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 Integrar os conceitos de Saúde Planetária e Big Data ao modelo de Donabedian, para avaliar o Programa de Combate à Dengue no estado de São Paulo. MÉTODOS Foram adotados métodos de Ciência de Dados para integração e análise de dados relacionados à dengue, agregando o contexto aos componentes de estrutura e de resultado do modelo de Donabedian. Esses dados, considerando o período de 2010 a 2019, foram coletados de fontes como Datasus, Instituto Brasileiro de Geografia e Estatística (IBGE), WorldClim e MapBiomas, e integrados em um Data Warehouse. Para a identificação de grupos com contextos similares, foi utilizado o algoritmo K-means. Em seguida, foram realizadas análises estatísticas e visualizações espaciais dos grupos, considerando variáveis socioeconômicas, demográficas, solo, estrutura de saúde e casos de dengue. RESULTADOS Com o uso das variáveis climáticas, o algoritmo K-means identificou quatro grupos de municípios com características similares. A comparação dos seus indicadores revelou certos padrões nos municípios com pior desempenho quanto aos resultados de casos de dengue. Embora tivessem melhores condições econômicas, eles tinham menor número médio de agentes comunitários e de unidades básicas de saúde por habitante. Dessa forma, as condições econômicas não refletiram em melhor estrutura de saúde nos três indicadores avaliados. Outra característica desses municípios é a urbanização. Os municípios de pior desempenho tinham maior taxa de população urbana e de modificações antrópicas relacionadas à urbanização. CONCLUSÕES Por meio desta metodologia, foi possível identificar importantes deficiências nas condições para a execução do programa de combate à dengue no estado de São Paulo. A integração de diversas bases de dados e a utilização de métodos de Ciência de Dados permitiram a avaliação do programa em larga escala, considerando o contexto em que as ações são executadas. Dessa forma, a gestão pública pode utilizar as informações coletadas para planejar ações e investir de acordo com as deficiências de cada local. Donabedian Paulo 201 2019 Datasus IBGE, IBGE , (IBGE) MapBiomas Warehouse similares Kmeans. Kmeans K means. means seguida socioeconômicas demográficas solo climáticas habitante forma avaliados urbanização metodologia escala executadas local 20 (IBGE 2

ABSTRACT OBJECTIVE This study aims to integrate the concepts of planetary health and big data into the Donabedian model to evaluate the Brazilian dengue control program in the state of São Paulo. METHODS Data science methods were used to integrate and analyze dengue-related data, adding context to the structure and outcome components of the Donabedian model. This data, considering the period from 2010 to 2019, was collected from sources such as Department of Informatics of the Unified Health System (DATASUS), the Brazilian Institute of Geography and Statistics (IBGE), WorldClim, and MapBiomas. These data were integrated into a Data Warehouse. K-means algorithm was used to identify groups with similar contexts. Then, statistical analyses and spatial visualizations of the groups were performed, considering socioeconomic and demographic variables, soil, health structure, and dengue cases. OUTCOMES Using climate variables, the K-means algorithm identified four groups of municipalities with similar characteristics. The comparison of their indicators revealed certain patterns in the municipalities with the worst performance in terms of dengue case outcomes. Although presenting better economic conditions, these municipalities held a lower average number of community healthcare agents and basic health units per inhabitant. Thus, economic conditions did not reflect better health structure among the three studied indicators. Another characteristic of these municipalities is urbanization. The worst performing municipalities presented a higher rate of urban population and human activity related to urbanization. CONCLUSIONS This methodology identified important deficiencies in the implementation of the dengue control program in the state of São Paulo. The integration of several databases and the use of Data Science methods allowed the evaluation of the program on a large scale, considering the context in which activities are conducted. These data can be used by the public administration to plan actions and invest according to the deficiencies of each location. Paulo denguerelated 201 2019 DATASUS, DATASUS , (DATASUS) IBGE, IBGE (IBGE) WorldClim MapBiomas Warehouse Kmeans K means contexts Then performed variables soil cases characteristics outcomes inhabitant Thus urbanization scale conducted location 20 (DATASUS (IBGE 2

