Resumo A investigação identifica o efeito da política pública implementada no ano 2008 pelo Estado equatoriano em relação à democratização do acesso à educação superior, entendida a jeito de direito que reduze as divisões existentes entre homens e mulheres, etnias e quintis; para esse propósito, usou-se uma metodologia mista na que, dentro da análise qualitativa, examinaram -se os instrumentos legais principais de regulação da educação superior no Equador, além de artigos escolhidos da área temática. Dentro da metodologia quantitativa, usaram-se os reportes do Sistema Nacional de Informação (SNI) referentes à taxa líquida de matrícula na educação superior aportado pela Secretaria Nacional de Planificação, para fazer uma análise descritiva da evolução em relação ao sexo, etnia e quintis de admissão. Entre os resultados principais, determinou-se que a política de gratuidade teve um efeito positivo no acesso à educação superior para homens, mulheres, afro-equatorianos e indígenas e, nos quintis 1, 2 e 3, até o ano 2011, observou-se um incremento na taxa líquida de matrícula ao nível nacional entre os anos 2007 ao 2011, com 4.95 pontos percentis, até o começo da validade da política de meritocracia no 2012.

Abstract This study identifies the effect of the public policy implemented in the State of Ecuador in 2008 in regard to democratization of access to higher education, being understood as a right that reduces the existing gaps between men and women, ethnicities and quintiles; for this purpose, a mixed methodology is used as the starting point and, using a qualitative analysis, a review of the main legal instruments regulating higher education in Ecuador was performed, along with specific articles related to this subject. For quantitative methodology, the starting points were reports of the National Information System (SNI) in regards to net rate of enrollment in higher education, managed by the National Secretariat of Planning in order to perform a descriptive analysis on its evolution in gender, ethnicity and registration quintiles. Among the main results obtained, it was determined that the gratuity policy did have a positive effect for access to higher education for men, women, African-Ecuadorian and indigenous peoples and, for quintiles 1, 2 and 3 until year 2011, a noticeable increase was seen in nationwide net rate of enrollment with 4.95 percentile points between 2007 and 2011, until the meritocracy policy entered in force in 2012.

Resumen Esta investigación identifica el efecto de la política pública implementada en 2008 por el Estado ecuatoriano referente a la democratización del acceso a la educación superior, entendida como un derecho que reduce las brechas que existen entre hombres y mujeres, etnias y quintiles; para ello, se parte de una metodología mixta, en la que, dentro del análisis cualitativo, se revisan los principales instrumentos legales que regulan la educación superior en Ecuador, y artículos seleccionados sobre la temática. En la metodología cuantitativa, se parte de los reportes del Sistema Nacional de Información (SNI) referentes a la tasa neta de matrícula en educación superior, administrado por la Secretaría Nacional de Planificación, para realizar un análisis descriptivo sobre su evolución a nivel de sexo, etnia y quintiles de ingreso. Entre los principales resultados, se determina que la política de gratuidad tuvo un efecto positivo en el acceso a la educación superior, para hombres, mujeres, afroecuatorianos e indígenas, y en los quintiles 1, 2 y 3, hasta el año 2011, evidenciando un incremento en la tasa neta de matrícula a nivel nacional, de 2007 a 2011, de 4,95 puntos porcentuales, hasta que entró en vigor la política de meritocracia, en 2012.

ABSTRACT Introduction : Access to modern contraceptive methods constitutes a key determinant in sexual and reproductive health, particularly in regions with socioeconomic inequalities. In Argentina, several public policies have sought to guarantee this access, especially in the northern regions of the country. Objective : To analyze variations in the use of contraceptive methods among women aged 15-49 years in Argentina, with emphasis on the NOA and NEA regions during 2011-2012 and 2019-2020, examining their distribution according to socioeconomic strata. Materials and methods : Quantitative, cross-sectional descriptive study. Data from the National Multiple Indicator Cluster Surveys (MICS) 2011-2012 (n=20844) and 2019-2020 (n=11763) were analyzed. Comparative prevalence analysis was performed with 95% confidence intervals. Results: A significant increase in the use of contraceptive methods was observed in Argentina (57.69% to 61.33%) and NOA (43.78% to 57.46%) between 2011-2012 and 2019-2020. Subdermal implants showed the greatest increase in adolescents in the NOA (0% to 35.24%) and NEA (0% to 32.59%). In the poorest quintiles, contraceptive use increased significantly, especially in the NEA (31.04% to 52.30%). Conclusion : The increase in the use of modern contraceptive methods, particularly in vulnerable populations of Northern Argentina, suggests a positive impact of the implemented public policies, especially the ENIA Plan, in improving access to contraception.

