ABSTRACT BACKGROUND: Vaccination hesitation spans from historical diseases such as smallpox to the current challenges with the coronavirus disease (COVID-19). In Brazil, vaccination faces obstacles related to trust and convenience. Despite the National Immunization Program, fear of adverse effects as well as misinformation challenge confidence in vaccines, and anti-vaccine movements have gained momentum. OBJECTIVES: This study investigated childhood vaccine refusal, including COVID-19 vaccines, by comparing the reasons for and sociodemographic differences between vaccinated individuals and those who hesitated or refused immunization. DESIGN AND SETTING: A cross-sectional study was conducted in São Paulo, Brazil, using questionnaires administered during pediatric consultations between January and April 2023. METHODS: This study investigated vaccine hesitancy and the attitudes of parents and caregivers of children (0–12 years) towards vaccines. The questionnaire was administered during routine pediatric consultations at three different locations, each with 50 participants for a total of 150 participants, to avoid selection bias. RESULTS: Marked differences were evident among caregivers in terms of sex, race, income, education, and religion, which influenced their attitudes toward vaccination. There was an increase in the refusal of seasonal vaccinations and a significant distrust of the efficacy of the COVID-19 vaccine (52%), with concerns about its side effects. Although most patients did not stop vaccination, significant delays occurred, especially in the clinical setting (58%). CONCLUSIONS: This study emphasizes the importance of childhood health decisions, indicating the need to build trust in vaccines, tailor health policies, and investigate the causes of distrust to promote childhood immunizations. BACKGROUND COVID19. COVID19 COVID 19 . (COVID-19) Brazil convenience Program vaccines antivaccine anti momentum OBJECTIVES COVID-1 immunization SETTING crosssectional cross sectional Paulo 2023 METHODS 0–12 012 0 12 (0–1 years locations 5 15 bias RESULTS sex race income education religion 52%, 52 52% , (52%) occurred 58%. 58 58% (58%) CONCLUSIONS decisions policies immunizations COVID1 1 (COVID-19 COVID- 202 0–1 01 (0– (52% (58% (COVID-1 20 0– (0 (52 (58 (COVID- 2 ( (5 (COVID

Resumen Introducción: Los homicidios son causas importantes de mortalidad en el mundo, especialmente en Brasil, que representa aproximadamente dos tercios de las muertes por causas externas y el tercer lugar entre las causas de muerte en el país. Materiales Y métodos: Estudio retrospectivo sobre la ocurrencia de causas de muertes violentas ocurridas en diferentes regiones de Municipio de São Paulo de 2000 a 2014 según el Sistema de Información de Mortalidad de la Secretaría de Salud Municipal. Se calculó el coeficiente estandarizado (CP) para la ocurrencia de homicidios y las tasas de riesgo según la población y el sexo masculino. Resultados: De 11.981 casos, el CP mostró que las regiones sur y este mostraron un aumento en la ocurrencia de homicidios entre los años 2000 y 2005 en comparación con los años 2010 y 2014. Considerando la suma del CP en los 15 años, Es posible observar la mayor ocurrencia de homicidios en las regiones sur y oriente de la ciudad de São Paulo, sin embargo, con una reducción entre los años 2010 y 2014. En cuanto a la tasa de riesgo relativo de homicidio, la región norte tuvo tasas más altas entre 2000 y 2005. Al considerar el género masculino, la región oeste mostró un aumento en la tasa de riesgo entre 2000 y 2005. Para los años 2010 la tasa de riesgo se mantuvo elevada para las regiones: norte (1,14) y este (1,15), mientras que para los hombres la tasa de riesgo (0,91) se mantuvo alta para la región sur. En 2014, la tasa de riesgo más alta (1,18) se trasladó a la región occidental, mientras que para los hombres la tasa de riesgo más alta se dirigió a la región central (0,92). Conclusiones: Se mantuvieron altas tasas de ocurrencia de homicidios para las regiones sur y oriente de la ciudad de São Paulo durante los últimos 15 años. La tasa de riesgo difiere entre las regiones de la ciudad de São Paulo, destacando la región norte entre los años 2000, 2005 y 2010 y la región occidental en 2014. El género masculino influye en las tasas de riesgo entre regiones, especialmente la región occidental entre 2000 y 2005, la región sur en 2010 y la región central en 2014, mostrando su influencia en la ocurrencia de homicidios.

