Cadernos de saude publica最新文献

{"title":"[Floods in Rio Grande do Sul State, Brazil, in 2024 and their effects on the epidemiology of leptospirosis].","authors":"Bernardo Madeira Diefenthaeler, Alexia Antunes Deluca, Jéssica Manami Seki, Marco Antônio Tavares Duarte, Vinícius da Silva Gregory, Sofia Giacomet Borges, Roger Ferreira Gomes, Maria Helena Rigatto","doi":"10.1590/0102-311XPT111125","DOIUrl":"10.1590/0102-311XPT111125","url":null,"abstract":"<p><p>Extreme climate events favor the spread of waterborne diseases. This study analyzes the impact of the historic floods occurred in Rio Grande do Sul State, Brazil, in 2024 on leptospirosis incidence. This is a descriptive cross-sectional study based on secondary data from official health information systems, comparing confirmed cases, hospitalizations, and deaths between April and July 2023 and the same period in 2024. Monthly trends, sociodemographic characteristics, and spatial distribution of cases were examined. From April to July, the number of cases increased from 117 in 2023 to 1,007 in 2024, a 7.6-fold rise, with a peak in May 2024 (516 cases). Hospitalizations increased from 89 to 228, with June showing a marked rise (76 in 2024 and 15 in 2023), and deaths rose from seven to 35, with the sharpest increase in May (one in 2023 and 20 in 2024). Despite the absolute increase, mortality rates declined from 6% in 2023 to 3.5% in 2024. In 2024, the most affected groups remained young white men, consistent with the 2023 profile. Over 200 municipalities reported cases in 2024, particularly Porto Alegre, Alvorada, Canoas, and São Leopoldo (all located in the Porto Alegre Metropolitan Area), which together accounted for nearly half of cases. The findings suggest that floods contributed to intensified transmission, increased hospital burden, and higher leptospirosis-related mortality. These results underscore the need for integrated epidemiological surveillance, resilient urban infrastructure, and preventive strategies to reduce population vulnerability to future climate-related disasters.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00111125"},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403693","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":"[The \"danger of delay\" in access to legal abortion in Brazil: the experience of 111 women].","authors":"Debora Diniz, Ilana Ambrogi","doi":"10.1590/0102-311XPT230925","DOIUrl":"10.1590/0102-311XPT230925","url":null,"abstract":"<p><p>This study analyzes the barriers women, adolescents, and girls face in accessing legal abortion in Brazil by monitoring Projeto Vivas (a civil society organization for access to information on legal abortion) from February to November 2025. This study dialogues with the decision of the Brazilian Federal Supreme Court, which denied the urgency to the request toward expanding nurses' role in legal abortion procedures. This time-descriptive study assessed the barriers for access to legal abortion in Brazil, especially the need for travel. In total, 111 women had to travel from their municipalities for an abortion, averaging 1,307km (half had to travel over 1,000km). Almost all cases stemmed from rape; 67.5% sought the Vivas Project before the 12th week of their pregnancy (during which the procedure entails low complexity). Participants' profile indicates social and economic vulnerability: 69.3% earned an income of up to two minimum wages and 49.5% were Black. The most frequent barriers included care refusal, lack of physicians and referral services, and mistaken requirements. Long distances and waiting times delay care and can configure cruel, inhuman or degrading treatment according to the World Health Organization (WHO). Health policies to decentralize care and expand professionals trained for legal abortion in primary care (such as nurses) agree with WHO guidelines and deserve consideration to address the barriers identified in this study.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00230925"},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403720","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":"[Distribution of Dental Specialty Centers across health regions in Brazil, 2023].","authors":"Iêda Lenzi Durão, Marla Presa Raulino Schilling, Margareth Crisóstomo Portela","doi":"10.1590/0102-311XPT165425","DOIUrl":"10.1590/0102-311XPT165425","url":null,"abstract":"<p><p>This study aims to analyze the distribution of Dental Specialty Centers (CEOs, acronym in Portuguese) across Brazilian health regions and to identify contextual factors associated with this distribution. This ecological cross-sectional study used secondary data from 1,214 active CEOs in December 2023, extracted from the Brazilian National Registry of Health Establishments. The hurdle negative binomial model was applied to identify factors associated with the distribution of these services, considering demographic and socioeconomic characteristics, as well as the availability of