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Journal: Cadernos de saude publica


Abortion is a very sensitive issue with relevance to public health; however few clinical or population-based studies have examined induced abortion among drug users. The study aims to evaluate the prevalence of induced abortion and sex-related conditions in an inpatient drug user sample. A cross-sectional design study was conducted in an inpatient addiction treatment unit in São Paulo, Brazil, with a sample of 616 patients, aged 18-75. Sociodemographic data, sexual behavior, and dependence severity were evaluated in relation to induced abortion. Approximately 27% of patients reported having a history of abortion (themselves in the case of women or partners in the case of men). The mean age was 34.6±10.9 years old, 34.9% diagnosed with severe alcohol dependence, 33% were diagnosed with severe levels of dependence on other drugs, 69.6% were diagnosed cocaine users (inhaled and smoked), and alcohol was the drug of choice for 30.4%. Chances of having a history of abortion is greater for women than for men with a odds ratio (OR = 2.9; 95%CI: 1.75-4.76), (OR = 1.7; 95%CI: 1.09-2.75) of no condom use; (OR = 2.0; 95%CI: 1.35-3.23) of history of STI and (OR = 3.2; 95%CI: 1.29-5.73) use of morning-after pill. Drug- and alcohol-dependent patients have high-risk behaviours of sporadic use or no-condom use which contribute to unplanned pregnancy and induced abortion, making this vulnerable population a group which deserves special attention in sexual health prevention programmes and health promotion efforts for the reduction of induced abortion.

Concepts: Pregnancy, Birth control, Epidemiology, Alcoholism, Abortion, Drug addiction, Addiction, History of abortion


The current article examines surgical care as a public health issue and a challenge for health systems organization. When surgery fails to take place in timely fashion, treatable clinical conditions can evolve to disability and death. The Lancet Commission on Global Surgery defined indicators for monitoring sustainable universal access to surgical care. Applied to Brazil, the global indicators are satisfactory, but the supply of surgeries in the country is marked by regional and socioeconomic inequalities, as well as between the public and private healthcare sectors.

Concepts: Health care, Health economics, Medicine, Healthcare, Public health, Health, Surgery


The aim of this study was to analyze the association between the characteristics of the built and social and environmental microscale and walking and bicycling for transportation in adults in Curitiba, Paraná State, Brazil. A cross-sectional study was performed in 2009 with a household survey that included 1,419 adults. Objective evaluation of environment was performed on the resident’s street segments, using an instrument for systematic observation consisting of six dimensions: “land use”, “public transportation”, “streetscape”, “conditions and aesthetics”, “places for walking and bicycling”, and “social environment”. The score for each dimension was obtained as the sum of positive items related to physical activity. The items for “public transportation” (≥ 1 items) and “places for walking and bicycling on the streets” (≥ 3 items) were dichotomized, while the scores for the other items were classified in tertiles. Walking and bicycling for transportation were assessed with the International Physical Activity Questionnaire (IPAQ). The data were analyzed using multilevel Poisson regression. Medium “streetscape” score was inversely associated with walking ≥ 150min/week (PR = 0.60; 95%CI: 0.40-0.91; VPC = 12%) and bicycling (PR = 0.54; 95%CI: 0.29-0.99; VPC = 60%). In conclusion, only “streetscape” was associated with walking and bicycling for transportation in adults.

Concepts: Regression analysis, Econometrics, Exercise, Transport, The Score, Street, Automobile, Sustainable transport


The article probes the origins and content of the Framework of Engagement with Non-State Actors (FENSA) of the World Health Organization (WHO), approved on May 28, 2016, at the 69th World Health Assembly, which established different rules of collaboration to four categories of actors: nongovernmental organizations (NGOs), private sector entities, philanthropic foundations, and academic institutions. Applying the findings of International Legal Theory and based on extensive documentary research, we sought to determine whether FENSA is an appropriate accountability mechanism according to four functions of accountability: constitutional, democratic, epistemic, and populist. The article concludes that there is a risk of the prevalence of the populist function at the expense of the accountability potential that could result from the better use of the other three accountability functions.

Concepts: Law, Human rights, World Health Organization, Non-governmental organization, United Nations, Civil society, Non-profit organization, Philanthropy


Despite the overall benefits of immunization, vaccine hesitancy has been a growing trend and has been associated with the resurgence of vaccine-preventable diseases. The aim of this study was to assess vaccine confidence and hesitancy in Brazil, as part of a wider project to map vaccine confidence globally. One thousand subjects were interviewed, either online or face-to-face, based on a general questionnaire regarding perceptions on vaccines and vaccination. Further exploratory questions were used with the subset of respondents who were parents of children aged under 5. Such questions extracted information regarding vaccination behavior, opinions on vaccination and government health services, and vaccine hesitancy. Reasons for hesitancy were classified as relating to confidence, convenience and/or complacency, and the population was also analyzed socio-demographically. The results showed that overall confidence in immunization was higher than confidence in family planning services, community health workers and emergency services. Seventy-six people reported hesitancy to vaccinate. The commonest reasons for hesitancy were issues with confidence (41.4%), efficacy/safety of the vaccine (25.5%) and concerns about adverse events (23.6%). The sociodemographic analysis revealed that vaccine hesitancy was associated with marital status, level of education and income. Despite overall vaccine confidence being high, a clear trend toward lower levels of confidence was associated with higher levels of hesitancy, which warrants on-going monitoring, due to the dynamic and changing nature of vaccine hesitancy.


