Revista de saude publica最新文献

{"title":"Artificial intelligence and oral photography: an approach to the epidemiology of dental caries.","authors":"Luiz Roberto Augusto Noro, Maria Cristina Manzanares Céspedes","doi":"10.11606/s1518-8787.2025059006910","DOIUrl":"10.11606/s1518-8787.2025059006910","url":null,"abstract":"<p><strong>Objective: </strong>Dental caries is an important public health issue due to its high prevalence around the world, its impact on people's quality of life, and the existence of effective methods to control and prevent it. This study aims to find the state of the art regarding the diagnosis of caries with the use of artificial intelligence in the scientific literature, which could represent future advances in its use in oral health epidemiology.</p><p><strong>Methods: </strong>A scoping review was carried out based on a search strategy on the main health databases that found 1,439 articles by descriptors or keywords related to caries, diagnosis, and artificial intelligence.</p><p><strong>Results: </strong>After analysis, 17 scientific articles composed the final sample. Of these, 94.1% are quite recent, published from 2020 onward. Although the articles were based on a clinical perspective, their objectives, results, and conclusions signal the possible effectiveness of artificial intelligence as a strategic tool for epidemiology. Frontal, lateral, and occlusal photographs served to diagnose caries on all sides of the teeth.</p><p><strong>Conclusion: </strong>It is essential to invest in alternatives related to artificial intelligence and oral photography to replace traditional epidemiological surveys, which would enable the full development of oral health surveillance.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e53"},"PeriodicalIF":2.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985387","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":"Profile of deaths and causes of mortality among international migrants in Brazil, 2011-2022.","authors":"João Roberto Cavalcante, Anete Trajman, Eduardo Faerstein","doi":"10.11606/s1518-8787.2025059006519","DOIUrl":"10.11606/s1518-8787.2025059006519","url":null,"abstract":"<p><strong>Objective: </strong>To describe the mortality profile and analyze the causes of death among international migrants residing in Brazil between 2011 and 2022.</p><p><strong>Methods: </strong>This is a cross-sectional, descriptive, and ecological study based on secondary data. The sociodemographic profile of deaths reported from 2011 to 2022 was analyzed. Absolute and relative frequencies, as well as mortality rates per 100,000 inhabitants, were calculated by country of birth, macroregion, and federative unit of residence. The underlying causes of death were also analyzed.</p><p><strong>Results: </strong>A total of 173,807 deaths among international migrants were recorded between 2011 and 2022, with the highest number in 2021 (17,779; 10.2%). The predominant mortality profile was male (97,053; 55.8%), aged ≥ 81 years (104,308; 60.0%), White (136,835; 78.7%), and widowed (72,156; 41.5%). Most deceased migrants were born in Portugal (64,909; 37.3%), Japan (22,748; 13.1%), Italy (16,178; 9.3%), and Spain (12,835; 7.3%). The highest mortality rates were observed among migrants born in Lithuania (190,079/100,000), Serbia (146,794/100,000), and Hungary (96,395/100,000). The Southeast (137,457; 79.1%) and South (18,603; 10.7%) macroregions accounted for the majority of deaths, with the highest mortality rates observed in the states of Rio de Janeiro (25,349/100,000), São Paulo (23,574/100,000), and Mato Grosso do Sul (18,683/100,000). The covid-19 pandemic led to an increase in infectious and parasitic diseases from 2020 onward, peaking in 2021 (4,460; 25.0% of deaths that year). The most frequent underlying cause of death during the study period was unspecified acute myocardial infarction (12,141; 7.0%).</p><p><strong>Conclusion: </strong>This study highlights the need for targeted health actions addressing international migrant profiles at higher risk of death and their specific causes of mortality. However, the general invisibility of this population in public health indicators hinders the implementation of effective strategies. Policies ensuring equitable access to healthcare services, medications, and vaccines are essential to improve long-term health outcomes of this population.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e46"},"PeriodicalIF":2.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985421","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":"TVISARS-CoV-2: a multicriteria index and urban dynamics in Minas Gerais, Brazil.","authors":"Matheus Luiz Jorge Cortez, Úrsula Ruchkys de Azevedo, Sónia Maria Carvalho Ribeiro, Anacleto Marito Diogo, Danilo Cirino Muniz do Nascimento","doi":"10.11606/s1518-8787.2025059006877","DOIUrl":"10.11606/s1518-8787.2025059006877","url":null,"abstract":"<p><strong>Objective: </strong>To develop a municipal-level vulnerability index to COVID-19 transmission that integrates socioeconomic factors, urban infrastructure, mobility, and composite indicators of social vulnerability and leisure for Minas Gerais. This study found factors associated with the spatial distribution of COVID-19 and classified the 853 municipalities in the state by vulnerability levels.