Revista de saude publica最新文献

{"title":"Progress, challenges, and lessons for climate resilient and low carbon health systemsin Latin America and the Caribbean: an exploratory mixed-methods study.","authors":"Yasna Palmeiro-Silva, Camila Llerena-Cayo, Sebastian Bauhoff, Kristie L Ebi, Catharina Giudice, Cristian A Herrera, Jeremy J Hess, Zuhelen Padilla, Karen Alicia Polson, Zoila Vela-Clavo, Daniel Forsin Buss, Stella M Hartinger","doi":"10.11606/s1518-8787.2026060007430","DOIUrl":"10.11606/s1518-8787.2026060007430","url":null,"abstract":"<p><strong>Objective: </strong>To assess progress, challenges, and enabling factors for building climate-resilient and low-carbon health systems across Latin America and the Caribbean, a region facing accelerating climate-sensitive health burdens amidst persistent health system fragilities.</p><p><strong>Methods: </strong>We conducted an explanatory, sequential, mixed-methods study integrating quantitative analysis of the Pan American Health Organisation Climate Change and Health surveys from 2021/2022 (n = 24 countries) and 2023/2024 (n = 27 countries) with semi-structured interviews involving four countries demonstrating progress (Argentina, Chile, Jamaica, Peru). Quantitative data were analysed descriptively across three sub-regions (Caribbean, Central America, South America). Qualitative data underwent two-stage coding (deductive and inductive) with three-researcher consensus to identify barriers, enablers, and lessons learned.</p><p><strong>Results: </strong>By 2023/2024, 93% of countries had designated climate-health focal points (71% in 2021/2022). However, implementation gaps persist: less than 50% of countries had integrated climate change into national health reports; 22%-40% developed national climate-health strategies; and vulnerability assessments rarely informed policy. Access to international climate finance remained inequitable. Whilst 60%-74% developed disaster preparedness plans, only 30%-44% implemented public health communication campaigns. Training focused on environmental health personnel, with doctors, nurses, and planning staff minimally engaged. Qualitative analysis revealed interconnected barriers: climate change perceived as distant rather than urgent, competing priorities overwhelming decision-makers, institutional silos, and misalignment between available training and local needs. Key enablers included linking climate action to established health priorities, institutionalising responsibilities through formal mechanisms, multi-stakeholder engagement, and committed individuals with diplomatic skills navigating cross-sectoral dynamics.</p><p><strong>Conclusion: </strong>Latin America and the Caribbean countries are establishing foundations for climate-resilient and low-carbon health systems, but translating governance progress into sustained implementation requires addressing systemic barriers through institutionalisation beyond political cycles, tailored capacity building, and innovative financing mechanisms. These findings inform guidance for health systems strengthening amidst accelerating climate change.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e24"},"PeriodicalIF":2.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrological disasters and health losses: an index-based analysis for Brazil.","authors":"Gisele Paixão Pereira, José Firmino de Sousa Filho, Thomás Rocha Ferreira, Paulo Victor Maciel da Costa, Andrêa Jacqueline Forte Ferreira, Julia Moreira Pescarini, Joanna Miguez Nery Guimarães, Sofia Rafaela Maito Velasco, Danielson Jorge Delgado Neves, Jean Souza Dos Reis, Kecia Cristina Miranda da Silva, Gervásio Ferreira Dos Santos, Rita de Cássia Ribeiro Silva, Roberto Fernandes Silva Andrade, Maurício Lima Barreto","doi":"10.11606/s1518-8787.2026060007333","DOIUrl":"10.11606/s1518-8787.2026060007333","url":null,"abstract":"<p><strong>Objective: </strong>To develop and apply composite indices to assess immediate losses caused by hydrological disasters in Brazil between 2000 and 2023, with a focus on human losses and damages to health infrastructure.</p><p><strong>Methods: </strong>Data were obtained from the Integrated Disaster Information System, which consolidates national records of hydrological disasters. Seven indicators were selected for the Human Loss Index and four for the Health Infrastructure Loss Index. Indicators were normalized using Min-Max procedures and weighted through a combined Analytic Hierarchy Process and entropy method. The General Severity Index was calculated as the arithmetic mean of Human Loss Index and Health Infrastructure Loss Index, stratified into four levels of severity. Spatial and temporal analyses were conducted to identify critical regions and municipalities.</p><p><strong>Results: </strong>The findings reveal significant heterogeneity in disaster impacts across time and space. Human losses exhibited greater variability than health infrastructure losses, with notable peaks in 2006, 2011, 2015, and 2019. Infrastructure damages were less frequent but highly disruptive, especially in 2012, 2019, and 2023. Municipalities in the Amazon region, particularly Japurá and Atalaia do Norte, registered the highest combined indices, reflecting compounded vulnerabilities from geographic isolation, fragile infrastructure, and socioeconomic inequalities. High General Severity Index scores were concentrated in the North, while human losses were more widely distributed, including along the densely populated southeastern coast. Results confirm that small and socioeconomically vulnerable municipalities are disproportionately affected, with limited institutional capacity to respond.