Death In Brazil Research Articles

Wearable sensors for cardiological monitoring in the SUS: regulatory challenges and impacts on Brazilian Public Health

Cardiovascular diseases are the leading cause of death in Brazil, with approximately 400,000 deaths annually, which corresponds to almost 30% of all deaths in the country. In addition to the impact on mortality, these conditions generate an enormous economic burden for the health system, with costs associated with the treatment of diseases such as heart attack and heart failure exceeding R$50 billion per year. In this context, the use of wearable devices for continuous monitoring of cardiovascular parameters emerges as an opportunity to improve the management and prevention of these diseases. This study conducts a scoping review of the regulatory challenges involved in the incorporation of wearables into the Unified Health System (SUS), with a focus on cardiological monitoring. Articles published between 2019 and 2024 were analyzed, discussing issues such as data accuracy, interoperability between systems, protection of sensitive data, and training of health professionals. In addition, the study examines the economic and social implications of the adoption of these technologies in a context of profound socioeconomic inequalities. The results indicate that, although wearables have the potential to transform cardiovascular care in Brazil, regulatory and technical barriers still limit their large-scale adoption in the SUS. Adequate regulation, aligned with the General Data Protection Law (LGPD), and investments in infrastructure and training are essential for the safe and effective integration of these technologies into public health.

Epidemiological profile of bronchial lung cancer between the years 2013 to 2023 in the northern region of Brazil

Lung and bronchial cancer is one of the leading causes of death in Brazil, with higher incidence among men, although the number of cases in women is increasing. Smoking is the main risk factor, but late diagnosis worsens disease progression, especially in marginalized regions like the North of the country. Therefore, this study aimed to analyze the evolution of lung and bronchial cancer cases in the North region of Brazil over the past ten years. Data were collected from the Department of Informatics of the Unified Health System (DATASUS) and the oncology panel, organized by age group, sex, and state. Analyses were conducted using RStudio and Excel. The state of Pará showed the highest increase in lung and bronchial cancer cases in 2023, followed by Rondônia and Amazonas, which recorded significant increases in 2021. A rise in cases was observed with advancing age, especially among men. The results suggest that delayed diagnosis, combined with the precariousness of the healthcare infrastructure in Northern Brazil, may contribute to disease progression and increased mortality. The marginalization of this region in the national healthcare context is a relevant factor in this scenario. It is concluded that delayed diagnosis and structural failures in the healthcare system are key determinants of the increase in lung and bronchial cancer cases in the North region, and that structural measures are necessary to improve early diagnosis and reduce mortality.

AIDS mortality in Brazil, 2012–2022: a time series study

BackgroundHuman immunodeficiency virus (HIV) infection is a health problem in Brazil and worldwide. Without treatment, the infection can progress to Acquired Immunodeficiency Syndrome (AIDS), with a high mortality potential. The objective of this study was to analyze the time trend of AIDS mortality in Brazil, macro-regions, federal units and their respective capitals, from 2012 to 2022.MethodsThis is a time-series study of all AIDS deaths in Brazil from 2012 to 2022. The study included the annual number of deaths and the crude and standardized mortality rates. The Joinpoint regression model was used for the time analysis of the standardized rates. Annual percentage change (APC) and average annual percentage change (AAPC) were calculated. A 95% confidence interval (CI) and a 5% significance level were used.ResultsDuring the period analyzed, 128,678 AIDS deaths were recorded in Brazil, with a crude mortality rate of 6.3/100,000 and a standardized mortality rate of 5.3/100,000. From 2012 to 2020, three regions showed a declining trend in AIDS mortality: Central-West (AAPC − 2.3%; 95%CI -4.3 to -0.21; p = 0.03), Southeast (AAPC − 5.6%; 95%CI -6.8 to -4.0; p < 0.001), and South (AAPC − 4.4%; 95%CI -5.27 to -3.6; p < 0.001). There was also a downward trend in 10 states and 10 capitals. There was an increase in the number of deaths from 2020 onwards in the North, Northeast and Southeast regions compared to 2019.ConclusionThere was a downward trend in AIDS mortality from 2012 to 2020 and an upward trend from 2020 to 2022. The regional differences observed could reflect the social disparities that exist in Brazil. In addition, the Covid-19 pandemic has had an impact on the process of dealing with HIV in Brazil.