RESUMO A pandemia de covid-19 gerou um numeroso volume de produções científicas com diferentes níveis de qualidade. A velocidade com que o conhecimento era produzido e compartilhado a nível mundial impôs à gestão em saúde o desafio de buscar meios de identificar as melhores evidências disponíveis para subsidiar suas decisões. Em resposta a este desafio, o Departamento de Ciência e Tecnologia do Ministério da Saúde do Brasil estabeleceu um serviço para elaborar e disponibilizar conhecimento científico abordando questões prioritárias de saúde pública no cenário da pandemia. Entre os temas abordados estão tratamentos medicamentosos, medidas não farmacológicas, testagem, reinfecção e resposta imunológica, imunização, fisiopatologia, síndrome pós-covid e eventos adversos. Neste artigo, discute-se os pontos fortes e lições aprendidas, bem como os desafios e perspectivas que fornecem um exemplo real sobre como disponibilizar as melhores evidências científicas, em tempo hábil e de forma oportuna, para auxiliar o processo decisório durante uma emergência em saúde pública. covid19 covid 19 covid-1 qualidade decisões medicamentosos farmacológicas testagem imunológica imunização fisiopatologia póscovid pós adversos artigo discutese discute se aprendidas oportuna covid1 1 covid-

ABSTRACT The COVID-19 pandemic generated a large volume of scientific productions with different quality levels. The speed with which knowledge was produced and shared worldwide imposed on health management the challenge of seeking ways to identify the best available evidence to support its decisions. In response to this challenge, the Department of Science and Technology of the Brazilian Ministry of Health started offering a service to produce and provide scientific knowledge addressing priority public health issues in the pandemic scenario. Drug treatments, non-pharmacological measures, testing, reinfection and immunological response, immunization, pathophysiology, post-COVID syndrome and adverse events are among the topics covered. In this article, we discuss the strengths and lessons learned, as well as the challenges and perspectives that present a real example of how to offer the best scientific evidence in a timely manner in order to assist the decision-making process during a public health emergency. COVID19 COVID 19 COVID-1 levels decisions scenario treatments nonpharmacological non pharmacological measures testing immunization pathophysiology postCOVID post covered article learned decisionmaking decision making emergency COVID1 1 COVID-

RESUMO OBJETIVO Avaliar e comparar o protagonismo das equipes de Saúde Bucal (eSB) no processo de trabalho em equipe na Atenção Primária à Saúde (APS) ao longo de cinco anos, e estimar a magnitude das disparidades entre as macrorregiões brasileiras. MÉTODOS Estudo ecológico que utilizou dados secundários extraídos do Sistema de Informação em Saúde para a Atenção Básica (SISAB), de 2018 a 2022. Foram selecionados indicadores de matriz avaliativa previamente validada, calculados a partir dos registros na Ficha de Atividade Coletiva do grau de protagonismo das eSB nas reuniões de equipe, bem como do seu grau de organização em relação às pautas dos encontros. Foi realizada análise descritiva e da amplitude da variação dos indicadores ao longo do tempo, e também foi calculado o índice de disparidade para estimar e comparar a magnitude das diferenças entre as macrorregiões no ano de 2022. RESULTADOS No Brasil, entre 3,06% e 4,04% das reuniões de equipe foram lideradas por profissionais da eSB. No período, o Nordeste e o Sul foram as regiões que apresentaram maiores (3,71% a 4,88%) e menores proporções (1,21% a 2,48%), respectivamente. No período de 2018 a 2022, houve uma redução do indicador “grau de protagonismo das eSB” no Brasil e nas macrorregiões. Os temas mais frequentes em reuniões sob responsabilidade das eSB foram processo de trabalho (54,71% a 70,64%) e diagnóstico e monitoramento do território (33,49% a 54,48%). As maiores disparidades entre as regiões foram observadas para o indicador “grau de organização das eSB, em relação à discussão de caso e de projeto terapêutico singular”. CONCLUSÕES O protagonismo das eSB no processo de trabalho em equipe na APS é incipiente e apresenta disparidades regionais, o que desafia gestores e eSB para o rompimento do isolamento e da falta de integração, visando a oferta de atenção à saúde integral e de qualidade ao usuário do Sistema Único de Saúde (SUS). (eSB (APS anos brasileiras SISAB, SISAB , (SISAB) 201 2022 validada encontros tempo 306 3 06 3,06 404 4 04 4,04 3,71% 371 71 (3,71 4,88% 488 88 1,21% 121 1 21 (1,21 2,48%, 248 2,48% 2 48 2,48%) respectivamente 54,71% 5471 54 (54,71 70,64% 7064 70 64 33,49% 3349 33 49 (33,49 54,48%. 5448 54,48% . 54,48%) singular. singular singular” regionais integração SUS. SUS (SUS) (SISAB 20 202 30 0 3,0 40 4,0 3,71 37 7 (3,7 4,88 8 1,21 12 (1,2 24 2,48 54,71 547 5 (54,7 70,64 706 6 33,49 334 (33,4 544 54,48 (SUS 3, 4, 3,7 (3, 4,8 1,2 (1, 2,4 54,7 (54, 70,6 33,4 (33, 54,4 (3 1, (1 2, 54, (54 70, 33, (33 ( (5

