RESUMO O mieloma múltiplo é o segundo câncer hematológico mais comum; representa aproximadamente 10% de todas os cânceres hematológicos e 1%-2% de todos as neoplasias. Foi conduzido um estudo ecológico para descrever a morbidade, a mortalidade e a carga da doença no Brasil e suas 27 unidades federativas e avaliar tendências entre 1990-2019. Dados do estudo da Carga Global de Doenças foram avaliados para descrever medidas ajustadas por idade: incidência, prevalência, mortalidade, anos de vida ajustados pela incapacidade e seus componentes de acordo com sexo e Índice Sociodemográfico. As tendências foram estimadas usando regressão linear e expressas como Variação Percentual Anual Média (AAPC) e Intervalos de Confiança (IC) 95%. Tendências ascendentes das medidas foram observadas. A mortalidade aumentou em menor extensão comparada à incidência (AAPC=1,3%;IC95%=1,2-1,3 vs. AAPC=1,5%;IC95%=1,5-1,5 homens; AAPC=0,9%; IC95%=0,9-0,9 vs. AAPC=1,1%; IC95%=1,1-1,2 mulheres), resultando em tendências crescentes da prevalência para ambos os sexos. Todas as medidas foram mais altas nos quintis do índice sociodemográfico alto e médio-alto; tendências ascendentes mais altas foram encontradas em quintis do índice sociodemográfico mais baixos. Envelhecimento, nível de desenvolvimento, acesso ao diagnóstico e tratamento parecem explicar as medidas ascendentes do mieloma múltiplo no Brasil e suas diferenças entre as unidades federativas.

ABSTRACT Multiple myeloma is the second most common hematological cancer; it accounts for approximately 10% of all hematologic malignancies and 1%-2% of all cancer diagnoses. From 1990 to 2019, an ecological study was conducted to describe and evaluate trends in Brazil’s morbidity, mortality, and disease. The Global Burden of Disease data described age-standardized (+40 years) incidence, prevalence, mortality, disability-adjusted life years, and its components in Brazil and across its 27 federative units according to sex and Socio-demographic Index quintiles. Trends were estimated using linear regression and expressed as Average Annual Percentage Changes (AAPC) and 95% Confidence Intervals (CI). Ascending trends of the measures were found for both sexes in Brazil and its federative units. Mortality increased to a lesser extent than incidence (AAPC=1.3%; 95%CI=1.2-1.3 vs. AAPC=1.5%; 95%CI= 1.5-1.5 for men; AAPC=0.9%; 95%CI=0.9-0.9 vs. AAPC=1.1%; 95%CI=1.1-1.2 for women), resulting in higher rising trends in prevalence for both sexes. All the measures were significantly higher in high- and high-middle socio-demographic quintiles; however, higher ascending trends were found in lower socio-demographic quintiles. Aging, level of development, diagnosis, and treatment appear to explain Brazil’s ascending multiple myeloma rates and their differences among the federative units.