Governmental Expenditures and the Challenges to Improve Road Safety in Brazil

This article addresses governmental actions to improve road safety through the analysis of road traffic fatalities and expenditures in education, engineering, and enforcement (the 3E’s approach) in Brazil between 2011 and 2021 from the Fundo Nacional de Segurança e Educação de Trânsito (Funset), a public fund to support actions in safety, education, and engineering to improve Brazilian road safety. Graphical analysis was conducted, Pearson correlation coefficient was used for the variables of Funset expenditures (lnpay) and road deaths in Brazil (lndeaths), and a linear regression model was built to estimate the variation in road fatalities as a function of Funset expenditures. The results show a decrease in road deaths in Brazil with a slight upward trend and a reduction in Funset expenditures for road safety improvement. There is a positive correlation between the downward trend in Funset public investments in education, engineering, and enforcement and fatalities on roads of 0.79. Funset expenditures are inadequately allocated with low expenditure execution average (16.8%). There are many challenges for the Brazilian public administration to ensure road safety, however, it is important to maintain financial support for road safety strategies to improve it and save lives.

Transition towards cancer mortality predominance over cardiovascular disease mortality in Brazil, 2000–2019: a population-based study

Cardiovascular disease (CVD) and cancer are the first and second leading causes of death in Brazil and worldwide. However, an ongoing epidemiological transition in which cancer surpasses CVD has been observed in many high and middle-income countries. In this study, we provided a nationwide analysis of the transition towards cancer mortality predominance over CVD mortality in Brazil. We leveraged data from 5570 municipalities using the Mortality Information System and classified the causes of death using ICD-10 codes. Age-standardized CVD and cancer mortality rates were calculated annually between 2000 and 2019. Mortality rate ratios (MRRs=CVD rates divided by cancer rates) described the predominance of cancer or CVD mortality across municipalities and states. Choropleth maps displayed state-specific MRRs and the transition in the predominant cause of death over time. From 2000 to 2019, CVD mortality rates declined in 25 out of 27 states, whereas cancer mortality increased in 15 states, indicating a shift towards cancer predominance. While in 2000 cancer mortality was lower than CVD in all states and only exceeded the latter in 7% of the municipalities, by 2019 the gap narrowed considerably, with 13% of municipalities displaying higher cancer mortality rates vs CVD mortality rates. Additionally, higher household income correlated with higher mortality from cancer vs CVD. An ongoing epidemiological transition in which cancer mortality surpasses CVD mortality is occurring in Brazil, particularly in municipalities with higher household incomes. Our findings may provide important information for policymakers and public health practitioners in Brazil. National Council for Scientific and Technological Development (CNPq).

Time series analysis of comprehensive maternal deaths in Brazil during the COVID-19 pandemic

The effects of the COVID-19 pandemic on comprehensive maternal deaths in Brazil have not been fully explored. Using publicly available data from the Brazilian Mortality Information (SIM) and Information System on Live Births (SINASC) databases, we used two complementary forecasting models to predict estimates of maternal mortality ratios using maternal deaths (MMR) and comprehensive maternal deaths (MMRc) in the years 2020 and 2021 based on data from 2008 to 2019. We calculated national and regional standardized mortality ratio estimates for maternal deaths (SMR) and comprehensive maternal deaths (SMRc) for 2020 and 2021. The observed MMRc in 2021 was more than double the predicted MMRc based on the Holt-Winters and autoregressive integrated moving average models (127.12 versus 60.89 and 59.12 per 100,000 live births, respectively). We found persisting sub-national variation in comprehensive maternal mortality: SMRc ranged from 1.74 (95% confidence interval [CI] 1.64, 1.86) in the Northeast to 2.70 (95% CI 2.45, 2.96) in the South in 2021. The observed national estimates for comprehensive maternal deaths in 2021 were the highest in Brazil in the past three decades. Increased resources for prenatal care, maternal health, and postpartum care may be needed to reverse the national trend in comprehensive maternal deaths.