ABSTRACT OBJECTIVE Evaluate and compare the protagonism of Oral Health teams (OHt) in the teamwork process in Primary Healthcare (PHC) over five years and estimate the magnitude of disparities between Brazilian macro-regions. METHODS Ecological study that used secondary data extracted from the Sistema de Informação em Saúde para a Atenção Básica (SISAB – Health Information System for Primary Healthcare) from 2018 to 2022. Indicators were selected from a previously validated evaluative matrix, calculated from records in the Collective Activity Form on the degree of OHt’s protagonism in team meetings and its degree of organization concerning the meeting agendas. A descriptive and amplitude analysis of the indicators’ variation over time was carried out, and the disparity index was also calculated to estimate and compare the magnitude of differences between macro-regions in 2022. RESULTS In Brazil, between 3.06% and 4.04% of team meetings were led by OHt professionals. The Northeast and South regions had the highest (3.71% to 4.88%) and lowest proportions (1.21% to 2.48%), respectively. From 2018 to 2022, there was a reduction in the indicator of the “degree of protagonism of the OHt” in Brazil and macro-regions. The most frequent topics in meetings under OHt’s responsibility were the work process (54.71% to 70.64%) and diagnosis and monitoring of the territory (33.49% to 54.48%). The most significant disparities between regions were observed for the indicator “degree of organization of the OHt concerning case discussion and singular therapeutic projects”. CONCLUSIONS The protagonism of the OHt in the teamwork process in PHC is incipient and presents regional disparities, which challenges managers and OHt to break isolation and lack of integration, aiming to offer comprehensive and quality healthcare to the user of the Unified Health System (SUS). (OHt (PHC macroregions. macroregions macro regions. SISAB 201 2022 matrix OHts s agendas indicators out 306 3 06 3.06 404 4 04 4.04 professionals 3.71% 371 71 (3.71 4.88% 488 88 1.21% 121 1 21 (1.21 2.48%, 248 2.48% , 2 48 2.48%) respectively 54.71% 5471 54 (54.71 70.64% 7064 70 64 33.49% 3349 33 49 (33.49 54.48%. 5448 54.48% . 54.48%) projects. projects projects” integration SUS. SUS (SUS) 20 202 30 0 3.0 40 4.0 3.71 37 7 (3.7 4.88 8 1.21 12 (1.2 24 2.48 54.71 547 5 (54.7 70.64 706 6 33.49 334 (33.4 544 54.48 (SUS 3. 4. 3.7 (3. 4.8 1.2 (1. 2.4 54.7 (54. 70.6 33.4 (33. 54.4 (3 1. (1 2. 54. (54 70. 33. (33 ( (5