oral health teams in primary care. The results showed that 82.44% of Brazil's health regions have at least one CEO. The Northeast stood out, with 93.23% of its health regions housing CEOs, exceeding proportions observed in other regions. The social vulnerability index was associated with both the presence and the number of CEOs, showing paradoxical effects. Regions with higher vulnerability were less likely to have a CEO (OR = 0.905; 95%CI: 0.871-0.940), but among regions with at least one CEO, higher vulnerability was associated with an increased number of these services (RR = 1.023; 95%CI: 1.013-1.033). Although CEOs are predominantly implemented in less vulnerable regions, compensatory strategies appear to be emerging to ensure service availability in more vulnerable areas, consistent with the inverse equity hypothesis. However, significant challenges remain regarding Brazil's territorial dimension, gaps in service coverage, and the need to optimize the use of CEOs. Although secondary oral healthcare must be considered within a regionalized context, the unequal distribution of health regions across states and geographic regions, variation in territorial area, and mobility constraints may affect access to CEOs.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00165425"},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403764","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":"[Gender inequality: implications for the relationship between food insecurity and obesity in Rio de Janeiro, Brazil].","authors":"Luana Teixeira Ghiggino, Talita Barbosa Domingos, Rosana Salles-Costa, Aline Alves Ferreira","doi":"10.1590/0102-311XPT131525","DOIUrl":"10.1590/0102-311XPT131525","url":null,"abstract":"<p><p>This study aimed to evaluate the association between food insecurity and obesity in adult heads of household considering the differences between men and women. This cross-sectional study used data from the I Survey on Food Insecurity in the City of Rio de Janeiro. Adults (aged 20-59 years) who headed households (n = 1,026) were analyzed. Food security and food insecurity levels (mild and moderate/severe) were assessed by the Brazilian Food Insecurity Scale. Self-reported weight and height were used to estimate obesity, assessed by body mass index. Associations between families' food insecurity levels and obesity were estimated by multinomial logistic models (relative risk ratios - RRR - and their 95% confidence intervals - 95%CI) on Stata software. Women with mild (RRR = 2.8; 95%CI: 1.3-5.8) and moderate/severe food insecurity (RRR = 2.5; 95%CI: 1.0-6.4) had a higher risk of obesity. food insecurity constituted a risk factor for obesity only in women, with no statistically significant results in men, showing how gender inequality amplifies the adverse effects of food insecurity on female-headed households, compromising the quality and quantity of their diet.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00131525"},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403712","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":"[Therapeutic indications in lawsuits seeking medical Cannabis in Brazil: a cross-sectional study in light of scientific evidence].","authors":"Cláudia Du Bocage Santos Pinto, Tatiana De Jesus Nascimento Ferreira, Catia Veronica Dos Santos Oliveira, Ângela Esher, Marina Fajardo Villela Martins Pompilho da Hora, Claudia Garcia Serpa Osorio-de-Castro","doi":"10.1590/0102-311XPT220525","DOIUrl":"10.1590/0102-311XPT220525","url":null,"abstract":"<p><p>In recent years, the rapid expansion of the medical Cannabis products (MCP) market has led to increased consumption and a rise in lawsuits seeking access to MCP in Brazil. This study aimed to analyze therapeutic indications cited in lawsuits filed against the Brazil's Federal Government requesting MCP and to assess these indications in light of the available scientific evidence. This cross-sectional study was conducted analyzing cases filed between 2020 and 2023. Additionally, a rapid qualitative evidence synthesis (RQES) was performed addressing the medical Cannabis indications reported in the lawsuits. Across 2,024 lawsuits, 1,962 primary diagnoses were identified. The most frequent conditions were epilepsy (36.24%), autism spectrum disorder (ASD) (25.54%), and pain (8.92%). A high proportion of claimants in the 1 to 19 age range was observed for epilepsy, ASD, paralysis, and intellectual disabilities. The RQES retrieved 115 reviews that applied quality assessment tools and reported on the effectiveness of MCP. The most frequently studied conditions were pain (40.86%), neoplasms (10.43%), and epilepsy (9.56%). Only five diagnoses - epilepsy, multiple sclerosis, anxiety, neoplasms, and pain - had some degree of support in the literature, varying in strength and with a low proportion of high-quality reviews. The substantial pressure from health-related litigation and the large number of indications lacking supporting evidence highlight a significant public health risk that has not been addressed in a timely manner in Brazil. Regulation of MCP and appropriate prescribing practices are urgently needed, restricting public provision to indications supported by robust evidence.