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.

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.

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 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.

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 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.

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.

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.

ABSTRACT Lutzomyia longipalpis (Lutz & Neiva, 1912) constitutes the most epidemiologically relevant vector of visceral leishmaniasis (VL) in the New World. On October 25, 2023, the Macapá Center for Strategic Information in Health Surveillance registered a case of VL in the Km9 neighborhood, in Macapá. This study aimed to describe the Phlebotominae species in this area to assist the confirmation of the autochthony of the case. In total, 12 specimens were collected, of which five belonged to the Lutzomyia longipalpis species, confirming the presence of the VL agent vector and the possible autochthony of the transmission. Lutz Neiva 1912 (VL World 25 2023 Km neighborhood total 1 collected transmission 191 2 202 19 20

RESUMO Lutzomyia longipalpis (Lutz & Neiva, 1912) é o vetor do agente da leishmaniose visceral (LV) no Novo Mundo de maior relevância epidemiológica. Em 25 de outubro de 2023, o Centro de Informações Estratégicas em Vigilância em Saúde de Macapá detectou um caso de LV no bairro Km9 desse município. O objetivo deste estudo foi identificar as espécies de flebotomíneos nessa área a fim de auxiliar na confirmação da autoctonia do caso. Foram coletados 12 espécimes, desses, cinco foram de Lu. longipalpis, confirmando assim a presença do vetor do agente da LV e a possível autoctonia da transmissão. Lutz Neiva 1912 (LV epidemiológica 2 2023 Km município 1 espécimes desses Lu transmissão 191 202 19 20

RESUMO OBJETIVO: Analisar a tendência temporal dos recursos públicos federais investidos na agenda brasileira de Segurança Alimentar e Nutricional do período de 2000–2022. MÉTODOS: Realizou-se um estudo de série temporal com dados coletados de um sistema de acesso público sobre planejamento e orçamento do Governo Federal. Foram analisadas as ações orçamentárias e seus recursos indicados pela Dotação Orçamentária e o Valor Liquidado. As ações foram categorizadas em temas da agenda de SAN, analisadas a partir da regressão de Prais-Winsten, juntamente com o método de Cochrane-Orcutt. Os valores foram corrigidos pelo Índice de Preços ao Consumidor Amplo, para janeiro de 2023. RESULTADOS: O investimento na área de Segurança Alimentar e Nutricional apresentou uma tendência crescente em duas décadas de financiamento federal, apesar de ter demonstrado oscilações em determinados anos. A Dotação Orçamentária mostrou uma variação anual de 10,1%, e o Valor Liquidado obteve 10,8%. No entanto, há um desequilíbrio no financiamento federal entre as áreas estratégicas, com tendência crescente na saúde (37,4%), soberania alimentar (23,7%) e acesso à alimentação (12,3%); e tendência negativa de investimento em algumas áreas, como desenvolvimento agrário (-7,0%). Constatou-se uma alocação de recursos concentrada em ações assistenciais para garantia do acesso à alimentação, em média 73,4% do total de recursos executados. CONCLUSÃO: Os resultados apresentaram um comportamento crescente do investimento público na agenda brasileira de Segurança Alimentar e Nutricional, embora expressassem oscilações em determinados anos e uma concentração de recursos em áreas específicas. Apesar de 2/3 do orçamento ser exclusivamente para ações de acesso à alimentação, dados recentes demonstram que a fome ainda assola a realidade brasileira. Reforçando a necessidade de um investimento contínuo e mais equânime entre as áreas, como forma de fortalecer políticas públicas estruturantes que garantam de forma permanente a Segurança Alimentar e Nutricional da população brasileira. OBJETIVO 20002022 2000 2022 2000–2022 MÉTODOS Realizouse Realizou se Federal SAN PraisWinsten, PraisWinsten Prais Winsten, Winsten Prais-Winsten CochraneOrcutt. CochraneOrcutt Cochrane Orcutt. Orcutt Cochrane-Orcutt Amplo 2023 RESULTADOS 101 10 1 10,1% 108 8 10,8% entanto estratégicas 37,4%, 374 37,4% , 37 4 (37,4%) 23,7% 237 23 7 (23,7% 12,3% 123 12 3 (12,3%) 7,0%. 70 7,0% . 0 (-7,0%) Constatouse Constatou 734 73 73,4 executados CONCLUSÃO específicas 2 2/ 2000202 200 202 2000–202 10,1 10,8 37,4 (37,4% 23,7 (23,7 12,3 (12,3% 7,0 (-7,0% 73, 200020 20 2000–20 10, 37, (37,4 23, (23, 12, (12,3 7, (-7,0 20002 2000–2 (37, (23 (12, (-7, 2000– (37 (2 (12 (-7 (3 ( (1 (-