RESUMEN Introducción: El acceso a métodos anticonceptivos modernos constituye un determinante clave en la salud sexual y reproductiva, particularmente en regiones con desigualdades socioeconómicas. En Argentina, diversas políticas públicas han buscado garantizar este acceso, especialmente en las regiones del Norte del país. Objetivo: Analizar las variaciones en el uso de métodos anticonceptivos entre mujeres de 15-49 años en Argentina, con énfasis en las regiones NOA y NEA durante 2011-2012 y 2019-2020, examinando su distribución según estratos socioeconómicos. Materiales y métodos: Estudio cuantitativo, transversal descriptivo. Se analizaron datos de las Encuestas Nacionales de Indicadores Múltiples por Conglomerados (MICS) 2011-2012 (n=20844) y 2019-2020 (n=11763). Se realizó análisis comparativo de prevalencias con intervalos de confianza del 95%. Resultados: Se observó un incremento significativo en el uso de métodos anticonceptivos en Argentina (57,69% a 61,33%) y NOA (43,78% a 57,46%) entre 2011-2012 y 2019-2020. Los implantes subdérmicos mostraron el mayor aumento en adolescentes del NOA (0% a 35,24%) y NEA (0% a 32,59%). En los quintiles más pobres, el uso de anticonceptivos aumentó significativamente, especialmente en el NEA (31,04% a 52,30%). Conclusión: El incremento en el uso de métodos anticonceptivos modernos, particularmente en poblaciones vulnerables del Norte argentino, sugiere un impacto positivo de las políticas públicas implementadas, especialmente del Plan ENIA, en la mejora del acceso a la anticoncepción.

Instructional leadership practices in terms of defining the school mission, managing instructional programmes, and developing a positive school learning climate are significantly and positively associated with teachers' effectiveness. Such practices have also been found to be critical in promoting teacher learning and development both at school and higher education levels. The key question posed in this study was what mathematics teachers' perceptions of their principal's management of the instructional programme of their schools were. The Principal Instructional Management Rating Scale was used as a lens for evaluating teacher perceptions in the study. The study was conducted in two Quintiles 1-3 schools in the town of Kariega, Eastern Cape, South Africa where two secondary school and three primary school teachers participated. The lower socioeconomic status of the two schools under scrutiny seemed to have played a role in the teachers' perceptions of the principals' role as instructional leader. Although the principals conducted and facilitated several professional development sessions with the mathematics teachers, the principal and his assistants were not always familiar with the mathematics pedagogical content knowledge that was required to evaluate lessons at the required level. Factors such as learner discipline, lack of parental support, and socioeconomic problems surrounding the school had an impact on the principals' ability to exercise instructional leadership in their schools.

RESUMEN Objetivo: Estimar la cobertura de ser beneficiario de los programas Vaso de Leche (VDL) y Qali Warma (QW) en niños menores de cinco años y determinar los factores asociados. Materiales y métodos: Estudio de fuente secundaria basado en la Encuesta demográfica y de salud familiar (Endes) del 2022 del Perú. Se seleccionó a mujeres de entre 15 y 49 años que tuviesen hijos de cinco años o menos, con datos antropométricos completos y que hayan respondido preguntas sobre ser beneficiario de VDL y QW. La variable dependiente fue ser o no beneficiario del programa, y se comparó la proporción de quienes sí lo eran según estratos de las variables independientes. Para el análisis multivariado, se usó la regresión log-binomial de la familia de modelos lineales generalizados, y se consideró un nivel de significancia del 5 %. Resultados: Entre los niños menores de cinco años, la proporción de beneficiarios del programa VDL fue de 34,13 %, mientras que la de QW fue 85,88 %. Las variables asociadas con ser beneficiario del VDL incluyen ser menor de doce meses de edad, peso al nacer <2500 g, educación materna, pertenencia a los quintiles más pobres y residencia rural. Los factores asociados con ser beneficiario de QW son vivir en una zona rural y pertenecer a los quintiles más pobre y pobre. No hubo asociación entre ser beneficiario de QW (RPa: 1,01; IC 95 %: 0,97-1,05) y VDL (RPa: 1,02; IC 95 %: 0,97-1,07) y ser un niño con desnutrición crónica al momento de la encuesta. Conclusiones: La cobertura de los programas VDL y QW difiere significativamente y varía de acuerdo con el sector. Provenir del quintil más pobre y vivir en áreas rurales fueron correlatos comunes en ambos programas. Sin embargo, también se beneficiaron niños que no necesariamente se encontraban en condiciones socioeconómicamente desfavorecidas, lo que sugiere problemas en la implementación de los objetivos previstos.