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00220525"},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403777","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":"Diet quality and adherence to nutritional recommendations: a multicenter study based on caregiver-child dyads.","authors":"Nelson Hun, Carolina Saravia, Jenny Arteaga, Felipe González-Fernández, Caroline Yans, Víctor Sepúlveda, Claudia Villablanca, Nicole Lasserre-Laso, Daniela Robles-Tapia","doi":"10.1590/0102-311XEN167925","DOIUrl":"10.1590/0102-311XEN167925","url":null,"abstract":"<p><p>In recent decades, overweight and obesity among school-aged children have steadily increased, accompanied by a marked rise in the consumption of processed and ultra-processed foods, highlighting the need to examine school dietary patterns. This study aimed to assess diet quality and adherence to nutritional recommendations among schoolchildren, based on caregiver-reported information, within caregiver-child dyads across seven municipalities in Chile. A cross-sectional, descriptive, and correlational study was conducted with a sample of 2,115 dyads. Associations between sociodemographic variables and categories of the Global Diet Quality Index were analyzed using chi-squared tests and multinomial logistic regressions, and relative risks were calculated to estimate the magnitude of these associations. Statistical significance was set at p < 0.05. Children attending subsidized private schools showed higher overall diet quality (p ≤ 0.001), while those enrolled in municipal schools were more likely to meet recommendations for fruits (p = 0.001), vegetables (p = 0.009), and legumes (p = 0.000). Preschool children demonstrated greater adherence to nutritional recommendations compared with those in primary and secondary education. In conclusion, diet quality and adherence to nutritional recommendations vary significantly according to school type and educational level, reinforcing the need for tailored strategies to promote healthy eating across educational stages and school contexts.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00167925"},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403309","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":"[Temporal trends and clinical-epidemiological profile of visceral leishmaniasis-HIV coinfection in Brazilian states between 2009 and 2024].","authors":"Marina França, Mirella Ferreira da Cunha Santos, Juceli Gonzalez Gouveia, Leandro Antero","doi":"10.1590/0102-311XPT163425","DOIUrl":"10.1590/0102-311XPT163425","url":null,"abstract":"<p><p>This study aimed to analyze temporal trends and the clinical-epidemiological profile of visceral leishmaniasis (VL)-HIV coinfection in Brazil between 2009 and 2024. This ecological time-series and descriptive cross-sectional study used data from the Brazilian Information System for Notifiable Diseases (SINAN, acronym in Portuguese) covering eight states with the highest VL incidence: Bahia, Ceará, Maranhão, Minas Gerais, Mato Grosso do Sul, Pará, São Paulo, and Tocantins. Annual coinfection rates were calculated as the ratio between the number of reported VL-HIV coinfection cases and the resident population of the respective state in the same year, multiplied by 100,000. Temporal trends were evaluated using segmented regression to estimate the annual percentage change (APC). Correlation analyses (Spearman), categorical associations (Pearson's chi-squared test), differences in means (Student's t-test), and binary logistic regression (odds ratio - OR) for symptoms were also performed. An increasing trend in coinfection rates was observed in Bahia (APC = 4.2), Mato Grosso do Sul (APC = 19.7), Pará (APC = 10.4), and Tocantins (APC = 8.4). Ceará and Minas Gerais showed an initial increase followed by a decline. A moderate positive correlation was observed between VL cases and coinfection (ρ = 0.313; p < 0.001). Coinfected individuals had a higher mean age (37.9 versus 27.3 years; p < 0.001) and were predominantly male (72.4% versus 59.8%). Mixed-race individuals were the most prevalent, with a higher proportion of Black individuals among coinfected patients. Symptoms associated with coinfection included fever (OR = 2.44), jaundice (OR = 1.69), and edema (OR = 1.56), whereas weight loss, hepatomegaly, and associated infection were associated with lower odds. VL-HIV coinfection shows heterogeneous patterns, with increasing trends in endemic states and distinct temporal segments across Federative Units. These findings reinforce the need for integrated strategies for surveillance, diagnosis, and treatment.