ABSTRACT Objective: To analyze the time trend of federal public resources invested in the Brazilian Food and Nutrition Security agenda from 2000–2022. MethodS: A time series study was carried out with data collected from a publicly accessible system on the Federal Government’s planning and budget. We analyzed the budget actions and their resources indicated by the Budget Allocation and the Settled Amount. The actions were categorized into themes of the Food Nutrition Security agenda, analyzed using the Prais-Winsten regression, together with the Cochrane-Orcutt method. The values were adjusted by the Broad Consumer Price Index for January 2023. Results: Investment in the area of Food and Nutrition Security has shown an upward trend over two decades of federal funding, although it has shown fluctuations in certain years. The Budgetary Allocation showed an annual variation of 10.1%, and the Settled Amount obtained 10.8%. However, there is an imbalance in federal funding between strategic areas, with an upward trend in health (37.4%), food sovereignty (23.7%), and access to food (12.3%); and a downward trend in investment in some areas, such as agrarian development (-7.0%). The allocation of resources was concentrated on welfare actions to guarantee access to food, averaging 73.4% of the total resources spent. Conclusion: The results show that public investment in Brazil’s Food and Nutrition Security agenda has been on the rise, although there have been fluctuations in certain years and a concentration of resources in specific areas. Despite having two thirds of the budget aimed exclusively at actions toward access to food, recent data shows that hunger still plagues the Brazilian reality. This reinforces the need for continuous and more equitable investment between areas, as a way of strengthening structuring public policies that permanently guarantee Food and Nutrition Security for the Brazilian population. Objective 20002022 2000 2022 2000–2022 MethodS Governments Government s PraisWinsten Prais Winsten regression CochraneOrcutt Cochrane Orcutt method 2023 Results 101 10 1 10.1% 108 8 10.8% However areas 37.4%, 374 37.4% , 37 4 (37.4%) 23.7%, 237 23.7% 23 7 (23.7%) 12.3% 123 12 3 (12.3%) 7.0%. 70 7.0% . 0 (-7.0%) 734 73 73.4 spent Conclusion Brazils Brazil rise reality population 2000202 200 202 2000–202 10.1 10.8 37.4 (37.4% 23.7 2 (23.7% 12.3 (12.3% 7.0 (-7.0% 73. 200020 20 2000–20 10. 37. (37.4 23. (23.7 12. (12.3 7. (-7.0 20002 2000–2 (37. (23. (12. (-7. 2000– (37 (23 (12 (-7 (3 (2 (1 (- (

ABSTRACT OBJECTIVES: To correlate the incidence of leptospirosis with sociodemographic data in the Brazilian Unified Health System from 2011 to 2022. METHODS: This ecological study used national health and economic secondary data sources. Secondary analyses summarized the scenario of disease-related hospitalizations among federative units. In total, two analyses were conducted: variable description for relationship analysis and a secondary analysis with population health and sanitation indicators and economic indicators from the Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). The statistical analysis following this framework summarized raw data by year-month-federative unit. A time series regression was conducted, comparing the time variable with other national-level variables. Then, several simple linear regressions were performed. RESULTS: Linear regressions show the relationship between the reduction in cases and improved access to treated water and sewage collection, whereas an increase in per capita income seems to be inversely related to leptospirosis incidence. Geospatial distribution shows higher incidence in the Brazilian South and Southeast. Disease lethality varied over time but without significant change during the period. The average treatment cost remained constant over the years, despite its complexity. CONCLUSION: Leptospirosis incidence in Brazil from 2011 to 2021 decreased and was associated with improvements in socioeconomic conditions despite no changes in lethality. OBJECTIVES 201 2022 METHODS sources diseaserelated disease units total conducted IBGE Statistics. Statistics . Statistics) yearmonthfederative year month unit nationallevel level variables Then performed RESULTS collection Southeast period years complexity CONCLUSION 202 20 2

