Cadernos de saude publica最新文献

[Privatizing Universalism in the Brazilian health system and the Now There Are Specialists Program]. [私有化巴西卫生系统的普遍主义和现在有专家计划]。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-10-05 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XPT244725

Danielle Conte Alves Riani Costa, Ligia Bahia, José Felipe Riani Costa, José Luiz Riani Costa

{"title":"[Privatizing Universalism in the Brazilian health system and the Now There Are Specialists Program].","authors":"Danielle Conte Alves Riani Costa, Ligia Bahia, José Felipe Riani Costa, José Luiz Riani Costa","doi":"10.1590/0102-311XPT244725","DOIUrl":"10.1590/0102-311XPT244725","url":null,"abstract":"This article reflects on the Now There Are Specialists Program (PATE, acronym in Portuguese) in light of the concept of Privatizing Universalism in the Brazilian health system. The program, presented by the Brazilian Ministry of Health, aims to expand its capacity to provide care and reduce patient waiting lists in the Brazilian Unified National Health System (SUS, acronym in Portuguese). Given the health policies introduced under the PATE, which involve health insurance plans and private hospitals, it is essential to analyze the Program based on the theoretical framework of Privatizing Universalism, which assesses the relationship between the public and private sectors in the Brazilian health system. The concept refers to the way universality has been pursued, through the universalization of the private component. The article identifies the policies introduced by the PATE, as well as the main challenges. The study found that PATE should not be considered a dimension of Privatizing Universalism because it does not increase private health spending, generate tax exemptions, promote the expansion of health insurance plans, or transfer functions and responsibilities from the public to the private sector. In addition, it seeks to secure more resources for the SUS, reduce disparities in access to health services, and place the private health sector at the service of the Brazilian population. It is essential to monitor the repercussions of the PATE and its results in reducing health inequalities, especially regarding the discrepancies that currently exist in the distribution of resources and in the use of services between the country's regions and between the public and private health sectors.","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00244725"},"PeriodicalIF":2.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134918","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}

引用次数: 0

[A spatiotemporal analysis of canine visceral leishmaniasis in Uruguaiana, Rio Grande do Sul, Brazil (2009-2019)]. [2009-2019年巴西巴西大德州乌拉圭犬内脏利什曼病时空分析]。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-10-05 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XPT153625

Júlia Birnie Farias Covatti, Laura Ilarraz Massia, José Ricardo Wellicks, Rita Daniela Quevedo Lamadril, Debora da Cruz Payão Pellegrini

引用次数: 0

[The precautionary principle in preventive actions: considerations on an absence]. [预防行动中的预防原则：关于缺席的考虑]。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-10-05 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XPT195125

Charles Dalcanale Tesser

{"title":"[The precautionary principle in preventive actions: considerations on an absence].","authors":"Charles Dalcanale Tesser","doi":"10.1590/0102-311XPT195125","DOIUrl":"10.1590/0102-311XPT195125","url":null,"abstract":"The precautionary principle (PP) consists of measures to be taken to avoid harm under serious damage or catastrophe to the environment or human health and scientific uncertainty about its causes and/or incidence. However, PP has not been used to prevent severe iatrogenic harm from actions derived from primary (P1) or secondary (P2) prevention actions in medicine or health systems. This essay synthesizes a proposal for this use, defends its adequacy, and offers four comprehensive, interconnected, and synergistic hypotheses as to why it is yet to occur: (a) such use is very anti-intuitive due to the teleological similarity between PP and prevention and their contextual differences; (b) the future moral expansion of medicine has generated a preventive supremacy that unrestrictedly expands tolerance to P1/P2 iatrogenesis; (c) some of these iatrogenic diseases are anomalies (in Thomas Kuhn's sense) with complex identification and measurement, making it difficult to accept and value them; (d) the following ongoing naturalization of preventive iatrogenesis makes it unthinkable to consider PP for its management in serious cases of doubt, leaving it outside the horizon of preventive medicine and paradoxically making it more necessary.","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00195125"},"PeriodicalIF":2.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134885","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}

引用次数: 0

[What is the cost of neonatal respiratory distress for the Brazilian Unified National Health System? A national analysis of direct costs, regional distribution, and temporal variation]. [巴西统一国家卫生系统新生儿呼吸窘迫的费用是多少？]直接成本、区域分布和时间变化的全国分析[d]。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-10-05 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XPT220625

