César Eduardo Fernandes

This study discusses the challenges encountered in breast cancer screening coverage in Brazil. The aim was to verify mammography coverage in Brazil. A cross-sectional study was carried out using data provided by the Ministry of Health verifying the following information: method of detection, analysis of coverage, clinical and sociodemographic variables of breast cancer. We observed significant differences in the number of mammograms performed between Brazilian regions and between levels of education, which may be determining factors for adherence to the examination, as well as differences related to the collection period analyzed. Raising awareness among the population about the importance of mammography and training health professionals are fundamental to increasing coverage. It is necessary to invest in awareness-raising strategies and in a health care network prepared to welcome women with suspicious signs and symptoms, ensuring investigation and treatment.

SUMMARY OBJECTIVE: This study aimed to describe the design and linkage procedures of the Career, Autonomy, Rights and Equity among Doctors Brazil survey coordinated by the Brazilian Medical Association, and to assess the composition and geographic coverage of its analytic sample against national benchmarks. METHODS: This national cross-sectional online survey was conducted from January 29 to September 10, 2026. The invitation frame came from Demografia Médica no Brasil, a census-based investigation of the physician workforce conducted since 2010. Four nonoverlapping random samples totaling 110,000 physicians were invited; participation was voluntary. Survey records were audited, deduplicated, linked to professional sources through a restricted key, compared with 2024 national benchmarks, and calibrated for sex, region, and age group. RESULTS: Of 4,437 submissions, 4,002 physicians formed the analytic sample. Women accounted for 51.6%, mean age was 48.3 years, and 70.9% had at least one recognized specialty, compared with 49.3%, 44.8 years, and 59.1% in the observed 2024 national benchmark. Calibration weights ranged from 0.396 to 3.134; the Kish weight-based design effect was 1.259, and the effective sample size was 3,180. CONCLUSION: Career, Autonomy, Rights and Equity among Doctors Brazil documents a linked physician sample and quantifies differences from national benchmarks. The low matched participation fraction and voluntary response create substantial potential for selection bias. Random invitations, linkage, and calibration do not establish population representativeness or remove unmeasured nonresponse bias. The findings primarily characterize the analytic sample and inform the interpretation of subsequent thematic studies.

SUMMARY OBJECTIVE: To develop a national consensus catalog of essential psychomotor competencies and establish the minimum expected competence levels for graduating medical students across anesthesiology and surgical specialties in Brazil using a modified Delphi process. METHODS: This national consensus-development study used a two-round modified Delphi process coordinated by the Brazilian Medical Association. Scientific Committees representing anesthesiology and 14 surgical specialty societies developed preliminary specialty-specific catalogs and proposed the expected competence level for each competency. Board-certified specialists evaluated the competency–competence-level combinations using a five-point Likert scale. Consensus was predefined as ≥75% combined agreement. RESULTS: A total of 802 specialists participated in the first Delphi round, and 622 completed the second round. The preliminary catalogs comprised 343 competency statements. Of these, 273 (79.6%) achieved consensus, whereas 70 (20.4%) were excluded. During the first Delphi round, participants proposed 103 additional competency statements, of which 90 (87.4%) achieved consensus after evaluation during the second Delphi round. The final consensus catalog comprised 363 specialty-specific psychomotor competencies, corresponding to 244 unique psychomotor competencies after harmonization. Most competencies were classified as Perform independently (n=274), followed by Perform under supervision (n=55) and Master the technique (n=34). CONCLUSION: This modified Delphi study established a national consensus catalog of psychomotor competencies and expected competence levels for graduating medical students across anesthesiology and 14 surgical specialties. The catalogue provides a national consensus-based reference for competency-based undergraduate medical education. Future studies should evaluate its implementation and educational impact.

SUMMARY OBJECTIVE: To develop Part II of the National Consensus Catalogue of essential psychomotor competencies and establish the minimum expected competence levels for graduating medical students across 11 clinical and diagnostic support specialties in Brazil using a modified Delphi process. METHODS: This national consensus-development study used a two-phase, two-round modified Delphi process coordinated by the Brazilian Medical Association. Preliminary specialty-specific catalogues were developed between February and June 2025 by Scientific Committees from 11 specialty societies, which also proposed the minimum expected competence level for each psychomotor competency statement. Round 1 of the modified Delphi process was conducted from August to December 2025, and Round 2 was conducted from February to June 2026. Board-certified physicians evaluated each competency-competence level combination using a five-point Likert scale. Consensus was predefined as ≥75% agreement. Statements achieving <60% agreement were excluded after Round 1, whereas those achieving 60.0–74.9% agreement were revised and reassessed in Round 2. Additional competency statements proposed during Round 1 were evaluated in Round 2. RESULTS: A total of 667 physicians participated in Round 1, and 499 completed Round 2. The preliminary catalogues comprised 346 psychomotor competency statements; 240 (69.4%) achieved consensus and 106 (30.6%) were excluded. Participants proposed 38 additional statements, of which 36 (94.7%) achieved consensus in Round 2. The Part II catalogue comprised 276 specialty-specific psychomotor competency statements, corresponding to 229 unique psychomotor competencies after harmonization. Most competency statements were classified as perform independently (n=195), followed by perform under supervision (n=62) and master the technique (n=19). CONCLUSION: This modified Delphi study established Part II of the National Consensus Catalogue of essential psychomotor competencies and minimum expected competence levels for graduating medical students, encompassing 11 clinical and diagnostic support specialties in Brazil.