RESUMO OBJETIVO: Investigar os elementos da rede social associados à síndrome da fragilidade em adultos brasileiros mais velhos. MÉTODOS: Foram utilizados dados da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil, 2015–2016). Definiu-se a fragilidade pelo fenótipo de Fried (perda de peso, exaustão, fraqueza, lentidão da marcha e baixo nível de atividade física). A rede social foi avaliada a partir do modelo conceitual de Berkman e Krishna (estrutura da rede social, característica dos laços da rede social, apoio social e interação social negativa). Potenciais variáveis de confusão incluíram características sociodemográficas (idade, sexo, escolaridade, cor autorreferida, renda familiar per capita e local de moradia) e de saúde (polifarmácia, multimorbidade, depressão, quedas, hospitalização e função cognitiva). As análises foram baseadas na regressão logística multinomial. RESULTADOS: Entre os 8.629 participantes, 53,5% eram pré-frágeis e 9,1% frágeis. Os elementos da rede social que foram consistentemente associados à pré-fragilidade e à fragilidade são os seguintes: característica dos laços da rede social, apoio social e interação social negativa. Associação positiva foi encontrada para frequência menor que semanal de contato virtual com filhos(as) (OR = 1,15; IC95% 1,01–1,33 para pré-fragilidade e OR = 1,51; IC95% 1,13–2,02 para fragilidade) e para solidão (OR = 1,36; IC95% 1,19–1,56 para pré-fragilidade e OR=1,40; IC95% 1,12–1,75 para fragilidade). Associação negativa foi encontrada para apoio social (ajuda com empréstimos) (OR = 0,75; IC95% 0,60–0,94 para pré-fragilidade e OR = 0,54; IC95% 0,40–0,74 para fragilidade). Contudo, a percepção de críticas associou-se somente à fragilidade (OR = 1,35; IC95% 1,11–1,64). CONCLUSÃO: A rede social é um elemento importante para a diminuição/prevenção da fragilidade em adultos mais velhos. Desse modo, políticas públicas, profissionais da saúde e da assistência social devem abranger a rede social de adultos mais velhos, em relação à característica dos laços da rede social, ao apoio social e à interação social negativa. OBJETIVO velhos MÉTODOS ELSIBrasil, ELSIBrasil ELSI Brasil, Brasil (ELSI-Brasil 2015–2016. 20152016 2015–2016 . 2015 2016 2015–2016) Definiuse Definiu se perda peso exaustão fraqueza física. física física) estrutura negativa) idade, idade (idade sexo escolaridade autorreferida moradia polifarmácia, polifarmácia (polifarmácia multimorbidade depressão quedas cognitiva. cognitiva cognitiva) multinomial RESULTADOS 8629 8 629 8.62 participantes 535 53 5 53,5 préfrágeis pré frágeis 91 9 1 9,1 préfragilidade seguintes filhosas filhos as filhos(as 1,15 115 15 IC95 IC 101133 01 33 1,01–1,3 1,51 151 51 113202 13 2 02 1,13–2,0 1,36 136 36 119156 19 56 1,19–1,5 OR=1,40 OR140 40 112175 12 75 1,12–1,7 fragilidade. ajuda empréstimos 0,75 075 0 060094 60 94 0,60–0,9 0,54 054 54 040074 74 0,40–0,7 Contudo associouse associou 1,35 135 35 1,11–1,64. 111164 1,11–1,64 11 64 1,11–1,64) CONCLUSÃO diminuiçãoprevenção diminuição prevenção modo públicas 2015201 2015–201 201 862 62 8.6 53, 9, 1,1 IC9 10113 3 1,01–1, 1,5 11320 1,13–2, 1,3 11915 1,19–1, OR=1,4 OR14 4 11217 7 1,12–1, 0,7 07 06009 6 0,60–0, 0,5 05 04007 0,40–0, 11116 1,11–1,6 201520 2015–20 20 86 8. 1, 1011 1,01–1 1132 1,13–2 1191 1,19–1 OR=1, OR1 1121 1,12–1 0, 0600 0,60–0 0400 0,40–0 1111 1,11–1, 20152 2015–2 101 1,01– 113 1,13– 119 1,19– OR=1 112 1,12– 060 0,60– 040 0,40– 111 1,11–1 2015– 10 1,01 1,13 1,19 OR= 1,12 06 0,60 04 0,40 1,11– 1,0 0,6 0,4 1,11