Letícia Araujo Villarinho, Julia Raffin Moura, Mchilanny Bussinguer de Menezes, Emilie Freire Batista, Silvana Alves Pereira, Aline Martins de Toledo

{"title":"[What is the cost of neonatal respiratory distress for the Brazilian Unified National Health System? A national analysis of direct costs, regional distribution, and temporal variation].","authors":"Letícia Araujo Villarinho, Julia Raffin Moura, Mchilanny Bussinguer de Menezes, Emilie Freire Batista, Silvana Alves Pereira, Aline Martins de Toledo","doi":"10.1590/0102-311XPT220625","DOIUrl":"10.1590/0102-311XPT220625","url":null,"abstract":"Neonatal respiratory distress syndrome shows high clinical severity and economic burden for the Brazilian Unified National Health System. This study estimated the direct costs of hospitalizations from 2018 to 2021 and described their distribution by diagnosis, region, and period. A cost-of-disease study with a top-down approach and authorizations for hospitalization of newborns aged from 0 to 27 days was carried out. Values were updated to December 2025 and standardized per 1,000 live births. The period included 1,449,694 neonatal hospitalizations, of which 227,130 (15.7%) were due to respiratory distress (about half of which were classified as \"unspecified\" by the International Classification of Diseases, 10th revision). Total spending neared BRL 1.4 billion, 69.6% of which referred to care in neonatal intensive care units. The cost per 1,000 live births ranged from BRL 111,625 in the Brazilian North to BRL 769,847 in the South. Respiratory distress syndrome had the highest median cost per hospitalization (BRL 8,060). Admissions decreased due to respiratory distress syndrome but increased due to transient tachypnea, other discomforts, and unspecified diagnoses. Cost medians decreased in the period. A greater use of neonatal intensive care beds and an increase in proportional mortality in \"unspecified\" cases occurred from 2020 to 2021. Regions show high and heterogeneous economic burden. Estimates by diagnosis and region can guide neonatal intensive care capacity planning and equity policies in perinatal care.","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00220625"},"PeriodicalIF":2.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135012","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}

引用次数: 0

Food insecurity as a barrier to care for people with diabetes in Brazil: gaps and challenges for public health, food, and social protection policies. 粮食不安全是巴西糖尿病患者护理的障碍：公共卫生、粮食和社会保护政策方面的差距和挑战。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-10-05 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XEN054726

Daniel Ferreira da Silva, Dirce Maria Lobo Marchioni

引用次数: 0

A comprehensive model of maternal health behavior: the interplay of sociodemographic and digital determinants in Nigeria. 产妇保健行为综合模型：尼日利亚社会人口和数字决定因素的相互作用。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-09-18 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XEN184125

Muyiwa Oladosun, Anthony Etim

{"title":"A comprehensive model of maternal health behavior: the interplay of sociodemographic and digital determinants in Nigeria.","authors":"Muyiwa Oladosun, Anthony Etim","doi":"10.1590/0102-311XEN184125","DOIUrl":"10.1590/0102-311XEN184125","url":null,"abstract":"This study develops an integrated model to identify significant sociodemographic and digital determinants of maternal health service utilization among married women in Nigeria. A cross-sectional analysis of data from the 2018 Nigeria Demographic and Health Survey (NDHS) was conducted on 28,888 married women aged 15-49. All analyses were conducted using the Complex Samples module in IBM SPSS Statistics, applying design-corrected variance estimation appropriate for the stratified cluster design of the NDHS. The design-weighted prevalence of six or more antenatal care visits was 25%, and the prevalence of facility-based delivery was 28.7%. A comprehensive multivariate binary logistic regression model assessed influences on both outcomes. Higher education and household wealth were the strongest determinants. Mobile phone ownership was consistently and positively associated with both outcomes (OR = 1.29, 95%CI: 1.16-1.43 for antenatal care; OR = 1.36, 95%CI: 1.24-1.49 for facility delivery). Internet use was independently and positively associated with antenatal care attendance, while frequent internet use was independently and negatively associated with antenatal care attendance. Mobile financial transactions were associated with significantly lower odds of facility delivery. A complex interplay of structural inequities and digital influences shapes maternal health behavior in Nigeria. Policies must be multisectoral, addressing foundational determinants such as education and wealth, while recognizing that the impact of digital technology on health choices is not uniformly linear.","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00184125"},"PeriodicalIF":2.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036529","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}