</p><p><strong>Conclusions: </strong>Hydrological disasters in Brazil are strongly mediated by social inequalities, deficient urban planning, and weak preventive policies. Human and infrastructure losses disproportionately affect vulnerable populations, particularly in the North, where access to health services is precarious. The findings emphasize the need for territorially integrated strategies that combine climate adaptation, poverty reduction, and investments in resilient public health infrastructure.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e25"},"PeriodicalIF":2.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age at menarche and general and abdominal obesity in older Brazilian women: ELSI-Brazil.","authors":"Nair Tavares Milhem Ygnatios, Juliana Vaz de Melo Mambrini, Juliana Lustosa Torres, Núbia Carelli Pereira de Avelar, Ana Lúcia Danielewicz, Rosana Carolina Souza Duarte de Matos, Luciana de Souza Braga, Maria Fernanda Lima-Costa, Bruno de Souza Moreira","doi":"10.11606/s1518-8787.2026060007243","DOIUrl":"10.11606/s1518-8787.2026060007243","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between age at menarche and general and/or abdominal obesity in Brazilian women aged ≥ 50 years.</p><p><strong>Methods: </strong>Cross-sectional study conducted with data from the second wave of the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Saúde dos Idosos Brasileiros(ELSI-Brazil, 2019-2021), in a nationally representative sample of community-dwelling individuals aged ≥ 50 years. Self-reported age at menarche was categorized as ≤ 12 years, 13-15 years, and ≥ 16 years. General obesity was defined as a body mass index of ≥ 30 kg/m2, and abdominal obesity as a waist circumference of ≥ 88 cm. The variables were combined into \"general or abdominal obesity\" and \"general and abdominal obesity\". Multinomial logistic regression adjusted for sociodemographic and lifestyle characteristics was used.</p><p><strong>Results: </strong>Among the 4,229 participants, 41.1% (95% confidence interval -95%CI 37.9-44.3) reported menarche at ≤ 12 years and 9.3% (95%CI 8.0-10.9) at ≥ 16 years. The prevalence of general or abdominal obesity was 36.6% (95%CI 33.7-39.5), while the prevalence of general and abdominal obesity was 35.0% (95%CI 32.5-37.7). After adjustments, women with age at menarche of ≤ 12 and 13-15 years had, respectively, 84% (odds ratio - OR = 1.84; 95%CI 1.14-2.98) and 64% (OR = 1.64; 95%CI 1.04-2.57) greater odds of general and abdominal obesity compared with those with menarche at ≥ 16 years. There was no significant association between age at menarche and general or abdominal obesity.</p><p><strong>Conclusion: </strong>Menarche before age 16 is associated with a higher odds of general and abdominal obesity combined, but not in isolation, suggesting its potential as a relevant marker for the formulation of public policies aimed at preventing obesity in girls from school age onwards.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e23"},"PeriodicalIF":2.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional variation and factors associated with average expenditure per headache disorder hospitalization in Brazil: a macrocosting analysis in the SUS (2008-2023).","authors":"Jesuély Spieckert de Souza, Vanise Grassi, Marcos Otávio Brum Antunes, Mariana Cristina Ribeiro, Vinicius da Silva Lessa de Oliveira, Adriel Brandão, João José Freitas de Carvalho, Frederico Friedrich","doi":"10.11606/s1518-8787.2026060007119","DOIUrl":"10.11606/s1518-8787.2026060007119","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the total expenditure on hospitalizations due to headache disorders within the Brazilian Unified Health System (SUS) and to identify the sociodemographic, clinical, and regional factors associated with the average expenditure per hospitalization.</p><p><strong>Methods: </strong>This observational study used SIH-SUS data from 2008 to 2023. Expenditures were inflation-adjusted and categorized by sex, age, and ICD-10 diagnosis. Given the extreme positive asymmetry of the expenditure data, a Generalized Linear Model with a Gamma family and log link function was used to identify adjusted expenditure multipliers.</p><p><strong>Results: </strong>Total expenditure reached BRL 77,643,809.55. The highest volume was concentrated among females (65.7%) and the 19-59 age group (66.1%). The Generalized Linear Model revealed that patients aged 60 years or older had a 21% higher expenditure multiplier (multiplier = 1.21) per event. The South Region showed a structurally 73.7% higher expenditure multiplier (Multiplier = 1.737) per event, even after adjustment for complexity. Vascular headache not elsewhere classified (247.2% higher) and status migrainosus (124.8% higher) were the costliest diagnoses. Crude rate analysis showed the South Region with the highest utilization rate (108.0 hospitalizations per 100,000 inhabitants).