</p><p><strong>Methods: </strong>Data on COVID-19 cases from February 2022 were combined with nine variables in three domains: (i) socioeconomic factors (trade, service, construction, and manufacturing jobs); (ii) urban infrastructure and mobility (urban area, road connectivity, and vehicle density); and (iii) composite indicators (index of social vulnerability and access to culture, sports, and leisure). A multicriteria analysis model with Pearson's correlations was elaborated and validated by cross-validation.</p><p><strong>Results: </strong>The vulnerability index ranged from 1 to 8. The municipality of Belo Horizonte showed the highest value (8), followed by Uberlândia (6) and other medium to large municipalities with high urban dynamism. Urban area (22.92%), road connectivity (17.54%), and vehicle density (12.86%) constituted the most influential variables in the model. Spatial distribution indicated greater vulnerability in metropolitan regions and regional hubs.</p><p><strong>Conclusions: </strong>The proposed index highlighted the role of structural and occupational characteristics in territorial vulnerability to COVID-19. Limitations such as the time lag of some variables, source heterogeneity, and case underreporting-especially in municipalities with lower testing capacity-may have influenced the results. Incorporating emerging technologies and sustainable practices can mitigate the risks of future pandemics and improve quality of life. The index offered a useful tool for health planning (which may be adapted to other communicable diseases).</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e49"},"PeriodicalIF":2.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985411","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":"Dental caries and fluorosis after 40 years of community water fluoridation in São Paulo, Brazil.","authors":"Paulo Capel Narvai, Carlos Cesar da Silva Soares, Antonio Carlos Frias, José Leopoldo Ferreira Antunes","doi":"10.11606/s1518-8787.2025059007126","DOIUrl":"10.11606/s1518-8787.2025059007126","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the non-exclusive impact of community water fluoridation on the prevalence of caries and dental fluorosis in schoolchildren in the municipality of São Paulo between 1986 and 2023.</p><p><strong>Methods: </strong>Secondary data were used for the index age of 12 years, provided by the Ministry of Health, covering caries and dental fluorosis in different years, from 1986 to 2023. The degree of caries polarization was calculated using the Gini index. Two recognized risk factors for caries-low maternal schooling and per capita income-were obtained from the municipal human development index for 1991, 2000, and 2010, the years for which they are available. Exposure to community fluoridated water was verified by analyzing 49,515 water samples obtained between 1990 and 2021.</p><p><strong>Results: </strong>Caries prevalence was 94.9% (95%CI: 92.7-97.1) in 1986; 68.1% (95%CI: 60.9-75.3) in 1996; 60.2% (95%CI: 54.2-66.3) in 2003; 47.6% (95%CI: 41.2-54.1) in 2010; and 46.3% (95%CI: 38.3-54.3) in 2023. The mean DMFT decreased from 6.47 (95%CI: 6.05-6.89) in 1986 to 2.37 (95%CI: 1.96-2.78) in 1996; 1.75 (95%CI: 1.48-2.02) in 2003; 1.40 (95%CI: 1.13-1.67) in 2010 and 1.51 (95%CI: 1.03-1.99) in 2023. The proportion of decayed teeth (\"D\" component of DMFT) was 58.5% in 1986; 33.3% in 1996; 32.3% in 2003; 51.2% in 2010, and 56.0% in 2023. Fluoride concentrations in the public water supply were adequate during the period in question, with values predominantly (98.0%) between 0.545 mgF/L and 0.944 mgF/L of water. The mean concentration was 0.663 mgF/L and the standard deviation was 0.167.</p><p><strong>Conclusion: </strong>The significant decline in the mean value of the DMFT index, in the order of 76.7% from 1986 to 2023, indicates the effectiveness of fluoridation, corroborating the scientific evidence related to its effectiveness and the continuity of this measure, especially considering the persistent difficulties in accessing dental care in the city of São Paulo.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e47"},"PeriodicalIF":2.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985326","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":"Out-of-pocket expenditures on child health during an economic recession in Brazil.","authors":"Marcelo Torres da Silva, Cesar Augusto Oviedo Tejada, Anderson Moreira Aristides, Alicia Matijasevich, Iná S Santos, Andréa Dâmaso Bertoldi","doi":"10.11606/s1518-8787.2025059006388","DOIUrl":"10.11606/s1518-8787.2025059006388","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between the 2014-2016 economic recession in Brazil and households' direct expenditures on child health across the distribution of such expenditures.