INEQUALITIES IN STROKE CARE: AN INTEGRATIVE REVIEW OF SOCIAL DETERMINANTS OF HEALTH

Stroke disproportionately affects developing countries and is among the leading causes of death in Brazil. Social determinants of health reflect not only the risk of stroke, but also post-treatment health outcomes. In order to identify which social determinants of health influence post-stroke treatment, an integrative literature review was conducted. Articles indexed in the Scopus, Scielo and Pubmed databases were consulted, using controlled descriptors in the English language, from the last five years, with 33 articles analyzed by title, author, year, objective, methodology, social determinants analyzed and related to stroke treatment and main results. Income was the social determinant with the greatest relation to stroke treatment, leading to higher health costs, mortality and morbidity. Analyzing and recognizing the relationships between stroke and its social determinants allows for a better definition of public and health policies, adjusted to the real needs of patients in recovery.

Death, flies and environments: Towards a qualitative assessment of insect (Diptera) colonization of human cadavers retrieved from sites of death in Brazil

Empirical data on decomposition ecology have long established blowflies (Calliphoridae) and flesh flies (Sarcophagidae) (Diptera) as the most frequent colonizers of carrion, especially at early stages of decomposition. However, the scarcity of studies based on human cadavers has hindered inferences about colonization of homicide victims in real case scenarios. We describe here a survey of insects associated with cadavers retrieved from the site of death in Northeastern Brazil, with emphasis on the association between species diversity and the surrounding environment. We examined 81 cadavers, most of which were of men and resulting from violent death. Twelve cadavers (14.8 %) contained insect larvae, which were reared in the laboratory until adult emergence and identification. Ten species of Diptera effectively colonized the cadavers; seven of Family Calliphoridae – Chrysomya albiceps (Wiedemann, 1819), Chrysomya megacephala (Fabricius, 1794), Chrysomya putoria (Wiedemann, 1830), Cochliomyia macellaria (Fabricius, 1775), Hemilucilia segmentaria (Fabricius, 1805), Lucilia cuprina (Wiedemann, 1830), Lucilia eximia (Wiedemann, 1819) and three of Family Sarcophagidae, Blaesoxipha (Gigantotheca) stallengi (Lahille, 1907), Microcerella halli (Engel, 1931) and Peckia (Sarcodexia) lambens (Wiedemann, 1830). The species C. albiceps and C. macellaria were the most frequent colonizers, while Sarcophagidae was reported in only four cases. Insects were present on cadavers found in urban (n = 8) and rural (n = 4) sites, outdoors (n = 6) and inside (n = 6) residences. Presence of larvae was more frequent in the natural orifices in the head (n = 11). Clothing did not prevent from ovi/larviposition for most species. We present the first register of B. stallengi colonizing human corpses and expand the knowledge on the geographical distribution of necrophagous insects. Our protocol may contribute to forensic entomology in areas exposed to fast decomposition, such as the Neotropical Region.

B-212 Laboratory Performance in Molecular Detection of Mycobacterium tuberculosis Through Analysis of External Quality Assessment Program Results: WHO-Recommended Tests Outperform Others