</p><p><strong>Conclusion: </strong>The high adjusted expenditure multipliers in the South/Southeast and the long median stays in the North/Northeast point to structural inequalities in the cost and timeliness of care provision. Public policies must reinforce specialized outpatient management to reduce high-cost hospitalizations and promote equitable resource allocation.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e20"},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of two methods for assessing weight gain in Brazilian pregnant women.","authors":"Natalia Posses Carreira, Daiane Leite da Roza, Daniela Saes Sartorelli, Maria Carolina de Lima, Lívia Castro Crivellenti","doi":"10.11606/s1518-8787.2026060007244","DOIUrl":"10.11606/s1518-8787.2026060007244","url":null,"abstract":"<p><strong>Objective: </strong>To compare two methods for assessing gestational weight gain (GWG) among overweight adult pregnant women receiving care in Primary Health Care.</p><p><strong>Methods: </strong>This is a secondary analysis of a randomized controlled clinical trial conducted between 2018 and 2021 involving 260 overweight pregnant women receiving prenatal care at primary health care centers in the municipality of Ribeirão Preto, São Paulo. Participants were assigned to two groups: intervention (received individualized nutritional counseling- GI) or control (received only standard prenatal nutritional guidance-GC). Prenatal weight gain (PWG) was classified according to the U.S. guidelines of the National Academy of Medicine (NAM) and in accordance with Brazilian growth curve recommendations. To assess agreement between the methods, the kappa coefficient was used, and for the classification of weight gain (adequate, insufficient, or excessive), the criteria adopted by each method were used. Logistic regression models were employed to analyze the association between the groups (IG and GC) and the two methods used in the assessment of PWG.</p><p><strong>Results: </strong>Moderate agreement was observed between the methods, with a pattern of disagreement indicating possible underestimation of GPG by the NAM guidelines. Pregnant women in the GI had a higher likelihood of insufficient GPG according to the Brazilian method (OR = 2.87; 95%CI 0.88-9.25) and a lower likelihood of excessive weight gain according to the US method (OR = 0.63; 95%CI 0.34-1.17), compared to women in the GC, although neither finding was statistically significant.</p><p><strong>Conclusion: </strong>The Brazilian curves proved to be more appropriate for classifying GPG in overweight Brazilian pregnant women, better reflecting weight monitoring during prenatal care. Their adoption may facilitate the early identification of GPG inadequacies and, consequently, contribute to improving the quality of prenatal care.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e18"},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intimate partner violence and associated factors among adult women: a population-based study.","authors":"Camila Simon, Juvenal Soares Dias da Costa, Maria Teresa Anselmo Olinto, Fernanda Souza de Bairros, Tonantzin Ribeiro Gonçalves","doi":"10.11606/s1518-8787.2026060007176","DOIUrl":"10.11606/s1518-8787.2026060007176","url":null,"abstract":"<p><strong>Objective: </strong>The study investigated the lifetime prevalence of intimate partner violence among women aged 20 to 69 years residing in the urban area of São Leopoldo (RS) and associated factors.</p><p><strong>Methods: </strong>This was a population-based cross-sectional study in which 1,113 women were interviewed. The outcome was self-reported lifetime intimate partner violence, and sociodemographic, physical and mental health, and behavioral variables were assessed. A stratified analysis by age group was performed.</p><p><strong>Results: </strong>The prevalence of intimate partner violence in the sample was 17.9% (95%CI 15.6-20.1). In the adjusted analysis, the outcome was associated with lower socioeconomic status, a history of sexually transmitted infections, and the presence of common mental disorders. In the stratified analysis, women aged 20-39 years had a 13.7% (95%CI 10.5-16.8) lifetime prevalence of intimate partner violence, with nearly three times the likelihood among those with common mental disorders. Among women aged 40 years or older, the prevalence was 20.7% (95%CI 17.6-23.8), with those in the lowest socioeconomic class, who were single, divorced, or widowed, who self-reported sexually transmitted infections, and who had common mental disorders being more likely to experience the outcome. Secondary intersectional analyses revealed a higher prevalence of intimate partner violence among Black or Brown women with low educational attainment (PR = 1.67; 95%CI 1.14-2.45) and White women with low educational attainment (PR = 1.58; 95%CI 1.14-2.19), compared to white women with higher educational attainment.</p><p><strong>Conclusions: </strong>The study demonstrated a high lifetime prevalence of intimate partner violence, reinforcing the need for public policies that improve women's socioeconomic conditions, as well as integrated gender-based violence prevention programs that incorporate mental health care in the support provided to victims.