ABSTRACT Objective: To estimate the coverage of being a beneficiary of the Vaso de Leche (VDL - Glass of Milk) and Qali Warma (QW - Vigorous Child) programs among children under 5 years of age and to determine the associated factors. Materials and methods: This study used a secondary source, based on the 2022 Encuesta Demogrática y de Salud Familiar (Endes - National Demographic and Family Health Survey) in Peru. For this purpose, women aged 15 to 49 years with children aged five years or younger and complete anthropometric data were selected to answer questions about being a beneficiary of the VDL and QW programs. The dependent variable was being or not a beneficiary of the programs, and the rate of beneficiaries was compared across levels of the independent variables. A log-binomial regression from the family of generalized linear models was used for the multivariate analysis, with a significance level of 5 %. Results: Among children under five years of age, the rate of beneficiaries of the VDL program was 34.13 %, while that of the QW program was 85.88 %. Variables associated with being a beneficiary of the VDL program included being ≥ 12 months, birth weight < 2,500 g, mother’s level of education, belonging to the poorest quintiles and rural residence. The factors associated with being a beneficiary of the QW program included rural residence and belonging to the poor and poorest quintiles. There was no association between being a beneficiary of the QW (aPR: 1.01; 95 % CI: 0.97-1.05) and VDL (aPR: 1.02; 95 % CI: 0.97-1.07) programs and being a child with chronic malnutrition at the time of the survey. Conclusions: The coverage of the VDL and QW programs differs significantly and varies according to sector. Being from the poorest quintile and living in rural areas were common correlates across both programs. Nevertheless, these programs also benefited children who were not necessarily in socioeconomically disadvantaged conditions, suggesting issues in the implementation of the intended objectives.

The COVID-19 pandemic severely disrupted schooling, not only in South Africa, but globally. In the study reported on here we investigated the perceived psychosocial effects of the pandemic on the teaching realities of Foundation Phase (FP) educators in rural quintiles 1 to 3 schools in the North West province, South Africa. A qualitative, case study design was adopted with 10 educators purposively selected from 3 schools to participate through telephonic interviews. The findings reveal that as educators contended with the new rotational method of school attendance, challenges of limited teaching time, curriculum coverage, learner absenteeism and the lack of parental support that negatively affected their overall state of psychosocial well-being. This state of well-being was characterised by high stress levels, feelings of hopelessness, anxiety and a lack of accomplishment for educators. Despite these experiences, some educators demonstrated agency and resilience in ensuring that they carried out their core responsibility of teaching, but perceived themselves as requiring psychosocial support. The conclusion reached is that the available support structures provided by the Department of Basic Education appeared to be under-utilised and there was a critical need to introduce and advocate for mental health interventions to support educators emotionally.

Resumen Objetivo: Analizar los factores condicionantes al pie diabético de las personas hospitalizadas, del 2017 al 2020, en el hospital San Juan de Dios, desde el marco de los Determinantes Sociales de la Salud de la Organización Mundial de la Salud (OMS). Materiales y métodos: Investigación mixta, con una muestra de 243 pacientes, un muestreo no aleatorio, con dos momentos metodológicos, con posterior triangulación de datos. El primer momento metodológico fue cuantitativo, se tomó el universo de 243 pacientes, se realizó un análisis descriptivo de la base de datos con el programa estadístico SPSS. El segundo fue cualitativo, se tomó una muestra por conveniencia de 30 personas, se les aplicó una entrevista semiestructurada. Resultados: Se evidenciaron los determinantes sociales de la salud de la población en estudio, a saber, que las personas más afectadas por pie diabético son hombres entre 50 a 59 años, con analfabetismo o primaria incompleta, con actividades económicas dentro de los quintiles más bajos, con prevalencia de trastornos psicoafectivos; además disponen de ausencia de acciones preventivas de los establecimientos de salud. Adicionalmente, el impacto de esta enfermedad es aún mayor dado que se evidenció la falta de una política de educación para la salud, el desempleo e informalidad, la no participación comunitaria, más la transición demográfica de Costa Rica. Conclusiones: Las condiciones sociales y económicas como baja escolaridad, género, bajo ingresos económicos, desempleo e informalidad, pobres redes de apoyo y la no participación social inciden negativamente en las personas con factores de riegos para padecer pie diabético. Aunado a lo anterior, las personas no reciben una atención integral e integrada, con un autocuidado deficiente y poco conocimiento y empoderamiento sobre la enfermedad, son factores que permiten que las personas con Diabetes puedan tener un riesgo mayor de padecer Pie diabético.

Abstract Objective: Analyze the related factors from the structural determinants, establish their intermediate determinants and determine precipitating risk factors in the study population. Materials and methods: Mixed research, collection of quantitative and qualitative data, with subsequent triangulation of data, with quantitative descriptive analysis of the database of the Diabetic Foot Clinic of the San Juan de Dios hospital of people hospitalized in the established period, and a semi-structured interview with thirty subjects with a history of hospitalization. Results: It was evident that the people most affected by diabetic foot are men between 50 and 59 years old, with illiteracy or incomplete primary school, with economic activities within the lowest quintiles, with a prevalence of psycho-affective disorder. They also have an absence of preventive actions by health establishments. The lack of a health education policy, unemployment and informality, lack of community participation, added to the demographic transition of Costa Rica, has a greater impact of this disease on the population. Conclusions: Social and economic conditions such as low schooling, gender, low income, unemployment and informality, poor support networks and lack of social participation negatively affect people with risk factors for suffering from Diabetes. In addition to the above, people do not receive comprehensive and integrated care, with poor self-care and little knowledge and empowerment about the disease, these are factors that allow people with Diabetes to have a higher risk of suffering from diabetic foot.

