Cadernos de saude publica最新文献

{"title":"[Fragmentation, heterogeneity, and challenges facing the Argentine healthcare system in the context of emerging ultraliberal reforms].","authors":"Evangelina Martich, Adelyne Maria Mendes Pereira, Eduarda Ângela Pessoa Cesse","doi":"10.1590/0102-311XES012725","DOIUrl":"10.1590/0102-311XES012725","url":null,"abstract":"<p><p>This study analyzed the characteristics of fragmentation in the Argentine health system and its implications for inequalities in health outcomes. The study covers the period from 1994, the year in which the last constitutional reform was carried out and a process of decentralization and deregulation of health care was promoted, to 2024, marked by a government that proposes to reorganize the health system implementing ultra-liberal measures that could further exacerbate problems of access and equity in the system. The research was conducted based on the following dimensions: (1) political and economic context in Argentina; and (2) characteristics of the fragmentation of the Argentine health system. Secondary sources were analyzed, including scientific articles, official documents and databases, and gray literature. The results indicate that the trajectory of fragmentation of the Argentine health system is characterized by three phases. The first phase (1994-2002) was marked by fragmentation through deregulation and decentralization of functions in the health system, with a loss of national coordination capacity. The second phase (2002-2015) shows the intention to reduce fragmentation and inequalities in health provision through regulation and programs aimed at the most vulnerable population. It was an important period, but the lack of structural changes contributed to the third phase (2015-2024) being characterized by deepening fragmentation, the reduction of the role of the State and ultra-liberal reforms from 2023 onwards. The analysis shows that the Argentine health system needs to be reorganized to prioritize universalization and equitable access.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 suppl 1","pages":"e00012725"},"PeriodicalIF":2.1,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683603","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":"[Public-private partnerships in the Colombian healthcare system: institutional mechanisms and disputes over healthcare management].","authors":"Mónica Uribe-Gómez, Yadira Borrero-Ramírez, Adriana Mendoza-Ruíz","doi":"10.1590/0102-311XES014125","DOIUrl":"10.1590/0102-311XES014125","url":null,"abstract":"<p><p>This article explores the expansion of public-private partnerships in the Colombian healthcare system, focusing on the institutional mechanisms of healthcare policies that facilitate private sector participation in service provision and resource management. The study analyzes the legal and political reforms that have driven these partnerships, as well as the disputes between public and private actors over the approach and functioning of the healthcare system. The study seeks to understand how these types of alliances have impacted health management, access, and service provision. A case study was conducted with a thematic analysis of official documents, Constitutional Court rulings, and press releases, complemented by a critical review of the specialized literature. The findings indicate that institutional mechanisms have favored the consolidation of the private sector, facilitating its access to financial resources and the formation of strategic networks to legitimize the business perspective in health.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 suppl 1","pages":"e00014125"},"PeriodicalIF":2.1,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683550","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":"[Universalization of primary health care: \"heart\" of health reform in Chile].","authors":"Patty Fidelis de Almeida, Márcia Cristina Rodrigues Fausto, Oscar Arteaga, Jose Zamorano, Manuel Navarrete, Lígia Giovanella","doi":"10.1590/0102-311XPT225624","DOIUrl":"10.1590/0102-311XPT225624","url":null,"abstract":"<p><p>The proposal for the universalization of primary health care (PHC) has become the main strategy of the Chilean government (2022-2026) for reform of the healthcare system under the values of equity in access, quality of care, and financial protection. The article identifies and analyzes strategies related to the universalization of PHC with regards to operationalization, reform, and measures to expand and qualify access to PHC. A case study was carried out with a qualitative approach based on interviews with key actors during on-site visits complemented by documental analysis. The implementation of the universalization of PHC is supported by an advisory council and commissions that seek to ensure political pluralism with a view to governability. It was initiated through pilot projects currently in 21 \"pioneer communes\". The following strategies to expand and qualify access to PHC stand out: extended office hours at health centers; remote demand management system; guidelines for the comprehensive management of chronic conditions with \"care by pairs\" and a \"consensual care plan\"; \"citizen dialogues\" and mapping of community assets to strengthen social participation. After the defeat of the proposed Constitution in 2022 and in a context conditioned by political conflicts, low governability, and the neoliberal directives of previous public policies in Chile, the universalization of PHC emerged as possible, consensual, and without substantial resistance, gaining prominence in the face of the impossibility of structural reforms in the healthcare system, which remains polarized.