ABSTRACT OBJECTIVE: To investigate the elements of the social network associated with frailty syndrome in older Brazilian adults. METHODS: Baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2015–2016) were used. Frailty was defined by the Fried phenotype (unintentional weight loss, exhaustion, weakness, slowness, and low level of physical activity). The social network was assessed using the conceptual model of Berkman and Krishna (social network structure, characteristics of social network ties, social support, and negative social interaction). Potential confounding variables included sociodemographic (age, sex, education, self-reported race, per capita family income, and place of residence) and health characteristics (polypharmacy, multimorbidity, depression, falls, hospitalization, and cognitive function). Analyses were based on multinomial logistic regression. RESULTS: Among the 8,629 participants, 53.5% were pre-frail individuals and 9.1% were frail individuals. The elements of the social network that were consistently associated with pre-frailty and frailty were the following: characteristics of social network ties, social support, and negative social interaction. A positive association was found for less-than-weekly frequency of virtual contact with sons and daughters (OR = 1.15; 95%CI 1.01–1.33 for pre-frailty and OR = 1.51; 95%CI 1.13–2.02 for frailty) and for loneliness (OR = 1.36; 95%CI 1.19–1.56 for pre-frailty and OR = 1.40; 95%CI 1.12–1.75 for frailty). A negative association was found for social support (help with loans) (OR = 0.75; 95%CI 0.60–0.94 for pre-frailty and OR = 0.54; 95%CI 0.40–0.74 for frailty). However, the perception of criticism was only associated with frailty (OR = 1.35; 95%CI 1.11–1.64). CONCLUSION: Social network is an important element for reducing/preventing frailty in older adults. Therefore, public policies and health and social assistance professionals should encompass the older adults’ social network regarding the characteristics of social network ties, social support, and negative social interaction. OBJECTIVE adults METHODS ELSIBrazil, ELSIBrazil ELSI Brazil, Brazil (ELSI-Brazil 2015–2016 20152016 2015 2016 used unintentional loss exhaustion weakness slowness activity. activity . activity) structure ties interaction interaction) age, age (age sex education selfreported self reported race income residence polypharmacy, polypharmacy (polypharmacy multimorbidity depression falls hospitalization function. function function) regression RESULTS 8629 8 629 8,62 participants 535 53 5 53.5 prefrail pre 91 9 1 9.1 prefrailty following lessthanweekly less than weekly 1.15 115 15 95CI CI 95 101133 01 33 1.01–1.3 1.51 151 51 113202 13 2 02 1.13–2.0 1.36 136 36 119156 19 56 1.19–1.5 1.40 140 40 112175 12 75 1.12–1.7 frailty. help loans 0.75 075 0 060094 60 94 0.60–0.9 0.54 054 54 040074 74 0.40–0.7 However 1.35 135 35 1.11–1.64. 111164 1.11–1.64 11 64 1.11–1.64) CONCLUSION reducingpreventing reducing preventing Therefore 2015–201 2015201 201 862 62 8,6 53. 9. 1.1 10113 3 1.01–1. 1.5 11320 1.13–2. 1.3 11915 1.19–1. 1.4 14 4 11217 7 1.12–1. 0.7 07 06009 6 0.60–0. 0.5 05 04007 0.40–0. 11116 1.11–1.6 2015–20 201520 20 86 8, 1. 1011 1.01–1 1132 1.13–2 1191 1.19–1 1121 1.12–1 0. 0600 0.60–0 0400 0.40–0 1111 1.11–1. 2015–2 20152 101 1.01– 113 1.13– 119 1.19– 112 1.12– 060 0.60– 040 0.40– 111 1.11–1 2015– 10 1.01 1.13 1.19 1.12 06 0.60 04 0.40 1.11– 1.0 0.6 0.4 1.11