RESUMEN Introducción. La emergencia de COVID-19 causó una pandemia con gran impacto en la mortalidad en Perú. Objetivo. Analizar la magnitud de la mortalidad por COVID-19 e identificar algunas características sociodemográficas. Métodos. Se realizó un estudio descriptivo de tipo ecológico, se analizaron los datos de muertes por COVID-19 durante el periodo 2020-2023, así como indicadores socioeconómicos y demográficos de acceso público. Las variables incluidas en el estudio fueron año de defunción, número de muertes, sexo, grupo etario, provincia de procedencia, región natural, macrorregión, índice de desarrollo humano (IDH), necesidades básicas insatisfechas (NBI) y densidad poblacional. Resultados. Se reportaron 220628 muertes por la COVID-19, de las cuales, 219374 (99,43%) ocurrieron durante la pandemia y 1254 (0,57%) en periodo pospandemia. La tasa de mortalidad acumulada fue de 6,76 muertes/1000 habitantes. La curva de muertes por COVID-19 muestra que entre el 2020-2023 ocurrieron cinco olas siendo la de mayor mortalidad la segunda, seguida por la primera ola. La mortalidad predominó en hombres, adultos mayores (69,77%) y adultos (28,11%). La macrorregión de Lima Metropolitana y Callao tuvo las más altas tasas de mortalidad con 9,36 muertes/1000 habitantes. Las provincias con mayores tasas de mortalidad acumulada fueron las ubicadas en la costa, en quintiles con menos NBI, en quintiles de mayor IDH y en aquellas provincias con mayor densidad poblacional. Conclusiones. La pandemia COVID-19 causó elevada mortalidad en Perú, siendo mayor en varones, adultos mayores, de ciudades de costa, de mayor densidad poblacional y mejores indicadores socioeconómicos.

ABSTRACT Introduction. The COVID-19 emergency caused a pandemic with a great impact on mortality in Peru. Objective. To analyze the magnitude of mortality due to COVID-19 and identify some sociodemographic characteristics. Methods. A descriptive ecological study was carried out, analyzing data on deaths due to COVID-19 during the period 2020-2023, as well as publicly accessible socioeconomic and demographic indicators. The variables included in the study were: year of death, number of deaths, sex, age group, province of origin, natural region, macroregion, human development index (HDI), unmet basic needs (UBN) and population density. Results. 220,628 deaths due to COVID-19 were reported, of which 219,374 (99.43%) occurred during the pandemic and 1,254 (0.57%) in the post-pandemic period; The cumulative mortality rate was 6.76 deaths/1000 inhabitants. The COVID-19 death curve shows that between 2020-2023, five waves occurred, with the second wave having the highest mortality, followed by the first wave. Mortality predominated in men, older adults (69.77%) and adults (28.11%). The macroregion of Metropolitan Lima and Callao had the highest mortality rates with 9.36 deaths/1000 inhabitants. The provinces with the highest cumulative mortality rates were those located on the coast, in quintiles with less NBI, in quintiles with a higher HDI and in those provinces with a higher population density. Conclusions. The COVID-19 pandemic caused high mortality in Peru, being higher in males, older adults, from coastal cities, with higher population density and better socioeconomic indicators.

RESUMEN Introducción. Uno de los principales desafíos para la primera infancia es brindar cuidados adecuados que reduzcan desigualdades y promuevan desarrollo infantil temprano (DIT). El objetivo del trabajo fue describir relaciones entre los cuidados que reciben niños y niñas de 3 y 4 años, según el marco para el cuidado cariñoso y sensible (NC, por sus siglas en inglés), y sus niveles de DIT en Argentina, considerando región y quintiles de riqueza. Población y métodos. Estudio analítico observacional de corte transversal, a partir de las bases de datos de la Encuesta Nacional de Niñas, Niños y Adolescentes (MICS) Argentina 2019-2020. Se seleccionaron 11 indicadores de NC y se estimó el nivel de DIT utilizando el Índice de Desarrollo Infantil Temprano (ECDI) para un análisis estadístico descriptivo. Resultados. En 2638 niños y niñas de 3 y 4 años evaluados, el promedio de acceso a indicadores de cuidados fue del 79,1 %; el acceso fue alto en 7 indicadores (entre el 84,2 % y el 97,9 %) y medio en 4 (entre el 46,9 % y el 65,1 %); la mayor frecuencia fue contar con registro de nacimiento (97,9 %) y la menor, la cobertura de seguro de salud (46,9 %). El 87,9 % alcanzó niveles adecuados de ECDI. Los resultados registran diferencias según quintiles de riqueza y regiones. Conclusiones. Los resultados evidencian desigualdades de acceso a cuidados y en DIT adecuado de niños y niñas de 3 y 4 años de áreas urbanas de Argentina según la región donde viven y el nivel de riqueza de sus hogares.

