Resumo em Inglês:

ABSTRACT OBJECTIVE: To analyze the trends and spatial patterns of hepatitis C-related mortality in Brazil from 2000 to 2020. METHODS: A population-based, mixed ecological study of spatial and temporal trends, using secondary data from death certificate (DC) registries, in which hepatitis C was mentioned as an underlying or associated cause of mortality. Temporal trends were analyzed by joinpoint regression, and spatial analysis by the distribution of adjusted rates by age and sex, and spatial autocorrelation by the local Moran index and the Getis-Ord Gi* index (Gi star). RESULTS: From 2000 to 2020, 64,029 deaths due to hepatitis C were recorded in the Mortality Information System (SIM), representing 0.26% of deaths in Brazil. Most deaths were due to underlying causes (n = 33,652, 52.6%). Areas with high rates in all five analyzed periods were identified in the states of São Paulo, southern Minas Gerais, southern Rio de Janeiro, northern Paraná, southern and coastal Santa Catarina, eastern Mato Grosso do Sul, and Rio Grande do Sul. The states of Acre and southern Amazonas showed high rates after 2004, which spread to northern Rondônia from 2016 to 2020. The joinpoint regression model showed an increasing trend in hepatitis C mortality in Brazil from 2000 to 2015, but a decreasing trend from 2016-2020. The mortality rate was higher in men and people over sixty years of age. CONCLUSION: Differences were observed in the temporal and spatial trend of hepatitis C mortality in different regions of Brazil. These data may support the design of hepatitis C elimination strategies in Brazil, according to regional specificities.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To explore the associations between current mental health symptoms and social disparities in university students. METHODS: We recruited participants from nine public universities in Brazil, from August to November 2022, using online advertisements and in-person lectures. All participants completed an online survey containing social (sex, race/color, gender identity, sexual orientation, and income) and mental health assessments. The Jeopardy index was composed of social variables. The index considered zero points for subjects with less oppressive experienced characteristics (men, White, cisgender, heterosexual, higher income) and one point for the opposite characteristics. We defined six clusters according to Jeopardy Index results: 0, 1, 2, 3, 4, and 5 points, with the greatest number of points representing the most disadvantaged group. The mental health symptoms were assessed on two levels. First by the “DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure – Adult,” and second by the “Patient Health Questionnaire-9,” and the “Generalized Anxiety Disorder Questionnaire-7.” Adjusted Odds Ratio (OR) analyses was performed for age and educational level. RESULTS: 748 participants were allocated into the six Jeopardy clusters: 0 (n = 46; 6.1%), 1 (n = 112; 15.0%), 2 (n = 163; 21.8%), 3 (n = 218; 29.1%), 4 (n = 171; 22.9%), and 5 (n = 38; 5.1%). It was observed a high prevalence of anxiety (42.5%) and depression (51.0%), however, the less privileged group (5) had a higher risk of having severe symptoms of anxiety (OR = 6.21; 1.51–25.58; p < 0.01) and depression (OR = 8.60; 2.15–34.43; p < 0.01), compared against the most privileged group. CONCLUSION: Although anxiety and depressive symptoms were highly prevalent for all participants, these disorders are not equally distributed in this population and the intersectionality between social factors plays an important role in contributing to these differences.

Resumo em Português:

RESUMO OBJETIVO Avaliar a tendência espaço-temporal da mortalidade fetal no Brasil no período de 1996 a 2021. MÉTODOS Estudo ecológico de séries temporais com dados secundários de mortes fetais com idade gestacional (IG) ≥ 20 semanas do Sistema de Informações sobre Mortalidade (SIM) no Brasil, entre 1996 e 2021, pré-pandemia de covid-19 (1996–2019) e anos de 2020 e 2021 da pandemia. Analisou a taxa de mortalidade fetal (TMF) para identificar o risco anual de morte fetal na população específica. Foram calculadas a variação percentual (VP), variação percentual anual (VPA) e variação percentual média anual (VPMA) por meio de regressão Joinpoint, para determinar os padrões de tendência: crescente, decrescente ou estacionária. Utilizou-se os softwares Excel 2019, Stata e Joinpoint Regression. RESULTADOS No Brasil, mortes fetais na IG ≥ 20 semanas representaram 1,14% dos nascimentos e 58% das mortes perinatais no período analisado. Cerca de 93% foram anteparto, 6% intraparto e 1% foram registradas como ocorrido após o parto. A TMF global do período, considerando a IG ≥ 20, ≥ 22 e ≥ 28 semanas, foi de 11,4, 10,7 e 8,6/1.000 nascimentos, respectivamente. Apesar da tendência crescente dos natimortos nas mortes perinatais, desaceleração na redução e aumento durante a pandemia de covid-19, a TMF, nas idades gestacionais avaliadas, diminuiu 20%, 25% e 41%, respectivamente, com VPMA de -1,00, -1,13 e -1,89. CONCLUSÃO A mortalidade fetal apresentou tendência decrescente de longo prazo em âmbito nacional e regional no Brasil, com exceção da região Centro-Oeste, onde a tendência foi estacionária. A pandemia de covid-19 desacelerou a redução e aumentou a medida, no entanto, a tendência decrescente não foi interrompida. No âmbito regional, as TMF mais elevadas e as menores reduções ocorreram no Norte, Nordeste e Centro-Oeste, evidenciando desigualdades regionais.

Resumo em Inglês:

ABSTRACT OBJECTIVE To evaluate the space-time trend of fetal mortality in Brazil from 1996 to 2021. METHODS Ecological time series study with secondary data on fetal deaths at gestational age (GA) ≥ 20 weeks from the Mortality Information System (SIM) in Brazil, between 1996 and 2021, covid-19 pre-pandemic (1996–2019), and years 2020 and 2021 of the pandemic. It analyzed the fetal mortality rate (FMR) to identify the annual risk of fetal death in the specific population. The percentage change (PC), annual percentage change (APC), and average annual percentage change (AAPC) were calculated using Joinpoint regression to determine the trend patterns: increasing, decreasing, or stationary. Excel 2019, Stata, and Joinpoint Regression software were used. RESULTS In Brazil, fetal deaths at GA ≥ 20 weeks accounted for 1.14% of births and 58% of perinatal deaths in the period analyzed. Around 93% were antepartum, 6% intrapartum, and 1% were recorded as occurring postpartum. The overall FMR for the period, considering GA ≥ 20, ≥ 22, and ≥ 28 weeks, was 11.4, 10.7, and 8.6/1,000 births, respectively. Despite the increasing trend of stillbirths in perinatal deaths, a slowdown in the reduction and an increase during the covid-19 pandemic, the FMR at the gestational ages evaluated decreased by 20%, 25%, and 41%, respectively, with a AAPC of -1.00, -1.13, and -1.89. CONCLUSION Fetal mortality showed a long-term downward trend at the national and regional levels in Brazil, except in the Central-West region, where the trend was stationary. The covid-19 pandemic slowed down the reduction and increased the measure, however, the downward trend was not interrupted. Regionally, the highest FMRs and the smallest reductions occurred in the North, Northeast, and Central-West, showing regional inequalities.

Resumo em Português:

RESUMO OBJETIVO Apresentar um rastreador para consumo de alimentos ultraprocessados para crianças na primeira infância, avaliando a capacidade do escore gerado por esse rastreador de refletir a participação de alimentos ultraprocessados na alimentação das crianças. MÉTODOS Estudo realizado com uma subamostra de conveniência da Coorte de Nascimentos de Pelotas de 2015 (n = 365). As mães das crianças participantes responderam a um questionário de consumo alimentar no dia anterior à entrevista (rastreador) contendo 16 subgrupos de alimentos ultraprocessados, seguido por um recordatório alimentar tradicional de 24 horas (R24h). O escore de consumo de alimentos ultraprocessados de cada participante correspondeu ao número de subgrupos de alimentos consumidos e o percentual de energia proveniente da participação dos alimentos ultraprocessados na alimentação do mesmo dia foi calculado a partir das respostas do R24h. A associação entre o escore e o percentual de energia proveniente de alimentos ultraprocessados foi testada por modelos de regressão linear. A avaliação do grau de concordância entre a classificação dos participantes segundo quintos aproximados do percentual de calorias de alimentos ultraprocessados e segundo os intervalos do escore foi feita a partir do índice Pabak. RESULTADOS O percentual médio de participação de alimentos ultraprocessados no valor calórico total da dieta, calculado com base no R24h, foi direta e significativamente associado com o aumento do escore de consumo de alimentos ultraprocessados. Foi observada concordância substancial entre os intervalos do escore de consumo de alimentos ultraprocessados, obtido pelo rastreador, e os quintos aproximados da participação de alimentos ultraprocessados na dieta, calculada pelo R24h (índice Pabak = 0,65). CONCLUSÕES O escore de consumo de alimentos ultraprocessados, obtido a partir de um rastreador de consumo de alimentos ultraprocessados, um instrumento prático e ágil, é capaz de refletir a participação de alimentos ultraprocessados na alimentação das crianças, no que diz respeito à Coorte de Nascimentos de Pelotas de 2015.

Resumo em Inglês:

ABSTRACT OBJECTIVE To present a screener for consumption of ultra-processed foods for children in early childhood, evaluating the ability of the score generated by this screener to reflect the participation of ultra-processed foods in children’s diets. METHODS This study was conducted with a convenience subsample of the 2015 Pelotas Birth Cohort (n = 365). The mothers of the participating children answered a food consumption questionnaire the day before the interview (screener) containing 16 subgroups of ultra-processed foods, followed by a traditional 24-hour food recall (24hR). Each participant’s ultra-processed food consumption score corresponded to the number of food subgroups consumed and the percentage of energy derived from the participation of ultra-processed foods in the diet on the same day was calculated from the answers in the 24hR. The association between the score and the percentage of energy from ultra-processed foods was tested using linear regression models. The degree of agreement between the classification of participants according to approximate fifths of the percentage of calories from ultra-processed foods and according to the score intervals was assessed using the Pabak index. RESULTS The average percentage share of ultra-processed foods in the total caloric value of the diet, calculated using the 24hR, was directly and significantly associated with an increase in the ultra-processed food consumption score. There was substantial agreement between the ranges of the ultra-processed food consumption score obtained by the screener and the approximate fifths of the share of ultra-processed foods in the diet calculated by the 24hR (Pabak index = 0.65). CONCLUSIONS The ultra-processed food consumption score, obtained from an ultra-processed food consumption screener, a practical and agile instrument, is capable of reflecting the participation of ultra-processed foods in children’s diets, with regard to the 2015 Pelotas Birth Cohort.

Resumo em Português:

RESUMO OBJETIVO Analisar a eficiência na atenção primária à saúde das capitais brasileiras no período 2008–2019, considerando o modelo de gestão: administração pública direta ou administração cedida a terceiros. MÉTODOS Estudo de propósito avaliativo, objetivo analítico, com dados secundários de acesso público, analisados em recorte transversal (2019) e longitudinal (2008, 2012, 2016 e 2019). Para caracterizar as cidades e sua atenção primária à saúde, utilizaram-se dados demográficos, socioeconômicos e sete indicadores relacionados à atenção primária à saúde (cobertura em atenção básica, internações por condições sensíveis à atenção básica, cura de tuberculose, mortalidade infantil, materna e prematura por condições crônicas, incidência de sífilis congênita). A esses indicadores foram acrescidos os de gastos em saúde e em atenção primária à saúde e realizou-se a análise envoltória de dados voltada a outputs (sem admitir redução de gastos) para cálculo da eficiência em 2008, 2012, 2016 e 2019. Com o índice de Malmquist, buscou-se identificar possíveis ganhos de produtividade entre 2008 e 2019. RESULTADOS Quatro capitais identificadas como de administração cedida a terceiros (São Paulo, Rio de Janeiro, Porto Alegre e Fortaleza) não obtiveram maior eficiência perante a administração pública direta, tampouco evoluíram quando comparados os seus próprios resultados no tempo. Em 2019, e na abordagem longitudinal, apenas capitais de gestão por administração pública direta obtiveram índice máximo de eficiência relativa na comparação entre as capitais. Doze capitais em administração pública direta mantiveram-se eficientes em todos os anos, ao passo que as em administração cedida a terceiros apresentaram, consistentemente, ineficiência fraca em atenção primária à saúde, ou seja, no período estudado, a relação entre investimentos na atenção primária à saúde e resultados obtidos é inferior ao alcançado pelas capitais eficientes. CONCLUSÕES Não encontramos evidências de ganhos de eficiência com a adoção de administração cedida a terceiros. Ressalte-se que a eficiência produtiva não representa, necessariamente, o atendimento de necessidades de saúde.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze efficiency in primary health care in Brazilian state capitals in the period 2008–2019, considering the management model: direct public administration or administration assigned to third parties. METHODS This is an evaluative study with an analytical objective, using publicly available secondary data, analyzed cross-sectionally (2019) and longitudinally (2008, 2012, 2016, and 2019). Demographic and socioeconomic data and seven indicators related to primary health care were used to characterize the cities and their primary health care (primary care coverage, hospitalizations for primary care-sensitive conditions, tuberculosis cures, infant, maternal, and premature mortality due to chronic conditions, incidence of congenital syphilis). To these indicators were added health and primary health care expenditures and data envelopment analysis focused on outputs (without admitting a reduction in expenditures) to calculate efficiency in 2008, 2012, 2016, and 2019. The Malmquist index was used to identify possible productivity gains between 2008 and 2019. RESULTS Four capitals identified as being managed by third parties (São Paulo, Rio de Janeiro, Porto Alegre, and Fortaleza) did not achieve greater efficiency compared to direct public administration, nor did they evolve when comparing their own results over time. In 2019, and in the longitudinal approach, only capitals managed by direct public administration obtained the maximum relative efficiency index in the comparison between capitals. Twelve capitals with direct public administration remained efficient in all years, while those with third-party administration consistently showed weak inefficiency in primary health care, i.e. in the period studied, the relationship between investments in primary health care and results obtained is lower than that achieved by the efficient capitals. CONCLUSIONS We found no evidence of efficiency gains with the adoption of third-party management. It should be noted that productive efficiency does not necessarily mean that health needs are met.