SUMMARY OBJECTIVE: The aim of this methodological study was to translate, culturally adapt, and validate the Genital Self-Image Scale (GSIS-20) into Brazilian Portuguese. METHODS: The cross-cultural adaptation followed a standardized five-step process: (1) initial translation into Portuguese by two independent bilingual translators; (2) synthesis of the translations; (3) back-translation into English by two independent native speakers; (4) expert committee review to ensure semantic, idiomatic, experiential, and conceptual equivalence; and (5) pre-test with 15 women to evaluate comprehension and cultural relevance. Subsequently, the psychometric properties of the adapted instrument were assessed in 148 women divided into three groups: nulliparous (n=53), primiparous without pelvic organ prolapse (n=52), and women with stage III or IV pelvic organ prolapse (n=43). The Genital Self-Image Scale (GSIS-20) was applied at three time points to assess internal consistency (Cronbach's alpha), test–retest, and interobserver reliability (intraclass correlation coefficient), and discriminant validity. RESULTS: All subscales of the Genital Self-Image Scale (GSIS-20) showed statistically significant differences between groups. The instrument demonstrated excellent internal consistency (Cronbach's alpha=0.925) and reproducibility (intraclass correlation coefficient >0.75). CONCLUSION: The Genital Self-Image Scale (GSIS-20) was successfully translated and culturally adapted into Brazilian Portuguese, showing satisfactory psychometric properties for use in this population.

Menopausal hormone therapy (MHT) is the most effective treatment for relieving menopausal symptoms. However, many women avoid this therapy due to fear, and in Brazil numerous cities lack access to this treatment in the public health system. This study aimed to investigate prescribing habits regarding MHT among gynecologist-obstetricians in the Brazilian public versus private health systems, and to identify the main barriers to its use. This descriptive cross-sectional study utilized a quantitative approach. Gynecologist-obstetricians from across Brazil were invited to complete a structured electronic questionnaire assessing their prescribing practices in both the public and private health sectors. A total of 433 valid responses were analyzed. Among them, 51.5% of participants reported providing care to climacteric patients in the public health system, with 46.2% working in both sectors. Among physicians practicing in both settings, 76.5% reported prescribing MHT more frequently in the private sector. The main barriers to MHT prescription in the public system were treatment cost (68.2%) and lack of availability of free medication (61.4%), while in the private system the predominant barriers were fear of therapy-related risks (93.6%), especially cancer. Only 27.8% reported free access to MHT in their cities. The findings indicate that MHT prescribing practices in Brazil are still significantly influenced by structural barriers in the public sector and by negative perceptions in the private sector. Interventions aimed at expanding access and educating both physicians and patients are essential to ensure safe and equitable use of MHT.

This study aimed to assess the risk factors associated with sarcopenia and identify risk profiles through cluster analysis in postmenopausal women treated at specialized outpatient clinics. A retrospective cross-sectional study evaluated data from 287 postmenopausal women. Sarcopenia was determined by handgrip and gait speed testing. Cluster analysis was applied to identify risk subgroups, and logistic regression to identify factors associated with sarcopenia. Sarcopenia was identified in 18.50% of women. Advanced age (odds ratio [OR] = 1.12; 95% confidence interval [CI]: 1.07-1.16; p < 0.01), number of pregnancies (OR = 1.14; 95% CI: 1.00-1.29; p = 0.04), hip Fracture Risk Assessment Tool (FRAX) (OR = 1.29; 95% CI: 1.12-1.49; p < 0.01), systemic arterial hypertension (OR = 3.20; 95% CI: 1.66-6.17; p < 0.01) and multiple comorbidities (OR = 2.46; 95% CI: 1.19-5.09, p = 0.01) were associated with higher risk for sarcopenia. Cluster analysis revealed an increased risk profile for women who were aged over 70 years, multiparous, hypertensive, with hip FRAX greater than 3% and with major fractures greater than 6%. Postmenopausal women with sarcopenia are more likely to have fragility fractures at 10 years, to be older, multiparous and hypertensive, and to have multiple comorbidities.

The use of compounded hormonal pellets has recently gained popularity in Brazil, driven by claims of benefits beyond their intended clinical indications, such as enhanced muscle mass, improved physical and sexual performance, and overall well-being. However, this growing trend raises significant concerns within the medical community due to the lack of robust scientific evidence supporting their safety and efficacy in the treatment of gynecological conditions, as well as insufficient regulatory oversight.

This study evaluated the prevalence of women attending gynecological consultations who wish to discuss weight issues, barriers preventing physicians from addressing obesity, and differences in perceptions between patients and physicians. A cross-sectional study was conducted from July 2021 to June 2022 at the Centro de Aten & ccedil;& atilde;o Integral & agrave; Sa & uacute;de da Mulher in S & atilde;o Bernardo do Campo, including 404 female patients (median age: 47.5 years) and 140 gynecologists. Most patients were obese, with class I obesity being the most common (58 percent). Among obese participants, 46.4 percent reported chronic hypertension, and 12.7 percent had type 2 diabetes. Nearly 90 percent of women supported discussing weight during consultations, and 80 percent recognized the benefits of modest weight loss. Physicians (average consultation time: 30 minutes) addressed weight regularly (75 percent) but cited insufficient time (55.7 percent) and inadequate training (40 percent) as barriers. While 67 percent of patients felt motivated to lose weight, 77.8 percent of physicians believed their patients lacked motivation. Both groups largely rejected pharmacological and surgical treatments. Most women viewed weight loss as their personal responsibility, while fewer than half of physicians agreed. These findings highlight gaps in communication and differing perceptions, emphasizing the need for educational interventions to enhance physician-patient interactions and integrate weight management into routine gynecological care.