Abstract This study analyzed the prevalence of complete neonatal screening (CNS) of children aged under 2 years in Brazil and associated factors using data from the 2013 (n=4,442) and 2019 (n=5,643) national health surveys. We conducted a cross-sectional study to compare prevalence of CNS (eye, ear and heel prick tests) adopting 95% confidence intervals (95%CI) and a 5% significance level. Crude and adjusted Poisson regression was performed to estimate prevalence ratios (PR) and 95%CI to assess the association between socioeconomic, demographic and health variables and CNS. There was a statistically significant increase in CNS prevalence, from 49.2% (95%CI: 47.1-51.3) in 2013 to 67.4% (95%CI: 65.5-69.3) in 2019. However, large disparities persist across states and between sociodemographic groups. In both years, CNS prevalence was lowest among brown and black children, those from families in the three lowest income quintiles, children without health insurance, those from families registered in the Family Health Strategy and children living in the North, cities outside the state capital/metropolitan regions and rural areas. Despite the increase in prevalence of CNS, deep individual and contextual inequalities persist, posing challenges for health policies. (CNS 201 n=4,442 n4442 n 4 442 (n=4,442 n=5,643 n5643 5 643 (n=5,643 surveys crosssectional cross sectional eye, eye (eye tests 95 95CI CI (95%CI level PR (PR socioeconomic 492 49 49.2 47.151.3 471513 47.1 51.3 47 1 51 3 47.1-51.3 674 67 67.4 65.569.3 655693 65.5 69.3 65 69 65.5-69.3 However groups quintiles insurance North capitalmetropolitan capital metropolitan areas policies 20 n=4,44 n444 44 (n=4,44 n=5,64 n564 64 (n=5,64 9 49. 151 47.151. 47151 471 47. 513 51. 47.1-51. 6 67. 569 65.569. 65569 655 65. 693 69. 65.5-69. n=4,4 n44 (n=4,4 n=5,6 n56 (n=5,6 15 47.151 4715 47.1-51 56 65.569 6556 65.5-69 n=4, n4 (n=4, n=5, n5 (n=5, 47.15 47.1-5 65.56 65.5-6 n=4 (n=4 n=5 (n=5 47.1- 65.5- n= (n= (n

Resumo Analisou-se a prevalência e fatores associados à realização da Triagem Neonatal Completa (TNC) entre crianças (<2 anos de idade) no Brasil incluídas na Pesquisa Nacional Saúde 2013 (n=4.442) e 2019 (n=5.643). Estudo transversal comparou as estimativas de prevalência e intervalos de confiança de 95% (IC95%) da TNC (testes do olhinho, orelhinha e pezinho). Diferenças foram consideradas estatisticamente significante ao nível de 5%. Regressões de Poisson bruta e ajustada foram realizadas para estimar Razões de Prevalência (RP) e IC95% para a associação das variáveis socioeconômicas, demográficas e de saúde com a TNC. Verificou-se aumento estatisticamente significante da TNC: 67,4% (IC95%: 65,5-69,3) em 2019, ante 49,2% (IC95%: 47,1-51,3) em 2013. Porém, ainda existem desigualdades e defasagens entre os estados da federação e variáveis sociodemográficas. Entre os anos, a TNC foi menor nas crianças de cor/raça parda e preta, dos três piores quintis de renda, sem plano de saúde, cadastradas na Estratégia de Saúde da Família, da região norte, de cidades do interior e da zona rural do Brasil. Apesar de o aumento da prevalência de TNC, desigualdades e defasagens individuais e contextuais permaneceram, indicando os desafios das políticas de saúde. Analisouse Analisou se (TNC <2 2 (< idade 201 n=4.442 n4442 n 4 442 (n=4.442 n=5.643. n5643 n=5.643 . 5 643 (n=5.643) 95 IC95 IC (IC95% testes olhinho pezinho. pezinho pezinho) 5% RP (RP socioeconômicas Verificouse Verificou 674 67 67,4 65,569,3 655693 65,5 69,3 65 69 3 65,5-69,3 492 49 49,2 47,151,3 471513 47,1 51,3 47 1 51 47,1-51,3 Porém sociodemográficas corraça cor raça preta renda Família norte permaneceram < ( 20 n=4.44 n444 44 (n=4.44 n564 n=5.64 64 (n=5.643 9 IC9 (IC95 6 67, 569 65,569, 65569 655 65, 693 69, 65,5-69, 49, 151 47,151, 47151 471 47, 513 51, 47,1-51, n=4.4 n44 (n=4.4 n56 n=5.6 (n=5.64 (IC9 56 65,569 6556 65,5-69 15 47,151 4715 47,1-51 n=4. n4 (n=4. n5 n=5. (n=5.6 (IC 65,56 65,5-6 47,15 47,1-5 n=4 (n=4 n=5 (n=5. 65,5- 47,1- n= (n= (n=5 (n