Resumo em Inglês:

ABSTRACT OBJECTIVES To compare rates, disability-adjusted life years (DALYs), and years of healthy life lost due to disability (YLDs) associated with deaths due to self-harm in Brazil. METHODS This epidemiological study utilized secondary data obtained from the Global Burden of Disease Study. Analytical examinations were conducted to provide detailed descriptions of national and subnational rates. RESULTS We identified mortality rates, DALYs, and YLDs resulting from deaths due to self-harm - national data from 26 states and the Federal District - between 1990 and 2019. The national rates in 1990 and 2019 were the same for mortality = 6.2 deaths per 100.000 inhabitants, reduced for DALYs = 312-289 DALYs, and the same for YLDs = 1.6 YLDs. Four united federations had higher mortality rates, DALYs, and YLDs caused by self-harm compared to national rates throughout the analyzed period (between 1990 and 2019) – Goiás (mortality = 11-67%, DALYs = 13-73%, and YLDs = 4-45%), Mato Grosso do Sul (mortality = 23-42%, DALYs = 28-46%, and YLDs = 13-64%), Minas Gerais (mortality = 5-25%, DALYs = 7-25%, and YLDs = 19-35%), and Rio Grande do Sul (mortality = 73-98%, DALYs = 55-84 %, and YLDs = 52-70%). CONCLUSION Although national mortality rates and YLD caused by self-harm have been maintained, there has been a decrease in the incidence of DALYs. However, certain states in Brazil have rates higher than the national average, indicating the need for multiple strategies to be implemented to reduce mortality rates, DALYs, and YLDs resulting from self-harm in these specific states.

Resumo em Inglês:

ABSTRACT OBJECTIVE We tested the reliability and validity of the Perceived Stress Scale, an online questionnaire, among college students from low-income Brazilian regions. METHODS We assessed 195 college students from a region with a Gini index of 0.56 for the validity study and a subsample of 117 students for the reliability study, where we evaluated the Perceived Stress Scale with the 14 original items. We also applied the shortened version of the Brief Symptom Inventory with 18 items (BSI-18). The psychometric properties analyzed, including temporal stability, internal consistency, and structural and convergent validity, were assessed using Spearman’s correlation coefficient, Cronbach’s alpha coefficient, unsupervised machine learning, and confirmatory factor analysis. RESULTS The questionnaire showed acceptable reliability (temporal stability [rho ≥ 0.32] and internal consistency [alpha ≥ 0.79]). In construct validity, we identified two clusters, “helplessness” and “self-efficacy”, as structure solutions for our sample via unsupervised machine learning. An acceptable fit for the two-factor structure of the scale was indicated by multiple indices (chi-square/degrees of freedom [χ2/df] = 119/76; Tucker-Lewis Index [TLI] = 0.916; Comparative Fit Index [CFI] = 0.930; root mean square error of approximation [RMSEA] = 0.054; standardized root mean-squared residual [SRMR] = 0.078)) on confirmatory factor analysis. Moreover, convergent validity was supported by significant correlations of the BSI-18 Global Severity Index score with perception of helplessness (rho = 0.71) and self-efficacy (rho = -0.42). CONCLUSION The Perceived Stress Scale, which is an online tool, is a reliable and valid self-report tool for college students.

Resumo em Português:

RESUMO Objetivo: Estimar a prevalência de subtipos da violência e analisar alguns dos fatores demográficos, socioeconômicos e de saúde associados a Violência Contra as Mulheres (VCM) no Brasil. Métodos: Estudo epidemiológico transversal utilizando base de dados da Pesquisa Nacional de Saúde (PNS) 2019. Foram estimadas as prevalências de alguns subtipos da violência (psicológica, física e sexual) nos 12 meses anteriores a entrevista, no Brasil e nas unidades federativas. Analisou-se também algumas das características de cada subtipo. Estimou-se ainda a Razão de Prevalência bruta e ajustada por modelo multivariado segundo potenciais fatores demográficos, socioeconômicos e de saúde associados: faixa etária, escolaridade, cor da pele, local de moradia, renda domiciliar, estado civil, rede social de apoio, autoavaliação em saúde, consumo de álcool, depressão e infecções sexualmente transmissíveis (ISTs). Resultados: Em 2019, 19,38% das mulheres brasileiras relataram algum episódio de violência, sendo a violência psicológica o subtipo mais comum, tanto isolada quanto concomitante com outros subtipos. O principal agressor foi um parceiro íntimo e a maioria dos atos violentos ocorreu na residência, com mais da metade das mulheres relatando ao menos uma consequência desses atos. Mulheres mais jovens, com pior autoavaliação em saúde, consumo de álcool, depressão e diagnóstico de ISTs tiveram maior prevalência de todos os subtipos de violência. Conclusão: Uma em cada cinco mulheres brasileiras relataram algum episódio de violência nos últimos 12 meses. A VCM está positivamente associada a idades mais jovens, baixa escolaridade, cor da pele preta e parda, menor rede de apoio, além de fatores ligados a saúde, como autoavaliação em saúde, consumo de álcool, depressão e ISTs.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To estimate the prevalence of violence subtypes and analyze some demographic, socioeconomic, and health factors associated with violence against women in Brazil. METHODS: Cross-sectional epidemiological study using the 2019 National Survey of Health. The prevalences of some violence subtypes (psychological, physical, and sexual) in the 12 months prior to the interview were estimated in the country, per federative units. The characteristics of each subtype of violence were also analyzed. Additionally, the crude and adjusted prevalence ratios were estimated by a multivariate model according to the following potential demographic, socioeconomic, and health associated factors: age group, education, skin color, place of residence, household income, marital status, social support network, self-rated health, alcohol consumption, depression, and sexually transmitted infections. RESULTS: In 2019, 19.38% of Brazilian women reported experiencing violence, with psychological violence being the most common subtype both in isolation and in conjunction with other subtypes. The main aggressor was an intimate partner and most of the violent acts occurred at home, with more than half of women reporting at least one consequence of these acts. Younger women, those with worse self-rated health, alcohol consumption, depression, and sexually transmitted infections had a higher prevalence of all violence subtypes. CONCLUSION: One in five Brazilian women reported experiencing violence in the past 12 months. Violence against women is positively associated with younger ages, lower education, Black and Brown skin color, smaller support networks, and health-related factors such as self-rated health, alcohol consumption, depression, and sexually transmitted infections.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To explore the spatial distribution of bacille Calmette-Guerin (BCG) vaccination coverage and tuberculosis cases in Brazilian children under the age of ten in the last two decades. METHODS: This is a population-based ecological study using data from the Sistema de Informação de Agravos de Notificação (SINAN – Information System for Notifiable Diseases) from January 2001 to December 2022. We investigated tuberculosis incidence and vaccination coverage in all Brazilian municipalities. Spatial dependence was analyzed by the Global Moran Index and Local Indicators of Spatial Association (LISA). Joinpoint regression was used to assess trends in tuberculosis and BCG rates over time. RESULTS: The results indicated 39,840 pediatric tuberculosis cases, with 60.65% in children under the age of five. The highest incidence rates were in the states of Amazonas, Mato Grosso, and Rio de Janeiro. Spatial analysis showed significant positive spatial autocorrelation in pediatric tuberculosis cases, with high-high clusters in several states and municipalities. Tuberculosis cases in children under five have been declining since 2000 but rose in 2020 (APC = 26.64; p-value = 0.032). An earlier increase was observed in children up to ten years old, starting six years prior. CONCLUSION: The study highlights the decline in BCG vaccination coverage below 90%, with the most significant drop in 2020, particularly in the Northeast. The findings underscore the need for high maintain vaccination coverage and robust public health policies to mitigate tuberculosis in children. Addressing these issues requires targeted public health interventions, especially in regions with higher tuberculosis burdens.

Resumo em Inglês:

ABSTRACT OBJECTIVES: To investigate the association between unplanned pregnancy and use of modern contraceptive methods at 3-, 12-, and 24-months postpartum using an intersectional approach for examining inequalities, in the 2015 Pelotas birth cohort, Brazil. METHODS: We evaluated the use of modern contraceptives after delivery, comparing women who had planned and unplanned pregnancies in 2015. The number of women included in this study was: 4,021, 3,687, and 3,558, at 3-, 12-, and 24-month postpartum follow-ups, respectively. Analyses were restricted to women who needed contraception by the time of each postpartum follow-up interview. Sociodemographic indicators were also investigated. Descriptive (absolute and relative frequencies), bivariate, and multivariate statistical analyses were conducted. These analyses included the main exposure and the sociodemographic variables. In the three follow-up interviews, double stratification was used to investigate for intersectionalities between pregnancy planning and family income, and pregnancy planning and living with partner. RESULTS: Women who had unplanned pregnancies presented the lowest use of modern contraceptives. A negative association between unplanned pregnancy and use of modern contraception was found at 3- (PR = 0.97, 95%CI: 0.95–0.99) and 24-months postpartum (PR = 0.96, 95%CI: 0.94–0.98). In general, women who did not live with a partner, with lower schooling level, and who were 35 or older presented lower use of modern contraception. Women who had unplanned pregnancies with lower family income and who did not live with a partner presented a lower prevalence of modern contraceptive use. CONCLUSIONS: Despite the possible benefits of the use of modern contraception in the postpartum period, women who had unplanned pregnancies presented the lowest prevalence. No consistent pattern was identified for this association over time. It is necessary to consider important sociodemographic factors such as living with partner as well as possible pathways to reduce inequalities.

Resumo em Português:

RESUMO OBJETIVO Investigar a relação entre os indicadores de cobertura vacinal e a estrutura da atenção primária para imunização nos municípios brasileiros. MÉTODOS Trata-se de um estudo ecológico temporal que utilizou dados do Sistema de Informação do Programa Nacional de Imunizações (SI-PNI) e do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ) ao longo de três ciclos de avaliação. Ao todo, foram avaliadas 13 variáveis, sendo cinco relacionadas à estrutura das unidades básicas de saúde (UBS) e oito à disponibilidade de imunobiológicos. Foram realizadas análises de comparações, associações e modelos longitudinais para avaliar a influência desses indicadores nos níveis de cobertura vacinal. RESULTADOS As variáveis e os indicadores relacionados à estrutura das UBS, à disponibilidade de imunobiológicos nos municípios brasileiros e às coberturas vacinais apresentaram variações significativas ao longo dos ciclos. As estruturas das UBS variaram de regular a boa, com percentuais mais baixos no Ciclo 1 e aumentos nos Ciclos 2 e 3 para a maioria das variáveis analisadas. A disponibilidade de imunobiológicos também melhorou ao longo dos ciclos, apesar de algumas exceções. Os indicadores de cobertura vacinal adequada aumentaram do Ciclo 1 para o Ciclo 2, mas diminuíram no Ciclo 3. Melhorias na estrutura das UBS e na disponibilidade de imunobiológicos foram associadas a maiores coberturas vacinais adequadas. Mantendo a disponibilidade de imunobiológicos fixa como boa, a chance de ter cobertura adequada é 86,28% maior para uma estrutura boa em comparação a uma ruim. CONCLUSÕES Mudanças na estrutura das UBS municipais e na disponibilidade de imunobiológicos ao longo dos ciclos avaliados foram identificas e elas foram associadas a uma maior cobertura vacinal quando ocorreram simultaneamente (boa disponibilidade de imunobiológicos e estrutura regular ou boa nas UBS). Destaca-se a importância da qualidade da atenção primária para o alcance das metas de cobertura vacinal nos municípios brasileiros.

Resumo em Inglês:

ABSTRACT OBJECTIVES To investigate the relationship between vaccination coverage indicators and the structure of primary care for immunization in Brazilian municipalities. METHODS This was a time series ecological study using data from the National Immunization Program Information System (SI-PNI) and the National Program for Improving Primary Care Access and Quality (PMAQ) over three evaluation cycles. A total of 13 variables were assessed, five of which related to the structure of basic health units (BHU) and eight to the availability of immunobiologicals. Analyses of comparisons, associations, and longitudinal models were carried out to assess the influence of these indicators on vaccination coverage levels. RESULTS The variables and indicators related to the structure of BHUs, the availability of immunobiologicals in Brazilian municipalities and vaccination coverage showed significant variations over the cycles. BHU structures ranged from fair to good, with lower percentages in Cycle 1 and increases in Cycles 2 and 3 for most of the variables analyzed. The availability of immunobiologicals also improved over the cycles, despite a few exceptions. Indicators of adequate vaccination coverage increased from Cycle 1 to Cycle 2 but decreased in Cycle 3. Improvements in the structure of the BHU and the availability of immunobiologicals were associated with higher adequate vaccination coverage. Keeping the availability of immunobiologicals fixed at good, the chance of having adequate coverage is 86.28% higher for a good structure compared to a poor one. CONCLUSIONS Changes in the structure of municipal BHUs and in the availability of immunobiologicals over the cycles evaluated were identified and were associated with higher vaccination coverage when they occurred simultaneously (good availability of immunobiologicals and regular or good structure in BHUs). This highlights the importance of the quality of primary care in achieving vaccination coverage targets in Brazilian municipalities.

