools in Manaus and Porto Velho and increased awareness of the need for pharmacovigilance. A training approach for nationwide implementation of these tools was devised. Implementing quantitative G6PD testing and tafenoquine represents a significant shift in P. vivax malaria case management. Consistent engagement with HCPs is needed to overcome challenges in fully integrating these tools within the Brazilian health system. Author summary: Brazil has implemented tafenoquine and quantitative G6PD testing as a crucial component of its comprehensive strategy to eliminate Plasmodium vivax malaria. Training of healthcare professionals (HCPs) has played a pivotal role in facilitating the adoption of these new strategies. In any implementation, it is necessary to identify barriers and facilitators and consider data that cannot typically be collected in purely quantitative studies. This qualitative study describes the perceptions of HCPs regarding the training they received and the knowledge gaps that only became apparent in their professional practice after the training. These insights were instrumental in developing various communication and continuing education strategies that enhanced HCP knowledge following training. Finally, the study presents a training approach for applying quantitative G6PD testing and the tafenoquine treatment regimen, including the most effective educational activities and materials to support the HCP learning process. [ABSTRACT FROM AUTHOR]

Background: Government-led, population-wide initiatives are crucial for advancing the management of hypertension − a leading cause of cardiovascular disease (CVD) morbidity and mortality. An urban population health initiative was conducted against this backdrop, focussing on hypertension in the primary health system in São Paulo, Brazil. Within the frame of the initiative and under the supervision and leadership of the municipal health authorities, a situational analysis was conducted on the needs in hypertension management, marking the first phase of a Design Thinking process. This article describes the situational analysis process and presents the identified elements to be strengthened considering hypertension diagnosis, treatment and control. Methods: First, a mixed-methods approach was used, starting with a literature review of municipal hypertension data followed by meetings (N = 20) with the local public health administration to assess health system level components. To investigate activities on hypertension diagnosis, treatment and control, nine primary healthcare units were selected from two districts of São Paulo city– Itaquera and Penha– which received an online form addressed to managers, participated in conversation circles of staff and patients, and underwent shadowing of community health agents. Results: Data gave rise to two main outputs: (i) a patient care journey map; and (ii) a matrix summarizing the identified needs at patient, healthcare professional and health system level for diagnosis, treatment and control of hypertension. Patient awareness and knowledge of hypertension was found to be insufficient and its management needs to be improved. For health professionals, disease awareness, technical training, more time dedicated to patients, and simplified guidelines and clinical decision-making tools for hypertension management were identified as principal needs. The situational analysis found that the healthcare systems efficiency might be improved by establishing defined treatment and care delivery goals with a focus on outcomes and implemented through action plans. Conclusions: This situational analysis identified several needs related to hypertension control in São Paulo that are in line with global challenges to improve the control of CVD risk factors. Findings were also confirmed locally in an expansion phase of this situational analysis to additional primary care facilities. As a consequence, solutions were designed, promptly taken up and implemented by the municipal health secretariat. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop a Digital Speech Assessment Instrument to evaluate the phonological and motor speech skills of Brazilian Portuguese–speaking children and adolescents through six tasks: (a) word naming, (b) word imitation, (c) pseudoword imitation, (d) word repetition, (e) pseudoword repetition, and (f) diadochokinesis. Method: The assessment instrument was developed and validated in a seven-step process, beginning with stimulus selection and ending with Pilot Study 1 (involving children and adolescents with typical speech development) and Pilot Study 2 (involving children and adolescents with speech sound disorders [SSDs]). Participants of the study included expert and nonexpert judges, children, and adolescents. Results: The Digital Speech Assessment Instrument contains 91 real words (61 in the naming task, 51 in the imitation task, and five in the repetition task), 26 pseudowords (26 in the imitation task and four in the repetition task), and six stimuli for diadochokinesis. The test contains stimuli in the form of images as well as audio and video recordings and allows for the analysis and storage of participant data in a virtual database. Conclusions: This study described the development of the Digital Speech Assessment Instrument, available in Brazilian Portuguese for the evaluation of several aspects of speech production (including word and pseudoword naming, imitation, and repetition and diadochokinesis). The test was developed for children aged 2;0 (years;months) to 17;11 and is administered fully online. In the future, the instrument can be used to provide a timely and accurate diagnosis of SSDs. [ABSTRACT FROM AUTHOR]