</p><p><strong>Methods: </strong>Using longitudinal datasets that followed children born in Pelotas, in the state of Rio Grande do Sul, in 2004 and 2015, estimates were obtained using a Double-Hurdle model, which provides one outcome for the probability of incurring any expenditure and another for the expected value of those expenses when they occur.</p><p><strong>Results: </strong>The findings showed that the economic recession during this period reduced the likelihood of incurring any health-related expenditure, excluding health insurance, by 34% among 12-month-old children and by 29% among 24-month-old children. Regarding health insurance expenditures, the recession reduced the likelihood of occurrence by 37% among 12-month-olds and by a substantial 68% among 24-month-olds. As for the amount spent, given that some expenditure occurred, the economic recession was associated with an expected 15% higher total spending excluding health insurance, and a 9% lower expected spending on health insurance for 12-month-old children.</p><p><strong>Conclusions: </strong>Thus, total health expenditures, excluding health insurance, were less likely to occur during the economic recession; however, when such expenditures occurred, their expected value was higher. In contrast, spending on health insurance was lower in both analyses, reinforcing its preventive nature.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e48"},"PeriodicalIF":2.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985328","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":"BrDMrisc - Online Brazilian Risk Score for Incident Type 2 Diabetes - ELSA-Brasil Cohort.","authors":"Paula Andreghetto Bracco, Maria Inês Schmidt, Alvaro Vigo, José Geraldo Mill, Pedro Guatimosim Vidigal, Sandhi Maria Barreto, Mária de Fátima Sander Diniz, Maria de Jesus Mendes da Fonseca, Bruce Bartholow Duncan","doi":"10.11606/s1518-8787.2025059007088","DOIUrl":"10.11606/s1518-8787.2025059007088","url":null,"abstract":"<p><strong>Objective: </strong>To describe the Brazilian Diabetes Risk Score (BrDMrisc), an online calculator for estimating the risk of developing diabetes in 10 years, comparing it to other commonly used screening approaches to identify high-risk of future diabetes.</p><p><strong>Methods: </strong>BrDMrisc is derived from 7.4-year follow-up data from ELSA-Brasil, a contemporary Brazilian cohort. Risk functions to predict future diabetes were based on socioeconomic, lifestyle, clinical, and laboratory variables, many of which are incorporated as continuous variables on a training sample including half of the analyzed cohort. We used ELSA-Brasil participant baseline data and incident diabetes cases detected during follow-up on the other half to compare the predictive capacity of BrDMrisc against traditional pre-diabetes screening strategies.</p><p><strong>Results: </strong>BrDMrisc's 27 risk functions offer versatility to the online app, enabling estimates based on differing combinations of clinical and laboratory findings, which present more favorable diagnostic properties than other recommended approaches. For example, the BrDMrisc function based on clinical data plus fasting glucose, when compared with detection using solely the presence of impaired fasting glucose (≥ 100 mg/dL), identified a more manageable fraction (20.0% versus 40.6%) of the population as high risk, with those identified as presenting a two-fold risk of developing diabetes (28.5% versus 17.1%).</p><p><strong>Conclusions: </strong>BrDMrisc diabetes risk calculator, based on data from a contemporary Brazilian cohort, is readily available online, versatile, and presents generally more favorable diagnostic properties than other commonly used screening strategies.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e52"},"PeriodicalIF":2.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985352","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":"Recrudescence of tuberculosis in the state of São Paulo post-COVID-19: trends and clusters.","authors":"Reginaldo Bazon Vaz Tavares, Nathalia Zini, Yan Mathias Alves, André Luiz Teixeira Vinci, Natacha Martins Ribeiro, Ariela Fehr Tártaro, Valter Chicalo António Caripa, Maria Eduarda Pagano Pelodan, Clara Ferreira de Souza, Aline Aparecida Monroe, Jaqueline Garcia de Almeida Ballestero, Ione Carvalho Pinto, Pedro Fredemir Palha, Ricardo Alexandre Arcêncio","doi":"10.11606/s1518-8787.2025059006987","DOIUrl":"10.11606/s1518-8787.2025059006987","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the recrudescence of tuberculosis in the state of São Paulo after the COVID-19 pandemic, identifying temporal trends and spatial clusters of the disease.