ABSTRACT OBJECTIVE: To investigate the relationship between sociodemographic factors, musculoskeletal pain and its characteristics, and the type of primary health care received with self-reported disability. METHODS: This is a cross-sectional study, interviewing individuals selected from spontaneous demand for health care in two types of care: health center and family health unit. Disability was investigated using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 and characteristics of intensity, frequency, duration, number of pain sites, and regions. Measures of association between predictors and disability were performed with non-parametric statistical tests, whereas non-parametric regression models were presented for pain characteristics and for the general population. RESULTS: In total, 2.3% of family health users and 7.2% of health center users had severe levels of disability. Health center users had more self-reported disability than family health users (p < 0.001). Fewer years of life (p = 0.034) and lower per capita income quintile (p = 0.014) were associated with greater disability. The most intense pain and pain in the greatest number of sites increased the disability score by 1.8 (95%CI = 1.0–2.6) and 6.3 (95%CI = 0.1–12.2) points, respectively. CONCLUSION: Users who had more disabilities sought care at walk-in health centers, had lower per capita income, presented musculoskeletal pain of worse intensity, and pain in a greater number of sites. OBJECTIVE factors selfreported self reported METHODS crosssectional cross sectional study unit WHODAS (WHODAS 20 2 0 2. intensity frequency duration regions nonparametric non parametric tests population RESULTS total 23 3 2.3 72 7 7.2 p 0.001. 0001 0.001 . 001 0.001) 0.034 0034 034 0.014 0014 014 18 1 8 1. 95%CI 95CI CI 95 1.0–2.6 1026 6 63 6. 0.1–12.2 01122 12 points respectively CONCLUSION walkin walk centers 7. 000 0.00 00 0.03 003 03 0.01 01 9 1.0–2. 102 0.1–12. 0112 0.0 1.0–2 10 0.1–12 011 0. 1.0– 0.1–1 1.0 0.1– 0.1

ABSTRACT OBJECTIVE To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84–2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85–2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03–3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64–1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77–2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities. (MM (MMR 201 2022 country cause analysis Q CI (CI calculated 680100000 68 0 100 000 68.0/100,00 LB. LB . (LB) 125.81 12581 125 81 6415 64 15 64.15 196 1 96 1.96 95%CI1.84–2.08 95CI184208 95%CI 1.84–2.08 95 84 2 08 95%CI:1.84–2.08 125.8 1258 8 (125. 640 64.0 95CI 1.85–2.09. 185209 1.85–2.09 85 09 1.85–2.09) regions 115.5 1155 115 5 (115. 608 60 60.8 248 48 2.48 2.03–3.03. 203303 2.03–3.03 03 3 2.03–3.03) covid19 covid 19 covid-1 pandemic 1441 144 144.1 748 74 74. 805100000 80 80.5/100.00 LB, , LB) 179 79 1.79 1.64–1.95 164195 192 92 1.92 1.77–2.09 177209 77 remained causes years Brazil determinant disparities 20 202 68010000 6 10 00 68.0/100,0 (LB 12 641 64.1 9 1.9 CI1 95%CI1.84–2.0 95CI18420 184208 1.84–2.0 95%CI:1.84–2.0 125. (125 64. 18520 1.85–2.0 115. 11 (115 60. 24 4 2.4 20330 2.03–3.0 covid1 covid- 14 144. 7 80510000 80.5/100.0 17 1.7 1.64–1.9 16419 1.77–2.0 17720 6801000 68.0/100, 1. 95%CI1.84–2. 95CI1842 18420 1.84–2. 95%CI:1.84–2. (12 1852 1.85–2. (11 2. 2033 2.03–3. 8051000 80.5/100. 1.64–1. 1641 1.77–2. 1772 680100 68.0/100 95%CI1.84–2 95CI184 1842 1.84–2 95%CI:1.84–2 (1 185 1.85–2 203 2.03–3 805100 80.5/100 1.64–1 164 1.77–2 177 68010 68.0/10 95%CI1.84– 95CI18 184 1.84– 95%CI:1.84– ( 18 1.85– 2.03– 80510 80.5/10 1.64– 16 1.77– 6801 68.0/1 95%CI1.84 95CI1 1.84 95%CI:1.84 1.85 2.03 8051 80.5/1 1.64 1.77 680 68.0/ 95%CI1.8 1.8 95%CI:1.8 2.0 805 80.5/ 1.6 68.0 95%CI1. 95%CI:1. 80.5 68. 95%CI1 95%CI:1 80.