Resumo em Português:

RESUMO OBJETIVO: Analisar a adesão às recomendações do Guia Alimentar e sua relação com fatores sociodemográficos entre adultos e idosos participantes do estudo Brazuca Natal. MÉTODOS: Trata-se de uma pesquisa transversal, com 411 adultos e idosos do município de Natal, Rio Grande do Norte (RN), selecionados a partir de uma amostra probabilística por conglomerados, em dois estágios (setores censitários e domicílios). A coleta de dados foi realizada por questionário eletrônico na plataforma digital Epicollect 5, contendo dados sociodemográficos e uma escala multidimensional para mensuração da adesão às práticas alimentares recomendadas pelo Guia Alimentar para População Brasileira. A escala é composta por 24 perguntas, obedecendo uma escala Likert (discordo fortemente; discordo; concordo; concordo fortemente). O escore final pode variar de 0 a 72 e ser classificado como baixa adesão (< 32 pontos), média adesão (32 a 41 pontos), ou alta adesão ao Guia (> 41 pontos). Para verificar a associação entre a adesão ao Guia com as variáveis sociodemográficas, foi realizada análise múltipla por regressão logística incondicional. RESULTADOS: O escore médio foi de 40,5 (7,9), e a alta adesão ao Guia foi observada em 40,8% (IC95% 30,8–51,5) da população, com associação significativa para o sexo feminino (RP = 1,27; IC95% 1,03–1,55) e pessoas idosas (RP = 1,46; IC95% 1,19–1,79). Pessoas que declararam renda per capita mensal inferior a um salário-mínimo obtiveram menor probabilidade de ter alta adesão ao Guia, fator intensificado para aqueles que ganhavam um valor ≤ 1/4 salário-mínimo (RP = 0,47; IC95% 0,32–0,68). CONCLUSÕES: Ser do sexo feminino e ser idoso são condições que predizem maior adesão ao Guia, enquanto possuir uma baixa renda per capita prediz menor adesão na população avaliada. É necessário estabelecer políticas de redução às desigualdades sociais e ações para o maior acesso às práticas alimentares alinhadas ao Guia entre adultos e idosos.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To analyze the adherence of adults and older adults in the Brazuca Natal study to the recommendations of the Dietary Guideline for the Brazilian Population and to determine its relation with sociodemographic factors. METHODS: This cross-sectional study was carried out with 411 adults and older individuals residing in Natal, Rio Grande do Norte. Participants were selected from a probabilistic sample by clusters in two stages (census tracts and households). Data were collected by an electronic questionnaire on the Epicollect 5 digital platform. The questionnaire contained sociodemographic data and a multidimensional scale to measure adherence to the dietary practices recommended by the Dietary Guidelines for the Brazilian population. The scale consists of 24 questions following a Likert scale (strongly disagree; disagree; agree; and strongly agree). Total scores ranged from 0 to 72, with classifications of low (total score < 32), medium (total score from 32 to 41), and high adherence (total score > 41) to the Dietary Guideline. To verify the association between adherence to the Guide and sociodemographic variables, multiple analysis by unconditional logistic regression were performed. RESULTS: The mean score equaled 40.5 (7.9), and high adherence to the Guide occurred in 40.8% (95%CI 30.8–51.5) of the population. Women (PR = 1.27; 95%CI 1.03–1.55) and older individuals (PR = 1.46; 95%CI 1.19–1.79) showed a significant association. Individuals who reported a monthly per capita income below one minimum wage were less likely to show high adherence to the Guide, a factor that was intensified for those who earned ≤ 1/4 of the minimum wage (PR = 0.47; 95%CI 0.32–0.68). CONCLUSIONS: The findings of this study indicate that women and older age predict greater adherence to the Dietary Guideline. Conversely, having a low per capita income predicts alower adherence in the evaluated population. Establishing policies to mitigate social inequalities and initiatives to enhance access to dietary practices in line with the Dietary Guideline among adult and older adult populations is imperative.

Resumo em Português:

RESUMO OBJETIVO: Investigar os efeitos do retardo no crescimento intrauterino e da situação socioeconômica de nascimento no desenvolvimento intelectual. MÉTODOS: Estudo realizado com 313 participantes de uma coorte de nascimentos de São Luís, Maranhão, avaliados ao nascerem e entre 18 a 19 anos. Utilizando modelagem de equações estruturais, as variáveis do nascimento e primeiros anos de vida (idade materna, escolaridade materna, escolaridade paterna, ocupação do chefe da família, renda familiar, ganho de peso materno gestacional, retardo no crescimento intrauterino, baixo peso ao nascer e tempo de aleitamento materno) e a escolaridade aos 18 e 19 anos foram testadas como determinantes do quociente de inteligência aos 18 e 19 anos. RESULTADOS: O retardo no crescimento intrauterino não apresentou efeito total (p-valor = 0,957), direto (p-valor = 0,184) ou indireto (p-valor=0,108) sobre o quociente de inteligência aos 18 e 19 anos. A situação socioeconômica no nascimento apresentou efeito total positivo de 0,406 desvio-padrão (p-valor < 0,001) sobre sua média, correspondendo a elevação de 4,54 pontos no quociente a cada elevação do nível socioeconômico no nascimento. Esse efeito não foi mediado pelas demais variáveis explanatórias inclusas no modelo, contudo, identificou-se efeito direto positivo de 0,416 (p-valor < 0,001) da situação socioeconômica sobre a escolaridade, que apresentou correlação positiva (CP = 0,439; p-valor < 0,001) com a inteligência. A idade materna no nascimento também apresentou efeito positivo direto de 0,116 desvio-padrão (p-valor = 0,042) sobre a média do quociente de inteligência aos 18 e 19 anos, correspondendo ao incremento de 1,30 pontos no quociente a cada elevação de 1 ano na idade materna no nascimento. CONCLUSÃO: Maiores níveis socioeconômicos no nascimento geraram efeito positivo direto de longo prazo sobre a inteligência e escolaridade do participante, elevando a média do QI e o nível de escolaridade aos 18 e 19 anos. Identificou-se também correlação positiva entre as duas variáveis.

Resumo em Inglês:

ABSTRACT OBJECTIVE: Investigate the effects of intrauterine growth restriction and socioeconomic status at birth on intellectual development. METHODS: Study conducted with 313 participants from a birth cohort from São Luís, in the state of Maranhão, assessed at birth and between 18 and 19 years of age. Variables at birth and early years of life (maternal age, maternal education, paternal education, occupation of the head of the household, family income, maternal gestational weight gain, intrauterine growth restriction, low birth weight, and breastfeeding duration), and education at 18 and 19 years were tested as determinants of intelligence quotient at 18 and 19 years using structural equation modeling. RESULTS: Results: Intrauterine growth restriction did not have a total (p-value = 0.957), direct (p-value = 0.184), or indirect (p-value = 0.108) effect on the intelligence quotient at 18 and 19 years of age. Socioeconomic status at birth had a total positive effect of 0.406 standard deviations (p-value < 0.001) on its mean, corresponding to an increase of 4.54 points in the quotient for each increase in socioeconomic level at birth. This effect was not mediated by the other explanatory variables included in the model; however, a direct positive effect of 0.416 (p-value < 0.001) of socioeconomic status on education was identified, which showed a positive correlation (PC = 0.439; p-value < 0.001) with intelligence. Maternal age at birth also had a direct positive effect of 0.116 standard deviations (p-value = 0.042) on the mean intelligence quotient (QI) at 18 and 19 years, corresponding to an increase of 1.30 points for each 1-year increase in maternal age at birth. CONCLUSION: Higher socioeconomic levels at birth directly affected the participant’s intelligence and education positively, increasing the mean QI and education level at 18 and 19 years. A positive correlation was also identified between the two variables.

Resumo em Português:

RESUMO OBJETIVO: Estimar a participação calórica de alimentos ultraprocessados (% AUP) nos 5.570 municípios brasileiros. MÉTODOS: A estimativa de % AUP nos municípios foi realizada a partir de um modelo estatístico de predição construído com base nos dados de 46.164 indivíduos com idades >10 anos participantes da Pesquisa de Orçamentos Familiares (POF 2017–2018). Regressão linear múltipla foi usada para estimar a % média de AUP (medida por meio de dois recordatórios alimentares de 24 h) em função das variáveis preditoras (sexo, idade, renda, escolaridade, raça/cor, urbanidade, Unidades da Federação e localização geográfica). O modelo foi avaliado quanto a sua adequabilidade por meio de análise de resíduos e pela comparação entre valores preditos pelo modelo e mensurados diretamente na POF 2017–2018 por meio do coeficiente de correlação-concordância de Lin (CCC). Os coeficientes lineares obtidos no modelo de regressão linear múltiplo foram aplicados aos dados sociodemográficos da amostra do Censo de 2010 (aferidos de forma semelhante à da POF) para estimar o % de AUP de cada um dos municípios. RESULTADOS: O modelo estatístico mostrou-se adequado, apresentando distribuição normal dos resíduos e um CCC de 0,87, indicando concordância quase perfeita. Foi observada uma heterogeneidade na distribuição das estimativas de % AUP, variando de 5,75% em Aroeiras do Itaim (PI) a 30,5% em Florianópolis (SC). As estimativas de % AUP foram mais altas (>20%) em municípios da região Sul e do estado de São Paulo. As capitais apresentam maiores estimativas de participação calórica de alimentos ultraprocessados em relação aos demais municípios de seus estados. CONCLUSÕES: O modelo preditivo revelou diferenças de % AUP entre os municípios brasileiros. As estimativas geradas podem contribuir para o monitoramento do consumo alimentar de ultraprocessados no nível municipal e fortalecer e subsidiar a criação de políticas públicas focadas na promoção da alimentação saudável.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To estimate the caloric share of ultra-processed foods (% UPF) in the 5,570 Brazilian municipalities. METHODS: The estimation of % UPF in municipalities was performed using a statistical prediction model based on data from 46,164 individuals aged over >10 years who participated in the Household Budget Survey (HBS 2017–2018). Multiple linear regression was used to estimate the average % UPF (measured through two 24-hour dietary recalls) based on predictor variables (sex, age, income, education, race/color, urbanity, federative units, and geographic location). The model's adequacy was assessed through residual analysis and by comparing predicted values with those directly measured in POF 2017–2018 using Lin's concordance correlation coefficient (CCC). The linear coefficients obtained from the multiple linear regression model were applied to the sociodemographic data from the 2010 Census (measured similarly to POF) to estimate the % UPF for each municipality. RESULTS: The statistical model proved adequate, showing normally distributed residuals and a CCC of 0.87, indicating almost perfect agreement. There was heterogeneity in the distribution of % UPF estimates, ranging from 5.75% in Aroeiras do Itaim (PI) to 30.5% in Florianópolis (SC). % UPF estimates were higher (>20%) in municipalities from the South region and the state of São Paulo. Capitals had higher estimates of caloric contribution from ultra-processed foods compared to other municipalities in their states. CONCLUSIONS: The predictive model revealed differences in % UPF among Brazilian municipalities. The generated estimates can contribute to monitoring ultra-processed food consumption at the municipal level and support the development of public policies focused on promoting healthy eating.

Resumo em Português:

RESUMO OBJETIVO Analisar o acesso geográfico das crianças com a síndrome congênita da zika (SCZ), diagnosticadas entre 2015 e 2017 residentes do município do Rio de Janeiro, aos serviços de reabilitação. MÉTODOS Estudo ecológico, pautado na análise espacial. Foram construídos mapas de fluxo utilizando o QGis 3.36.3 e calculadas as distâncias, o tempo e o custo entre os serviços de reabilitação e as residências das crianças com SCZ, no município do Rio de Janeiro, notificadas entre 2015 e 2017 no Sistema do Registro de Eventos em Saúde Pública. RESULTADOS Foram identificadas 47 crianças, seis evoluíram ao óbito. Entre as 41 sobreviventes, 17 foram acompanhadas na atenção primária e na atenção secundária à saúde (APS e ASS), 10 somente na APS, sete apenas na ASS e sete não tinham registro de acompanhamento. Os casos de SCZ foram mais frequentes nas zonas norte e oeste da cidade. Foram identificados 143 trajetos percorridos pelas 36 crianças entre a residência e algum serviço de reabilitação; 147 fluxos, percorridos de uma a 106 vezes; a maioria com destino a três unidades (n = 17 – 47,0%). A maior quantidade de trajetos e fluxos foram entre residentes nas zonas norte e oeste da cidade, regiões mais pobres, com maiores distâncias, custo e tempo gasto no percurso entre a residência e a unidade de saúde. CONCLUSÕES A variação de percursos, a quantidade de fluxos registrados e o número de unidades incluídas nas trajetórias sugerem a complexidade da condição clínica das crianças, desde cuidados básicos na APS a procedimentos com maior densidade tecnológica na atenção especializada.

Resumo em Inglês:

ABSTRACT OBJECTIVES To analyze the geographic access of children with congenital Zika syndrome (CZS), residing in the city of Rio de Janeiro between 2015 and 2017, to rehabilitation services. METHODS Ecological study, based on spatial analysis. Commute maps were constructed using QGis 3.36.3 and the distances, time and cost between rehabilitation services and the homes of children with CZS, in the city of Rio de Janeiro, reported between 2015 and 2017 in the Registry System of Public Health Events. RESULTS 47 children were identified, 6 died. Among the 41 survivors, 17 were followed up in primary and secondary health care (PHC and SHC), 10 only in PHC, 7 only in SHC, and 7 had no follow-up record. CZS cases were more frequent in the north and west zones of the city. 143 trajectories followed by the 36 children between home and a rehabilitation service were identified; 147 commutes, followed 1 to 106 times; the majority destined for 3 units (n = 17 – 47.0%). The largest number of trajectories and commutes were among residents in the north and west zones of the city, poorer regions, with greater distances, cost, and time spent traveling between home and the health unit. CONCLUSIONS The variation in trajectories, the number of recorded commutes, and the number of units included in the trajectories suggest the complexity of the children’s clinical condition, from basic care in PHC to procedures with greater technological density in specialized care.

Resumo em Português:

RESUMO OBJETIVO Identificar aglomerados espaciais de risco e cartografar a rede de cuidado às pessoas com tuberculose drogarresistente no estado de São Paulo. MÉTODOS Trata-se de estudo do tipo ecológico, realizado por meio da coleta de dados provenientes do Sistema de Informação de Tratamentos Especiais de Tuberculose (Site-TB) de pessoas tratadas para tuberculose drogarresistente de 2013 a 2020, no estado de São Paulo. Foi realizada a cartografia por meio das técnicas Kernel e de estatística de varredura. RESULTADOS Foram notificados 1.084 casos no período analisado. São Paulo, Ribeirão Preto, Santos, Guarulhos e Campinas foram os municípios que apresentaram o maior número de registros. O padrão espacial de aglomeração dos casos e dos Centros de Referência para o tratamento foram similares, com vazios de cobertura no sudoeste e noroeste do estado. Seis aglomerados espaciais foram identificados: quatro de baixo risco e dois de alto risco, localizados em São Paulo, Diadema, Santos e Guarujá. CONCLUSÕES A concentração de casos e Centro de Referência Terciária em áreas metropolitanas evidencia desigualdades no acesso ao tratamento da tuberculose drogarresistente. Estes achados indicam a necessidade de políticas de saúde para expandir o diagnóstico e tratamento, melhorando o controle da tuberculose drogarresistente no estado de São Paulo.