</p><p><strong>Methods: </strong>An ecological study of tuberculosis cases reported on TBWeb in all São Paulo municipalities between January 2015 and December 2023. Time decomposition techniques, interrupted time series analysis by month and spatial analysis by municipality (global Moran index and Getis-Ord Gi*) were applied to identify trends, abrupt changes associated with the pandemic and clusters of high incidence, mortality, and treatment outcomes. The pre-pandemic (01/2015 to 01/2020), pandemic (02/2020 to 04/2022), and post-pandemic (05/2022 to 12/2023) periods were analyzed separately.</p><p><strong>Results: </strong>There was an upsurge in tuberculosis in the post-pandemic period, with a 21.2% increase in the number of municipalities with an incidence > 110 cases per 100,000 inhabitants. There was a progressive increase in the mortality trend of 0.0026 (95%CI: 0.0016 to 0.0035) deaths per 100,000 inhabitants per month after the pandemic. There was a gradual drop of 0.67% (95%CI: -1.099 to -0.246) per month in the proportion of people cured after the pandemic. High incidence clusters persisted in the Presidente Prudente region in all periods, and new clusters in Marília and Registro after the pandemic. Areas with high mortality rates persisted in the regions of Taubaté, Baixada Santista, Grande São Paulo, Registro, Sorocaba and Campinas in all periods.</p><p><strong>Conclusion: </strong>The recrudescence of tuberculosis in São Paulo in the post-pandemic context highlights the need for targeted strategies for early diagnosis, strengthening treatment and intensive monitoring in regions identified as clusters, especially those with vulnerable populations and structural challenges in health services.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e50"},"PeriodicalIF":2.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985407","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":"Economic burden, mortality, and incidence of hospital admissions for cerebrovascular diseases in Brazil from 2017 to 2022: a perspective of the Brazilian Unified Health System.","authors":"Gabriel Medeiros Correia da Silva, Luana Kitagawa Cunha Soares, Ana Clara Ramon Giannelli, Fernando Rocha Oliveira, Luiz Vinicius de Alcantara Sousa, Laércio da Silva Paiva","doi":"10.11606/s1518-8787.2025059006781","DOIUrl":"10.11606/s1518-8787.2025059006781","url":null,"abstract":"<p><strong>Objective: </strong>To analyze hospitalizations, mortality, and costs related to cerebrovascular diseases in Brazil from 2017 to 2022 and to evaluate the impact of the COVID-19 pandemic on these numbers.</p><p><strong>Methods: </strong>Data were collected from the Brazilian Unified Health System Information Technology Department via the Hospital and Mortality Information Systems. The 2010 censuses and the inter-census projections (2017 to 2022) of the Brazilian Institute of Geography and Statistics were searched for population data. The mortality rates and incidence of hospital admissions for cerebrovascular diseases were calculated by dividing the number of deaths and the number of hospital admissions due to cerebrovascular diseases by the total population at risk, multiplied by 100,000 inhabitants, respectively. The results were stratified by age groups, regions of Brazil, sex, and calendar years. Rates were standardized by age, following the direct method from the World Health Organization.</p><p><strong>Results: </strong>Data on mortality from cerebrovascular diseases showed a significant reduction throughout Brazil in general and by sex. The Brazilian Northeast showed a decrease in overall mortality, especially in women, whereas its South showed stationary numbers. Hospitalization rates remain stable, with notable increases in the age groups for younger (from zero to four years of age) and female (from five to nine years of age). Hospitalization costs increased significantly throughout Brazil, with the highest increase in its Northeast, North, Southeast, and Midwest.</p><p><strong>Conclusion: </strong>Mortality rates from cerebrovascular diseases decreased in Brazil, showing regional and age group variations and a worrying increase in young men. Despite stable hospitalizations, hospital costs significantly increased, indicating greater complexity of cases and reinforcing the need for more effective prevention and control strategies.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e44"},"PeriodicalIF":2.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12674689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725425","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":"Spatio-temporal analysis of the double burden of malnutrition in children from the Brazilian semi-arid region.","authors":"Maisa Póvoa de Oliveira, Cíntia Pereira Donateli, Daniela Mayumi Usuda Prado Rocha, Helen Hermana Miranda Hermsdorff","doi":"10.11606/s1518-8787.2025059006605","DOIUrl":"10.11606/s1518-8787.2025059006605","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the temporal trend of the double burden of malnutrition in the Brazilian semi-arid and non-semi-arid regions, and to assess its spatial distribution in the Brazilian semi-arid region among children aged 5 to 9 years, between 2008 and 2022.