Category: Nevin Manimala

JMIR Form Res. 2026 Aug 12;10:e92230. doi: 10.2196/92230.

ABSTRACT

BACKGROUND: Breast cancer is a leading cause of mortality among Thai women. Breast self-examination (BSE) is a low-cost practice that promotes breast health awareness and familiarity with breast changes; however, adherence and correct technique remain suboptimal, partly due to limited guidance and reminder systems. Mobile health (mHealth) interventions could support BSE practice.

OBJECTIVE: This study aimed to develop VCheck, a culturally tailored mHealth app for Thai women, and conduct a formative evaluation of its usability and feasibility.

METHODS: A user-centered design framework guided the development of VCheck using the Thunkable cross-platform environment. The app included educational multimedia content, step-by-step BSE guidance, and a smart reminder system. A formative pilot usability study was conducted among 55 female volunteers aged 20 to 50 years over a 2-month period. Usability was assessed using the System Usability Scale. Feasibility and interface design were evaluated using a multidimensional satisfaction questionnaire, and qualitative feedback was collected.

RESULTS: The mean System Usability Scale score was 85.4 (SD 6.8), indicating excellent usability. Participants reported high overall satisfaction (mean 4.46, SD 0.68), including with feasibility (mean 4.48, SD 0.64) and interface design (mean 4.44, SD 0.72). Qualitative feedback suggested that the app was easy to navigate and culturally appropriate.

CONCLUSIONS: In this formative evaluation, VCheck demonstrated high usability and user acceptance as a culturally tailored mHealth tool for breast health education and BSE awareness among Thai women. The findings support further refinement and larger-scale evaluation of behavioral and implementation outcomes.

PMID:42585541 | DOI:10.2196/92230

J Intensive Care Med. 2026 Aug 12:8850666261475636. doi: 10.1177/08850666261475636. Online ahead of print.

ABSTRACT

ObjectiveTo evaluate the prevalence, clinical trajectory, and biologic phenotype of patients with rapidly improving acute hypoxemic respiratory failure (riAHRF), a subgroup of mechanically ventilated patients hypothesized to share features with the low-mortality, hypo-inflammatory phenotype previously described in rapidly improving ARDS.DesignSingle-center retrospective cohort study with nested biomarker analysis.SettingAcademic quaternary care medical intensive care unit (ICU) in California.PatientsTwo cohorts of mechanically ventilated ICU patients with AHRF were included: (1) 631 patients identified through the electronic health record (EHR) between March 1, 2022 and February 1, 2024, and (2) 164 patients in the Stanford ICU Biobank who had banked plasma samples collected within 24 h of intubation. Patients with cardiogenic or traumatic etiologies were excluded in both cohorts. AHRF was defined by PaO²/FiO² < 300 or SpO²/FiO² < 315 on the day of intubation. Resolution of hypoxemia was defined by achievement of minimal ventilator settings (FiO² ≤ 0.4 and PEEP ≤ 5 cmH²O for ≥ 6 h). riAHRF was defined as reaching minimal ventilator settings within 24 h of intubation.InterventionsNone.Measurements and Main ResultsIn the EHR cohort, 61% of patients experienced riAHRF. These patients had significantly lower 90-day mortality (22% vs 49%, P < .001) and more ventilator-free days (median 25 vs 23, P < .001) compared to non-riAHRF patients. Differences in clinical variables related to respiratory status, including S:F, respiratory rate, and blood gas data were subtle but statistically significant. In the BioBank cohort, riAHRF patients had lower levels of IL-8, IL-6, and sTNFR.ConclusionsRapidly improving AHRF (riAHRF) is common in patients intubated for AHRF and is associated with lower mortality and a hypo-inflammatory biomarker profile.

PMID:42585534 | DOI:10.1177/08850666261475636

Rev Bras Epidemiol. 2026 Aug 7;29:e260035. doi: 10.1590/1980-549720260035. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the classification of the risk of transmission of vaccine-preventable diseases among children under 2 years of age in a large Brazilian municipality in 2022 and 2023.

METHOD: Ecological epidemiological study using secondary data on vaccination coverage (VC) for nine immunobiologicals recommended in the vaccination schedule for children under 2 years of age. Immunobiological dose data were obtained from the National Immunization Program Information System (Sistema de Informações do Programa Nacional de Imunizações – SI-PNI), while data were collected from the Ministry of Health website and filtered by place of residence. Data were analyzed using the R software package.