Resumo em Inglês:

ABSTRACT OBJECTIVE To identify spatial clusters of risk and map the care network for people with drug-resistant tuberculosis in the state of São Paulo. METHODS This is an ecological study, carried out by collecting data from the Special Tuberculosis Treatment Information System (Site-TB) of people treated for drug-resistant tuberculosis from 2013 to 2020, in the state of São Paulo. Mapping was carried out using Kernel and scan statistic techniques. RESULTS 1,084 cases were reported in the period analyzed. São Paulo, Ribeirão Preto, Santos, Guarulhos, and Campinas were the municipalities with the highest number of cases. The spatial pattern of agglomeration of cases and referral centers for treatment were similar, with gaps in coverage in the southwest and northwest of the state. Six spatial clusters were identified: four low-risk and two high-risk, located in São Paulo, Diadema, Santos, and Guarujá. CONCLUSIONS The concentration of cases and tertiary referral centers in metropolitan areas highlights inequalities in access to treatment for drug-resistant tuberculosis. These findings indicate the need for health policies to expand diagnosis and treatment, improving the control of drug-resistant tuberculosis in the state of São Paulo.

Resumo em Inglês:

ABSTRACT OBJECTIVE To evaluate the differential impact of arboviral infections, specifically dengue virus, chikungunya virus, and Zika virus, on women in Brazil, with a focus on sex- and age-disaggregated analyses. METHODS A comprehensive epidemiological and geospatial data analysis was conducted utilizing data from Brazil’s national health data system, including the disease notification system (Sistema de Informação de Agravos de Notificação) and mortality information system (Sistema de Informação sobre Mortalidade), covering national and municipal level data. Arboviral case notification rates were analyzed using generalized linear mixed models with negative binomial regression, stratified by sex, age group, and year. Geospatial visualizations mapped the case rate distribution highlighting the top municipalities with the most female case rate and hospitalizations rate. All analyses were implemented in the statistical software R. RESULTS Significant sex- and age-stratified differences were observed in the arbovirus notification rates for dengue virus, chikungunya virus, and Zika virus over the past seven years, with consistently higher rates among women compared to men. Stratified analyses revealed that females aged 20–59 years, particularly those of reproductive age, bore a disproportionately higher burden across all three viruses. The low serotyping resolution for the dengue virus constrained further granular analysis, particularly for severe outcomes such as hospitalizations and mortality based on dengue serotype. CONCLUSION Sex- and age-disaggregated epidemiological surveillance is critical to inform public health policies and interventions targeting arboviral diseases. This study underscores the necessity of incorporating sex-specific data analyses to optimize responses for vulnerable female populations. Geospatial visualizations reveal infection hotspots, providing actionable insights for region-specific interventions to improve health outcomes in Brazil.

Resumo em Inglês:

ABSTRACT OBJECTIVE The Munduruku indigenous people are among those most severely impacted by mercury (Hg) contamination in the Amazon region. Mercury exposure can have severe consequences for the physical and cognitive development of children. We aimed to describe the health assessment in indigenous Munduruku children in the Tapajós River basin, possibly exposed chronically to Hg. METHODS A cross-sectional study with children <12 years old living in the Sawré Muybu (SM), Poxo Muybu (PM), and Sawré Aboy (SA) villages. We collected data between October 29th and November 9th, 2019, through interviews and clinical evaluation (child neurodevelopment tests and anthropometric measurements), and measured blood hemoglobin levels and Hg in hair samples. The history of immunization and other health issues were collected from the Brazilian health booklets. We investigated the prevalence of Hg exposure ≥ 6.0 µg/g. The measure of association used was the Prevalence Ratio (PR), with a 95% CI. RESULTS We examined 83 children, 40 in SM, 15 in SA, and 28 in PM. 51.8% were girls, 45.7% had completed the vaccination schedule, 16.0% had changes in the neurodevelopment test, and 13.9% had anemia. Their weight and height/length averages were (Z-scores) -0.86 and -1.59, respectively. 45.1% of children had Hg-levels ≥ 6.0 µg/g. The prevalence of mercury contamination in children in SA was almost four times greater (PR:3.66; 95%CI 2.17-6.18) than that in children in SM, and girls were almost twice as likely (PR:1.67; 95%CI 1.07-2.62) to have mercury levels ≥ 6.0 µg/g, when compared with boys in the study villages. CONCLUSIONS The higher concentration of hair Hg-levels occurred in SA, where Hg exposure is higher. Although we cannot prove causality, we believe that understanding the possible health impacts of mercury exposure among the Munduruku children is vital for developing strategies to mitigate these effects and for supporting the fight for their rights and the protection of their territories.

Resumo em Português:

RESUMO OBJETIVO Analisar a tendência temporal de indicadores da operação de coleta dos dados do Vigitel entre 2006 e 2023. MÉTODOS Estudo metodológico que analisou a tendência temporal de três indicadores da operação do Vigitel: taxa de elegibilidade, taxa de resposta e taxa de recusa, além do número de contatos atendidos segundo dias da semana e horários. Uma série de regressões lineares foi empregada para identificar variações temporais para o período completo (2006 a 2023) e para o quinquênio final desse período (2018 a 2023). RESULTADOS Durante as 17 edições analisadas, observou-se uma diminuição na taxa de elegibilidade (-3,26 pp/ano; p < 0,001) com maior magnitude no período mais recente (-12,23 pp/ano; p = 0,010). Embora a inclusão de telefones móveis no cadastro em 2023 tenha atenuado a queda da elegibilidade, sobretudo nos últimos anos, a redução permaneceu elevada (-10,43 pp/ano; p = 0,020). A taxa de resposta também diminuiu no período completo (-0,78; p < 0,001) e, conjuntamente com a queda da elegibilidade, representa um obstáculo para a sustentabilidade do inquérito. Em contrapartida, a taxa de recusa também diminuiu (-0,23 pp/ano; p = 0,030), indicando a consistente qualidade na operação do sistema. O número de contatos atendidos se concentrou em dias da semana e horário entre 9h e 20h. CONCLUSÕES A análise dos dados da operação do inquérito Vigitel sugere uma fadiga da metodologia empregada, com reduções na elegibilidade e na taxa de resposta ao longo dos anos. Apenas a taxa de recusa que, a despeito de estar longe de seus menores níveis, permanece em patamares satisfatórios. A busca de alternativas que tornem a participação mais conveniente para o respondente é um caminho importante para inquéritos dessa natureza, visando a manutenção da qualidade da vigilância em saúde no País.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the time trend of indicators from the Vigitel data collection operation between 2006 and 2023. METHODS A methodological study that analyzed the temporal trend of three Vigitel operation indicators: eligibility rate, response rate and refusal rate, as well as the number of contacts answered according to days of the week and times of day. A series of linear regressions was used to identify temporal variations for the entire period (2006 to 2023) and for the final five years of this period (2018 to 2023). RESULTS During the 17 editions analyzed, there was a decrease in the eligibility rate (-3.26 pp/year; p < 0.001) with the greatest magnitude in the most recent period (-12.23 pp/year; p = 0.010). Although the inclusion of mobile phones in the register in 2023 has mitigated the drop in eligibility, especially in recent years, the reduction has remained high (-10.43 pp/year; p = 0.020). The response rate also fell over the entire period (-0.78; p < 0.001) and, together with the fall in eligibility, represents an obstacle to the sustainability of the survey. On the other hand, the refusal rate also fell (-0.23 pp/year; p = 0.030), indicating the consistent quality of the system’s operation. The number of contacts answered was concentrated on weekdays and between 9am and 8pm. CONCLUSIONS An analysis of the data from the Vigitel survey suggests that the methodology used has become fatigued, with reductions in eligibility and response rates over the years. Only the refusal rate, despite being far from its lowest levels, remains at satisfactory levels. The search for alternatives that make participation more convenient for the respondent is an important path for surveys of this nature, with a view to maintaining the quality of health surveillance in the country.

Resumo em Português:

RESUMO OBJETIVO Avaliar a validade de estrutura interna e a confiabilidade da versão brasileira da Hospital Anxiety and Depression Scale (HADS) para o rastreio de sintomas depressivos e ansiosos em profissionais de saúde da atenção primária. MÉTODOS Estudo psicométrico realizado com profissionais de saúde dos serviços da atenção primária à saúde de um município do Rio Grande do Sul, Brasil, em 2023. A qualidade do instrumento HADS foi avaliada pela validade de estrutura interna, por meio da Análise Fatorial Exploratória (AFE), da Análise Fatorial Confirmatória (AFC), e pela consistência interna, pelos coeficientes Alfa de Cronbach e Ômega de McDonald’s. RESULTADOS Participaram do estudo 217 profissionais de saúde, de ambos os sexos e de diferentes categorias profissionais, como médicos, enfermeiros, técnicos e auxiliares de enfermagem, dentistas e auxiliares de saúde bucal, e agentes comunitários de saúde. A AFE evidenciou o modelo de dois fatores, ansiedade e depressão, como originalmente proposto. A AFC confirmou que o modelo bidimensional possui bom ajuste para a amostra investigada. Os valores de Alfa e Ômega foram 0,833 e 0,838 para ansiedade; 0,763 e 0,766 para depressão, respectivamente. Ambos indicaram confiabilidade aceitável. CONCLUSÕES A HADS é um instrumento válido e confiável para o rastreio de sintomas de ansiedade e depressão em profissionais da atenção primária no Rio Grande do Sul, Brasil.

Resumo em Inglês:

ABSTRACT OBJECTIVE To assess the validity of the internal structure and reliability of the Brazilian version of the Hospital Anxiety and Depression Scale (HADS) for screening depressive and anxious symptoms in primary care health professionals. METHODS A psychometric study carried out with health professionals from primary health care services in a municipality in Rio Grande do Sul, Brazil, in 2023. The quality of the HADS instrument was assessed by internal structural validity, using Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and internal consistency, using Cronbach’s Alpha and McDonald’s Omega coefficients RESULTS 217 health professionals took part in the study, of both sexes and from different professional categories, such as doctors, nurses, nursing technicians and assistants, dentists and oral health assistants, and community health workers. The EFA showed the two-factor model, anxiety and depression, as originally proposed. The CFA confirmed that the two-dimensional model was a good fit for the sample investigated. The Alpha and Omega values were 0.833 and 0.838 for anxiety and 0.763 and 0.766 for depression, respectively. Both indicated acceptable reliability. CONCLUSIONS The HADS is a valid and reliable instrument for screening symptoms of anxiety and depression in primary care professionals in Rio Grande do Sul, Brazil.

Resumo em Português:

RESUMO OBJETIVO Analisar a evolução das desigualdades socioeconômicas e regionais na mortalidade entre menores de cinco anos de idade no Brasil entre 2010 e 2022. MÉTODOS Foram analisados dados de 37.639.196 nascidos vivos e 563.711 óbitos ocorridos entre crianças menores de cinco anos no período de 2010 a 2022. Calcularam-se taxas de mortalidade infantil entre menores de um ano de idade (TMI) e de mortalidade entre crianças com um a quatro anos. Para análise das desigualdades, os municípios foram agrupados segundo decis do Índice de Desenvolvimento Humano Municipal (IDH-M) de 2010 e foram calculados o Slope Index of Inequality (SII) e o Relative Index of Inequality (RII). O excesso de óbitos foi estimado aplicando-se taxas de mortalidade observadas no decil de maior IDH-M aos demais. Realizou-se distribuição espacial dos óbitos segundo microrregiões brasileiras RESULTADOS A TMI diminuiu de 13,0 para 12,7 por mil nascidos vivos entre 2010 e 2022, enquanto a mortalidade entre crianças de um a quatro anos foi de 2,5 por mil nascidos vivos nos anos extremos analisados. Houve apenas discreta redução nas desigualdades, com o SII oscilando entre 2010 e 2022 de -5,63 a -4,91 na TMI e -2,42 a -1,71 na mortalidade entre crianças de um a quatro anos. Em 2022, municípios com menor IDH-M apresentaram taxas 49,0% e 93,0% maiores em relação àqueles com maior IDH-M na TMI e na mortalidade entre um e quatro anos, respectivamente. Na TMI, as desigualdades foram mais acentuadas em doenças nutricionais-metabólicas-endócrinas, com a mortalidade sendo quatro vezes maior nos municípios com menor IDH-M. Houve excesso de 76.832 óbitos infantis no Brasil entre 2010 e 2022. Em 2022, 42,2% das microrregiões do Norte estavam entre as 100 com maiores taxas de mortalidade infantil, valor que chegou a apenas 3,2% no Sul. CONCLUSÕES Houve pequena redução na mortalidade entre crianças e persistiram significativas desigualdades socioeconômicas e regionais no Brasil.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the evolution of socioeconomic and regional inequalities in mortality among children under five years of age in Brazil between 2010 and 2022. METHODS Data from 37,639,196 live births (LB) and 563,711 deaths among children under five years during the period were analyzed. Mortality rates for infants (<one year-old, IMR) and children aged one to four years were calculated. For inequality analysis, municipalities were grouped according to deciles of the 2010 Municipal Human Development Index (M-HDI). The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated. The excess mortality was estimated by applying the mortality rates observed in the highest M-HDI decile to the other deciles. The spatial distribution of deaths was analyzed according to the country’s microregions. RESULTS The IMR decreased from 13.0 to 12.7 per thousand LB between 2010 and 2022, while mortality among children aged one to four years remained stable at 2.5 per thousand LB in 2010-2022. There was only a slight reduction in inequalities, with the SII oscillating from -5.63 to -4.91 in IMR and from -2.42 to -1.71 in mortality among children aged one to four years between 2010-2022. In 2022, municipalities with lower M-HDI had mortality rates 49.0% and 93.0% higher than those with higher M-HDI in IMR and mortality among children aged one to four years, respectively. Inequalities in IMR were more pronounced in nutritional, metabolic, and endocrine diseases, where mortality was four times higher in municipalities with lower M-HDI. There was an excess of 76,832 child deaths in Brazil between 2010-2022. In 2022, 42.2% of the microregions in the North were among the top 100 with the highest IMR, compared to only 3.2% in the South. CONCLUSIONS There was a slight reduction in child mortality, but significant socioeconomic and regional inequalities persisted in Brazil.