Resumen El envejecimiento poblacional se posiciona como un importante cambio demográfico. Este trabajo analiza las características de los adultos mayores en situación de dependencia, las estrategias de cuidado y el perfil de personas cuidadoras para Chile, Colombia, Paraguay, El Salvador y Uruguay. La población en situación de dependencia funcional es mayoritariamente femenina y mayor de 75 años. Entre un 54 % y un 70 % recibe algún tipo de cuidado, principalmente a partir de la remuneración familiar. Las cuidadoras no remuneradas son mayoritariamente mujeres, menores de 65 años y económicamente inactivas; más aún, existe una asociación negativa entre el cuidado de adultos mayores y el empleo, que se recrudece al evaluar solamente la población femenina. Si bien esta asociación se mantiene para todas las edades y quintiles de ingreso, la brecha de empleo entre cuidadores y no cuidadores se reduce sustancialmente cuanto mayor sea el ingreso del hogar. Políticas de cuidados a la adultez tendrían efectos positivos en el empleo femenino y la desigualdad.

Abstract Population aging has positioned as a key demographic change. This paper analyzes the characteristics of older adults in situations of dependence, care strategies and the profile of caregivers for Chile, Colombia, Paraguay, El Salvador and Uruguay. The population in a situation of functional dependence is mostly female and over 75 years old. Between 54% and 70% receive some type of care, with unpaid family care being the main care strategy. Unpaid caregivers are mostly women, under 65, and economically inactive. We evidence a negative relationship between the status of elderly caregiver and employment, that is stronger for women. Although elderly informal care leads to a lower probability of employment among individuals of all ages and income quintiles, the employment gap between caregivers and non-caregivers narrows substantially among higher-income people. Improving care for older people would have positive effects on female employment and inequality.

SUMMARY: The identification of children and adolescents who are at risk of sarcopenic obesity development often requires specialized equipment and expensive test procedures. Therefore, the establishment of cheaper and faster methods would be greatly useful, especially if they could be applied in the field. The study’s objective was to establish if identification of female adolescents who suffer the risk of developing sarcopenic obesity can be obtained through the standing-long-jump test application. To achieve the research objectives, various anthropometric and body composition measurements were performed and lower limb explosive strength was assessed using the standing long jump fitness test. The research was conducted on a sample of 535 female respondents randomly selected from 9 elementary schools in the Skopje region of the Republic of North Macedonia. The respondents were divided into quintiles according to BMI z-scores, and the arithmetic means and SD about muscle-to-fat ratio were calculated for each quintile. The cutoff was determined based on the mean and standard deviation of the muscle-to-fat ratio for the 3rd quintile of BMI and the percentage of respondents with sarcopenic obesity was examined. The optimal cut-off value of the long jump fitness test results for predicting sarcopenic obesity in an adolescent girl showed that the area under the ROC curve was 0.781 (95 % CI 0.743-0.815). The standing-long-jump test values, on grounds of odds ratio (OR 95 % CI) about the girls at risk of sarcopenic obesity development, which was identified on muscle-to-fat ratio base, were 8.76 (4.39 - 17.54, p 0.001). It can be used to predict sarcopenic obesity presence in female adolescents, which can be vital in case of health intervention.

RESUMEN: La identificación de niños y adolescentes que corren riesgo de desarrollar obesidad sarcopénica a menudo requiere equipos especializados y procedimientos de pruebas costosos. Por lo tanto, el establecimiento de métodos más baratos y rápidos sería de gran utilidad, especialmente si pudieran aplicarse en el campo. El objetivo del estudio fue establecer si la identificación de mujeres adolescentes que sufren riesgo de desarrollar obesidad sarcopénica se puede obtener mediante la aplicación de la prueba de salto de longitud de pie. Para lograr los objetivos de la investigación, se realizaron diversas mediciones antropométricas y de composición corporal y se evaluó la fuerza explosiva de los miembros inferiores mediante la prueba de aptitud de salto de longitud de pie. La investigación se realizó con una muestra de 535 mujeres encuestadas seleccionadas al azar de 9 escuelas primarias de la región de Skopje, en la República de Macedonia del Norte. Los encuestados se dividieron en quintiles según las puntuaciones z del IMC, y se calcularon las medias aritméticas y la DE sobre la relación músculo-grasa para cada quintil. El límite se determinó en función de la media y la desviación estándar de la relación músculo-grasa para el tercer quintil del IMC y se examinó el porcentaje de encuestados con obesidad sarcopénica. El valor de corte óptimo de los resultados de la prueba de condición física de salto de longitud para predecir la obesidad sarcopénica en una adolescente mostró que el área bajo la curva ROC fue 0,781 (IC del 95 %: 0,743-0,815). Los valores de la prueba de salto de longitud de pie, sobre la base del odds ratio (OR IC del 95 %) sobre las niñas en riesgo de desarrollar obesidad sarcopénica, que se identificó sobre la base del ratio músculo-grasa, fueron 8,76 (4,39 - 17,54, p. 0,001). Puede utilizarse para predecir la presencia de obesidad sarcopénica en adolescentes, lo que puede ser vital en caso de intervención sanitaria.