Abstract Background In 2022, tuberculosis caused 11,200 deaths in Brazil and 1,300,000 globally. With 87,344 new cases, it remains a leading infectious cause of death, second only to COVID-19. Prompt detection is critical, particularly with the growing resistance to rifampicin and isoniazid, highlighting the need for molecular testing. External Quality Assessment Programs (EQAP) are essential to ensure the accuracy, reliability, and harmonization of laboratory results amid the complexities of M. tuberculosis infection. Here, we evaluate the overall performance of participating laboratories (labs) in three EQAP related to tuberculosis: M. tuberculosis molecular detection (MTB), Rifampicin resistance detection (RIF), and Isoniazid resistance detection (INH). All are organized by a Brazilian provider accredited according to the ABNT NBR ISO/IEC 17043:2011 standard. Methods The EQAP samples were suspensions containing human cells, with or without the addition of cultured, inactivated, and lyophilized M. tuberculosis. Labs received two samples quarterly for testing accuracy, sensitivity, and specificity. We computed these metrics along with participant and round numbers. The Mann-Kendall test assessed accuracy trends over time. Furthermore, kit type accuracies for in-vitro diagnostic (IVD) vs. laboratory-developed tests (LDT), World Health Organization recommended (WHO-recommended) vs. other kits (non-WHO), and methods (qPCR vs. PCR) were compared using chi-square tests and odds-ratio calculations. Results In the MTB EQAP (2018-2022), 63 labs participated over 20 rounds, with 22 (range: 6-48) labs per round on median, achieving 96.6% accuracy (853/883), 97.5% sensitivity (556/570), and 94.9% specificity (297/313). The Mann-Kendall test found no significant accuracy trends over time (τ = -0.91, p = 0.36). IVDs outperformed LDTs with 97.8% (751/768) vs. 87.9% (102/116) accuracy (OR=6.0, 95%CI 3.42-20.9, p&amp;lt;0.0001). WHO-recommended kits were more accurate than non-WHO kits, 98.2% (674/686) vs. 90.4% (179/198) (OR=5.96, 95%CI 1.05-12.7, p&amp;lt;0.0001). qPCR exceeded the accuracy of PCR, 97.2% (833/857) versus 74% (20/27) (OR=12.1, 95%CI 4.8-32.9, p&amp;lt;0.0001). For RIF EQAP (2020-2022), 49 laboratories in 9 rounds, with 25 (range: 18-42) laboratories per round on median, showed 97.4% accuracy (297/305), 97.2% sensitivity (176/181), and 97.6% specificity (121/124). In the INH EQAP (2021-2022), 7 laboratories over 7 rounds, with 4 (range: 2-5) laboratories per round on median, reached 95.2% accuracy (20/21), 100% sensitivity (4/4), and 94.1% specificity (16/17). Differences between types of kits and methods for RIF and INH, as well as trends over time, were not significant or could not be calculated due to the limited number of samples. Conclusions The MTB EQAP underscored the high participation and suitability of labs, along with excellent diagnostic performance; IVD kits were 6 times more likely to yield adequate results than LDTs. WHO-recommended kits were 5.9 times more likely to produce adequate results than non-WHO kits. qPCR was 12.6 times more likely to achieve adequate results than PCR. Despite fewer participants in RIF and INH, their performance rates were high; more data are needed for conclusive results on kit and method types. This study affirms the quality of molecular diagnostics for tuberculosis in Brazil, informs on kit and method selection, and underscores the critical role of EQAPs in combating a significant global health issue.

Perfil Epidemiológico Dos Pacientes Com Diabetes Mellitus (Dm) E Hipertensão Arterial Sistêmica (Has) No Centro De Atenção Psicossocial II De Santa Inês – MA Em 2024

This observational, cross-sectional, descriptive methodological study, with a quantitative approach, based on the database on patients with Arterial Hypertension and Diabetes Mellitus followed by the Psychosocial Care Center (CAPS) II of the Municipality of Santa Inês, in Maranhão, presents the epidemiological profile of patients served by the endorsed health center. This is a study with a population of 48 patients, of which 16 have Has, 27 have DM and 5 have comorbid health conditions, with both health complications. The general objective of this study was to delimit the epidemiological profile of patients at CAPS II in Santa Inês MA-Brazil, with Has and DM, the results point to a female majority who present the health problems mentioned and alert to the fact that these two conditions of Health causes considerable deaths in Brazil and needs to be treated properly.