Background Hansen's disease is a chronic, infectious and transmissible disease that is considered a public health problem in Brazil. Hansen's disease is marked by stigma and prejudice, because it carries with it a strong negative social image, reinforced by policies of social isolation in the community. Methods A qualitative study was conducted in Ribeirão Preto, an inland city of the state of São Paulo, Brazil. Eleven patients under treatment for the disease were interviewed. The interviews were audio recorded and transcribed in full, then were analyzed through the stages of transcription, transposition and reconstitution, as informed by concepts proposed by Goffman. Results The results showed that the marks of stigma are still present in the twenty-first century and were presented in two axes: 'Stigma and work for the person affected by Hansen's disease' and 'The experience of stigma in the family'. The participants refer to fears of losing their jobs and of being ridiculed, which stops them talking about the disease. Regarding their families, the participants reported episodes of discrimination, the creation of family secrets and fear of relatives' reactions. Conclusions All these aspects interfere in the follow-up and treatment of patients and need to be considered and welcomed by health professionals. It is recommended that these aspects are addressed in the initial training and continuing education of health professionals. Contexte La maladie de Hansen est une maladie chronique, infectieuse et transmissible, considérée comme un problème de santé publique au Brésil. La maladie de Hansen est marquée par la stigmatisation et les préjugés, car elle véhicule une image sociale fortement négative, renforcée par des politiques d'isolement social au sein de la communauté. Méthodes Étude qualitative menée à Ribeirão Preto, une ville intérieure de l'État de São Paulo, au Brésil. Onze patients traités pour la maladie ont été interrogés. Les entretiens ont été enregistrés et transcrits intégralement, et ont été analysés en suivant les étapes de transcription, de transposition et de reconstitution, selon les concepts proposés par Goffman. Résultats Les résultats montrent que les marques de la stigmatisation sont toujours présentes au 21ème siècle et ont été présentées selon deux axes : 'La stigmatisation et le travail pour la personne affectée par la maladie de Hansen' et 'L'expérience de la stigmatisation dans la famille'. Les participants évoquent la peur de perdre leur emploi, la peur d'être ridiculisés, ce qui les pousse à ne pas parler de la maladie. En ce qui concerne les familles, les participants ont rapporté des épisodes de discrimination, la création de secrets de famille et la peur des réactions des proches. Conclusions Tous ces aspects interfèrent dans le suivi et le traitement des patients et doivent être pris en compte et accueillis par les professionnels de la santé. Il est recommandé que ces aspects soient abordés dans la formation initiale et la formation continue des professionnels de la santé. Antecedentes La enfermedad de Hansen es una enfermedad crónica, infecciosa y transmisible, considerada un problema de salud pública en Brasil. La enfermedad de Hansen está marcada por el estigma y el prejuicio, ya que conlleva una fuerte imagen social negativa, reforzada por políticas de aislamiento social en la comunidad. Métodos Estudio cualitativo realizado en Ribeirão Preto, una ciudad del interior del estado de São Paulo, Brasil. Se entrevistaron a once pacientes en tratamiento para la enfermedad. Las entrevistas fueron grabadas en audio, transcritas en su totalidad y analizadas a través de etapas de transcripción, transposición y reconstitución, según los conceptos propuestos por Goffman. Resultados Los resultados muestran que las marcas del estigma siguen presentes en el siglo XXI y se presentaron en dos ejes: 'Estigma y trabajo para la persona afectada por la enfermedad de Hansen' y 'La experiencia del estigma en la familia'. Los participantes mencionan el miedo a perder sus trabajos, el temor a ser ridiculizados, lo que les impide comentar sobre la enfermedad. En cuanto a las familias, los participantes reportaron episodios de discriminación, la creación de secretos familiares y el miedo a las reacciones de los familiares. Conclusiones Todos estos aspectos interfieren en el seguimiento y tratamiento de los pacientes y deben ser considerados y acogidos por los profesionales sanitarios. Se recomienda abordar estos aspectos en la formación inicial y la educación continua de los profesionales sanitarios. [ABSTRACT FROM AUTHOR]