ABSTRACT OBJECTIVE To describe two low-burden diet quality scores and evaluate their performance in reflecting the dietary share of the least and most processed foods defined within the Nova food system classification. METHODS This cross-sectional study included data from the NutriNet-Brasil cohort. Participants answered the Nova24hScreener, a 3-minute self-administered questionnaire measuring the consumption of a set of foods on the day before. Food items included in this tool belong to two main groups of the Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 items) and ultra-processed foods (UPF, 23 items). Two scores were obtained by summing the number of items checked: the Nova-WPF and the Nova-UPF. We compared the scores, respectively, with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods obtained from a full self-administered web-based 24-hour recall performed on the same day. RESULTS The approximate quintiles of each score had a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend < 0.001). We found a substantial agreement between the intervals of each score and the corresponding % of energy intake (Nova-WPF score: Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) 0.72, 95%CI 0.64–0.81; Nova-UPF score: PABAK 0.79, 95%CI 0.69–0.88). CONCLUSIONS These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can be used to evaluate and monitor diet quality.

RESUMO Objetivo Investigar a evolução da prevalência de gastos catastróficos no Distrito Federal em três momentos distintos (2003, 2009 e 2018), bem como identificar a composição dos gastos diretos em saúde dos recursos financeiros das famílias nos respectivos anos. Métodos Estudo de série temporal, usando dados da Pesquisa sobre Orçamento Familiar. A prevalência foi estratificada por quintis do consumo. Resultados Foram selecionados como amostra 754 domicílios em 2003, 695 em 2009 e 1.000 em 2018. Para o limiar de 10% do consumo, a prevalência dos gastos catastróficos foi de 12,3% (IC95% 9,6;14,9) em 2003, 15,3% (IC95% 12,1;18,3) em 2009 e 14,1% (IC95% 11,8;16,2) em 2018. Domicílios com menor renda apresentaram maior prevalência de gastos catastróficos. Medicamentos têm maior peso no gasto das famílias de baixa renda. Conclusão Houve aumento da prevalência de gastos catastróficos no Distrito Federal. Medicamentos foram o principal gasto das famílias mais pobres.

RESUMEN Objective Investigar la evolución de prevalencia del gasto catastrófico en Distrito Federal en tres momentos diferentes (2003, 2009 y 2018), así como identificar la composición del gasto directo en salud de los recursos de las familias en los respectivos años. Method Estudio de series temporales, utilizando datos descriptivos de Encuesta de Presupuestos Familiares. La prevalencia se estratificó por quintiles de consumo. Results Se seleccionaron como muestra 754 hogares en 2003, 695 en 2009 y 1.000 en 2018. El umbral del 10% del consumo, la prevalencia del gasto catastrófico fue 12,3% (IC95% 9,6;14,9) en 2003, del 15,3% (IC95% 12,1;18,3) en 2009 y del 14,1% (IC95% 11,8;16,2) en 2018. Hogares pobres tuvieron una mayor prevalencia de gastos catastróficos. Medicamentos tienen un mayor peso en los gastos de familias pobres. Conclusions Hubo un aumento en la prevalencia de gastos catastróficos en el Distrito Federal. Los medicamentos fueron el principal gasto en familias paupérrimas.

ABSTRACT Objective To investigate the evolution of prevalence of catastrophic health expenditure in the Brazilian Federal District at three different times (2003, 2009 and 2018), as well, to identify the composition of outof- pocket expenditure in the respective years. Method Time series study, using descriptive data from the Family Budget Survey. Prevalence was stratified by consumption quintiles. Results 754 households were selected as a sample in 2003, 695 in 2009 and 1,000 in 2018. Taking a 10% consumption threshold, prevalence of catastrophic expenditure was 12.3% (95%CI 9.6;14.9) in 2003, 15.3% (95%CI 12.1;18.3) in 2009 and 14.1% (95CI% 11.8;16.2) in 2018. Households with lower income had higher prevalence of catastrophic expenditure. Medicines have a greater burden on expenditure of low-income families. Conclusions There was an increase in prevalence of catastrophic expenditure in the Federal District. Medicines were the main expense for the poorest families.