Tendência da taxa de mortalidade por sepse em Minas Gerais entre 2010 e 2023: um estudo ecológico

Sepsis is a critical condition with high mortality, responsible for approximately 11 million deaths annually worldwide and 20% of deaths in Brazil. Between 2010 and 2019, Brazil recorded over 1 million cases and around 463,000 deaths due to sepsis, with the highest mortality in the Southeast region. This ecological study analyzed the age-standardized mortality rate for sepsis in Minas Gerais from 2010 to 2023, using data from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE). Prais-Winsten linear regression was applied to identify trends, and the correlation between the age-standardized mortality rate for sepsis (TPMS) and the Social Development Index (SDI) was investigated. Results showed a significant increase in sepsis mortality, with the rate rising from 9.16 in 2010 to 17.98 in 2023, reflecting an Annual Percentage Variation (APV) of 12.86%. The analysis revealed a growing trend with an R² of 0.9600. The positive correlation between TPMS and SDI indicates that regions with higher social development may have higher mortality rates due to better diagnostic capabilities, rather than worse health conditions. The study highlights the urgent need for targeted interventions, such as awareness programs and improvements in sepsis management. Public health strategies focused on prevention, early diagnosis, and effective treatment are essential to mitigate the impact of sepsis and improve clinical outcomes in the region.

EFEITOS DO SUCO DE UVA TINTO INTEGRAL NA PRESSÃO ARTERIAL DE REPOUSO DE MULHERES CLIMATÉRICAS

Systemic Arterial Hypertension (SAH) is a disease that, in most cases, involves genetic factors and lifestyle that affects approximately 21.4% of the Brazilian population, with 55% of this number represented by women and individuals over 75 years, accounting for 22.6% of deaths in Brazil. In women, the increased risk of developing SAH occurs in the period corresponding to the climacteric. Considered as a moment of transition between a woman's reproductive and non-reproductive period, the climacteric occurs between 40 and 60 years and involves the following phases: premenopause, perimenopause and postmenopause. It is known that treatment for SAH is more effective when it involves nutritional and lifestyle strategies combined with drug treatment. Among the alternatives, studies indicate the existence of a hypotensive effect in substances derived from grapes. Thus, this study aimed to observe the effect of ingestion of whole red grape juice on resting blood pressure in climacteric and hypertensive women in the interior of São Paulo. This is a randomized controlled, exploratory study, which included women aged 40 to 60 years with more than three months of amenorrhea and at least two climacteric symptoms. They were randomly divided into 2 groups: Control Group (CG) and Intervention Group (IG) to ingest 190 ml of whole grape juice for 28 days. The volunteers answered self-administered questionnaires and underwent physical examinations and measurement of resting blood pressure data during the first and last visit to compare the effect of the intervention. After the experimental protocol, it was observed that the protocol and dose used were able to cause a decrease in diastolic blood pressure in the intervention group, without causing significant changes in other parameters. Despite the need for further studies with greater control in the organization of groups, in addition to more doses and treatment times, this work corroborates the data that whole grape juice is a potential aid in controlling blood pressure in postmenopausal women.

Hospital case fatality and mortality related to Chagas disease in Brazil over two decades

ObjectiveTo analyse hospital case fatality and mortality related to Chagas disease (CD) in Brazil, 2000–2019.MethodThis is a mixed ecological study with spatial and temporal trends, based on national population data from the Brazilian Ministry of Health - hospital admissions (HA) and death certificates (DC). Records with CD as a primary or secondary cause of death in HA and/or as an underlying or associated cause of death in DC were evaluated. Temporal trends were analysed by Joinpoint regression and the spatial distribution of age- and gender-adjusted rates, spatial moving averages, and standardized morbidity ratios.ResultsThere were a total of 4,376 HA due to CD resulting in death in Brazil, with a hospital case fatality rate of 0.11/100,000 inhabitants. The Southeast region had the highest rate (63.9%, n = 2,796; 0.17/100,000 inhabitants). The general trend for this indicator in Brazil is upwards (average annual percentage change [AAPC] 7.5; 95% confidence interval [CI] 5.3 to 9.9), with increases in the North, Northeast and Southeast regions. During the same period 122,275 deaths from CD were registered in DC, with a mortality rate of 3.14/100,000 inhabitants. The highest risk of CD-related death was found among men (relative risk [RR] 1.27) and Afro-Brazilians (RR 1.63). There was a downward trend in CD mortality in the country (AAPC − 0.7%, 95%CI -0.9 to -0.5), with an increase in the Northeast region (AAPC 1.1%, 95%CI 0.6 to 1.6). Municipalities with a very high Brazilian Deprivation Index tended to show an increase in mortality (AAPC 2.1%, 95%CI 1.6 to 2.7), while the others showed a decrease.ConclusionHospital case fatality and mortality due to CD are a relevant public health problem in Brazil. Differences related to gender, ethnicity, and social vulnerability reinforce the need for comprehensive care, and to ensure equity in access to health in the country. Municipalities, states, and regions with indicators that reveal higher morbidity and mortality need to be prioritized.

