Cadernos de saude publica最新文献

{"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}

{"title":"Feasibility of a generative AI chatbot to support breastfeeding in the Brazilian Unified National Health System.","authors":"Ari Pereira de Araújo Neto, Giovanny Rebouças Pinto, Adonias Caetano de Oliveira, Simone Nunes Leal Chagas, Francilidia Oliveira Vitorino de Assunção Conceição, Ariel Soares Teles","doi":"10.1590/0102-311XEN117825","DOIUrl":"10.1590/0102-311XEN117825","url":null,"abstract":"<p><p>This exploratory feasibility study aimed to evaluate the usability, user experience, and preliminary impacts of a generative language model-based chatbot (Lhia 2.0) on maternal self-efficacy and attitudes toward breastfeeding. A total of 13 mothers receiving care at the Human Milk Bank of the University Hospital of the Federal University of Maranhão interacted with the chatbot via WhatsApp over 15 days. The following instruments were applied before and after the use of Lhia 2.0: the Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF) and the Iowa Infant Feeding Attitude Scale (IIFAS). The User Experience Questionnaire - Short Version (UEQ-S) was applied after the interaction. Results indicated excellent usability (pragmatic quality = +2.36; hedonic quality = +2.57) and high engagement (average interaction time = 92 minutes). Statistically significant improvements were observed in BSES-SF (mean difference = 3.00; p = 0.042; Cohen's d = 0.778) and in IIFAS (mean difference = 3.50; p = 0.021; Cohen's d = 0.778). The results indicated high acceptance among mothers, with notable user engagement, excellent perceived usability, and positive effects on confidence and attitudes toward breastfeeding. Based on these findings, Lhia 2.0 is considered a feasible and promising tool for integration into breastfeeding promotion strategies, particularly within the context of the Brazilian Unified National Health System.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00117825"},"PeriodicalIF":2.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367138","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":"[Disease, social, and economic burden of smoking in Brazil and the impact of tax increases on the economy and on the reduction of morbidity and mortality].","authors":"Márcia Pinto, Ariel Bardach, Agustín Casarini, Federico Augustovski, Alfredo Palacios, Natalia Espinola, Marcia Gisele Santos, Kátia Marie Simões E Senna, Ana Clara de Moraes, Vera Luiza da Costa E Silva, Felipe Mendes, Cristiane Galhardo Ferreira Vianna, Ana Paula Leal Teixeira, Andres Pichon-Riviere","doi":"10.1590/0102-311XPT002425","DOIUrl":"10.1590/0102-311XPT002425","url":null,"abstract":"<p><p>This study aimed to estimate the disease, social, and economic burden of smoking in Brazil in 2022 and to predict the benefits of tax increases, including its effects of the illegal market. A probabilistic Markov microsimulation model was applied in which individuals aged 35 years or older were followed in hypothetical cohorts and quantified deaths, health events, the direct cost of medical care, and the indirect cost due to productivity losses. A model to estimate health and economic gains from 10-year tax increase scenarios was developed. Data on smoking prevalence, the Brazilian demographic structure, mortality, and morbidity were obtained from official databases and the literature. The used health resources were obtained from the literature and consultations with specialists. Smoking caused 174,000 deaths and 5.7 million years of life lost due to premature death and disability. Its economic burden totaled BRL 153 billion, of which BRL 67 billion was attributed to direct costs and BRL 45 billion to indirect costs. The cost of informal caregivers equaled BRL 41 billion. In the scenario with the illegal market for tobacco products, a 50% increase in the price of cigarettes may generate economic benefits of BRL 161 billion in 10 years. The current tax reform currently in Brazil may constitute a permanent pricing and tax policy.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00002425"},"PeriodicalIF":2.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367084","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":"Assessing intersectional disparities in obesity among Brazilian adults: a MAIHDA approach.","authors":"Marcos Fanton, Helena Mendes Constante, Raquel Canuto","doi":"10.1590/0102-311XEN161425","DOIUrl":"10.1590/0102-311XEN161425","url":null,"abstract":"<p><p>Obesity disproportionately affects socially marginalized populations, but traditional analyses often fail to capture the complexity of intersecting social determinants. To address this limitation, we applied the intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to examine how combinations of different systems of power shape obesity prevalence among Brazilian adults. Data from 71,896 individuals from the 2019 Brazilian National Health Survey were analyzed. Obesity was defined as body mass index ≥ 30kg/m2. Individuals were categorized into 162 intersectional strata based on five dimensions (race, gender, age, income, and education). Two multilevel logistic models were estimated to account for additive and multiplicative effects of these dimensions, and predicted obesity prevalence values across different social strata were examined. The prevalence of obesity varied significantly within and across intersectional strata, with the highest prevalence concentrated among Brown and Black women with lower income and education. The explanatory effect of the intersectional strata decreased from 3.08% to 1.67% after including social dimensions in the model. With a proportional change in variance of 46%, the analysis showed that interaction effects are needed to capture the observed inequities between groups. While additive effects account for part of the variance in obesity, persistent intersectional disparities highlight the limitations of traditional models. These findings underscore the importance of intersectional frameworks in revealing how oppression systems are embodied in health outcomes.