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00163425"},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403731","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":"[Unmet need for contraception in the racialized population in Colombia: analysis of the results of the 2015 National Demographic and Health Survey].","authors":"Lina Rodriguez-Aponte, Jorge Martin Rodriguez, Fernando Ruiz-Vallejo","doi":"10.1590/0102-311XES060925","DOIUrl":"10.1590/0102-311XES060925","url":null,"abstract":"<p><p>This article analyzes the results of the 2015 National Demographic and Health Survey (ENDS, acronym in Spanish) of Colombia, to establish the effect of different proxy variables of socioeconomic conditions on the risk of presenting unmet need for contraception. By comparing the population that self-identifies with some ethnic-racial belonging and that which does not identify as such, the study aimed to compare the prevalence of unmet need in contraception according to socioeconomic characteristics and to analyze socioeconomic factors that are significantly related to the risk of showing this unmet need. Based on multivariate regression models and machine learning, variables such as the region people live, the wealth index, the educational level, and the occupation of the women surveyed, marital status, and age, are contributing factors for unmet need for contraception. Moreover, belonging to a racialized population is an additional risk factor, which intersects with the inequities derived from the socioeconomic conditions mentioned above, and makes people from these communities especially vulnerable to the guarantee of access to contraceptive options, and therefore to the guarantee of their rights in sexual and reproductive health.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00060925"},"PeriodicalIF":2.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367142","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 inequalities in Brazil and new approaches to measuring population aging.","authors":"Anderson Gonçalves, Luciana Correia Alves","doi":"10.1590/0102-311XEN217725","DOIUrl":"10.1590/0102-311XEN217725","url":null,"abstract":"<p><p>This study aims to measure and analyze population aging in Brazil by combining chronological age and characteristics of population subgroups according to geographic region and sex. Using these indicators, the study advances the application of the relative age concept based on a physiological indicator related to the aging process. The data analyzed were drawn from the 2015 Brazilian Longitudinal Study of Aging. Variables analyzed included age, sex, region of residence (North, Northeast, Central-West, Southeast, and South), handgrip strength, and body mass index. The results indicate that individuals in the North and Northeast experience faster functional aging according to relative age estimates based on handgrip strength. Among women in these regions, the gap between relative and chronological age reaches up to 9.3 years. These findings highlight regional inequalities in aging and support the use of relative age as a composite indicator for monitoring and planning health policies.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00217725"},"PeriodicalIF":2.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367145","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":"[Technological and market analysis of the hemodialysis membranes segment in Brazil based on federal public procurement data].","authors":"Gustavo Feliciano de Jesus Barcelos, Beatriz Godoi de Nogueira, Kátia Cecília de Souza Figueiredo, Carlos Alberto Tagliati","doi":"10.1590/0102-311XPT106625","DOIUrl":"10.1590/0102-311XPT106625","url":null,"abstract":"<p><p>This study analyzes the market and technology of the hemodialysis membrane segment in Brazil, based on public acquisitions made by the Brazilian Company of Hospital Services (EBSERH, acronym in Portuguese). Kidney failure, which affects about 10% of the world's population, represents a growing challenge for health systems, and Brazil is highly dependent on imports to meet the demand for dialyzers. From August 2022 to July 2023, EBSERH acquired 144,162 dialyzers, from six international manufacturers, evincing the absence of a national production and a great technological dependence on Brazil. Additionally, the physical and transport characteristics of the membranes were evaluated, such as materials used (predominance of polysulfone), dimensions and ultrafiltration coefficient. The results point to the need for robust public policies to foster national production, reducing costs, promoting innovation and strengthening Brazil's technological autonomy. This work provides relevant information for the strategic planning of the hemodialysis sector, identifying gaps and opportunities for the development of a national hemodialysis membrane industry.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00106625"},"PeriodicalIF":2.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367130","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}