引用次数: 0

Invisible threats: environmental asbestos exposure and water contamination in a former mining area of Northeastern Brazil. 无形的威胁：巴西东北部一个前矿区的环境石棉暴露和水污染。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-09-18 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XEN271425

Orleane Souza de Brito, Matheus Felipe Manduca Pereira, Carmen Sofia Murilhas Cardoso de Lima, Gabriel Abelha Carrijo-Gonçalves

{"title":"Invisible threats: environmental asbestos exposure and water contamination in a former mining area of Northeastern Brazil.","authors":"Orleane Souza de Brito, Matheus Felipe Manduca Pereira, Carmen Sofia Murilhas Cardoso de Lima, Gabriel Abelha Carrijo-Gonçalves","doi":"10.1590/0102-311XEN271425","DOIUrl":"10.1590/0102-311XEN271425","url":null,"abstract":"Asbestos, a mineral fiber historically used in construction and industry due to its durability and resistance, is recognized as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), based on sufficient evidence of carcinogenicity through inhalation exposure. Although chrysotile asbestos was banned in Brazil in 2017, former mining areas remain major environmental liabilities, potentially sustaining long-term contamination of surrounding ecosystems. This study aimed to identify and characterize the qualitative presence of chrysotile asbestos fibers in surface waters and sediments in Bom Jesus da Serra, Bahia, Northeastern Brazil, where the São Félix mine operated for nearly three decades without subsequent remediation. Between August and November 2022, eight sampling sites were monitored across five field campaigns. Water and sediment samples were collected and analyzed for physicochemical parameters according to ABNT and CETESB standards, while asbestos fibers were detected and confirmed using phase-contrast microscopy, scanning electron microscopy coupled with energy-dispersive spectroscopy, and transmission electron microscopy. Chrysotile fibers were consistently detected in water and sediment samples from all sites, with higher accumulation in sediments, indicating persistent contamination of aquatic ecosystems. Most conventional water quality indicators complied with Brazilian standards. However, asbestos fibers were not quantified using regulatory metrics, preventing comparison with international guidelines and limiting exposure assessment. Their recurrent qualitative detection indicates environmental persistence and supports continued monitoring and future quantitative investigations to inform public health strategies in vulnerable communities.","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00271425"},"PeriodicalIF":2.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036487","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}

引用次数: 0

Prevalence of autism spectrum disorder in children: complete census of a Brazilian municipality. 儿童自闭症谱系障碍的患病率：巴西一个城市的完整人口普查。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-09-18 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XEN255925

Cassiano Forcelini, Ana Luisa Carregosa, Eduarda Leitzke, Gilmar da Silva, Regina Ampese, Itamara de Moura, Helena de Melo

{"title":"Prevalence of autism spectrum disorder in children: complete census of a Brazilian municipality.","authors":"Cassiano Forcelini, Ana Luisa Carregosa, Eduarda Leitzke, Gilmar da Silva, Regina Ampese, Itamara de Moura, Helena de Melo","doi":"10.1590/0102-311XEN255925","DOIUrl":"10.1590/0102-311XEN255925","url":null,"abstract":"The prevalence of autism spectrum disorder (ASD) has been an issue of great concern worldwide, leading to attempts to estimate prevalence based on population samples, including those conducted in Brazil. No epidemiological study in this field has covered an entire population. We aimed to determine the prevalence of ASD in a Brazilian population. This complete census was conducted from March to December 2024 in the municipality of Coxilha, Rio Grande do Sul State, Brazil. All children aged 2.5 to 12 years were screened using the Mini-TEA scale. Children with a score above the 100% sensitivity threshold (> 4 points) were then examined by a neurologist with experience in ASD to establish the diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders. Demographic data were obtained. There was no refusal to participate. Among the 475 children (240 boys and 235 girls), we found 16 ASD cases (15 boys and 1 girl), i.e., 1 in 30 children (1 in 16 boys and 1 in 235 girls), yielding an overall prevalence of 3.36% (6.25% among boys and 0.42% among girls). All ASD cases had also been diagnosed by other professionals. Only one child's previous diagnosis of ASD was rejected. ASD showed a high prevalence and male predominance in this unprecedented complete census. The overall prevalence is similar to that reported in the United States but higher than previous Brazilian estimates. Further research is necessary to investigate etiological factors.","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00255925"},"PeriodicalIF":2.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036492","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}