ABSTRACT OBJECTIVE To identify empirical patterns of multimorbidity and quantify their associations with socioeconomic, behavioral characteristics, and health outcomes in the megacity of São Paulo. METHODS This was a cross-sectional study conducted through household interviews with residents aged 20 years or older in urban areas (n = 3,184). Latent class analysis was used to identify patterns among the co-existence of 22 health conditions. Age-adjusted prevalence ratios were estimated using Poisson regression. RESULTS The analysis of latent classes showed 4 patterns of multimorbidity, whereas 58.6% of individuals were classified in the low disease probability group, followed by participants presenting cardiovascular conditions (15.9%), respiratory conditions (12.8%), and rheumatic, musculoskeletal, and emotional conditions (12.8%). Older individuals, with lower schooling and lower household income, presented higher multimorbidity prevalence in cardiovascular, respiratory, rheumatic, musculoskeletal, and emotional conditions patterns compared with the low disease probability pattern. CONCLUSION The results showed four distinct patterns of multimorbidity in the megacity population, and these patterns are clinically recognizable and theoretically plausible. The identification of trends between patterns would make it feasible to estimate the magnitude of the challenge for the organization of health care policies. socioeconomic characteristics Paulo crosssectional cross sectional 2 n 3,184. 3184 3,184 . 3 184 3,184) coexistence co existence Ageadjusted Age adjusted regression 586 58 6 58.6 group 15.9%, 159 15.9% , 15 9 (15.9%) 12.8%, 128 12.8% 12 8 (12.8%) rheumatic musculoskeletal 12.8%. income pattern population plausible policies 318 3,18 18 5 58. 15.9 1 (15.9% 12.8 (12.8% 31 3,1 15. (15.9 12. (12.8 3, (15. (12. (15 (12 (1 (

RESUMO Este estudo tem o objetivo de analisar a validade da autorreferência de medidas antropométricas (peso e altura) para a classificação do estado nutricional de adultos e idosos brasileiros a partir dos dados da Pesquisa Nacional de Saúde (PNS), edição de 2019. A amostra da PNS é constituída por domicílios particulares permanentes de todas as unidades federativas do Brasil e este é um recorte transversal no qual foram identificados 6.571 registros com dados aferidos e referidos, não sendo identificados dados perdidos para uma variável quando na presença de outra. A validação foi realizada com 6.381 dados após a retirada de dados atípicos. As variáveis utilizadas para estratificação foram: sexo, idade, raça/cor, escolaridade e renda e, para analisar a concordância entre as categorias do estado nutricional, foram utilizados o Coeficiente Kappa ponderado e o Coeficiente de Correlação Intraclasse (CCI). A acurácia foi analisada com base nos valores de sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN). E para a validade de constructo, foi realizada uma regressão de Poisson para cada desfecho (aferido e autorreferido), com as variáveis independentes “sexo”, “cor/raça”, “escolaridade” e “renda familiar”. Todas as análises mostraram resultados positivos para a validação. Houve uma maior reprodutibilidade entre adultos (18 a 59 anos) quando comparados às pessoas idosas e entre homens quando comparados às mulheres. Esta validação indica uma possibilidade concreta de realizar estudos observacionais de associação tendo como variável de desfecho o estado nutricional referido, como uma estratégia eficiente, podendo minimizar as dificuldades operacionais frequentemente encontradas. peso altura PNS, , (PNS) 2019 6571 6 571 6.57 referidos outra 6381 381 6.38 atípicos sexo idade raçacor raça cor raça/cor CCI. CCI . (CCI) sensibilidade especificidade VPP (VPP VPN. VPN (VPN) constructo aferido autorreferido, autorreferido autorreferido) “sexo” cor/raça, corraça cor/raça “cor/raça” “escolaridade familiar. familiar familiar” 18 (1 5 anos mulheres referido eficiente encontradas (PNS 201 657 57 6.5 638 38 6.3 (CCI (VPN “sexo “cor/raça 1 ( 20 65 6. 63 3 2