RESUMO OBJETIVO Analisar a distribuição e associação de fatores sociodemográficos e ocupacionais a acidentes de trabalho (AT) autorrelatados em uma amostra representativa da população brasileira, com ênfase na classe ocupacional, e examinar as diferenças de gênero nessa distribuição. MÉTODOS Estudo transversal de base populacional, com dados da Pesquisa Nacional de Saúde (PNS) de 2019, analisou as respostas de uma amostra de adultos com 18 anos ou mais de idade. Fatores associados a AT foram investigados por regressão logística binária e análise hierarquizada por meio de blocos (variáveis sociodemográficas e ocupacionais). O modelo final foi ajustado pelas variáveis de todos os blocos, adotando-se o nível de significância de 5%. Obtiveram-se os valores das razões de chance (RC) e respectivos intervalos de confiança. RESULTADOS Entre os participantes, 2,69% relataram ter sofrido AT, sendo mais alta a prevalência em homens (3,37%; IC95% 2,97–3,82%), se comparados às mulheres (1,86%; IC95% 1,55–2,23%). A análise identificou que faixa etária, trabalho noturno, jornada de trabalho e exposição a riscos laborais foram associados a AT, com destaque para as diferenças de gênero. A classe de trabalhadores manuais, tanto qualificados (RCmulheres = 2,87; IC95% 1,33–6,21 e RChomens = 2,46; IC95% 1,37–4,40) quanto não qualificados (RCmulheres = 2,55; IC95% 1,44–4,50 e RChomens = 3,70; IC95% 1,95–7,03), apresentaram maior chance de AT em comparação à classe de gerentes/profissionais. CONCLUSÃO Fatores ocupacionais contribuíram significativamente para o aumento na probabilidade de AT para homens e mulheres, com maior magnitude entre aqueles posicionados nos estratos inferiores da estrutura ocupacional. Os resultados obtidos são pistas para a elaboração de ações de prevenção de AT. (AT brasileira ocupacional populacional PNS (PNS 2019 1 idade ocupacionais. . ocupacionais) adotandose adotando 5 5% Obtiveramse Obtiveram RC (RC confiança participantes 269 2 69 2,69 3,37% 337 3 37 (3,37% IC95 IC 2,97–3,82%, 297382 2,97–3,82% , 97 82 2,97–3,82%) 1,86% 186 86 (1,86% 1,55–2,23%. 155223 1,55–2,23% 55 23 1,55–2,23%) etária noturno manuais RCmulheres 2,87 287 87 133621 33 6 21 1,33–6,2 2,46 246 46 1,37–4,40 137440 4 40 2,55 255 144450 44 50 1,44–4,5 3,70 370 70 1,95–7,03, 195703 1,95–7,03 95 7 03 1,95–7,03) gerentesprofissionais gerentes profissionais gerentes/profissionais 201 26 2,6 3,37 (3,37 IC9 29738 2,97–3,82 9 8 1,86 (1,86 15522 1,55–2,23 2,8 28 13362 1,33–6, 2,4 24 1,37–4,4 13744 2,5 25 14445 1,44–4, 3,7 19570 1,95–7,0 0 20 2, 3,3 (3,3 2973 2,97–3,8 1,8 (1,8 1552 1,55–2,2 1336 1,33–6 1,37–4, 1374 1444 1,44–4 3, 1957 1,95–7, (3, 297 2,97–3, 1, (1, 155 1,55–2, 133 1,33– 1,37–4 137 144 1,44– 195 1,95–7 (3 29 2,97–3 (1 15 1,55–2 13 1,33 1,37– 14 1,44 19 1,95– ( 2,97– 1,55– 1,3 1,37 1,4 1,95 2,97 1,55 1,9 2,9 1,5

ABSTRACT OBJECTIVE To analyze the distribution and association of sociodemographic and occupational factors with self-reported work accidents (WA) in a representative sample of the Brazilian population, with emphasis on occupational class, and to examine gender differences in this distribution. METHODS A population-based cross-sectional study, using data from the 2019 National Health Survey (PNS), analyzed the responses of a sample of adults aged 18 or over. Factors associated with WA were investigated using binary logistic regression and hierarchical analysis using blocks (sociodemographic and occupational variables). The final model was adjusted by variables from all blocks, adopting a significance level of 5%. The values of odds ratios (OR) and respective confidence intervals were obtained. RESULTS Among the participants, 2.69% reported having suffered a WA, with a higher prevalence in men (3.37%; 95%CI 2.97–3.82%) than in women (1.86%; 95%CI 1.55–2.23%). The analysis identified that age group, night work, working hours, and exposure to occupational risks were associated with WA, with emphasis on gender differences. The class of manual workers, both qualified (ORwomen = 2.87; 95%CI 1.33–6.21 and ORmen = 2.46; 95%CI 1.37–4.40) and unskilled (ORwomen = 2.55; 95%CI 1.44–4.50 and ORmen = 3.70; 95%CI 1.95–7.03), had a higher chance of WA than the class of managers/professionals. CONCLUSION Occupational factors contributed significantly to the increase in the probability of WA for men and women, with greater magnitude among those positioned in the lower strata of the occupational structure. The results obtained are clues for working out WA prevention actions. selfreported self (WA population populationbased based crosssectional cross sectional study 201 PNS, PNS , (PNS) 1 over variables. . variables) 5 5% OR (OR participants 269 2 69 2.69 3.37% 337 3 37 (3.37% 95CI CI 95 2.97–3.82% 297382 97 82 1.86% 186 86 (1.86% 1.55–2.23%. 155223 1.55–2.23% 55 23 1.55–2.23%) group hours workers ORwomen 2.87 287 87 133621 33 6 21 1.33–6.2 2.46 246 46 1.37–4.40 137440 4 40 2.55 255 144450 44 50 1.44–4.5 3.70 370 70 1.95–7.03, 195703 1.95–7.03 7 03 1.95–7.03) managersprofessionals managers professionals managers/professionals structure actions 20 (PNS 26 2.6 3.37 (3.37 9 2.97–3.82 29738 8 1.86 (1.86 15522 1.55–2.23 2.8 28 13362 1.33–6. 2.4 24 1.37–4.4 13744 2.5 25 14445 1.44–4. 3.7 19570 1.95–7.0 0 2. 3.3 (3.3 2.97–3.8 2973 1.8 (1.8 1552 1.55–2.2 1336 1.33–6 1.37–4. 1374 1444 1.44–4 3. 1957 1.95–7. (3. 2.97–3. 297 1. (1. 155 1.55–2. 133 1.33– 1.37–4 137 144 1.44– 195 1.95–7 (3 2.97–3 29 (1 15 1.55–2 13 1.33 1.37– 14 1.44 19 1.95– ( 2.97– 1.55– 1.3 1.37 1.4 1.95 2.97 1.55 1.9 2.9 1.5