Abstract Introduction : Homicides are important causes of mortality in the world, especially in Brazil, which represents approximately two thirds of deaths from external causes and the third place among the causes of death in the country. Methods: Retrospective study on the occurrence of causes of violent deaths occurring in different regions of the city of São Paulo from 2000 to 2014 according to the Mortality Information System of the Municipal Health Secretariat. The standardized coefficient (CP) for the occurrence of homicides and risk rates according to population and male gender were calculated. Results: The PC showed that the south and east regions had increased homicide occurrence between 2000 and 2005 when compared to the years 2010 and 2014. Considering the sum of the PC over the 15 years can be observed the highest occurrence of homicide. in the southern and eastern regions of São Paulo, however, with a reduction in occurrence between 2010 and 2014. Regarding the relative risk rate for homicide, the northern region presented higher rates between 2000 and 2005. When considering gender male population, the western region showed an increase in the risk rate between 2000 and 2005. For 2010, the risk rate remained higher for the northern (1.14) and eastern (1.15) regions, while for the male gender. For men, the risk rate (0.91) remained high for the southern region. In 2014 the highest risk rate (1.18) moved to the western region while for males the highest risk rate was directed to the central region (0.92). Conclusions: High homicide rates have remained in the southern and eastern regions of the city of São Paulo over the past 15 years. The risk rate differs between the regions of the city of São Paulo, highlighting the northern region between 2000, 2005 and 2010 and the western region in 2014. The male gender influences the risk rates between the regions, especially the western region between 2000 and 2005, the southern region in 2010 and the central region in 2014, showing their influence on homicide.

RESUMO Objetivo: Caracterizar os casos de acidentes de transporte terrestre nas macrorregiões do município de São Paulo nos anos de 2005, 2010 e 2015. Métodos: Trata-se de estudo de base populacional, longitudinal e retrospectivo de séries temporais, embasado em um levantamento quantitativo dos acidentes de transporte terrestres ocorridos no município de São Paulo nos anos de 2005, 2010 e 2015, utilizando dados provenientes do Sistema de Informações sobre Mortalidade. Resultados: Um total de 1.343, 1.567 e 1.088 óbitos por acidente foram registrados para a população do município nos anos de 2005, 2010 e 2015, respectivamente. A maior ocorrência se deu nas faixas etárias de 15 a 24 anos e 24 a 34 anos. O maior número de mortes por acidentes se deu no sexo masculino. As taxas de mortalidade observadas nas macrorregiões foram: Sul (23,8%), Leste (22%), Norte (21,6%), Oeste (7,1%) e Centro (3%). Comparando-se períodos, houve queda nos coeficientes padronizados de mortalidade geral por 100 mil habitantes na maioria das macrorregiões. Conclusão: Apesar da queda na mortalidade geral dos acidentes na maioria das macrorregiões, ela ainda merece atenção e foco em ações de trânsito preventivas direcionadas aos jovens do sexo masculino que residem em bairros periféricos, pois representam o grupo mais suscetível. Nível II - Estudo prognóstico - Investigação do efeito de características de um paciente sobre o desfecho da doença. Nível de Evidência II; Estudo retrospectivo.

ABSTRACT Objective: To characterize cases of land transport accidents in the macro-regions of city of São Paulo in 2005, 2010, and 2015. Methods: This is a population-based, longitudinal and retrospective study of time series, based on a quantitative survey of land transport accidents that occurred in the city of São Paulo in 2005, 2010 and 2015 using data from the Mortality Information System of the City of São Paulo. Results: A total of 1,343, 1,567 and 1,088 deaths by accident recorded in the city’ population in the years 2005, 2010 and 2015 respectively. The highest occurrences were in the age groups 15 to 24 years and 24 to 34 years. The highest number of deaths due to accidents was among males. The mortality rates observed in the macro-regions were South (23.8%), East (22%), North (21.6%), West (7.1%), and Center (3%). In comparing the years examined, there was a decline in the mortality rate per 100,000 inhabitants in most macro-regions. Conclusion: Despite the decrease in overall accident mortality in most macro-regions, it still deserves attention on preventive traffic actions focused on young males living in peripheral neighborhoods, since they represent the most susceptible group. Level of evidence II; Retrospective Study.