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 suppl 1","pages":"e00225624"},"PeriodicalIF":2.1,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683600","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":"Scientific production on health inequalities using the Brazilian Information System on Live Births: a scoping review.","authors":"Francine Dos Santos Costa, Luiza Eunice Sá da Silva, Janaína Calu Costa, Cauane Blumenberg, Luis Paulo Vidaletti Ruas, Fernando C Wehrmeister, Aluisio J D Barros","doi":"10.1590/0102-311XEN197425","DOIUrl":"10.1590/0102-311XEN197425","url":null,"abstract":"<p><p>The Brazilian Information System on Live Births (SINASC) is widely used by health managers to plan and monitor maternal and child health programs. Scientific research using SINASC data is also essential to identify underexplored topics that warrant further investigation. This study aims to describe the profile of scientific output based on SINASC data and to determine gaps in the literature, with particular attention to studies addressing health inequalities. A scoping review was conducted, including original articles reporting primary outcomes derived from SINASC data. Five databases were searched up to August 2025: PubMed, Embase, Scopus, Web of Science, and LILACS. Brazilian official websites were also manually consulted. A total of 7,363 records were identified, and 85 studies were included in the final analysis. The most frequently analyzed variables were congenital anomalies, birth weight, pregnancy duration, type of delivery, and maternal age. The most commonly reported outcomes were cleft lip/palate, prematurity, low birth weight, Cesarean section, and maternal age distribution. Almost all studies (95.3%) addressed at least one inequality dimension, most frequently geographic and maternal sociodemographic factors. The Human Development Index was the main external socioeconomic indicator. This review underscores the relevance of SINASC for advancing research on health equity in Brazil. Nonetheless, gaps remain in analyses of antenatal care and race/skin color.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00197425"},"PeriodicalIF":2.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683509","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":"[Between setbacks and advances: the trajectory of food insecurity in Black households in Brazil (2013-2023)].","authors":"Gleiciane Bueno da Silva Luiz, Lissandra Amorim Santos Degner, Aline Alves Ferreira, Rosana Salles-Costa","doi":"10.1590/0102-311XPT165825","DOIUrl":"10.1590/0102-311XPT165825","url":null,"abstract":"<p><p>This study aimed to evaluate the trajectory of food insecurity in Brazil according to the intersections of sex and race/skin color from 2013 to 2023. Microdata from population surveys were evaluated (Brazilian National Household Sample Survey [PNAD, acronym in Portuguese] 2013, n = 116,196, Brazilian Household Budget Survey 2018, n = 57,920, Continuous PNAD 2023, n = 173,676). Food security and insecurity were estimated based on the profiles of the heads of households, defined based on sex and self-reported race/skin color (white man, white woman, Mixed-race man, Mixed-race woman, Black man, Black woman). Relative risk ratios (RRR) were estimated by multinomial logistic regression models to test the trajectories of associations with food insecurity . From 2013 to 2017/2018, food security decreased in all profiles, increasing from 2018 to 2023, mainly in households headed by Black women (p-value < 0.001). The most severe forms of food insecurity remained significantly associated among households headed by Black or Brown people, being higher in those in which Black women occupied this position. Over the 10 years of the surveys, families in mild food insecurity headed by a white woman showed reduced RRR values (RRR = 1.2, 95%CI: 1.1-1.4). For those with severe food insecurity , the greatest reduction in RRR occurred in households headed by Black women (RRR = 2.1, 95%CI: 1.8-2.5). Although food insecurity decreased in Brazil in 2023, racial inequalities persist, reiterating the need for public policies to reduce the structural inequities faced by its Black population.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00165825"},"PeriodicalIF":2.