ABSTRACT The aim of this study was to analyze the validity of self-reported anthropometric measurements (weight and height) for classifying the nutritional status of Brazilian adults and elderly people using data from the 2019 National Health Survey (PNS). The PNS sample is made up of permanent private households from all of Brazil’s federative units and this is a cross-sectional study in which 6,571 records were identified with measured and reported data, with no missing data for one variable being identified when in the presence of another. Validation was carried out with 6,381 data after removing atypical data. The variables used for stratification were: gender, age, race/color, schooling, and income, and the weighted Kappa Coefficient and the Intraclass Correlation Coefficient (ICC) were used to analyze agreement between the nutritional status categories. Accuracy was analyzed based on sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). For construct validity, a Poisson regression was performed for each outcome (measured and self-reported), with the independent variables “gender”, “color/race”, “schooling”, and “family income”. All the analyses showed positive results for validation. There was greater reproducibility among adults (18 to 59 years old) compared to the elderly and among men compared to women. This validation indicates a concrete possibility of carrying out an association of observational studies using reported nutritional status as the outcome variable, as an efficient strategy which could minimize the operational difficulties often encountered. selfreported self weight height 201 PNS. . (PNS) Brazils Brazil s crosssectional cross sectional 6571 6 571 6,57 another 6381 381 6,38 gender age racecolor race color race/color schooling income ICC (ICC categories sensitivity specificity PPV (PPV NPV. NPV (NPV) selfreported, , self-reported) “gender” color/race, colorrace color/race “color/race” “schooling” family income. income” 18 (1 5 old women encountered 20 (PNS 657 57 6,5 638 38 6,3 (NPV “gender “color/race “schooling 1 ( 2 65 6, 63 3

ABSTRACT OBJECTIVE The transgender population in Brazil faces marginalization and difficulties in accessing education and health, leading many individuals to self-medicate. This study aimed to evaluate the impact of the implementation of Specialized Centers in the Transsexualizing Process (SCTP) on the use of cross-sex hormone therapy (CSHT) without medical prescription, as well as the level of education and mental health profile of these individuals. METHODS This is a cross-sectional study with data from physical and electronic medical records between September 2017 and February 2023 regarding the use of CSHT before and after the implementation of two SCTP in the state of Bahia, Brazil, in addition to data on education level, previous diagnosis of anxiety and depression of patients. RESULTS A total of 219 participants, 127 transgender men (TM) and 92 transgender women and travestis (TrTW), were assessed. A significant reduction in the prevalence of self-medication was observed in both TrTW (92.98% before and 51.43% after, p<0.001), and TM (47.17% before and 25.67% after, p = 0.010) with the implementation of SCTP. Transgender individuals who used CSHT before accessing the service were found to have a lower prevalence of depression. Self-medication was not significantly associated with education or anxiety in our sample. CONCLUSION The results indicate the need for the expansion of SCTP, as they were associated with lower rates of self-medication in the transgender population. selfmedicate. selfmedicate self medicate. medicate self-medicate (SCTP crosssex cross sex (CSHT prescription crosssectional sectional 201 202 Bahia patients 21 participants 12 (TM 9 TrTW, , (TrTW) assessed selfmedication medication 92.98% 9298 98 (92.98 5143 51 43 51.43 p<0.001, p0001 p<0.001 0 001 p<0.001) 47.17% 4717 47 17 (47.17 2567 25 67 25.67 0.010 0010 010 Selfmedication Self sample 20 2 1 (TrTW 92.98 929 (92.9 514 5 4 51.4 p000 p<0.00 00 47.17 471 (47.1 256 6 25.6 0.01 01 92.9 (92. 51. p00 p<0.0 47.1 (47. 25. 0.0 92. (92 p0 p<0. 47. (47 0. (9 p<0 (4 ( p<