RESUMO O mieloma múltiplo é o segundo câncer hematológico mais comum; representa aproximadamente 10% de todas os cânceres hematológicos e 1%-2% de todos as neoplasias. Foi conduzido um estudo ecológico para descrever a morbidade, a mortalidade e a carga da doença no Brasil e suas 27 unidades federativas e avaliar tendências entre 1990-2019. Dados do estudo da Carga Global de Doenças foram avaliados para descrever medidas ajustadas por idade: incidência, prevalência, mortalidade, anos de vida ajustados pela incapacidade e seus componentes de acordo com sexo e Índice Sociodemográfico. As tendências foram estimadas usando regressão linear e expressas como Variação Percentual Anual Média (AAPC) e Intervalos de Confiança (IC) 95%. Tendências ascendentes das medidas foram observadas. A mortalidade aumentou em menor extensão comparada à incidência (AAPC=1,3%;IC95%=1,2-1,3 vs. AAPC=1,5%;IC95%=1,5-1,5 homens; AAPC=0,9%; IC95%=0,9-0,9 vs. AAPC=1,1%; IC95%=1,1-1,2 mulheres), resultando em tendências crescentes da prevalência para ambos os sexos. Todas as medidas foram mais altas nos quintis do índice sociodemográfico alto e médio-alto; tendências ascendentes mais altas foram encontradas em quintis do índice sociodemográfico mais baixos. Envelhecimento, nível de desenvolvimento, acesso ao diagnóstico e tratamento parecem explicar as medidas ascendentes do mieloma múltiplo no Brasil e suas diferenças entre as unidades federativas. comum 10 1%2% 12 1% 2% 1 2 1%-2 neoplasias morbidade 19902019. 19902019 1990 2019. 2019 1990-2019 idade Sociodemográfico AAPC (AAPC IC (IC 95 95% observadas AAPC=1,3%IC95%=1,21,3 AAPC13IC951213 AAPCIC AAPC=1,3% IC95%=1,2 1,3 3 IC95 (AAPC=1,3%;IC95%=1,2-1, vs AAPC=1,5%IC95%=1,51,5 AAPC15IC951515 AAPC=1,5% IC95%=1,5 1,5 5 AAPC=1,5%;IC95%=1,5-1, homens AAPC=0,9% AAPC09 0 9 IC95%=0,90,9 IC950909 IC95%=0,9 0,9 IC95%=0,9-0, AAPC=1,1% AAPC11 IC95%=1,11,2 IC951112 IC95%=1,1 1,2 IC95%=1,1-1, mulheres, mulheres , mulheres) sexos médioalto médio médio-alto baixos Envelhecimento desenvolvimento 1%2 1%- 1990201 199 201 1990-201 21 AAPC=1,3%IC95%=1,21, AAPC13IC95121 AAPC13 AAPC=1,3 IC9512 IC95%=1, 13 1, IC9 (AAPC=1,3%;IC95%=1,2-1 51 AAPC=1,5%IC95%=1,51, AAPC15IC95151 AAPC15 AAPC=1,5 IC9515 15 AAPC=1,5%;IC95%=1,5-1 AAPC=0,9 AAPC0 90 IC95%=0,90, IC95090 IC9509 IC95%=0, 09 0, IC95%=0,9-0 AAPC=1,1 AAPC1 11 IC95%=1,11, IC95111 IC9511 IC95%=1,1-1 199020 19 20 1990-20 AAPC=1,3%IC95%=1,21 AAPC13IC9512 AAPC=1, IC951 IC95%=1 (AAPC=1,3%;IC95%=1,2- AAPC=1,5%IC95%=1,51 AAPC15IC9515 AAPC=1,5%;IC95%=1,5- AAPC=0, IC95%=0,90 IC950 IC95%=0 IC95%=0,9- IC95%=1,11 IC95%=1,1- 19902 1990-2 AAPC=1,3%IC95%=1,2 AAPC13IC951 AAPC=1 IC95%= (AAPC=1,3%;IC95%=1,2 AAPC=1,5%IC95%=1,5 AAPC15IC951 AAPC=1,5%;IC95%=1,5 AAPC=0 1990- AAPC=1,3%IC95%=1, AAPC13IC95 AAPC= IC95% (AAPC=1,3%;IC95%=1, AAPC=1,5%IC95%=1, AAPC15IC95 AAPC=1,5%;IC95%=1, AAPC=1,3%IC95%=1 AAPC13IC9 (AAPC=1,3%;IC95%=1 AAPC=1,5%IC95%=1 AAPC15IC9 AAPC=1,5%;IC95%=1 AAPC=1,3%IC95%= AAPC13IC (AAPC=1,3%;IC95%= AAPC=1,5%IC95%= AAPC15IC AAPC=1,5%;IC95%= AAPC=1,3%IC95% (AAPC=1,3%;IC95% AAPC=1,5%IC95% AAPC=1,5%;IC95% AAPC=1,3%IC95 (AAPC=1,3%;IC95 AAPC=1,5%IC95 AAPC=1,5%;IC95 AAPC=1,3%IC9 (AAPC=1,3%;IC9 AAPC=1,5%IC9 AAPC=1,5%;IC9 AAPC=1,3%IC (AAPC=1,3%;IC AAPC=1,5%IC AAPC=1,5%;IC