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ABSTRACT OBJECTIVE: This study aimed to characterize swallowing and investigate the association between self-reported coughing and/or choking during meals and the risk of dysphagia in frail elderly individuals receiving healthcare at a specialized center in São Paulo, Brazil. METHODS: This cross-sectional observational study included elderly individuals attending an Elderly Health Reference Unit (URSI) from July 2017 to December 2023. Data from all patients referred to the URSI were collected, excluding only those with incomplete medical records. The study proceeded in two phases: the first phase involved physical, functional, and social assessments, while the second phase included speech and swallowing evaluations. Participants were categorized into groups based on self-reported mealtime symptoms. Descriptive and inferential analyses compared these groups using the Mann-Whitney U test for quantitative data and Pearson's χ2 test for qualitative data. Risk analysis employed multiple logistic regression with forward stepwise selection. RESULTS: The study comprised 1,027 elderly individuals (mean age 78 years; 68.2% women; 64.2% self-identified as white). Approximately half reported frequent choking during meals. Sex, Multidimensional Assessment of the Elderly in Primary Care classification and score, polypharmacy, chronic diseases, falls, urinary incontinence, osteoporosis, cardiac disease, last dental visit, speech difficulty, change in food consistency, hearing loss, and hearing aid use were associated with mealtime symptoms. Speech alterations increased bronchoaspiration risk by 16%, memory complaints by 11%, and xerostomia and food consistency changes by 8%. CONCLUSION: Speech alterations, changes in food consistency, memory complaints, and xerostomia were identified as factors increasing the risk of bronchoaspiration. Early identification and a multidisciplinary approach to swallowing disorders in frail elderly individuals are crucial for preventing aspiration pneumonia and maintaining quality of life. These findings underscore the significance of proactive management strategies in clinical practice.

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ABSTRACT OBJECTIVE: To analyze the impact of the COVID-19 pandemic on food insecurity (FI) among families living in rural and urban areas of Brazil. METHODS: Cross-sectional and descriptive study based on the analysis of two nationally representative surveys conducted using probabilistic sampling by clusters in urban and rural areas of Brazil (2020 and 2022). FI was measured using the Brazilian Food Insecurity Scale. The households were classified as food secure, mild FI, or moderate/severe FI. Prevalence and 95% confidence intervals (95%CI) and analyses were performed in Stata 16 considering the respective sample weights (svy). Variations between the two surveys were analyzed by urban and rural area, and associations with gender and race/skin color. RESULTS: The majority of households were located in urban areas (2020: 85.6% [n = 1,662]; 2022: 85.5% [n = 10,365]) compared to rural areas (2020: 14.5% [n = 518]; 2022: 85.5% [n = 2,382]). with regard to the characteristics of the household reference person, schooling level, being a formal worker and the per capita family income were higher among families from urban areas. Between 2020 and 2022, the proportion of severe levels of FI increased significantly more in households from rural areas. Despite the higher FI in rural areas, a variation of +54% was noted in urban areas, where the prevalence of moderate/severe FI increased from 19.4% (2020) to approximately 30% (2022). There were greater proportions of FI in households headed by men in urban areas (+75.1%) and mixed race/black people (+55.9%), while households headed by white people saw an improvement in FS. CONCLUSION: The FI increased unequally between the rural and urban areas of Brazil during the COVID-19 pandemic. The results of this study reinforce the need to plan equitable public policies that debate the different vulnerability profiles aggravated by disparities as a way of guaranteeing food and nutritional security in post pandemic in Brazil.

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ABSTRACT OBJECTIVE: To characterize retractions of biomedical research papers that had a least one author affiliated with a Latin American (LATAM) institution. METHODS: We conducted a cross-sectional study of retracted research papers published in scientific journals focusing on the field of biomedical research and identified by means of the Retraction Watch database. The retracted articles identified were required to have at least one author whose institutional affiliation was in a LATAM country. Data were collected on the authors’ countries and institutional affiliations, the reason for retraction, dates of publication and retraction, indexing, journal quartile and impact factor. Reasons for retraction were categorized into three major groups, i.e., scientific misconduct, error, and not specified. RESULTS: According to Retraction Watch, 181 papers were retracted across 1987–2024 which fulfilled the inclusion criteria. Guatemala, Bolivia, Peru, Panama, Ecuador, Colombia, and Argentina were the countries that had a retraction rate above 1 per 10 thousand papers throughout the study period. The principal reason for retraction was scientific misconduct (63.0%) followed by honest error (21.5%). The main causes of retraction due to scientific misconduct were ethical and legal problems (33.1%), followed by fabrication/falsification (20.2%). CONCLUSION: The number of retractions in some LATAM countries, mainly due to scientific misconduct, highlights the need to strengthen ethical practices in research. Future initiatives should focus on developing and evaluating effective strategies to prevent misconduct and promote scientific integrity.

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ABSTRACT OBJECTIVE: To evaluate quality of life, sarcopenia and proteinuria, six and 12 months after infection with mild and moderate COVID-19. METHODS: We evaluated 253 individuals with mild (n = 119) and moderate (n = 134) clinical presentation for COVID-19 (reverse transcription-polymerase chain reaction—RT-PCR) after six (T6) and 12 (T12) months from the date of acute infection (T0). Quality of life, pain, risk for sarcopenia, muscle strength and proteinuria were assessed by the Short Form Health Survey 36 (SF-36) questionnaire; visual analogue scale (VAS); the Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F); hand grip and sit-up and the urinalysis strip, respectively. RESULTS: The average age was 44 ± 10 and 43 ± 12 years; female 68 and 59% for the mild and moderate groups, respectively. Seventy-five percent or more of patients were vaccinated with at least two doses before acquiring COVID-19 infection. Individuals with a moderate clinical presentation in relation to mild cases were hypertensive (23 and 6%, p < 0.001) and had diabetes mellitus (9 and 2%; p = 0.01) at the time of COVID-19 acute infection. The moderate group at T6 presented lower functional capacity (SF36: 46 ± 20 vs. 61 ± 24); more pain (SF36: 45 ± 29 vs. 67 ± 32 and VAS: 55 vs. 32%); greater dysfunctionality for daily activities (Duke Activity Status Index—DASI: 40 ± 11 vs. 45 ± 10); lower limb muscle strength (sit-up: 9 ± 2 vs. 11 ± 2); higher risk for sarcopenia (SARC-F: 6 ± 4 vs. 4 ± 3) and higher proteinuria ≥ 1"+": 59 vs. 42%) compared to the mild group. After 12 months, the moderate group remained with greater pain (SF36+VAS) and more dysfunctionality in daily activities (DASI) compared to the mild group. CONCLUSION: Comparing T12 to T6, we observed that the mild group had worse functional capacity; more pain (SF36+VAS); lower upper limb strength and higher proteinuria ≥ 1"+": 63 vs. 42%). We observed a negative correlation between SARC-F score and sit-up; functional capacity (SF36).

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ABSTRACT OBJECTIVE: To evaluate the efficacy of auricular acupuncture in reducing insomnia symptoms among individuals with depression compared with non-specific auricular acupuncture, at four weeks, six weeks, and three months after the intervention began. METHODS: A randomized, blinded clinical trial assessed sleep quality using the Pittsburgh Sleep Quality Index in 74 adults equally divided into two groups: specific auricular acupuncture and non-specific auricular acupuncture. Both groups underwent 12 auricular acupuncture sessions performed twice a week. RESULTS: After three months, the intention-to-treat analysis found no statistically significant difference in achieving good sleep quality between groups (33.3% versus 26.1%, p > 0.05). However, a trend toward statistical significance occurred after 4 weeks, with 50% of participants in the experimental group and 24.1% in the control group achieving good sleep quality (p = 0.057). CONCLUSIONS: We observed no statistically significant difference in sleep quality between individuals with depressive symptoms undergoing specific auricular acupuncture compared with non-specific after three months. However, a significant trend (p = 0.057) confirmed by the per-protocol analysis (p = 0.038) indicated that participants receiving specific auricular acupuncture had a 69% higher chance of achieving good sleep quality after four weeks. These findings should be interpreted with caution, as they did not reach statistical significance; rather, they reflect a trend toward significant improvement and are subject to the study's limitations.

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ABSTRACT OBJECTIVE: To investigate the impact of prenatal care on the reduction of maternal-child mortality in Brazilian municipalities following the new primary health care financing model, the Previne Brasil program. METHODS: This study comprised a nationwide cross-sectional observational analysis, utilizing secondary data from Departamento de Informática do Sistema Único de Saúde (Datasus – Information Technology Department of the Unified Health System), Sistema de Informação sobre Mortalidade (SIM – Mortality Information System), Sistema de Informação sobre Nascidos Vivos (Sinasc – Live Birth Information System), Sistema de Informação em Saúde para a Atenção Básica (Sisab – Primary Health Care Information System), and Instituto Brasileiro de Geografia e Estatística (IBGE – Brazilian Institute of Geography and Statistics). Medians of maternal mortality, infant mortality, and prenatal care rates were calculated for Brazilian municipalities from 2016 to 2022. Logistic regression analyses were conducted to assess associations between independent variables (primary care coverage, population size, Gross Domestic Product, and Gini index) and outcomes (variations in maternal and infant mortality rates). Both crude and adjusted odds ratios were estimated, with a significance level of 5%. RESULTS: Prenatal care rates increased by 86.7%, while maternal mortality rates decreased by 30.9%, with no association between them. Region, primary care coverage, municipal Gross Domestic Product, and population size were associated with variations in maternal mortality rates. The Southern region had a higher likelihood of reducing maternal mortality. No association was found between increased prenatal care rates and reduced infant mortality. Regional location, primary care coverage, population size, and the Gini index were associated with variations in infant mortality rates, with greater reductions observed in more populous municipalities and in the Northeast, Southeast, and Midwest. CONCLUSION: The Previne Brasil program led to an increase in prenatal care consultations in Brazilian municipalities but did not significantly impact the reduction of maternal-child mortality.

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RESUMO OBJETIVO Analisar o período transcorrido no processo pós-incorporação de procedimentos, órteses, próteses e materiais especiais, observando o cumprimento ao prazo legal de 180 dias estabelecido para a oferta da tecnologia. MÉTODOS A análise foi realizada com procedimentos e órteses, próteses e materiais especiais com recomendação de incorporação pela Comissão Nacional de Incorporação de Tecnologias entre 2012 e 2022, e código de identificação da tecnologia criado no Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos, Órteses, Próteses e Materiais Especiais do SUS após a incorporação. Para as tecnologias identificadas, foram calculados períodos que informam a mediana (Q1–Q3) dos dias transcorridos nos períodos de incorporação e pós-incorporação. Adicionalmente, foi verificada a proporção de tecnologias ofertadas conforme prazo legal, e analisada a influência de variáveis no período pós-incorporação. RESULTADOS Entre 41 relatórios de procedimentos, órteses, próteses e materiais especiais selecionados, 79 tecnologias foram analisadas. O período para codificação, definido como marco da oferta da tecnologia, apresenta mediana de 204 (57–425) dias. Esse período foi maior que 180 dias em 64% das tecnologias avaliadas. Variáveis como o grupo de organização a que a tecnologia pertence, indicação da necessidade de adequação para implementação no relatório de incorporação e atraso no período de avaliação para incorporação parecem influenciar o período para oferta da tecnologia. CONCLUSÕES A efetiva oferta das tecnologias incorporadas no sistema de saúde no Brasil não tem ocorrido dentro do período previsto de 180 dias na maioria dos casos, o que limita seu oferecimento à população. A previsão da necessidade de adequação para implementação, ainda durante a incorporação, parece ser uma forma de diminuir o período pós-incorporação.

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ABSTRACT OBJECTIVE To analyze the time elapsed in the post-incorporation process of procedures, orthoses, prostheses, and special materials, with a focus on compliance with the legal deadline of 180 days established for the provision of the technology. METHODS The analysis was conducted with procedures and orthoses, prostheses, and special materials recommended for incorporation by the National Commission for the Incorporation of Technologies from 2012 to 2022, and the technology identification code created in the Management System for the Table of Procedures, Medicines, Orthoses, Prostheses and Special Materials of the Brazilian Unified Health System, after incorporation. For the technologies identified, we calculated the median periods (Q1–Q3) of the days elapsed during the incorporation and post-incorporation periods. In addition, the proportion of technologies offered according to the legal deadline was verified, and the influence of variables on the post-incorporation period was analyzed. RESULTS Among 41 reports on procedures, orthoses, prostheses, and special selected materials, 79 technologies were analyzed. The coding period, defined as the benchmark for the supply of the technology, had a median of 204 (57–425) days. This period was longer than 180 days in 64% of the technologies assessed. Variables such as the organization group to which the technology belongs, indication of the need to adapt for implementation in the incorporation report, and delay in the evaluation period for incorporation seem to influence the period for providing the technology. CONCLUSIONS The effective provision of technologies incorporated into the health system in Brazil has not occurred within the expected period of 180 days in most cases, which limits their accessibility to the population. Anticipating the need for adaptation before implementation, even during incorporation, seems to be a way of reducing the post-incorporation period.

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RESUMO OBJETIVO Descrever o perfil de saúde e o padrão de exposição aos resíduos de minério nos três anos de uma coorte com crianças residentes nas localidades atingidas pelo desastre de rompimento da barragem de mineração em Brumadinho (MG), em 2019. MÉTODOS Coorte prospectiva cuja população de estudo é formada por todas as crianças entre 0 e 6 anos residentes em quatro localidades selecionadas, sendo três (Parque da Cachoeira, Córrego do Feijão e Tejuco) na área do desastre (área exposta) e uma (Aranha) situada a 10 km de distância (área não exposta). Foram realizadas avaliações do crescimento pôndero-estatural, desenvolvimento neuromotor e cognitivo e alterações respiratórias, bem como coletadas amostras de urina para análise de chumbo, arsênio, cádmio, mercúrio e manganês pelo método de espectrometria de massas com plasma indutivamente acoplado (ICP-MS). RESULTADOS O percentual médio de crianças avaliadas foi de 80% da população prevista no período. Houve aumento do percentual de crianças detectadas com níveis de arsênio urinário acima do valor de referência ao longo dos três anos (2021 = 42%; 2022 = 44%; 2023 = 57%) e das taxas de detecção de chumbo (88,9%) e mercúrio (63,9%) em 2021, para 100% em 2023. Houve aumento da mediana das concentrações de arsênio entre os anos de 2021 (9,35 µg/g; IQI = 5,45–13,9) e 2023 (10,8 µg/g; IQI = 7,0–15,3) no total de crianças avaliadas (p = 0,064), e de forma significativa nas crianças residentes na área exposta (p = 0,015, PC). Nos três anos ocorreu uma diminuição no percentual de alterações do neurodesenvolvimento e de sobrepeso e obesidade, e um aumento dos relatos de alterações respiratórias na população total, sem relação com a exposição a metais. CONCLUSÃO Observa-se um cenário de exposição permanente da população de estudo aos metais analisados, mas ainda sem indicação de alterações de saúde associadas aos mesmos. É importante a organização do Sistema Único de Saúde de acordo com as especificidades dos processos produtivos de cada território.