Mortality risk and burden of aortic aneurysm and dissection attributable to low temperatures: A nationwide case-crossover analysis in Brazil, a predominantly tropical country

BackgroundLow temperatures are adverse contributors to cardiovascular diseases, but the associations between short-term exposure to cold and the risk of death from aortic dissection and aneurysm remain unclear, particularly in tropical regions. ObjectiveThis study was conducted based on 123,951 records of deaths caused by aortic dissection and aneurysms extracted from the national Mortality Information System in Brazil between 2000 and 2019. MethodsRelative risks and 95 % confidence intervals (CI) for the aortic-related deaths associated with low ambient temperatures were estimated using the conditional logistic model combined with the distributed lag nonlinear model. Subgroup analyses were performed by age group, sex, race, education level, and residential region. Furthermore, this study calculated the number and fraction of aortic-related deaths attributed to temperatures below the temperature threshold to quantify the cold-related mortality burden of aortic diseases. ResultsDuring the study period, aortic-related deaths and mortality rates in Brazil exhibited a steady increase, rising from 4419 (2.66/100,000) in 2000 to 8152 (3.88/100,000) in 2019. Under the identified temperature threshold (26 °C), per 1 °C decrease in daily mean temperature was associated with a 4.77 % (95 % CI: 4.35, 5.19) increase in mortality risk of aortic-related diseases over lag 0–3 days. Females, individuals aged 50 years or older, Asian and Black race, and northern residents were more susceptible to low temperatures. Low temperatures were responsible for 19.10 % (95 % CI: 17.71, 20.45) of aortic-related deaths in Brazil. ConclusionThis study highlights that low temperatures were associated with an increased risk of aortic-related deaths, with a remarkable burden even in this predominantly tropical country.

Underreporting of diabetes mellitus as the cause of death in Bauru, State of São Paulo, Brazil over 40 years: a documental study.

To evaluate, characterize and search for trends in the underreporting of diabetes mellitus (DM) as the cause of death in Bauru, São Paulo, Brazil, over 40 years. This was a documental study. Clinical and mortality data were collected from individuals known to have type 1 (DM1) and type 2 diabetes mellitus (DM2), residing in Bauru, State of São Paulo, followed at a local endocrinology clinic from 1982 to 2021, who deceased during this period. A significant underreporting of DM as the cause of death (64.41%) was found, mostly associated with male gender (OR = 1.59 [95% CI: 1.18; 2.15]; p < 0.01), DM2 (OR = 2.64 [95% CI: 1.32; 5.26]; p < 0.01), dying in the first decade of the study (OR = 4.07 [95% CI: 1.54; 10.71]; p < 0.001) and shorter DM duration (OR = 1.02 [95% CI: 1.01; 1.04]; p < 0.01). Age, type of treatment, body mass index, marital status and ethnicity, did not show a significant association with DM underreporting. There was a decreasing trend in DM1 underreporting (Decade Percentual Change = -7.10 [95% CI: -11.35; -3.40]), but a stationary trend for DM and DM2. The main primary cause of death was cardiovascular-related complications. The underreporting of DM as the cause of death was very frequently found, and was associated with male gender, decade of death, shorter DM duration and DM2. If our data could be applied to the whole country, DM would possibly emerge as a more prominent cause of death in Brazil. Future studies in other cities and geographic regions are warranted to confirm our findings.