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683532","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":"[Implementation of the Brazilian National Health Policy for Persons with Disabilities in Rio de Janeiro, Brazil: evaluation of access to oral health].","authors":"Fernanda Nunes Marques Alves, Gisele O'Dwyer","doi":"10.1590/0102-311XPT219725","DOIUrl":"10.1590/0102-311XPT219725","url":null,"abstract":"<p><p>This case study evaluated the access of people with disabilities (PwD) to public health network services in Rio de Janeiro, Brazil in the primary health (PHC), specialized, and hospital care levels. Access dimensions (accessibility, availability, and adequacy) constituted the criteria to judge the degree of implementation of oral health care within the Brazilian National Health Policy for Persons with Disabilities. Quantitative and qualitative approaches and multiple sources and data collection techniques were used. This study considered the access of PwD to oral health services as \"incipient\", with the most critical points of implementation being professional training, shared construction of care, human and material resources, architectural accessibility, and provision of services. Barriers outnumbered facilitators. The former included long distances from reference hospitals to certain regions of the city, low quality and little integration between public transport modes, urban violence and inadequacy of public roads, insecurity of PHC dentists in assisting PwD, few opportunities for professional training, low frequency of matrix support from the Dental Specialties Centers to PHC, low oral health coverage in PHC, and limited offer of dental care under general anesthesia. The implementation of the policy has been taking place gradually without consistently considering PWD's health needs. The recommendations in this study can contribute to the comprehensive care of PWD by improving the components of the network in Rio de Janeiro.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00219725"},"PeriodicalIF":2.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683525","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":"Benchmarking large language models for clinical data extraction from Portuguese medical notes in a university hospital.","authors":"Breno Gabriel Araújo Sampaio de Jesus, Tomaz Castrillon Figueiredo, Clariele de Almeida Pereira, Bruno Henrique Lira Anjos, Ney Cristian Amaral Boa-Sorte, André Rodrigues Durães, Carlos Brites, Eduardo Martins Netto, Leandro Maciel Almeida, Cleber Zanchettin, Vinícius de Oliveira Menezes, Marcos Antônio Dórea Machado","doi":"10.1590/0102-311XEN145025","DOIUrl":"10.1590/0102-311XEN145025","url":null,"abstract":"<p><p>Extracting structured data from electronic health records (EHRs) remains a major challenge, particularly in non-English and resource-constrained healthcare systems. This study benchmarks multiple large language models (LLMs) for the automated extraction of structured clinical variables from Portuguese-language medical notes under limited computational resources. We evaluated five LLMs (GPT-4o mini, DeepSeek-V3, Mixtral-8x7B, LLaMA 8B, and Qwen-32B) against a manually curated dataset of cardiology and infectiology outpatient records. Models were deployed in quantized versions to optimize computational efficiency. Outputs were compared with human annotations using F1 score, balanced accuracy, and recall. Among the tested models, Qwen-32B achieved the highest performance in both the infectiology domain (balanced accuracy = 0.91 [0.07]) and cardiology domain (balanced accuracy = 0.89 [0.07]). Performance varied by clinical variable, with better results for frequently and consistently documented conditions (e.g., diabetes) and lower accuracy for complex or infrequent variables (e.g., tumors). Extraction time ranged from 0.9 to 24.2 minutes per patient, depending on clinical domain and model. These findings support the feasibility of applying LLM-based natural language processing tools in resource-limited, non-English healthcare settings. Future research should assess emerging high-parameter models and explore additional clinical domains.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00145025"},"PeriodicalIF":2.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683476","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":"Ultra-processed food consumption and body mass index from adolescence to early adulthood: multi-trajectory analysis using data from the 1993 Pelotas (Brazil) birth cohort.","authors":"Michele Krüger Vaz Moreira, Adriana Kramer Fiala Machado, Ana Maria Baptista Menezes, Helen Gonçalves, Fernando C Wehrmeister","doi":"10.1590/0102-311XEN185225","DOIUrl":"10.1590/0102-311XEN185225","url":null,"abstract":"<p><p>Given the evidence linking ultra-processed food consumption to adverse health outcomes and the lack of longitudinal studies jointly addressing ultra-processed food consumption and body mass index (BMI), this study identified multi-trajectory groups from adolescence to early adulthood and described their demographic and behavioral characteristics. Data from the 1993 Pelotas (Brazil) birth cohort at ages 15, 18, and 22 (n = 2,890) were analyzed. Sex-stratified multi-trajectory groups of daily ultra-processed food consumption and BMI (z-scores for age and sex) were estimated using Group-Based Trajectory Modelling. Daily ultra-processed food consumption was defined as the number of ultra-processed food items consumed at least once per day. Sixteen NOVA-classified foods were grouped into six categories. Groups were described according