ABSTRACT BACKGROUND: Suicide is one of the leading causes of death worldwide, accounting for one million deaths annually. Greater understanding of the causal risk factors is needed, especially in large urban centers. OBJECTIVE: To ascertain the epidemiological profile and temporal trend of suicides over two decades and correlate prevalence with social indicators. DESIGN AND SETTING: Descriptive population-based longitudinal retrospective study conducted in the city of São Paulo, Brazil. METHODS: A temporal trend series for suicide mortality in this city was constructed based on data from the Ministry of Health’s mortality notification system, covering 2000-2017. It was analyzed using classic demographic variables relating to social factors. RESULTS: Suicide rates were high throughout this period, increasing from 4.6/100,000 inhabitants in the 2000s to 4.9/100,000 in 2017 (mean: 4.7/100,000). The increase in mortality was mainly due to increased male suicide, which went from 6.0/100,000 to the current 8.0/100,000. Other higher coefficients corresponded to social risk factors, such as being a young adult (25-44 years old), being more educated (eight years of schooling) and having white ethnicity (67.2%). Suicide was also twice as likely to occur at home (47.8%). CONCLUSION: High suicide rates were seen over the period 2000-2017, especially among young adults and males. High schooling levels and white ethnicity were risk factors. The home environment is the crucial arena for preventive action. One special aspect of primary prevention is the internet and especially social media, which provides a multitude of information for suicide prevention.

RESUMO Introdução: a obesidade tornou-se problema de saúde pública no Brasil e no mundo, devido à alta prevalência. É considerada fator de risco para doenças metabólicas, como hipertensão arterial sistêmica (HAS) e diabetes Mellitus tipo 2 (DM2). Embora a modificação do estilo de vida possa controlar e até levar à remissão total do DM2, a maioria dos pacientes tem dificuldade em controlar a glicemia. Estudos recentes mostram que a derivação gástrica em Y de Roux (RYGB) é eficiente para a perda de peso e o controle de comorbidades em pacientes obesos. Objetivo: analisar o efeito da técnica RYGB no controle e tratamento de comorbidades relacionadas à obesidade. Método: trata-se de estudo de coorte retrospectivo, com informações obtidas pela revisão de prontuários, com coleta de dados no pré e pós-operatório de pacientes submetidos a cirurgia bariátrica. Selecionamos para o estudo aqueles com DM2 e HAS. Resultados: 252 pacientes foram submetidos à RYGB no serviço. Setenta e nove (31,3%) tinham DM2 e 64 tinham HAS associada a DM2. Com relação ao DM2 e à HAS, 37,9% e 43,7%, respectivamente, apresentaram remissão total da doença após a operação. Houve redução no pós-operatório do uso de Metformina, insulina/Gliclazida, Propranolol, Losartana e Hidroclorotiazida em 62%, 10,1%, 100%, 26,5% e 22,8% dos pacientes, respectivamente. Conclusão: a técnica da RYGB é efetiva na remissão do DM2 e HAS. Mesmo nos casos em que não houve a remissão total das doenças, houve queda significativa no uso de medicamentos usados para o tratamento.