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e17"},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hearing loss and postural balance performance in adults and the elderly in ELSA-Brazil.","authors":"Fernanda Yasmin Odila Maestri Miguel Padilha, Vitor Martins Guesser, Camila Maia Rabelo, Renata Rodrigues Moreira, Itamar de Souza Santos, Isabela M Bensenor, Paulo A Lotufo, Alessandra Giannella Samelli","doi":"10.11606/s1518-8787.2026060007332","DOIUrl":"10.11606/s1518-8787.2026060007332","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between hearing loss and postural balance in adults and the elderly participating in the Estudo Longitudinal da Saúde do Adulto (ELSA-Brazil - Longitudinal Study of Adult Health).</p><p><strong>Methods: </strong>Cross-sectional study with data from the fourth wave (2020-2025) of ELSA-Brazil, in the center of São Paulo. Sociodemographic, clinical, and audiological variables were analyzed. Hearing loss was defined by the average of the tonal thresholds (> 25 dBHL) in different criteria: PTA (0.5 kHz-2kHz), speech-frequency PTA (0.5 kHz-4kHz), and high-frequency PTA (3 kHz-8kHz), considering the better and the worst hearing ear. Balance was assessed using the modified Romberg test, in four progressive conditions (eyes open on a firm surface, eyes closed on a firm surface, eyes open on a soft surface, and eyes closed on a soft surface), with a binary classification (pass/fail). The outcome was performance in the balance test.</p><p><strong>Results: </strong>A total of 540 participants were assessed, mostly women, self-declared white, mean age of 63.1 years, mean Body Mass Index (BMI) of 28.4 kg/m2, with higher education and income between R$ 1,245.00 and R$ 3,319.00. The rate of balance failure was 13.3%. The prevalence of hearing loss ranged from 13.7% to 59.8%, depending on the criteria used. There was an association between hearing loss and worse performance in the balance test, especially for high-frequency PTA. In the logistic regression models, there was a significant association between the explanatory variable age and failure in the balance test. After excluding the age variable, there was an association for hearing loss, BMI, schooling, and income.</p><p><strong>Conclusion: </strong>There was an association between hearing loss and poorer balance performance. The highest proportion of failures was for the hearing loss criterion that included high frequencies. Age was the most relevant explanatory variable in balance test performance, in addition to hearing loss, schooling, income, and BMI, emphasizing the need for a multifactorial view of this function.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e22"},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to specialized outpatiecare: an analysis of regulation in Brazilian settings.","authors":"Thais Barros Zanette da Silva, Jozinélio Severino Teixeira, Carlos Amilcar Salgado, Luciano de Paula Camilo, Claudilene Sousa Fortaleza, Fábio Ferreira Amorim, Leila Bernarda Donato Göttems","doi":"10.11606/s1518-8787.2026060007411","DOIUrl":"10.11606/s1518-8787.2026060007411","url":null,"abstract":"<p><strong>Objective: </strong>To analyze how different subnational governments, based on common national guidelines, have developed their own models for regulating access to specialized care, with varying degrees of innovation, institutionalization, and integration of telehealth.</p><p><strong>Method: </strong>A descriptive and exploratory study with a qualitative approach that comparatively analyzes the implementation of regulations governing access to specialized care. Data were collected through document analysis, literature review, and, in some cases, interviews with key stakeholders, consolidated into detailed descriptions of each scenario to form the research corpus. Analysis was conducted using the Consolidated Framework for Implementation Research (CFIR). Experiences were selected from the municipalities of Curitiba (PR), Belo Horizonte (MG), Porto Alegre (RS), and São Paulo (SP), as well as the states of Ceará, Santa Catarina, Rio Grande do Sul, and the Federal District.</p><p><strong>Results: </strong>The eight Brazilian experiences with outpatient regulation are characterized by diversity in organizational models, degrees of institutionalization of teleconsultation, and integration across levels of care. The adoption of technologies, access regulation protocols, and computerized systems varied across locations, influenced by structural, regulatory, and contextual factors. When integrated, teleconsultation improved the quality of referrals and increased problem-solving capacity in primary care, but its implementation remains uneven across the country.</p><p><strong>Conclusion: </strong>The implementation of access regulation to specialized care in the Unified Health System varied according to institutional, organizational, and technological capacities. Weaknesses were identified in the integration of health information systems in the organization and delivery of specialized care, with structural inequalities; in governance, with low standardization of protocols; limited integration between Primary Health Care and specialized care; and professional resistance to change. Regions with better outcomes integrated teleconsultation into outpatient regulation; clinical and access protocols adopted health information systems integrated with analytical intelligence resources and institutionalized regulatory guidelines. The CFIR highlighted the influence of contexts, actors, and processes, reinforcing the importance of national guidelines for improving local organizations.