The aim of this article was to discuss the recommendation of mammogram screening for breast cancer and its technical basis. The first part discusses criteria for the decision, which should be consistent with high-quality scientific evidence. The second part discusses over-diagnosis (the greatest harm of screening) and its meaning in questioning the natural history of disease model. The third part summarizes studies on the efficacy, effectiveness, and harms of screening, showing that the latter (especially over-diagnosis and false-positives) are significant, shedding doubt on the balance between harms and benefits. In conclusion, the recommendation of mammogram screening at any age should be reconsidered by Brazilian health authorities.

Concepts: Cancer, Breast cancer, Metastasis, Oncology, Pleural effusion, Breast, Mammography, Nature


Evidence suggests that an old mineral storage site removed in 1998 due to high lead content, remains as a source of exposure in the city of Antofagasta, Chile. The aim was to determine the association between blood lead levels in children and the residential proximity to the old mineral storage site. A cross sectional study was conducted with 185 children aged 7 to 16 years. The outcome variable was blood lead levels measured in 2005. The exposure variable was the distance between the current residence and the old mineral storage site. The distance was measured in meters by Geographic Information System (GIS). The median blood lead level in 2005 was 3.3μg/dL (interquartile range ‒ IQR: 2.0-4.3). A significant inverse association was found between the residential distance to the old mineral storage site and the blood lead levels in children, after adjusting by confounders (β: -0.04; 95%CI: -0.09; -0.01). This result suggests that the old mineral storage site continues to be a source of lead exposure for the children living nearby.

Concepts: Geographic information system, Interquartile range, Mineral, Lead, Length, Lead poisoning, Blood lead level, Antimony


This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence. Resumo: Este estudo teve como objetivo avaliar a ocorrência de eventos adversos e o impacto deles sobre o tempo de permanência e a mortalidade na unidade de terapia intensiva (UTI). Trata-se de um estudo prospectivo desenvolvido em um hospital de ensino do Rio de Janeiro, Brasil. A coorte foi formada por 355 pacientes maiores de 18 anos, admitidos na UTI, no período de 1º de agosto de 2011 a 31 de julho de 2012. O processo de identificação de eventos adversos baseou-se em uma adaptação do método proposto pelo Institute for Healthcare Improvement. A regressão logística foi utilizada para analisar a associação entre a ocorrência de evento adverso e o óbito, ajustado pela gravidade do paciente. Confirmados 324 eventos adversos em 115 pacientes internados ao longo de um ano de seguimento. A taxa de incidência foi de 9,3 eventos adversos por 100 pacientes-dia, e a ocorrência de evento adverso impactou no aumento do tempo de internação (19 dias) e na mortalidade (OR = 2,047; IC95%: 1,172-3,570). Este estudo destaca o sério problema dos eventos adversos na assistência à saúde prestada na terapia intensiva e os fatores de risco associados à incidência de eventos.


Leishmaniasis is an endemic disease in Iran. Since education to prevent the disease is important, this study aimed to determine the effect of educational intervention based on the PRECEDE-PROCEED model on preventive behaviors of cutaneous leishmaniosis among housewives. In this quasi-experimental study, 240 housewives under the coverage of health centers, who lived in the endemic area of Mianshahr, Fasa city, Fars Province, Iran in 2016, were selected (120 people for the experimental group and 120 for the control group). The educational intervention for the experimental group was based on the PRECEDE model, which consists of seven 50-60-minute sessions of lectures, group discussions, role playing, practical displays, and video and PowerPoint displays. These sessions addressed the familiarity with cutaneous leishmaniasis and its different types and carriers, methods of preventing and fighting against it, personal protection, sanitation of the environment and drinking water, spraying of sites, use of mosquito nets, etc. Data were collected before educational intervention and three months after educational intervention. The mean age of the experimental group was 39.24±9.12 years and that of the control group was 38.84±9.28 years. Three months after the intervention, the experimental group showed a significant increase in knowledge, attitudes, reinforcing factors, enabling factors, and performance compared to the control group. The education based on enabling factors, reinforcing factors, and predisposing factors had a significant effect on the preventive behaviors of cutaneous leishmaniasis among housewives.


This paper provides estimates of mortality rates from Alzheimer’s disease dementia (AD) in the elderly Brazilian population. Data were obtained from the 2010 Population Census by Brazilian Institute of Geography and Statistics (IBGE) and microdata on mortality in Brazil’s 27 state capitals recorded in the Brazilian Mortality Information System (SIM) for the population 65 years or older by place of residence for the years 2009 to 2013. Corrections were obtained for underreporting of mortality, and final adjustments were made to the specific mortality rates based on Bayesian methods with prior probability distributions built on the basis of information obtained from a meta-analysis. The mortality rates from all dementias and from AD in Brazil were higher than in developed countries. The mortality rates from Alzheimer’s disease in 2013 were 140.03 (95%CI: 117.05; 166.4) and 127.07 (95%CI: 103.74; 149.62) per 100,000 inhabitants, respectively, in men and women. The contribution of AD to mortality in elderly Brazilians was 4.4% (95%CI: 3.25; 5.72) in the group with 0 to 3 years of schooling, independently of age and sex. The study aimed to increase knowledge on corrected estimates of mortality rates from Alzheimer’s disease based on vital statistics, providing more precise and pertinent evidence-based estimates.