The Challenge Of Clinical And Surgical Management Of An Acute Myocardial Infarction Simultaneously With An Acute Compressive Neurological Syndrome Due To Pituitary Adenoma: A Case Report

The term acute coronary syndrome represents a group of signs and symptoms in a patient who exhibits clinical and/or laboratory evidence of the occurrence of acute myocardial ischemia. This concept encompasses acute myocardial infarction, which represents the most important cause of death in Brazil and the world. Pituitary adenomas, in turn, are benign tumors, and are among the most common intracranial tumors, corresponding to 9 to 15% of intracranial tumors detected in autopsy series, and in radiological series, they can reach up to 22 to 23%. of cases. This study is a case report of the simultaneous occurrence of an acute myocardial infarction and an acute compressive neurological syndrome, due to pituitary adenoma, both serious, and the challenges encountered in making medical decisions regarding treatment priority. In daily practice, differentiating between urgency and emergency can be complex. In the case in question, although neurological compression implied the risk of irreversible vision loss, the team decided to prioritize the cardiac approach, to the detriment of the immediate attempt to preserve vision. The decision considered the imminent risk of death due to hemodynamic instability due to any decompensation during the neurological procedure.

Epidemiological study: Evolution of septicemia deaths in Brazil (2017-2022) in the face of the COVID-19 Pandemic

Epidemiological study: Evolution of septicemia deaths in Brazil (2017-2022) in the face of the COVID-19 Pandemic

Non-stationary Bayesian spatial model for disease mapping based on sub-regions.

This paper aims to extend the Besag model, a widely used Bayesian spatial model in disease mapping, to a non-stationary spatial model for irregular lattice-type data. The goal is to improve the model's ability to capture complex spatial dependence patterns and increase interpretability. The proposed model uses multiple precision parameters, accounting for different intensities of spatial dependence in different sub-regions. We derive a joint penalized complexity prior to the flexible local precision parameters to prevent overfitting and ensure contraction to the stationary model at a user-defined rate. The proposed methodology can be used as a basis for the development of various other non-stationary effects over other domains such as time. An accompanying R package fbesag equips the reader with the necessary tools for immediate use and application. We illustrate the novelty of the proposal by modeling the risk of dengue in Brazil, where the stationary spatial assumption fails and interesting risk profiles are estimated when accounting for spatial non-stationary. Additionally, we model different causes of death in Brazil, where we use the new model to investigate the spatial stationarity of these causes.

Exploring the Feasibility of a Cancer Awareness Program for High School Students in a Brazilian School: A Pilot Study.

Cancer is a leading cause of mortality globally and is projected to be the primary cause of death in Brazil by 2030. Yet, for high school students, information and understanding about cancer are primarily offered through standard biology lessons. This study aimed to assess the feasibility of a brief educational intervention related to cancer among high school students in a Brazilian private school. Participants attended a 1-h online session regarding different aspects of cancer. A self-reported questionnaire about the main topics addressed in the session was filled out before [pre] and after [post] the educational intervention and the results were compared by McNemar's chi-square test. From 900 parents invited, 44 (4.9%) responded to the invitation and agreed with their children's participation, and 24 students attended the activity. The questionnaire was easy to fill out for the students and allowed us to measure differences after the educational intervention. The high school students considered the most interesting topics cancer myths and protective/risk factors. The project was feasible and showed easy application and better knowledge after the educational intervention. The main challenge is related to the access to parents to authorize their children's participation. Designing interventions that focus on cancer education might be a viable way to increase prevention and early diagnosis with implications for students, their families, and the community.

Give Your Life to the Economy: Death Management and Neoliberalism in the Brazil of the Pandemic – A Secondary Publication

This essay is a reflection on how the coronavirus disease (COVID-19) pandemic has re-edited and updated the old mechanisms of neoliberalism and the management of death in Brazil. We discussed the imperatives and messages repeated since March 2020 in the media that transmit a false idea of freedom of choice concerning individual protection, while the State, reinforcing the neoliberal ideology and producing feelings of failure, guilt, and fear materially leaves a large part of the population unprotected. Then, we articulated notions about neoliberalism and the lack of social protection on how death management has been conducted during the pandemic. Finally, we reflected on the possibility of weather insurgency and promoted the idea that the established solidarity networks are expressions of solidarity and class identity based on what resembles us as humans.