ABSTRACT Introduction: obesity has become a public health problem in Brazil and worldwide, due to its high prevalence. It is considered a risk factor for systemic arterial hypertension (SAH) and type 2 diabetes mellitus T2DM. Although lifestyle changes can control and even achieve complete T2DM remission, most patients have difficulty controlling blood glucose. Recent studies show that the Roux-en-Y gastric bypass (RYGB) is efficient for weight loss and control of T2DM and SAH in obese individuals. Objective: to analyze the effect of the RYGB technique on the control and treatment of comorbidities related to obesity. Method: this is a retrospective cohort study, with information obtained from the review of medical records, with data collection in the pre and postoperative period of patients undergoing bariatric surgery. We selected those with T2DM and SAH for the study. Results: 252 patients underwent RYGB in the service. Seventy-nine (31.3%) had T2DM and 64 had SAH associated with T2DM. Regarding T2DM and SAH, 37.9% and 43,7%, respectively, showed total remission of the disease after surgery. There was a reduction in the postoperative use of Metformin, insulin / Gliclazide, Propranolol, Losartan and Hydrochlorothiazide in 62%, 10.1%, 100%, 26.5% and 22.8% of patients, respectively. Conclusion: the RYGB technique is effective in the remission of T2DM and SAH. Even in cases where there was no total remission of the diseases, there was a significant drop in the use of medicines used for their treatment.

OBJECTIVE: To characterize the motorcycle accidents occurred in the city of São Paulo, SP, Brazil in the year 2013, with emphasis on information about hospital admissions from SIH/SUS. METHODS: This is a retrospective cross-sectional study. The study covered 5,597 motorcyclists traumatized in traffic accident during the year 2013 occurred in the city of São Paulo. A survey was conducted using secondary data from the Information System of Hospitalization Health System (SIH/SUS). RESULTS: In 2013, in the city of São Paulo there were 5,597 admissions of motorcyclists traumatized in traffic accidents, of which 89.8% were male. The admission diagnosis were: leg fracture, femur fracture, and intracranial injury. CONCLUSION: This study confirms other preliminary studies on several points, among which stands out the highest prevalence of male young adults. Level of Evidence II, Retrospective Study.

OBJETIVO: Identificar fatores associados à alteração da linguagem entre variáveis sociais e nutricionais de pré-escolares. MÉTODOS: Estudo transversal realizado com 126 crianças com idade entre 6 meses e 6 anos da região sul do município de São Paulo. Utilizou-se o Teste de Triagem de Desenvolvimento de Denver II para detectar risco de linguagem. O resultado do teste foi comparado com as seguintes variáveis: idade, gênero, escolaridade da mãe, estado nutricional da criança, número e ordem de nascimento dos filhos e anemia. Os resultados receberam análise estatística. RESULTADOS: Segundo o teste de Denver II, dos 126 sujeitos da pesquisa 18,3% apresentaram risco para linguagem e 9,5% anemia. Não houve diferença entre os grupos risco e não risco para as variáveis idade, estado nutricional, escolaridade da mãe e gênero. Para as variáveis número de filhos, ordem de nascimento e presença de anemia, ao contrário, houve diferença entre os grupos risco e não risco. CONCLUSÃO: O maior risco para aquisição e desenvolvimento de linguagem centrou-se no grupo de anêmicos, filhos mais velhos e com menos de quatro irmãos. Estudos semelhantes são fundamentais para detectar possíveis alterações no desenvolvimento da linguagem e, consequentemente, na aprendizagem e futuro desempenho social da criança.

PURPOSE: To identify factors related to language disorders among social and nutritional variables in preschoolers. METHODS: Cross-sectional study carried out with 126 children from the south region of the city of São Paulo, with ages ranging from 6 months to 6 years. The Denver II Developmental Screening Test was administered to detect the risk for language disorders. The test results were compared to the following variables: age, gender, mother's level of education, child nutritional status, number and order of children's birth, and anemia. Results were statistically analyzed. RESULTS:According to the Denver II test, 18.3% of the 126 participants were at risk for language disorders, and 9.5% presented anemia. No differences were found between risk and non-risk groups regarding age, nutritional status, gender, and mother's education. Differences were found between groups regarding number of children per family, birth order, and presence of anemia. CONCLUSION: The risk for disorders in language acquisition and development was higher in the group with anemia, in the eldest children, and in the children with less than four siblings. Similar studies are necessary to detect possible deviations in language development and, consequently, in the child's learning process and future social performance.