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00161425"},"PeriodicalIF":2.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367106","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":"Identifying latent profiles of child abuse and their gendered effect on adolescent mental health: a school-based study from Rio de Janeiro, Brazil.","authors":"Daniela Porto Faus, Claudia Leite de Moraes, Michael Eduardo Reichenheim, Marcia C Castro, Claudia Reis Miliauskas, Emanuele Souza Marques, Stella Regina Taquette","doi":"10.1590/0102-311XEN185425","DOIUrl":"10.1590/0102-311XEN185425","url":null,"abstract":"<p><p>This study aimed to identify patterns of child abuse and neglect and to examine the associations between these patterns and psychological distress during adolescence. A school-based survey was conducted with 693 high school students in Rio de Janeiro, Brazil, during 2016-2017. Latent class analysis was used to identify child abuse and neglect patterns based on the Childhood Trauma Questionnaire items' combination. Psychological distress was measured using the General Health Questionnaire (GHQ-12). Multiple linear regression models were employed to examine the associations between child abuse and neglect patterns and psychological distress. Three classes of child abuse and neglect were identified for both sexes: (1) mild emotional violence and physical punishment, (2) emotional maltreatment, physical punishment, and neglect, and (3) poly-victimization. Being classified within the poly-victimization was significantly associated with higher psychological distress in both boys and girls. The class characterized by emotional maltreatment, physical punishment, and neglect was significantly associated with increased psychological distress among girls only. Health and educational services should assess child abuse and neglect when working with adolescents presenting psychological distress, as many may experience multiple forms of victimization. The high prevalence of childhood poly-victimization classes and their strong association with psychological distress highlight the urgent need for intersectoral strategies aiming at reducing child abuse and neglect.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00185425"},"PeriodicalIF":2.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367128","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":"Dengue virus introduction and 2025 outlook: scenario-based evaluation of vaccination impact using mathematical modeling.","authors":"Thomas Nogueira Vilches, Cláudia Pio Ferreira, Miguel Rubira Telles, Lais Moraes Paiz, Gabriel Berg de Almeida","doi":"10.1590/0102-311XEN150325","DOIUrl":"10.1590/0102-311XEN150325","url":null,"abstract":"<p><p>This study aims to model multiple scenarios of dengue introduction and spread in Botucatu, São Paulo State, Brazil, and to evaluate the impact of vaccination strategies on the epidemic trajectory in a city that, until 2023, had less than 1% of its population infected with dengue. First, we estimated the basic reproduction number (R 0 ) during the 2024 epidemic and compared it with values reported in the literature. We then developed an age-stratified mathematical model, calibrated to 2024 dengue case data using a genetic algorithm, to simulate transmission dynamics with and without vaccination. This approach enabled us to assess the potential reduction in infections under various immunization scenarios. The estimated R 0 for the 2024 epidemic was 1.57, resulting in an attack rate exceeding 10% of the population. Our model accurately fits the observed data and suggests that, under conditions similar to those of 2024, the introduction of a new serotype in 2025 would likely trigger another epidemic. Vaccination could reduce this peak by up to 80%, depending on coverage among individuals aged 10-14 years. The results indicate that the R 0 of dengue estimated for Botucatu in 2024 is consistent with values reported for other Brazilian cities. The vaccination campaign shows the potential to reduce dengue cases by 75% or more. However, since campaign effectiveness depends on the circulating serotype and the epidemiological status of vaccinated individuals, achieving vaccination coverage above 50% in the target population is essential to avoid the need for individual epidemiological screening.</p>","PeriodicalId":9398,"journal":{"name":"Cadernos de saude publica","volume":"42 ","pages":"e00150325"},"PeriodicalIF":2.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367101","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}