Resumo Este estudo objetivou identificar padrões alimentares e avaliar a associação entre percepção da imagem corporal e esses padrões em escolares. Um estudo transversal foi conduzido em 385 escolares (ambos os sexos, 10-17 anos de idade) de 4 escolas públicas de Salvador, Brasil. Dois recordatórios alimentares de 24h não consecutivos foram aplicados e o padrão alimentar foi determinado por Análise Fatorial Exploratória, após ajuste dos dados dietéticos pelo Multiple Source Method. Para avaliar percepção da imagem corporal, nós usamos uma escala brasileira de silhuetas. Avaliamos as associações entre percepção da imagem corporal e padrões alimentares usando o modelo de regressão logística politômica ajustado para covariáveis. Três padrões alimentares foram obtidos: “padrão ocidental”, “padrão saudável” e “comidas típicas/junk food”. Após ajuste, adolescentes que desejavam uma silhueta menor (2,48 [IC95%: 1,04-6,11], 3,49 [IC95%: 1,35-9,05] e 2,87 [IC95%: 1,13-7,26]) tinham mais chances de aderir aos quintis de menor consumo do padrão ocidental, comparados àqueles satisfeitos com sua imagem corporal. Nenhuma associação foi identificada nos outros dois padrões alimentares. Adolescentes insatisfeitos com seus corpos tendem a aderir menos a padrões alimentares não saudáveis.

Abstract This study aimed to identify dietary patterns and to evaluate the association between body image perception and these patterns among schoolchildren. A cross-sectional study was conducted on 385 schoolchildren (both sexes, 10-17 years old) from four public schools in Salvador, Brazil. Two non-consecutive 24-hour dietary recalls were applied, and the dietary pattern was determined by Exploratory Factor Analysis after adjustment of dietary data using the Multiple Source Method. To evaluate body image perception, the Brazilian body shape silhouette was used. The associations between body image perception and dietary patterns using the polytomous logistic regression model adjusted for covariables was assessed. Three dietary patterns were obtained: “Western standard,” unhealthy, “healthy pattern” and “typical dishes/ junk food.” After adjustment, adolescents who wished for a slimmer silhouette (2.48 [95%CI: 1.04-6.11], 3.49 [95%CI: 1.35-9.05] and 2.87 [95%CI: 1.13-7.26]) were more likely to adhere to the quintiles with the lowest consumption of the Western standard, compared to those satisfied with their body image. No associations were identified in the other two dietary patterns. Adolescents dissatisfied with their bodies tend to adhere less to unhealthy dietary patterns.

ABSTRACT OBJECTIVE To describe two low-burden diet quality scores and evaluate their performance in reflecting the dietary share of the least and most processed foods defined within the Nova food system classification. METHODS This cross-sectional study included data from the NutriNet-Brasil cohort. Participants answered the Nova24hScreener, a 3-minute self-administered questionnaire measuring the consumption of a set of foods on the day before. Food items included in this tool belong to two main groups of the Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 items) and ultra-processed foods (UPF, 23 items). Two scores were obtained by summing the number of items checked: the Nova-WPF and the Nova-UPF. We compared the scores, respectively, with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods obtained from a full self-administered web-based 24-hour recall performed on the same day. RESULTS The approximate quintiles of each score had a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend < 0.001). We found a substantial agreement between the intervals of each score and the corresponding % of energy intake (Nova-WPF score: Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) 0.72, 95%CI 0.64–0.81; Nova-UPF score: PABAK 0.79, 95%CI 0.69–0.88). CONCLUSIONS These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can be used to evaluate and monitor diet quality. lowburden low burden classification crosssectional cross sectional NutriNetBrasil NutriNet Brasil cohort Nova24hScreener NovahScreener hScreener 3minute minute 3 selfadministered self administered before WPF, WPF (WPF ultraprocessed ultra UPF, UPF (UPF 2 items. . checked NovaWPF NovaUPF. NovaUPF UPF. respectively ( webbased web based 24hour hour 24 pvalue p value 0.001. 0001 0.001 0 001 0.001) PrevalenceAdjusted Prevalence Adjusted BiasAdjusted Bias (PABAK 072 72 0.72 95CI CI 95 0.64–0.81 064081 64 81 079 79 0.79 0.69–0.88. 069088 0.69–0.88 69 88 0.69–0.88) 000 0.00 00 07 7 0.7 9 0.64–0.8 06408 6 8 06908 0.69–0.8 0.0 0. 0.64–0. 0640 0690 0.69–0. 0.64–0 064 069 0.69–0 0.64– 06 0.69– 0.64 0.69 0.6