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ABSTRACT OBJECTIVE To describe the health profile and patterns of exposure to mining waste over the period of three years in a cohort of children living in areas affected by the collapse of a mining tailings dam in Brumadinho, Minas Gerais State, Brazil, in 2019. METHODS This prospective cohort study included all children aged 0 to six years residing in four selected locations: three in the disaster zone (Parque da Cachoeira, Córrego do Feijão, and Tejuco – exposed areas) and one located 10 km away (Aranha – non-exposed area). Assessments included anthropometric growth, neuromotor and cognitive development, and respiratory conditions. Urine samples were collected and analyzed for lead, arsenic, cadmium, mercury, and manganese using inductively coupled plasma mass spectrometry (ICP-MS). RESULTS The average percentage of children assessed in the period was 80% of the projected population. There was an increase in the percentage of children with urinary arsenic levels above the reference value over the three-year period (2021 = 42%; 2022 = 44%; 2023 = 57%), as well as in detection rates of lead (88.9%) and mercury (63.9%) in 2021, both reached 100% in 2023. The median urinary arsenic concentration increased from 2021 (9.35 μg/g; IQR = 5.45–13.9) to 2023 (10.8 μg/g; IQR = 7.0–15.3) in the total sample of children (p = 0.064), with a statistically significant increase among those living in exposed areas (p = 0.015; Parque da Cachoeira). Over the three-year period, there was a decrease in the percentage of neurodevelopmental alterations and overweight/obesity, and an increase in reports of respiratory alterations in the total population, although these changes were not related to metal exposure. CONCLUSION The findings indicate ongoing exposure of the metals analyzed in the study population; however, no associated health effects have been identified thus far. It is essential that the Brazilian Unified Health System be structured according to specificities of the productive processes in each territory.

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ABSTRACT OBJECTIVE To evaluate the intra- and between-group (control and intervention) effect of counseling during pregnancy on pregnant women’s food consumption and physical activity. METHODS This randomized, parallel, two-arm clinical trial was carried out in primary health care in a Brazilian municipality from 2018 to 2021. Adult pregnant women with pre-gestational overweight (n = 350) were randomly assigned to the control or intervention groups. The intervention consisted of three counseling sessions based on the NOVA food classification system and encouragement toward physical activity. Then, 24-hour dietary records were obtained, and physical activity was assessed using a structured questionnaire. The Wilcoxon test was used for intra-group differences between assessments and the Mann-Whitney test, for differences between groups. RESULTS Women in the control group consumed less minimally and unprocessed foods (%E) (Δ = −4.08; -13.58 to 4.34; p = 0.006) and more ultra-processed foods (%E) (Δ = 3.74; −5.86 to 12.86; p = 0.009), with no difference between groups. The intervention group showed an increase in commuting-related physical activity (min/week) between assessments (Δ = 9.00; −30.00 to 70.00; p = 0.02), with no difference between groups. The other parameters showed no differences. CONCLUSIONS The intervention failed to affect outcomes. However, intragroup changes showed that the control consumed less minimally and unprocessed foods and more ultra-processed foods and the intervention group increased their commuting-related physical activities.

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ABSTRACT OBJECTIVE To investigate the effect of Zika virus on the locomotor activity of a Brazilian population of Aedes albopictus under laboratory conditions. METHODS Females of Aedes albopictus were infected with Zika virus orally or by intrathoracic injection. The locomotor activity was monitored using a Drosophila activity monitor under controlled conditions of 25°C and a 12h light/dark cycle. The infection status was determined using reverse transcription followed by real-time polymerase chain reaction (RT-qPCR). Statistical analyses were conducted using generalized linear mixed models (GLMMs). RESULTS The locomotor activities of Zika virus-infected and uninfected Aedes albopictus females were diurnal and bimodal, with peaks at lights on and off. The infection did not significantly alter the total activity, diurnal and nocturnal, or the light-on and light-off peaks of infected females compared with uninfected females, regardless of the method of infection (intrathoracic injection or orally). CONCLUSION This finding indicates that Zika virus infection does not affect the daily activity pattern of this species under laboratory conditions, which reinforces the importance of this species as a competent and adaptable vector in urban and rural areas, confirming the importance of ongoing surveillance and control strategies.

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RESUMO OBJETIVOS Apresentar o perfil dos egressos de um curso semipresencial de auriculoterapia e sua percepção da aceitação dos usuários e dos resultados clínicos dessa prática integrativa e complementar em saúde, a mais realizada atualmente no Sistema Único de Saúde. O curso é ofertado gratuitamente aos profissionais da atenção primária à saúde. MÉTODO Um questionário digital foi enviado em 2023 por correio eletrônico a todos os egressos até então (n = 13.851), com questões sobre seu perfil profissional, sua percepção da aceitação pelos usuários e dos resultados clínicos da auriculoterapia. Os dados foram discutidos por meio de estatística descritiva. RESULTADOS 5.461 profissionais responderam (41,34% dos egressos de nove edições do curso, com muitas turmas de cerca de 50 a 100 estudantes). A maioria era composta por mulheres (87,82%), enfermeiros (33,55%), fisioterapeutas (11,59%), psicólogos (5,40%), farmacêuticos (9,65%), nutricionistas (8,05%), dentistas (7,57%) e médicos (5,57%); de idades entre 30 e 49 anos (77,7%); atuantes na atenção primária à saúde (80,44%); sem prática prévia de prática integrativa e complementar em saúde (73,58%). 56,31% reportaram praticar a auriculoterapia após o curso. A aceitação dos usuários foi relatada como alta ou muito alta por 73,6% e média por 22,14% dos praticantes. Os resultados clínicos foram relatados como muito bons ou bons por 79,72% dos praticantes e médios por 18,35%. CONCLUSÃO Os egressos do curso de auriculoterapia que responderam à pesquisa são na maioria mulheres, profissionais da saúde da família e das equipes multiprofissionais atuantes na atenção primária à saúde, que relatam boa aceitação dos usuários e percebem bons resultados clínicos no uso da auriculoterapia.

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ABSTRACT OBJECTIVES To present the profile of graduates from a blended learning course in auriculotherapy and their perception of user acceptance and clinical outcomes of this integrative and complementary health practice, currently the most widely implemented in the Brazilian Unified Health System. The course is offered free of charge to primary health care professionals. METHOD A digital questionnaire was sent in 2023 by email to all graduates to date (n = 13,581), addressing their professional profile, their perception of user acceptance and the clinical outcomes of auriculotherapy. Data were analyzed using descriptive statistics. RESULTS A total of 5,461 professionals responded (41.34% of graduates from nine editions of the course, each with multiple classes of around 50 to 100 students). Most were women (87.82%), nurses (33.55%), physical therapists (11.59%), psychologists (5.40%), pharmacists (9.65%), nutritionists (8.05%), dentists (7.57%), and physicians (5.57%); aged 30 to 49 years (77.7%); working in primary health care (80.44%); without prior experience in integrative and complementary health practice (73.58%). After the course, 56.31% reported practicing auriculotherapy. User acceptance was reported as high or very high by 73.6% and as moderate by 22.14% of practitioners. Clinical outcomes were reported as very good or good by 79.72% and as moderate by 18.35%. of practitioners. CONCLUSION The graduates of the auriculotherapy course who responded to the survey are mostly women, family health professionals and members of multi-professional teams working in primary health care, who report higher user acceptance and perceive good clinical outcomes from the use of auriculotherapy.

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RESUMO OBJETIVO Investigar as tendências temporais e os agrupamentos regionais dos desfechos do tratamento da tuberculose em pessoas com HIV no Brasil, considerando sua relação com indicadores socioeconômicos e programáticos. MÉTODOS Estudo ecológico com dados de pessoas vivendo com HIV que iniciaram e encerraram o tratamento para tuberculose entre 2015 e 2021 no Brasil. Foram descritas as tendências semestrais das taxas de cura, interrupção do tratamento e óbito nos estados brasileiros, usando-se modelos de regressão joinpoint. Análises de cluster, estratificadas em três portes populacionais, foram realizadas pelo método k-means visando identificar agrupamentos nas 510 regiões geográficas imediatas. Empregaram-se indicadores socioeconômicos e programáticos relacionados à interrupção do tratamento e ao óbito, mediante associação em modelos multivariados de regressão binomial negativa. RESULTADOS Analisaram-se 54.362 tratamentos de tuberculose em pessoas com HIV, com taxas de cura em 55,51%, interrupção em 23,33% e óbito em 21,16%, para o período. Observou-se estabilidade na cura a nível nacional, enquanto a interrupção do tratamento aumentou semestralmente em 2,54% (variando entre 1,59% e 3,70%) e o óbito em 9,31% (oscilando entre 7,41% e 17,24%). Estados como Ceará e Amapá apresentaram as piores tendências para as taxas de interrupção do tratamento e óbito. Regiões com maiores desigualdades na distribuição de renda, percentuais de trabalhadores com ensino fundamental, percentuais de densidade domiciliar e coberturas da saúde suplementar tiveram elevadas taxas de interrupção do seguimento e óbito. Em contrapartida, aquelas com maiores expectativas de anos de estudo e internações por condições sensíveis à atenção primária apresentaram menores probabilidades desses desfechos. CONCLUSÃO Nacionalmente, apesar da estabilidade na cura, viu-se aumento nas taxas de interrupção do tratamento e óbito por tuberculose em pessoas com HIV. As disparidades regionais na relação de indicadores socioeconômicos e programáticos com os desfechos sugerem iniquidades no acesso e na adesão ao tratamento da tuberculose nos diferentes territórios do país.

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ABSTRACT OBJECTIVE To investigate the temporal trends and regional clusters of tuberculosis treatment outcomes among people with HIV in Brazil, as well as their relationship with socioeconomic and programmatic indicators. METHODS Ecological study with data from people living with HIV who initiated and completed tuberculosis treatment from 2015 to 2021 in Brazil. We described the semiannual trends of cure, treatment interruption, and death rates in Brazilian states using joinpoint regression models. Cluster analyses stratified by three population sizes were conducted using the k-means method to identify clusters in 510 immediate geographic regions. Socioeconomic and programmatic indicators related to treatment interruption and death were included in multivariate negative binomial regression models. RESULTS A total of 54,362 tuberculosis treatments in people with HIV were analyzed, with cure rates of 55.51%, interruption rates of 23.33%, and death rates of 21.16% for the period. Nationally, cure rates remained stable, while treatment interruption increased by 2.54% per semester (ranging from 1.59% to 3.70%) and death increased by 9.31% (ranging from 7.41% to 17.24%). The states of Ceará and Amapá showed the worst trends for treatment interruption and death. Regions with greater income inequality, higher percentages of workers with only primary education, higher household density, and broader private health coverage had higher rates of treatment interruption and death. Conversely, regions with higher expected years of schooling and hospitalizations for primary care-sensitive conditions had lower probabilities of these outcomes. CONCLUSION Nationally, despite stable cure rates, tuberculosis treatment interruption and death among people with HIV increased. Regional disparities in the relationship between socioeconomic and programmatic indicators and outcomes suggest inequities in access to and adherence to tuberculosis treatment across Brazil.

Resumo em Português:

RESUMO OBJETIVO Analisar a associação entre presença de síndrome pós-covid-19 após 6 meses e a qualidade de vida relacionada à saúde após 6 e 12 meses da alta hospitalar. MÉTODOS Estudo de coorte ambidirecional, realizado com indivíduos que receberam alta em três dos principais hospitais de Cuiabá (MT) entre outubro de 2021 e março de 2022. Após coleta de dados em prontuários, os indivíduos foram entrevistados por telefone após 6 meses (n = 189) e 12 meses (n = 159) da alta hospitalar, sendo avaliada a presença de pelo menos um sintoma persistente pós-covid-19 aos 6 meses (síndrome pós-covid-19) e a qualidade de vida relacionada à saúde (EQ-5D-3L) aos 6 e 12 meses, bem como das dimensões específicas (mobilidade, autocuidado, atividades habituais, dor/desconforto e ansiedade/depressão). A associação foi avaliada pela regressão de Poisson com variância robusta, ajustada para características sociodemográficas, de saúde e internação. RESULTADOS Dos indivíduos avaliados, 88,4% responderam que apresentaram sintomas da covid-19 na entrevista após 6 meses. Aos 6 e 12 meses de alta hospitalar, 55,0% e 74,2% dos indivíduos, respectivamente, apresentaram algum prejuízo na qualidade de vida. No modelo múltiplo, a síndrome pós-covid-19 manteve-se associada a ter qualquer problema de qualidade de vida (RR = 2,43; IC95% 1,06–5,57) e especificamente ao domínio ansiedade/depressão (RR = 2,74; IC95% 1,08–7,01) aos 6 meses após a alta. A associação não se manteve significativa após 12 meses. CONCLUSÃO Esses resultados demonstram as repercussões negativas a longo prazo da síndrome pós-covid-19 nas funções cognitivas, emocionais e físicas, expondo o impacto negativo para a qualidade de vida das pessoas acometidas.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the association between the presence of post-COVID-19 syndrome after six months and health-related quality of life 6 and 12 months after hospital discharge. METHOD An ambidirectional cohort study was conducted with individuals discharged from three of the main hospitals in Cuiabá (in the state of Mato Grosso) between October 2021 and March 2022. After collecting data from medical records, individuals were interviewed via telephone 6 months (n = 189) and 12 months (n = 159) after hospital discharge, evaluating the presence of at least one persistent post-COVID-19 symptom at 6 months (post-COVID-19 syndrome) and health-related quality of life (EQ-5D-3L) at 6 and 12 months, as well as specific dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). The association was assessed via Poisson regression with robust variance, adjusted for sociodemographic, health, and hospitalization characteristics. RESULTS Of the individuals assessed, 88.4% answered that they had COVID-19 symptoms in the interview after 6 months. At 6 and 12 months after hospital discharge, 55.0% and 74.2% of individuals, respectively, had some impairment in quality of life. In the multiple model, post-COVID-19 syndrome remained associated with having any quality of life issue (RR = 2.43; 95%CI: 1.06–5.57) and specifically with the anxiety/depression domain (RR = 2.74; 95%CI: 1.08–7.01) at 6 months after discharge. The association was no longer significant after 12 months. CONCLUSION These results show the long-term negative repercussions of post-COVID-19 syndrome on cognitive, emotional, and physical functions, exposing the negative impact on the quality of life of those affected.