RESULTS: In 2022, 100% of the Health Surveillance Units (Unidades de Vigilância em Saúde – UVIS) showed low VC for the second dose of the measles-mumps-rubella (MMR) vaccine. In the same year, 61% and 54% of the UVIS achieved adequate VC for the hepatitis A and human rotavirus vaccines, respectively. In 2023, improvements in VC were observed for most vaccines, except for the meningococcal C and varicella vaccines, which showed a reduction in the number of UVIS achieving adequate VC. Regarding the classification of the risk of reintroduction of vaccine-preventable diseases, the proportion classified as “low and very low” increased from 0% in 2022 to 10.7% in 2023.

CONCLUSION: VC improved in 2023 for most vaccines analyzed across the UVIS. However, variations in VC were observed according to vaccine type and year. These findings reinforce the need to maintain regional actions aimed at achieving vaccination targets, given the indications of a recovery in VC.

PMID:42585533 | DOI:10.1590/1980-549720260035

Rev Bras Epidemiol. 2026 Jun 1;29:e260025. doi: 10.1590/1980-549720260025. eCollection 2026.

ABSTRACT

OBJECTIVE: To describe the prevalence, incidence, and years lived with disability due to autism spectrum disorder in Brazil, as well as the variation of these metrics between 1990 and 2023.

METHODS: A time-series analysis using data for Brazil from the 2023 Global Burden of Disease study. Estimates of incidence, prevalence, and years lived with disability attributable to autism spectrum disorder were generated for Brazil and its regions. The study reports absolute frequencies, crude rates, and age-standardized rates per 100,000 inhabitants, all with 95% uncertainty intervals (95% UI), stratified by sex and age group.

RESULTS: In 2023, more than 1.1 million (95% UI: 0.58; 1.97) individuals on the autism spectrum were living in Brazil, representing 0.53% of the population (95% UI: 0.27; 0.93). The number of cases increased since 1990, while age-standardized prevalence remained stable over time. In 2023, more than 23,000 new autism spectrum disorder cases were estimated, with a rate of 11.19 per 100,000 individuals (95% UI: 2.47-31.39). Autism spectrum disorder was ranked within the top ten causes of years lived with disability for people younger than 20 years, being a non-fatal health burden.

CONCLUSION: In 2023, 0.53% of Brazilians were autistic, corresponding to more than 207,000 years lived with disability. Prevalence was higher in males and children under five years of age. The permanent and complex nature of autism spectrum disorder imposes a significant burden, requiring healthcare and education services to be adequately prepared. Further research is needed to deepen the understanding of autism spectrum disorder and validate screening tools in the Brazilian context.

PMID:42585532 | DOI:10.1590/1980-549720260025

Rev Assoc Med Bras (1992). 2026 Aug 7;72(6):e20260407. doi: 10.1590/1806-9282.20260407. eCollection 2026.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate university students’ knowledge, attitudes, and behaviors regarding sexual and reproductive health.

METHODS: This cross-sectional study was conducted using face-to-face questionnaires administered on a voluntary basis to university students aged 18-26 presenting to the Muğla Sıtkı Koçman University Kötekli No. 4 Family Health Center. Data were analyzed using International Business Machines Statistical Package for the Social Sciences Statistics version 26.0. Associations between categorical variables were evaluated using the chi-square and Fisher’s exact tests.

RESULTS: A total of 383 students participated in the study (55.4% female, n=212; 44.6% male, n=171). Of the participants, 42.3% reported having sexual experience, which was significantly higher among males (p=0.002). The most common source of information on sexual and reproductive health was the internet (65.3%). The best-known family planning method was the condom (98.7%). The most commonly known sexually transmitted infection was human ımmunodeficiency virus/acquired ımmunodeficiency syndrome, and the most frequently reported symptom was genital discharge.

CONCLUSION: University students’ level of knowledge regarding sexual and reproductive health is insufficient, and this gap suggests that knowledge alone is insufficient to drive behavior change, and that sociocultural and cognitive barriers-such as stigma, perceived norms, and risk misperception-play a mediating role.