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e19"},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the microenvironment for leisure physical activity and commuting in São Paulo.","authors":"Elaynne Silva de Oliveira, Inaian Pignatti Teixeira, Ítalo Vinícius Floriano de Paula, Jader Correia de Lacerda, Rildo de Souza Wanderley Junior, Alexandre Augusto de Paula da Silva, Adriano Akira Ferreira Hino, Alex Antonio Florindo","doi":"10.11606/s1518-8787.2026060006996","DOIUrl":"10.11606/s1518-8787.2026060006996","url":null,"abstract":"<p><strong>Objective: </strong>To describe the characteristics of the built environment at the micro-scale and to examine differences according to residential area and social and demographic variables among adults in São Paulo, Brazil.</p><p><strong>Methods: </strong>This is a cross-sectional study involving 1,434 adults from the ISA-Physical Activity and Environment cohort. Environmental characteristics were assessed using the Microscale Audit of Pedestrian Streetscapes (MAPS Global) method based on Google Earth images along 400-700-meter routes centered on the participants' georeferenced addresses. For the analysis, Mann-Whitney U tests were used for two independent groups and Kruskal-Wallis tests for three or more groups, followed by Dunn's post-hoc test, to assess differences in mean scores by health coordination unit, sex, age, educational level, and skin color.</p><p><strong>Results: </strong>The surroundings of residences in the Central-West region had the highest overall scores (p < 0.001). Individuals with higher education levels, who self-identified as White or Asian, and those aged 60 years or older resided in areas with better scores for aesthetics, social aspects, presence of trees, canopy cover, sidewalks, intersections, and overall environmental score (p < 0.001). In contrast, people with lower educational attainment and those who self-identified as Black or Brown lived in areas with poorer sidewalk conditions (p < 0.001).</p><p><strong>Conclusion: </strong>It is concluded that micro-scale conditions were better in the vicinity of residences in central regions and for individuals with higher education, White or Asian skin color, and older age, highlighting the need for public policies aimed at more equitable and inclusive urban planning.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e21"},"PeriodicalIF":2.4,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between food knowledge and adherence to the Brazilian Food Guide.","authors":"Kamila Tiemann Gabe, Patricia Constante Jaime","doi":"10.11606/s1518-8787.2026060006890","DOIUrl":"10.11606/s1518-8787.2026060006890","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between food knowledge according to the level of food processing and adherence to the recommendations of the Dietary Guidelines for the Brazilian Population.</p><p><strong>Methods: </strong>This study was carried out with a subsample of the NutriNet-Brazil cohort based on quotas (n = 1,053). Adherence to the Guide was assessed using a scale of dietary practices (24 items), which generates a score ranging from 0 to 72. To assess knowledge, participants indicated on a scale of 1 to 10 how healthy they considered each item on a list of 12 foods in four categories (fruit, meat, dairy products and grains), including three groups from the Nova food classification: fresh or minimally processed (G1); processed (G3); and ultra-processed (G4). To generate the score (0 to 8), two points were assigned in each category when option G1 was evaluated as healthier than G3, and both as healthier than G4. In the analysis, sample weighting was used to bring the distribution of the sample closer to the profile of the Brazilian population. The association between the knowledge score and adherence to the Guide was tested using linear regression with adjustment for sociodemographic, socioeconomic and behavioral variables.</p><p><strong>Results: </strong>The mean score for adherence to the Guide was 43.1 (SD = 9.29) and the mean score for knowledge was 5.4 (SD = 1.2). In the crude model, for every one point increase in knowledge, adherence to the Guide increased by an average of 0.8 points (p = 0.002). The association remained significant in the adjusted model, but the coefficient was reduced to 0.6 (p = 0.020) with the inclusion of socioeconomic variables in the model.</p><p><strong>Conclusion: </strong>Greater knowledge to recognize ultra-processed foods as less healthy is associated with greater adherence to the dietary practices recommended by the Dietary Guidelines for the Brazilian Population, reinforcing the importance of disseminating the recommendations.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"60 ","pages":"e16"},"PeriodicalIF":2.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}