Resumo em Português:

RESUMO OBJETIVO Investigar a visita domiciliar para consulta e/ou procedimentos e fatores associados em famílias com pessoas com dificuldade de locomoção e necessidade de atendimento no domicílio por médico ou enfermeiro. MÉTODOS Foi realizado um estudo transversal com dados do Ciclo III do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, entre setembro de 2017 e junho de 2018, que entrevistou mais de 140.000 usuários em 28.939 unidades básicas de saúde de 5.312 municípios. O estudo analisou o recebimento de visita domiciliar a indivíduos com dificuldade de locomoção e necessidade de atendimento no domicílio de acordo com fatores internos e externos, utilizando regressão de Poisson. RESULTADOS Do total de usuários dos serviços de atenção primária, 7,8% afirmaram ter alguém com dificuldade de locomoção e necessidade de atendimento domiciliar. Cerca de 70% receberam visita domiciliar. A maior prevalência de visita domiciliar, após análise ajustada, foi na região Nordeste. Quanto maior a vulnerabilidade social, menor a prevalência de recebimento de visita domiciliar em caso de dificuldade de locomoção. Em municípios com 100% de cobertura de estratégia saúde da família houve maior prevalência de visita domiciliar em relação àqueles com cobertura menor que 50%. CONCLUSÃO Fatores externos, como renda e índice de vulnerabilidade social, com maior relação com os macro determinantes sociais, permanecem apontando iniquidades na atenção; enquanto fatores internos, como a cobertura de saúde da família, a cobertura de agente comunitário de saúde em todas as microáreas e “porta aberta” como característica do processo de trabalho das equipes, indicaram melhores resultados. O estudo fortalece a importância de políticas públicas que incentivem a recomposição do número de profissionais das equipes de saúde da família, a fim de terem equipes completas e com capacidade de cuidado integral da população.

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ABSTRACT OBJECTIVE To investigate home visits by physicians or nurses for consultations and procedures and associated factors in families with people with mobility difficulties and need for home care. METHODS A cross-sectional study was carried out with data from Ciclo III do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (Cycle III of the National Program for Access and Quality Improvement in Primary Care) from September 2017 to June 2018, interviewing over 140,000 users in 28,939 basic health units in 5,312 municipalities. This study analyzed home visits to individuals with mobility difficulties and the need for home care according to internal and external factors via a Poisson regression. RESULTS Of all primary healthcare service users, 7.8% stated that someone in their home had mobility difficulties and needed home care. About 70% received home visits. The highest prevalence of home visits, after adjusted analysis, occurred in the Brazilian Northeast. The greater the social vulnerability, the lower the prevalence of home visits in the case of mobility difficulties. Municipalities with 100% coverage from the family health strategy showed a higher prevalence of home visits than those with coverage below 50%. CONCLUSION External factors, such as income and social vulnerability index (which have a greater relation with macrosocial determinants), continue to point toward inequalities in care; whereas internal factors, such as family health coverage, community health agent coverage in all micro-areas, and the possibility of receiving care without prior appointments indicated better results. This study reinforces the importance of public policies that encourage complete family health teams to provide comprehensive care to the population.

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RESUMO OBJETIVO Analisar a associação entre insatisfação dos usuários com os serviços farmacêuticos do Sistema Único de Saúde (SUS) e a não adesão ao uso de medicamentos por pacientes de doenças crônicas não transmissíveis. MÉTODOS Estudo transversal com dados do componente de avaliação de serviços da Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil, realizada de julho a dezembro de 2014. Foram analisadas entrevistas presenciais de usuários do SUS de 18 anos ou mais que usavam medicamentos para hipertensão, diabetes e dislipidemia e as farmácias do SUS nos três meses anteriores à pesquisa. A variável dependente foi a não adesão aos medicamentos avaliada por meio de três medidas: não adesão por falta do medicamento, não adesão nos últimos sete dias e não adesão declarada. A variável independente foi a insatisfação com as dimensões dos serviços farmacêuticos (oportunidade, disponibilidade e adequação), obtida por meio da teoria de resposta ao item. A regressão logística foi realizada com cálculo dos odds ratio (OR) brutos e ajustados. RESULTADOS Foram avaliados 2.448 usuários. A não adesão por falta foi de 31,6%, nos últimos sete dias de 11,5% e a declarada de 13,0% dos entrevistados. A falta de acesso e o esquecimento foram as principais justificativas para a não adesão nos últimos sete dias. Na análise ajustada a insatisfação com a dimensão “oportunidade” esteve associada à não adesão nos últimos sete dias (OR = 1,489; IC95% 1,023–2,168) e a dimensão “adequação” associada à não adesão declarada (OR = 3,132; IC95% 2,266–4,329). CONCLUSÃO Os insatisfeitos foram mais não aderentes ao uso de medicamentos em todas as dimensões e a insatisfação com a disponibilidade e adequação dos serviços dos serviços farmacêuticos esteve associada à não adesão ao uso de medicamentos.

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ABSTRACT OBJECTIVE To analyze the association between user dissatisfaction with the pharmaceutical services provided by the Brazilian Unified Health System (SUS) and nonadherence to medication use by patients with chronic non-communicable diseases. METHODS A cross-sectional study with data from the service evaluation component of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos in Brazil, conducted from July to December 2014. In-person interviews were analyzed with SUS users aged 18 or over who had used medications for hypertension, diabetes, and dyslipidemia and had visited SUS pharmacies in the three months prior to the survey. The dependent variable was medication nonadherence, assessed through three measures: nonadherence due to lack of medication, nonadherence in the past seven days and declared nonadherence. The independent variable was dissatisfaction with the dimensions of pharmaceutical services (timeliness, availability, and accommodation), measured using item response theory. Logistic regression was performed to calculate crude and adjusted odds ratios (OR). RESULTS A total of 2,448 users were evaluated. Nonadherence due to lack of medication was 31.6%; in the past seven days was 11.5%; and declared nonadherence 13.0%. Lack of access and forgetfulness were the main reasons for nonadherence in the past seven days. In the adjusted analysis, dissatisfaction with the “timeliness” dimension was associated with nonadherence in the past seven days (OR = 1.489; 95%CI: 1.023–2.168) and the “accommodation” dimension was associated with declared nonadherence (OR = 3.132; 95%CI: 2.266–4.329). CONCLUSION Dissatisfied users were more likely to be nonadherent to medication use across all service dimensions, and dissatisfaction with the availability and accommodation of pharmaceutical services was associated with nonadherence.

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ABSTRACT OBJECTIVE To analyze yellow fever mortality trends in Brazil, focusing on sexes differences and using an age-period-cohort model. METHODS This ecological study analyzed yellow fever mortality data in Brazil from 1980 to 2019 sourced from Datasus. Population estimates were retrieved from the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Mortality data, including age, year of death, and cause (ICD-9: 060; ICD-10: A95), were analyzed using an age period cohort model. A Poisson distribution was assumed for mortality counts, and analyses were conducted using Holford’s method and its adaptations on R. RESULTS The results show that the incidence rate peaked at younger ages, such as 30 years (0.010/100,000 individuals, 95%CI: 0.008/100,000 to 0.013/100,000), followed by a gradual declining trend with increasing age, reaching 0.007/100,000 individuals (95%CI: 0.005/100,000 to 0.010/100,000) at 50 years onward. Regarding period, a substantial increase in the adjusted hazard ratio occurred over time, especially in 2015 (13.923 [95%CI: 11.095 to 17.471]), suggesting a significant elevation when compared with previous periods. Cohort analysis showed a trend of increasing risk until 1960 (RR = 1.000), followed by a marked reduction for more recent cohorts, such as 2010: RR = 0.056 (95%CI: 0.028 to 0.112). Vaccination analysis showed alternating periods of significant increases and decreases in vaccination rates. CONCLUSIONS Younger individuals showed higher mortality rates, with a gradual decline with advancing age. Period effects highlighted a pronounced resurgence in recent years, particularly during the 2015 epidemic, underscoring the influence of temporal factors such as outbreaks and vaccination campaigns. Cohort analysis showed a progressive decline in mortality risk among more recent birth cohorts, likely reflecting the impact of expanded immunization programs and improved public health measures. The proposed yellow fever vaccination trends in Brazil may explain some of the observed patterns.

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ABSTRACT OBJECTIVE Compare the overall survival of women with non-metastatic breast cancer who received neoadjuvant systemic therapy followed by surgery versus those who underwent surgery followed by adjuvant systemic therapy. METHODS A nationwide retrospective cohort study was conducted using real-world data from 2008 to 2015 available on the Brazilian Unified Health System (SUS). Women aged ≥ 18 years with breast cancer undergoing surgery or neoadjuvant systemic therapy as their first treatment between 2008 and 2010 were included. Cohorts were matched using propensity score matching in a 1:1 ratio and assessed 5-year overall survival using Kaplan-Meier, compared by log-rank test and hazard ratios (HR) using Cox proportional HR model. RESULTS A total of 23,331 women began treatment for breast cancer in SUS with neoadjuvant systemic therapy (n = 6,040) and surgery (n = 17,291). In the matched cohorts (n = 6,040 in both groups), more deaths occurred among those who received neoadjuvant systemic therapy compared with surgery as first treatment (37.3% and 19.6%, respectively; p < 0.001). Overall survival after five years was 0.641 in neoadjuvant systemic therapy and 0.816 in the surgery group (p < 0.001). For both groups, older patients (≥ 70 years) living in northern and midwestern Brazil, in municipalities with low and medium HDI, and self-declared as Black presented the lowest overall survival probabilities. Use of hormone therapy after surgery and conservative surgery instead of mastectomy were associated with higher survival. HR was 5.13 (95%CI: 2.95–8.88) in stage I, 1.57 (95%CI: 1.27–1.95) in stage II, and 1.38 (95%CI: 1.26–1.50) in stage III. CONCLUSION Women who underwent surgery as first treatment had a significantly higher 5-year overall survival compared with those who received neoadjuvant systemic therapy. Socioeconomic and demographic factors influenced survival outcomes.

Resumo em Português:

RESUMO OBJETIVO Investigar a associação entre sintomas depressivos e a percepção da vizinhança entre adultos mais velhos residentes em áreas urbanas. MÉTODOS Trata-se de um estudo transversal incluindo 7.115 indivíduos (≥ 50 anos) da linha de base (2015–2016) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), residentes em áreas urbanas, com informações completas sobre o desfecho e respostas sem auxílio de respondente substituto. O desfecho foi medido pela 8-item Center for Epidemiologic Studies–Depression Scale (CES-D-8) (ponto de corte ≥ 4) e a exposição pela percepção da vizinhança sobre a área de residência dos participantes. Foi realizada regressão de Poisson univariada e múltipla, com ajuste de cada variável de exposição pelas características sociodemográficas e condições de saúde. RESULTADOS A prevalência de sintomas depressivos foi de 34,9%, sendo 43,8% e 24,5% entre mulheres e homens, respectivamente. Na análise múltipla, problemas de mobilidade urbana, presença de poluição sonora, desordem física, violência, ausência de agradabilidade do bairro, coesão social e sensação de insegurança foram significativamente associados ao aumento na prevalência de sintomas depressivos para o total da amostra e entre as mulheres. Já entre os homens, exceto pela sensação de insegurança, as demais variáveis também foram associadas significativamente ao aumento na prevalência de sintomas depressivos. CONCLUSÃO Os resultados apontam para a importância de uma ação intersetorial entre as políticas de saúde, mobilidade urbana, segurança pública e planejamento e organização das cidades com foco na promoção à saúde mental de adultos mais velhos residentes em áreas urbanas.

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ABSTRACT OBJECTIVE To investigate the association between depressive symptoms and neighborhood perception among older adults living in urban areas. METHODS This cross-sectional study included 7,115 individuals (≥ 50 years) from the baseline (2015–2016) of the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brazil – Brazilian Longitudinal Study of Aging) who lived in urban areas and had self-reported responses (no proxy respondents), with complete data on the outcome. The outcome was assessed using the 8-item Center for Epidemiologic Studies–Depression Scale (CES-D-8) (cutoff ≥ 4), and the exposure variable was neighborhood perception related to participants’ area of residence. Univariable and multivariable Poisson regression analyses were performed, with each exposure variable adjusted for sociodemographic characteristics and health conditions. RESULTS The prevalence of depressive symptoms was 34.9%, being 43.8% among women and 24.5% among men. In the multivariable analysis, urban mobility issues, noise pollution, physical disorder, violence, lack of neighborhood pleasantness, low social cohesion, and perceived insecurity were significantly associated with a higher prevalence of depressive symptoms in the overall sample and among women. Among men, all variables except perceived insecurity were also significantly associated with higher prevalence of depressive symptoms. CONCLUSION The findings highlight the importance of intersectoral action across health, urban mobility, public safety, and urban planning policies to promote mental health among older adults living in urban areas.

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RESUMO OBJETIVO Descrever a aquisição dos alimentos que passaram a compor a nova cesta básica de alimentos pelos domicílios em situação de baixa renda no Brasil em 2017–2018. MÉTODOS Foram utilizados dados de aquisição domiciliar de alimentos da Pesquisa de Orçamentos Familiares de 2017–2018, realizada pelo Instituto Brasileiro de Geografia e Estatística. Analisaram-se dados de 13.706 domicílios em situação de baixa renda (< ½ salário mínimo per capita). Os alimentos foram identificados com base na Portaria do Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome, que especifica a nova composição da cesta básica de alimentos. As estimativas foram expressas como percentual de participação calórica. RESULTADOS Os alimentos que passaram a compor a nova cesta básica representaram 84,1% do total de calorias adquiridas pelos domicílios de baixa renda do Brasil em 2017–2018, sendo essa participação ainda mais expressiva na área rural (88,0%) e nas regiões Norte (88,2%) e Nordeste (85,9%). Os grupos de alimentos com maiores contribuições foram cereais (33,5%), açúcares e óleos/gorduras (21,3%), e carnes e ovos (11,6%). Arroz, milho e outros grãos contribuíram com 19,7%, enquanto os feijões representaram 4,7% das calorias. Carnes de aves e bovina foram os alimentos mais adquiridos do grupo de carnes e ovos, com 5,0% e 4,0% das calorias, respectivamente. Frutas contribuíram com 1,9% e legumes e verduras com 0,7%. Não houve grandes diferenças na aquisição desses alimentos entre as categorias de raça/cor da pele do chefe da família. CONCLUSÃO Os dados mostram que, em 2017–2018, os alimentos que passaram a compor a nova cesta eram a base da alimentação dos domicílios em situação de baixa renda, reforçando a viabilidade cultural da sua implementação.