ABSTRACT OBJECTIVE To assess regional and national mortality and years of life lost (YLL) related to adverse drug events in Brazil. METHODS This is an ecological study in which death records from 2009 to 2018 from the Mortality Information System were analyzed. Codes from the International Classification of Diseases 10th revision (ICD-10) that indicated drugs as the cause of death were identified. The number of deaths and the YLL due to adverse drug events were obtained. Crude, age- and gender-specific, and age-adjusted mortality rates and YLL rates per 100,000 inhabitants were formed by year, age group, gender, and Brazilian Federative Unit. Rate ratios were calculated by comparing rates from 2009 to 2018. A joinpoint regression model was applied for temporal analysis. RESULTS For the selected ICD-10 codes, a total of 95,231 deaths and 2,843,413 YLL were recorded. Mortality rates from adverse drug events increased by a mean of 2.5% per year, and YLL rates increased by 3.7%. Increases in rates were observed in almost all age groups for both genders. Variations in rates were found between Federative Units, with the highest age-adjusted mortality and YLL rates occurring in the Distrito Federal. CONCLUSIONS The numbers and rates of deaths and YLL increased during the study period, and variations in rates of deaths and YLL were observed between Brazilian Federative Units. Information on multiple causes of death from death certificates can be useful for quantifying adverse drug events and analyzing them geographically, by age and by gender. (YLL Brazil 200 201 analyzed th ICD10 ICD 10 (ICD-10 identified obtained Crude genderspecific, genderspecific gender specific, specific gender-specific ageadjusted adjusted 100000 100 000 100,00 year group Unit analysis ICD-1 codes 95231 95 231 95,23 2843413 2 843 413 2,843,41 recorded 25 5 2.5 37 3 7 3.7% genders Units Federal period geographically 20 ICD1 1 (ICD-1 10000 00 100,0 ICD- 9523 9 23 95,2 284341 84 41 2,843,4 2. 3.7 (ICD- 1000 0 100, 952 95, 28434 8 4 2,843, 3. (ICD 2843 2,843 284 2,84 28 2,8 2,

ABSTRACT OBJECTIVE To identify the prevalence of contamination by pesticides and their metabolites in the milk of lactating mothers in Latin America. METHODS In this systematic review, the PubMed, LILACS, Embase, and Scopus databases were searched up to January 2022 to identify observational studies. The Mendeley software was used to manage these references. The risk of bias assessment was evaluated according to the checklist for prevalence studies and writing design, by the Prisma guidelines. RESULTS This study retrieved 1835 references and analyzed 49 studies. 69.38% of the analyzed studies found a 100% prevalence of breast milk contamination by pesticides among their sample. Main pesticides include dichlorodiphenyltrichloroethane (DDT) and its isomers (75.51%), followed by the metabolite dichlorodiphenyldichloroethylene (DDE) (69.38%) and hexachlorocyclohexane (HCH) (46.93%). This study categorized most (65.30%) studies as having a low risk of bias. CONCLUSIONS This review shows a high prevalence of pesticide contamination in the breast milk of Latin American women. Further investigations should be carried out to assess contamination levels in breast milk and the possible effects of these substances on maternal and child health. America PubMed LILACS Embase 202 design guidelines 183 4 6938 69 38 69.38 100 sample DDT (DDT 75.51%, 7551 75.51% , 75 51 (75.51%) DDE (DDE (69.38% HCH (HCH 46.93%. 4693 46.93% . 46 93 (46.93%) 65.30% 6530 65 30 (65.30% women health 20 18 693 6 3 69.3 10 755 75.51 7 5 (75.51% (69.38 469 46.93 9 (46.93% 65.30 653 (65.30 2 1 69. 75.5 (75.51 (69.3 46.9 (46.93 65.3 (65.3 75. (75.5 (69. 46. (46.9 65. (65. (75. (69 (46. (65 (75 (6 (46 (7 ( (4