Zoonotic sporotrichosis, a subcutaneous mycosis caused by Sporothrix brasiliensis, has become hyperendemic and a serious public health issue in Brazil and an emerging disease throughout the world. Typical sporotrichosis is defined as fixed or lymphocutaneous lesion development, however, reports of atypical presentations have been described in hyperendemic areas, which may result in a worse prognosis. Thus, considering an increase in atypical cases and in more severe extracutaneous cases and hospitalizations reported in Brazil, we aimed to perform a systematic review to search for hypersensitivity reactions (HRs) and extracutaneous presentations associated with zoonotic sporotrichosis. A systematic review was performed, following the PRISMA guidelines to search for atypical/extracutaneous cases (mucosal, osteoarthritis, HRs, pulmonary, meningeal) of zoonotic sporotrichosis. A total of 791 published cases over 26 years (1998–2023) in eleven Brazilian states were reviewed. Most cases corresponded to a HR (47%; n = 370), followed by mucosal (32%; n = 256), multifocal (8%; n = 60), osteoarthritis (7%; n = 59), meningeal (4%; n = 32), and pulmonary (2%; n = 14) infections. When available (n = 607), the outcome was death in 7% (n = 43) of cases. Here, we show a frequent and worrisome scenario of zoonotic sporotrichosis in Brazil, with a high and dispersed incidence of atypical/extracutaneous cases throughout the Brazilian territory. Therefore, educational measures are necessary to make health professionals and the overall population aware of this fungal pathogen in Brazil as well as in other countries in the Americas. [ABSTRACT FROM AUTHOR]

The World Health Organization has highlighted that cancer was the second-highest cause of death in 2019. This research aims to present the current forecasting techniques found in the literature, applied to predict time-series cancer incidence and then, compare these results with the current methodology adopted by the Instituto Nacional do Câncer (INCA) in Brazil. A set of univariate time-series approaches is proposed to aid decision-makers in monitoring and organizing cancer prevention and control actions. Additionally, this can guide oncological research towards more accurate estimates that align with the expected demand. Forecasting techniques were applied to real data from seven types of cancer in a Brazilian district. Each method was evaluated by comparing its fit with real data using the root mean square error, and we also assessed the quality of noise to identify biased models. Notably, three methods proposed in this research have never been applied to cancer prediction before. The data were collected from the INCA website, and the forecast methods were implemented using the R language. Conducting a literature review, it was possible to draw comparisons previous works worldwide to illustrate that cancer prediction is often focused on breast and lung cancers, typically utilizing a limited number of time-series models to find the best fit for each case. Additionally, in comparison to the current method applied in Brazil, it has been shown that employing more generalized forecast techniques can provide more reliable predictions. By evaluating the noise in the current method, this research shown that the existing prediction model is biased toward two of the studied cancers Comparing error results between the mentioned approaches and the current technique, it has been shown that the current method applied by INCA underperforms in six out of seven types of cancer tested. Moreover, this research identified that the current method can produce a biased prediction for two of the seven cancers evaluated. Therefore, it is suggested that the methods evaluated in this work should be integrated into the INCA cancer forecast methodology to provide reliable predictions for Brazilian healthcare professionals, decision-makers, and oncological researchers. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU). Methods: An observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use. Results: We observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments "before" tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments "after" tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed. Conclusions: HH compliance was very low. Inappropriate glove use was associated with low compliance and the unit's infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety. [ABSTRACT FROM AUTHOR]

Background: Effective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned. Main body: Each country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice. Conclusion: Stakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment. [ABSTRACT FROM AUTHOR]