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ABSTRACT OBJECTIVE To describe the purchase of foods included in the new staple food basket by low-income households in Brazil, from 2017 to 2018. METHODS Data on household food purchases were obtained from the 2017–2018 Household Budget Survey, conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Data from 13,706 low-income households (< ½ minimum wage per capita) were analyzed. Foods were identified based on an ordinance issued by the Ministry of Social Development and Fight Against Hunger, which specifies the composition of the new staple food basket. Estimates were expressed as a percentage of caloric intake. RESULTS Foods introduced into the new staple food basket accounted for 84.1% of the total calories purchased by low-income households in Brazil, from 2017 to 2018, with significant participation in rural areas (88.0%) and in the North (88.2%) and Northeast (85.9%) regions. Among food groups, cereals (33.5%), sugars and oils/fats (21.3%), and meats and eggs (11.6%) presented the highest contributions. Rice, corn, and other grains contributed 19.7%, whereas beans accounted for 4.7% of calories. Poultry meat and beef were the most purchased foods in the meat and egg group, representing 5.0% and 4.0% of calories, respectively. Fruits contributed 1.9% and vegetables 0.7% of calories. We observed no major differences in food purchase regarding the race/skin color of the head of the household. CONCLUSION Analysis shows that in the 2017–2018 period, the foods included in the new staple food basket became the basis of low-income households’ diet, reinforcing the cultural viability of its implementation.

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RESUMO OBJETIVO Analisar a tendência temporal da dupla carga de má nutrição no semiárido brasileiro e no não semiárido brasileiro, e avaliar sua distribuição espacial no semiárido brasileiro em crianças de 5 a 9 anos, no período de 2008 a 2022. MÉTODOS Estudo ecológico de série temporal a partir dos relatórios públicos, utilizando macrodados de índice de massa corporal para idade e altura para idade do Sistema de Vigilância Alimentar e Nutricional (Sisvan). Para análise temporal das prevalências de emaciação, de excesso de peso, de déficit de altura, de desnutrição e da dupla carga de má nutrição nas regiões do semiárido brasileiro e não semiárido brasileiro, utilizaram-se modelos de regressão de Prais-Winsten, com cálculo da variação percentual anual (APC%) de 2008 a 2022. Para avaliação da distribuição espacial na região do semiárido brasileiro, foram construídos mapas de evolução temporal das prevalências de excesso de peso, desnutrição e dupla carga de má nutrição. RESULTADOS De 2008 a 2022, 48,7 milhões de crianças de 5 a 9 anos foram registradas no Sisvan-Web para os índices de massa corporal para idade e altura para idade. Aproximadamente, 28,1% dessas residiam no semiárido brasileiro. A prevalência de dupla carga de má nutrição no semiárido brasileiro foi superior a 20%, com tendência crescente para crianças de 7 a 9 anos (APC = 0,61%; p < 0,05). O excesso de peso seguiu tendência crescente, enquanto a desnutrição diminuiu em todas as estratificações, exceto entre a população indígena, que apresentou estabilidade (APC = -1,12%; p > 0,05). As APC no semiárido brasileiro foram maiores do que na região do não semiárido. CONCLUSÃO O estudo apresenta uma alta prevalência da dupla carga de má nutrição no semiárido brasileiro, especialmente entre as crianças de 7 a 9 anos. Dessa forma, é crucial promover ações de saúde e prevenção da má nutrição, fortalecendo políticas já existentes e priorizando as populações mais vulneráveis.

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ABSTRACT OBJECTIVE To analyze the temporal trend of the double burden of malnutrition in the Brazilian semi-arid and non-semi-arid regions, and to assess its spatial distribution in the Brazilian semi-arid region among children aged 5 to 9 years, between 2008 and 2022. METHODS Ecological time-series study based on public reports, using macrodata of body mass index-for-age and height-for-age from the Sistema de Vigilância Alimentar e Nutricional (SISVAN – Brazilian Food and Nutritional Surveillance System). For temporal analysis of the prevalence of wasting, overweight, stunting, undernutrition, and the double burden of malnutrition in the semi-arid and non-semi-arid regions, Prais-Winsten regression models were used to estimate the annual percentage change (APC%) between 2008 and 2022. To evaluate spatial distribution in the Brazilian semi-arid region, maps showing the temporal evolution of the prevalence of overweight, undernutrition, and the double burden of malnutrition were constructed. RESULTS Between 2008 and 2022, 48.7 million children aged 5 to 9 years were registered in SISVAN-Web for body mass index-for-age and height-for-age indices. Approximately 28.1% of these lived in the Brazilian semi-arid region. The prevalence of the double burden of malnutrition in the semi-arid region exceeded 20%, with an increasing trend among children aged 7 to 9 years (APC = 0.61%; p < 0.05). Overweight showed a rising trend, while undernutrition decreased across all strata except among the Indigenous population, which remained stable (APC = −1.12%; p > 0.05). APCs in the semi-arid region were higher than in the non-semi-arid region. CONCLUSION The study highlights a high prevalence of the double burden of malnutrition in the Brazilian semi-arid region, especially among children aged 7 to 9 years. Therefore, it is crucial to promote health actions and malnutrition prevention, strengthening existing policies and prioritizing the most vulnerable populations.

Resumo em Inglês:

ABSTRACT OBJECTIVE To identify barriers to the implementation of the World Health Organization Safe Childbirth Checklist in two reference maternity hospitals—one for high-risk and one for routine-risk childbirths—and to develop a causal model applicable to these contexts. METHODS This qualitative, exploratory study was conducted in two public maternity hospitals that had been using the checklist, since its implementation in 2014. Data were collected through focus groups interviews and brainstorming sessions conducted in 2022 and 2023. Participants included healthcare professionals involved in childbirth care and members of the patient safety center. Content analysis categorized findings based on the five domains of the Consolidated Framework for Implementation Research (CFIR). A causal model was developed using a fishbone diagram to organize results by category. RESULTS The identified barriers were classified into four of the five CFIR domains. In the Innovation domain, the checklist itself posed challenges due to its design, complexity, and adaptability to existing workflows. In the Inner Setting, barriers included a weak patient safety culture and infrastructure limitations. The Implementation Process domain revealed deficiencies such as inadequate planning, lack of stakeholder involvement, and absence of feedback and assessment mechanisms. Unlike the high-risk maternity hospital, the Outer Setting barrier —lack of policies supporting continuing education—was identified in the routine-risk facility. CONCLUSIONS Implementation of the checklist in the studied maternity hospitals is hindered by structural, cultural, and adaptation challenges. Limited investment in training represents a significant obstacle, highlighting the need for professional development programs. High staff turnover and the absence of specific protocols further compromise consistent use. Addressing these barriers requires comprehensive strategies to enhance adherence to and integration of the checklist in maternal-newborn care.

Resumo em Português:

RESUMO OBJETIVO Analisar os preços pagos por medicamentos entre os municípios brasileiros em 2016, 2018 e 2020, comparando índice de desenvolvimento humano municipal, porte, região e modalidade de compra. MÉTODOS O estudo utiliza o indicador Razão Econômica, adaptado a partir do proposto para análises internacionais pela Organização Mundial da Saúde, e faz análises com os dados alimentados pelos municípios na Base Nacional de Dados de Ações e Serviços da Assistência Farmacêutica. RESULTADOS O estudo revela que os municípios social e economicamente mais vulneráveis pagam mais caro por esses medicamentos, especialmente nas regiões Norte e Nordeste, o que pode comprometer o acesso e a eficiência do Sistema Único de Saúde. Além disso, o artigo demonstra que municípios que realizam compras em associação tendem a pagar preços menores, sugerindo que consórcios podem ser uma estratégia para mitigar as desigualdades nos preços. CONCLUSÕES Com os resultados obtidos, propõe-se a adoção de estratégias regulatórias, econômicas e de negociação para reduzir essas diferenças e garantir uma distribuição mais equitativa dos medicamentos no Brasil.

Resumo em Inglês:

ABSTRACT OBJECTIVE The study analyzes the prices paid by Brazilian municipalities for medicines in 2016, 2018, and 2020, comparing municipal human development index, size, region, and purchase modality. METHODS Economic Ratio indicator, adapted from that proposed for international analyses by the World Health Organization, was used and analyses were performed using data provided by municipalities to the National Database of Pharmaceutical Assistance Actions and Services. RESULTS The study reveals that the most socially and economically vulnerable municipalities pay more for these medicines, especially in the North and Northeast regions, which can compromise access to and the efficiency of the Unified Health System. Moreover, the article shows that municipalities that purchased in association tend to pay lower prices, suggesting that consortia may be a strategy to mitigate price inequalities. CONCLUSIONS Based on the results obtained, we propose the adoption of regulatory, economic, and negotiation strategies to reduce these differences and ensure a more equitable distribution of medicines in Brazil.

Resumo em Português:

RESUMO OBJETIVO Analisar as hospitalizações, a mortalidade e os custos relacionados às doenças cerebrovasculares no Brasil de 2017 a 2022 e verificar o impacto da pandemia da covid-19 nesses números. MÉTODOS Os dados foram coletados junto ao Departamento de Informática do SUS, por meio do Sistema de Informações Hospitalares e pelo Sistema de Informação sobre Mortalidade. Para os dados populacionais foram consultados os censos de 2010 e as projeções intercensitárias (2017 a 2022) do Instituto Brasileiro de Geografia e Estatística. Calcularam-se as taxas de mortalidade e de incidência das admissões hospitalares por doenças cerebrovasculares, por meio da divisão do número de óbitos e do número de admissões hospitalares por doenças cerebrovasculares pela população total em risco, multiplicado por 100.000 habitantes, respectivamente. Os resultados foram estratificados por grupos etários, regiões do Brasil, sexo e anos civis. As taxas foram padronizadas por idade, seguindo o método direto proposto pela Organização Mundial da Saúde. RESULTADOS Os dados sobre mortalidade por doenças cerebrovasculares mostraram uma redução significativa em todo o Brasil, tanto no geral quanto por sexo. O Nordeste apresentou uma diminuição da mortalidade geral, principalmente feminina, enquanto a Região Sul manteve números estacionários. As taxas de internação permanecem estáveis, com aumentos notáveis em faixas etárias mais jovens (0 a 4 anos) e femininas (5 a 9 anos). Os custos de internação aumentaram significativamente em todo o país, com maior elevação no Nordeste, Norte, Sudeste e Centro-Oeste. CONCLUSÃO Verificou-se redução nas taxas de mortalidade por doenças cerebrovasculares no Brasil, com variações regionais e por faixa etária, embora com aumento preocupante entre homens jovens. Apesar da estabilidade nas internações, os custos hospitalares aumentaram significativamente, indicando maior complexidade dos casos e reforçando a necessidade de estratégias de prevenção e controle mais eficazes.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze hospitalizations, mortality, and costs related to cerebrovascular diseases in Brazil from 2017 to 2022 and to evaluate the impact of the COVID-19 pandemic on these numbers. METHODS Data were collected from the Brazilian Unified Health System Information Technology Department via the Hospital and Mortality Information Systems. The 2010 censuses and the inter-census projections (2017 to 2022) of the Brazilian Institute of Geography and Statistics were searched for population data. The mortality rates and incidence of hospital admissions for cerebrovascular diseases were calculated by dividing the number of deaths and the number of hospital admissions due to cerebrovascular diseases by the total population at risk, multiplied by 100,000 inhabitants, respectively. The results were stratified by age groups, regions of Brazil, sex, and calendar years. Rates were standardized by age, following the direct method from the World Health Organization. RESULTS Data on mortality from cerebrovascular diseases showed a significant reduction throughout Brazil in general and by sex. The Brazilian Northeast showed a decrease in overall mortality, especially in women, whereas its South showed stationary numbers. Hospitalization rates remain stable, with notable increases in the age groups for younger (from zero to four years of age) and female (from five to nine years of age). Hospitalization costs increased significantly throughout Brazil, with the highest increase in its Northeast, North, Southeast, and Midwest. CONCLUSION Mortality rates from cerebrovascular diseases decreased in Brazil, showing regional and age group variations and a worrying increase in young men. Despite stable hospitalizations, hospital costs significantly increased, indicating greater complexity of cases and reinforcing the need for more effective prevention and control strategies.

Resumo em Português:

RESUMO Dados epidemiológicos apontam que o consumo de alimentos de origem animal nos países de alta renda é excessivo e prejudicial à saúde. Mas é frequente, tanto na literatura científica como nos documentos das organizações multilaterais, a associação entre pobreza e carência de proteínas. Há uma armadilha conceitual neste vínculo, que consiste em concentrar a atenção em um nutriente e não no conjunto do padrão alimentar. Em 1974, num texto que se tornou um clássico da ciência da nutrição, Donald McLaren já mostrava o erro das organizações multilaterais de desenvolvimento em focar seus esforços na oferta de proteínas (inclusive sob formas industrializadas) sem levar em conta que, com raras exceções, quando se alcança suficiência energética, dificilmente haverá déficit proteico. Dados da Pesquisa de Orçamentos Familiares de 2017 a 2018 ajudam a desfazer esse mito: mesmo entre os 20% mais pobres da população brasileira, é ínfima a proporção dos que apresentam ingestão proteica insuficiente.

Resumo em Inglês:

ABSTRACT Epidemiological data shows that the consumption of animal-based foods in high-income countries is excessive and harmful to health. But the association between poverty and protein deficiency is frequent, both in scientific literature and in the documents of multilateral organizations. There is a conceptual trap in this link, which consists of focusing on one nutrient and not on the whole dietary pattern. In 1974, in a text that has become a classic of nutrition science, Donald McLaren has already highlighted the mistake made by multilateral development organizations in focusing their efforts on protein supply—often in industrialized forms—without considering that, in most cases, once energy needs are met, protein deficiency is unlikely to occur. Data from the 2017–2018 Consumer Expenditure Survey helps to dispel this myth: even among the poorest 20% of the Brazilian population, the proportion of those with insufficient protein intake is tiny.