RESUMO INTRODUÇÃO O câncer de pulmão (CP) é um relevante problema de saúde pública no Brasil e no mundo, dada sua alta incidência e mortalidade. Assim, objetiva-se analisar a distribuição do tabagismo e da carga tabágica segundo características sociodemográficas e disparidades no acesso, no tratamento e na mortalidade por CP no Brasil, em 2013 e 2019. MÉTODO Estudo retrospectivo de triangulação de fontes de dados de abrangência nacional: a) análise da distribuição do tabagismo, baseada na Pesquisa Nacional de Saúde (PNS); b) investigação dos registros de CP, via Registros Hospitalares de Câncer (RHC); e c) distribuição da mortalidade por CP, no Sistema de Informação sobre Mortalidade (SIM). RESULTADOS Verificou-se redução do percentual de pessoas que nunca fumaram de 2013 (68,5%) para 2019 (60,2%), assim como da carga tabágica (anos-maço). Esta foi observada maior em homens em pessoas de faixas etárias mais avançadas e de menor escolaridade. Em relação aos pacientes registrados no RHC, a entrada no serviço de saúde se dá a partir de 50 anos, e apenas 19% nunca fumaram. Ao passo que os fumantes na população são majoritariamente pardos, os pacientes no RHC são em maioria brancos. Quanto ao estadiamento inicial (I e II), é mais frequente em pessoas brancas e que nunca fumaram. A taxa de mortalidade apresentou variação de 1,00, para pessoas com ensino superior, a 3,36, entre pessoas sem instrução, assim como pessoas brancas têm uma taxa de mortalidade três vezes maior que a de pessoas negras e pardas. CONCLUSÃO Este artigo apontou relevantes disparidades sociodemográficas no acesso ao diagnóstico, tratamento e mortalidade do CP. Assim, recomenda-se: fortalecer o Registro de Câncer de Base Populacional; desenvolver e implementar estratégia de screening de CP no Brasil, uma vez que a realização de estratégias de prevenção e diagnóstico precoce combinadas funcionam melhor no controle da mortalidade pela doença; e investimento contínuo nas políticas de prevenção e controle do tabagismo. (CP mundo Assim objetivase objetiva 201 nacional PNS (PNS) b (RHC) c SIM. SIM . (SIM) Verificouse Verificou 68,5% 685 68 5 (68,5% 60,2%, 602 60,2% , 60 2 (60,2%) anosmaço. anosmaço anos maço (anos-maço) escolaridade 19 pardos brancos I II, II II) 100 1 00 1,00 superior 336 3 36 3,36 instrução pardas recomendase recomenda recomenda-se Populacional doença 20 (PNS (RHC (SIM 68,5 6 (68,5 60,2 (60,2% (anos-maço 10 0 1,0 33 3,3 68, (68, 60, (60,2 1, 3, (68 (60, (6 (60 (

ABSTRACT INTRODUCTION Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019. METHOD Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM). RESULTS There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people. CONCLUSION This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies. (LC worldwide Thus treatment 201 sources PNS (PNS) b Hospitalbased Hospital (HCR) c SIM. SIM . (SIM) 68.5% 685 68 5 (68.5% 60.2% 602 60 2 (60.2% packyears. packyears pack years (pack-years) men groups 50 19 Mixedrace, Mixedrace Mixed race, race Mixed-race I II, II , II) 100 1 00 1.0 336 3 36 3.3 Furthermore mixedrace mixed Therefore PopulationBased Population Based policies 20 (PNS (HCR (SIM 68.5 6 (68.5 60.2 (60.2 (pack-years 10 0 1. 33 3. 68. (68. 60. (60. (68 (60 (6 (