PMID:42585528 | DOI:10.1590/1806-9282.20260407

Arq Bras Cardiol. 2026 Aug 10;123(7):e20260069. doi: 10.36660/abc.20260069. eCollection 2026.

ABSTRACT

BACKGROUND: Sacubitril/valsartan reduced mortality and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) compared to enalapril in pivotal clinical trials. However, real-world data under optimized dosing remain limited.

OBJECTIVE: To compare the outcomes of HFrEF patients treated with sacubitril/valsartan versus either enalapril or losartan at guideline-recommended maximum dosages.

METHODS: We analyzed data from an observational heart failure cohort (n = 2,314) including patients receiving care between August 2010 and September 2024 at six public hospitals in a large metropolitan area. The primary analysis included 254 HFrEF patients receiving the guideline-recommended maximum dosages of the investigated drugs. A sensitivity analysis included 452 patients receiving any submaximal dosages. The primary outcome was combined hospitalization or death. Baseline differences were adjusted using propensity score matching. A p-value < 0.05 was considered significant.

RESULTS: Among 254 HFrEF patients (mean age 63.6 ± 12.3 years, 61.4% male), 115 received sacubitril/valsartan 97/103mg twice daily, 33 enalapril 20 mg twice daily, and 106 losartan 100 mg daily. Over the median follow-up of 23.9 months (interquartile range 11.9-41.1), there were 70 primary endpoint events (56 first hospitalizations, 32 deaths). Compared to equivalent dosages of enalapril or losartan, sacubitril/valsartan was not associated with significant reductions in combined hospitalization or death (odds ratio 0.650, 95% confidence interval 0.354-1.195, p = 0.165), but it was associated with functional status improvement (odds ratio 3.902, 95% confidence interval 1.745-8.726, p = 0.001).

CONCLUSION: This real-world study did not demonstrate significant reductions in hospitalization or mortality for sacubitril/valsartan compared with enalapril or losartan at guideline-recommended maximum dosages; however, sacubitril/valsartan was associated with improved functional status.

PMID:42585517 | DOI:10.36660/abc.20260069

Rev Bras Epidemiol. 2026 Jul 31;29(suppl 1):e260029supl1. doi: 10.1590/1980-549720260029.supl.1. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the evolution of inequalities in the distribution of complete denture use and need among older adults in Brazil, considering socioeconomic factors in 2010 and 2023.

METHODS: An analytical study was conducted using data from the Brazilian National Oral Health Surveys SB Brasil 2010 and 2023, with representative samples of individuals aged 65 to 74 years. The outcome integrated information on complete denture use and need, distinguishing need due to edentulism or replacement. Independent variables included sociodemographic and socioeconomic characteristics, with emphasis on the intersectional analysis of gender, race/skin color, and education. Descriptive analyses and the Concentration Index (CI) were performed to measure inequalities, accounting for the complex sampling design.

RESULTS: A slight increase was observed in the proportion of individuals who do not use and do not need dentures, particularly in the South (from 3.8%; 95% confidence interval – 95%CI 2.1-6.8 to 9.1%; 95%CI 5.7-14.3) and Southeast (from 2.3%; 95%CI 1.2-4.2 to 13.9%; 95%CI 9.1-20.7) regions. Nevertheless, around 90% of older adults still required complete dentures, either due to edentulism or replacement needs. Black men with low education concentrated the highest frequencies of need due to edentulism and showed the smallest reduction over the period. Concentration curves revealed the persistence of inequalities according to gender, race/skin color, education, and income.

CONCLUSION: Despite advances in public oral health policies, improvements in denture use and need occurred unevenly, favoring socially advantaged groups and maintaining gaps in oral health care among older adults in situations of greater vulnerability.

PMID:42585515 | DOI:10.1590/1980-549720260029.supl.1

Rev Bras Epidemiol. 2026 Jul 31;29(suppl 1):e260024supl1. doi: 10.1590/1980-549720260024.supl.1. eCollection 2026.

ABSTRACT

OBJECTIVE: To identify factors associated with the use of dental implants in Brazilian adults and older adults.

METHODS: This cross-sectional analytical study utilized population-based data from the 2023 National Oral Health Survey. The sample comprised adults (35-44 years) and older adults (65-74 years). Two dichotomous outcomes were modeled: self-reported implant use (yes/no) and clinically observed presence of implants (none/one or more). Adjusted odds ratios (ORs) were estimated using multiple logistic regression for complex samples, with demographic and socioeconomic factors, type of dental service used, and number of missing teeth as independent variables.