to ultra-processed food types, poverty level, physical activity, screen time, smoking, alcohol use, and risk behaviors. Three multi-trajectory groups were identified: two with low ultra-processed food (group 1 and group 2) and one with increasing ultra-processed food intake (group 3). In group 1 (38.7% males; 34% females), BMI increased over time, while in group 2 (39.4% males; 44.5% females) it remained stable. In group 3 (21.9% males; 21.5% females), ultra-processed food consumption increased over time, particularly fast food, soft drinks, and processed meats, while BMI z-scores remained close to zero in males and increased in females. Risk behaviors increased over time in group 3, whereas poverty was less prevalent in group 1. Individuals in group 3 generally exhibited higher ultra-processed food intake and a greater prevalence of risk behaviors across follow-ups, despite BMI remaining within the normal range. Monitoring ultra-processed food consumption may help identify at-risk groups before excess weight becomes evident during adolescence and early adulthood.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00185225"},"PeriodicalIF":2.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683479","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":"Health policies in Brazil (2016-2022): neoliberalism, pandemic, and threats to the Brazilian Unified National Health System.","authors":"Cristiani Vieira Machado, Luciana Dias de Lima","doi":"10.1590/0102-311XEN228525","DOIUrl":"10.1590/0102-311XEN228525","url":null,"abstract":"<p><p>The article analyzes health policies in Brazil from 2016 to 2022, a period marked by a shift in national politics and the COVID-19 pandemic. The study examines federal health policy management under the administrations of Michel Temer (2016-2018) and Jair Bolsonaro (2019-2022), considering the context, the political process, and policy content, as well as the different phases of the pandemic response. Drawing on historical institutionalism and the concept of critical juncture, the analysis explores continuities, changes, and disputes surrounding the Brazilian Unified National Health System (SUS). The study drew on document research, news articles, and the academic literature. The results indicate that the period was a critical juncture, with immediate and severe effects on policy implementation and the pandemic response. There were constraints on sectoral funding, setbacks in specific policies, institutional weakening, and forms of resistance within the state and society. During the period studied, no radical changes were observed in the direction of the Brazilian health system, due to structural factors, the institutional density of the SUS, competing policy agendas, the interaction of coalitions of actors with varied interests, or even the period's short duration. However, fully understanding the impact of this critical juncture, which is still recent, requires assessing its medium- and long-term repercussions at the global, regional, and national levels.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 suppl 1","pages":"e00228525"},"PeriodicalIF":2.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683589","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":"[Clinical Research Action Plan in Brazil: analysis of its implementation process and main results, 2018-2025].","authors":"Giovanny Vinícius Araújo de França, Evandro de Oliveira Lupatini, Michelle Zanon Pereira, Raisa Breda Tôso Sfalsini, Andréa Leite Ribeiro, Karla Andreia Mette Waldrich, Jaqueline Chueke Pureza, João Paulo Alves Oliveira, Patrícia de Souza Boaventura, Luciana Hentzy Moraes, Meiruze Sousa Freitas, Fernanda De Negri","doi":"10.1590/0102-311XPT240525","DOIUrl":"10.1590/0102-311XPT240525","url":null,"abstract":"<p><p>This study evaluated the Clinical Research Action Plan in Brazil (PAPCB, acronym in Portuguese), established in 2018 by the Brazilian Ministry of Health. This ex post public policy evaluation study was based on documentary analysis for the 2018-2025 period. The six strategic axes of the PAPCB were considered: ethical regulation, sanitary regulation, scientific and technological promotion, training in clinical research, the Clinical Research National Network (RNPC, acronym in Portuguese), and knowledge management. The results showed significant advances in scientific promotion and professional training, with broad execution of the planned actions. The training of more than 45,000 professionals stands out in the training axis. The RNPC underwent restructuring, giving rise to the Brazilian Network of Clinical Research (RBPClin, acronym in Portuguese). However, structural challenges persist, such as the need to modernize Plataforma Brasil, improve knowledge management, and strengthen network collaboration. This study recommends the review and update of the PAPCB, incorporating strategies to overcome these gaps to consolidate the Brazilian scientific, technological, and institutional capacity in clinical research.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00240525"},"PeriodicalIF":2.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618422","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}