</p><p><strong>Methods: </strong>Ecological time-series study based on public reports, using macrodata of body mass index-for-age and height-for-age from the Sistema de Vigilância Alimentar e Nutricional (SISVAN - Brazilian Food and Nutritional Surveillance System). For temporal analysis of the prevalence of wasting, overweight, stunting, undernutrition, and the double burden of malnutrition in the semi-arid and non-semi-arid regions, Prais-Winsten regression models were used to estimate the annual percentage change (APC%) between 2008 and 2022. To evaluate spatial distribution in the Brazilian semi-arid region, maps showing the temporal evolution of the prevalence of overweight, undernutrition, and the double burden of malnutrition were constructed.</p><p><strong>Results: </strong>Between 2008 and 2022, 48.7 million children aged 5 to 9 years were registered in SISVAN-Web for body mass index-for-age and height-for-age indices. Approximately 28.1% of these lived in the Brazilian semi-arid region. The prevalence of the double burden of malnutrition in the semi-arid region exceeded 20%, with an increasing trend among children aged 7 to 9 years (APC = 0.61%; p < 0.05). Overweight showed a rising trend, while undernutrition decreased across all strata except among the Indigenous population, which remained stable (APC = -1.12%; p > 0.05). APCs in the semi-arid region were higher than in the non-semi-arid region.</p><p><strong>Conclusion: </strong>The study highlights a high prevalence of the double burden of malnutrition in the Brazilian semi-arid region, especially among children aged 7 to 9 years. Therefore, it is crucial to promote health actions and malnutrition prevention, strengthening existing policies and prioritizing the most vulnerable populations.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e40"},"PeriodicalIF":2.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12674690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725582","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":"Barriers to implementing the WHO Safe Childbirth Checklist in maternity hospitals, Brazil.","authors":"Ewerton William Gomes Brito, Tatyana Maria Silva de Souza Rosendo, Fernanda Pereira Marinho Amaro, Wilton Rodrigues Medeiros, Flôrismeiire de Souza Silva, Marise Reis de Freitas, Rafhael Brito de Almeida Santos, Rose L Molina, Katherine E A Semrau, Lauren Bobanski, Danielle E Tuller, Zenewton André da Silva Gama","doi":"10.11606/s1518-8787.2025059006897","DOIUrl":"10.11606/s1518-8787.2025059006897","url":null,"abstract":"<p><strong>Objective: </strong>To identify barriers to the implementation of the World Health Organization Safe Childbirth Checklist in two reference maternity hospitals-one for high-risk and one for routine-risk childbirths-and to develop a causal model applicable to these contexts.</p><p><strong>Methods: </strong>This qualitative, exploratory study was conducted in two public maternity hospitals that had been using the checklist, since its implementation in 2014. Data were collected through focus groups interviews and brainstorming sessions conducted in 2022 and 2023. Participants included healthcare professionals involved in childbirth care and members of the patient safety center. Content analysis categorized findings based on the five domains of the Consolidated Framework for Implementation Research (CFIR). A causal model was developed using a fishbone diagram to organize results by category.</p><p><strong>Results: </strong>The identified barriers were classified into four of the five CFIR domains. In the Innovation domain, the checklist itself posed challenges due to its design, complexity, and adaptability to existing workflows. In the Inner Setting, barriers included a weak patient safety culture and infrastructure limitations. The Implementation Process domain revealed deficiencies such as inadequate planning, lack of stakeholder involvement, and absence of feedback and assessment mechanisms. Unlike the high-risk maternity hospital, the Outer Setting barrier -lack of policies supporting continuing education-was identified in the routine-risk facility.</p><p><strong>Conclusions: </strong>Implementation of the checklist in the studied maternity hospitals is hindered by structural, cultural, and adaptation challenges. Limited investment in training represents a significant obstacle, highlighting the need for professional development programs. High staff turnover and the absence of specific protocols further compromise consistent use. Addressing these barriers requires comprehensive strategies to enhance adherence to and integration of the checklist in maternal-newborn care.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e41"},"PeriodicalIF":2.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725485","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}