RESULTS: The prevalence of dental implants ranged from approximately one-tenth to one-fifth of the sample, depending on the method of identification. In the adjusted analysis for self-reported use, older adults, individuals with higher income, those who used private dental services, and those who sought care for treatment or rehabilitation had significantly higher odds of reporting implant use. Conversely, when analyzing clinically observed implants, only the number of permanent teeth lost showed a significant association.

CONCLUSION: The use of dental implants in the Brazilian population reflects both the accessibility of dental services and the clinical need for rehabilitation. Using different identification methods provides a more comprehensive understanding of the distribution of implants across the country. These findings can allow the refinement of clinical and organizational criteria for the provision of implant-supported oral rehabilitation within the public system, thereby promoting greater equity and sustainability.

PMID:42585513 | DOI:10.1590/1980-549720260024.supl.1

Rev Bras Epidemiol. 2026 Jul 31;29(suppl 1):e260017supl1. doi: 10.1590/1980-549720260017.supl.1. eCollection 2026.

ABSTRACT

OBJECTIVE: Analyze trends in socioeconomic inequalities in the distribution of dental caries among adolescents in the years 2003, 2010, and 2023.

METHODS: Longitudinal observational study using data from national oral health surveys. The Decayed, Missing and Filled Teeth (DMFT) index and the number of decayed teeth were analyzed, stratified by income and education. The analyses accounted for the complex sampling design and included measures of absolute inequality (Slope Index of Inequality – SII) and relative inequality (Relative Index of Inequality – RII). Statistical significance was assessed at the 95% confidence level (p < 0.05).

RESULTS: A global reduction in DMFT (Decayed, Missing, and Filled Teeth) and the number of decayed teeth was observed across all socioeconomic strata throughout the period, indicating a general improvement in oral health conditions. However, marked inequalities persisted between groups, maintaining the social gradient, in which adolescents with lower income and education levels presented worse indicators. The SII (Social Income Index) indicated stability in the absolute differences between the social extremes, while the RII (Inequality Index) showed variations over time, suggesting proportional changes in inequalities. For DMFT, an increase in inequalities was observed according to education level and a slight reduction in relation to income; for missing teeth, there was a reduction in inequalities in the most recent years.

CONCLUSION: Despite the overall improvement in caries indicators, socioeconomic inequalities in oral health among adolescents persist, reflecting structural social determinants. The findings reinforce the need for public policies aimed at reducing inequities and promoting equity in oral health.

PMID:42585512 | DOI:10.1590/1980-549720260017.supl.1

Rev Bras Epidemiol. 2026 Jul 31;29(suppl 1):e260015supl1. doi: 10.1590/1980-549720260015.supl.1. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the evolution of population-based epidemiological surveys in oral health (saúde bucal) in Brazil, and implications for the 2030 edition of the SB Brasil project, of the Ministry of Health.

METHODS: This is an essay problematizing methodological and management aspects, and their implications for fieldwork, of population epidemiological surveys in oral health carried out in Brazil in different years, from 1986 to 2023.

RESULTS: Methodological and management decisions of the editions of the SB Brasil project, including 2023, are analyzed, focusing on the inclusion and exclusion of variables, such as dental fluorosis and the PUFA index, which registers the presence of seriously damaged teeth and which have visibly compromised pulp (P), ulcers caused by fragments of loose teeth (U), fistula (F) and abscess (A). The list of variables and the sampling plans of the nationwide oral health surveys carried out in 1986, 1996, 2003, 2010, and 2023 are problematized. The consequences of considering only clinical interest as a criterion for inclusion and exclusion of variables from epidemiological survey protocols are discussed, and the difficulties for the calibration of examiners are addressed, even when standardized methods are used.

CONCLUSION: The next editions of the SB Brasil institutional project, of the Ministry of Health, will start from a relevant accumulation of knowledge and practices resulting from the Brazilian experience with oral health epidemiology, within the scope of SUS, developed in the second half of the 20th century and the first decades of the 21st century.

PMID:42585511 | DOI:10.1590/1980-549720260015.supl.1