引用次数: 0

Factors associated with functional dependence in older adults with disabilities in Brazil: a study based on the 2019 National Health Survey. 巴西残疾老年人功能依赖相关因素：一项基于2019年全国健康调查的研究

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-09-18 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XEN208525

Dalia Elena Romero, Leo Ramos Maia, Paulo Roberto Borges de Souza Júnior

{"title":"Factors associated with functional dependence in older adults with disabilities in Brazil: a study based on the 2019 National Health Survey.","authors":"Dalia Elena Romero, Leo Ramos Maia, Paulo Roberto Borges de Souza Júnior","doi":"10.1590/0102-311XEN208525","DOIUrl":"10.1590/0102-311XEN208525","url":null,"abstract":"This study aimed to analyze factors associated with moderate and severe functional dependence in older adults with sensory or motor disabilities in Brazil. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. The sample included 9,856 older adults (aged ≥ 60 years) with hearing, visual, or motor impairment. Functional dependence was chosen as the outcome variable, classified into three levels: independence, moderate functional dependence, and severe functional dependence. Personal and environmental factors were considered in this study. Crude and adjusted prevalence estimates and multinomial logistic regression models were estimated, adopting independence as the reference category. Among the older adults with disabilities, 44.4% lived independently, 33.6% had moderate dependence, and 22% experienced severe dependence. Severe or moderate functional dependence occurred more often in women, older individuals, and those with less schooling. Race/skin-color was only associated with severe functional dependence , with lower odds in Mixed-race individuals than in White ones. Regarding the environmental factors, higher chances of dependence occurred in those who occupied no leadership position in their household, residents of the Brazilian Northeast, and users of assistive technologies. Co-residency, receiving home visits from community health workers, and using regular rehabilitation care were specifically associated with severe functional dependence. The high proportion of older adults with disabilities who live independently challenges ableist conceptions about aging. However, the observed inequalities indicate that social and environmental factors still conditioned the maintenance of functional autonomy.","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00208525"},"PeriodicalIF":2.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036513","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}

引用次数: 0

["It all starts with welcoming": access, acceptability and elements for the promotion of the health of adolescents and young people in primary care]. [“一切从欢迎开始”：初级保健中促进青少年和年轻人健康的机会、可接受性和要素]。

IF 2.1 4区医学

Cadernos de saude publica Pub Date : 2026-08-31 eCollection Date: 2026-01-01 DOI: 10.1590/0102-311XPT007526

Jamile Guimarães, Valéria Monteiro Mendes, Isabella Silva de Almeida, José Ricardo de Carvalho Mesquita Ayres

{"title":"[\"It all starts with welcoming\": access, acceptability and elements for the promotion of the health of adolescents and young people in primary care].","authors":"Jamile Guimarães, Valéria Monteiro Mendes, Isabella Silva de Almeida, José Ricardo de Carvalho Mesquita Ayres","doi":"10.1590/0102-311XPT007526","DOIUrl":"10.1590/0102-311XPT007526","url":null,"abstract":"This article shows a qualitative study on the access of young people to public health services in the cities of Santos, São Paulo, and Sorocaba, São Paulo State, Brazil. The objective was to identify the meaning attributed to access experiences in order to characterize a set of criteria for the acceptability of health care practices. The methodological instruments used were the observation of daily life in the basic health units and in the assigned territories and 34 semi-structured interviews with young people between 15 and 24 years old. In addition to structural barriers that restrict presence in these services (long waiting times, difficulty in scheduling appointments and unsatisfactory care outcomes), the young people's narratives emphasize the interactive nature of care, the observance of the specificities of adolescence and the role of health services in the construction of themselves, through the intersubjective engendering of resources for a happier life. They affirm the centrality of their recognition as subjects of rights, co-producers of comprehensive health care, which contributes with learning for living. To this end, satisfactory care must promote their participation in the therapeutic process, provide information and guidance that enable dialogued decisions and, in a broader dimension, the development of autonomy.","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00007526"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886593","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}

引用次数: 0