ABSTRACT Multiple myeloma is the second most common hematological cancer; it accounts for approximately 10% of all hematologic malignancies and 1%-2% of all cancer diagnoses. From 1990 to 2019, an ecological study was conducted to describe and evaluate trends in Brazil’s morbidity, mortality, and disease. The Global Burden of Disease data described age-standardized (+40 years) incidence, prevalence, mortality, disability-adjusted life years, and its components in Brazil and across its 27 federative units according to sex and Socio-demographic Index quintiles. Trends were estimated using linear regression and expressed as Average Annual Percentage Changes (AAPC) and 95% Confidence Intervals (CI). Ascending trends of the measures were found for both sexes in Brazil and its federative units. Mortality increased to a lesser extent than incidence (AAPC=1.3%; 95%CI=1.2-1.3 vs. AAPC=1.5%; 95%CI= 1.5-1.5 for men; AAPC=0.9%; 95%CI=0.9-0.9 vs. AAPC=1.1%; 95%CI=1.1-1.2 for women), resulting in higher rising trends in prevalence for both sexes. All the measures were significantly higher in high- and high-middle socio-demographic quintiles; however, higher ascending trends were found in lower socio-demographic quintiles. Aging, level of development, diagnosis, and treatment appear to explain Brazil’s ascending multiple myeloma rates and their differences among the federative units. 10 1%2% 12 1% 2% 1 2 1%-2 diagnoses 199 2019 Brazils s morbidity mortality disease agestandardized age standardized +40 40 (+4 years disabilityadjusted disability adjusted Sociodemographic Socio demographic quintiles AAPC (AAPC 95 CI. CI . (CI) AAPC=1.3% AAPC13 3 (AAPC=1.3% 95%CI=1.21.3 95CI1213 95%CI=1.2 1.3 95%CI=1.2-1. vs AAPC=1.5% AAPC15 5 95CI 95%CI 1.51.5 1515 1.5 1.5-1. men AAPC=0.9% AAPC09 0 9 95%CI=0.90.9 95CI0909 95%CI=0.9 0.9 95%CI=0.9-0. AAPC=1.1% AAPC11 95%CI=1.11.2 95CI1112 95%CI=1.1 1.2 95%CI=1.1-1. women, women , women) high highmiddle middle sociodemographic socio however Aging development diagnosis 1%2 1%- 19 201 +4 4 (+ (CI AAPC=1.3 AAPC1 (AAPC=1.3 21 95%CI=1.21. 95CI121 95CI12 95%CI=1. 13 1. 95%CI=1.2-1 AAPC=1.5 51 1.51. 151 15 1.5-1 AAPC=0.9 AAPC0 90 95%CI=0.90. 95CI090 95CI09 95%CI=0. 09 0. 95%CI=0.9-0 AAPC=1.1 11 95%CI=1.11. 95CI111 95CI11 95%CI=1.1-1 20 + ( AAPC=1. (AAPC=1. 95%CI=1.21 95CI1 95%CI=1 95%CI=1.2- 1.51 1.5- AAPC=0. 95%CI=0.90 95CI0 95%CI=0 95%CI=0.9- 95%CI=1.11 95%CI=1.1- AAPC=1 (AAPC=1 AAPC=0 AAPC= (AAPC=

Abstract Introduction Life expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system. Objectives Estimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors. Methods A cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age≥18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration. Results Among 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37–35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94–7.37). Conclusions This study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.

RESUMO Objetivo Estimar a prevalência e os fatores associados ao uso de metilfenidato para neuroaprimoramento entre estudantes universitários. Métodos Amostra aleatória simples de discentes da Universidade Federal de Minas Gerais (n=438), convidados a responder um questionário online sobre o consumo de metilfenidato. A coleta ocorreu de setembro de 2014 a janeiro de 2015. A amostra foi descrita em termos de proporções, médias e desvio padrão. A análise multivariada foi realizada utilizando o algoritmo Classification and Regression Tree para classificação dos casos de uso do metilfenidato para neuroaprimoramento em grupos, com base nas variáveis de exposição. Resultados Dos 378 alunos incluídos, 5,8% (n=22) declararam ter feito uso de metilfenidato para neuroaprimoramento, sendo 41% (9/22) nas 4 semanas anteriores à pesquisa. A situação da moradia foi a variável mais associada ao uso de metilfenidato para neuroaprimoramento. Relataram o uso do metilfenidato para neuroaprimoramento e outros fins nas 4 semanas anteriores à pesquisa 11 estudantes, sendo que 27% não apresentaram prescrição médica para adquiri-lo. Conclusão O uso de metilfenidato para neuroaprimoramento ocorre no meio acadêmico brasileiro e deve ser considerado sério problema de saúde pública, principalmente diante dos riscos de danos e efeitos adversos associados ao seu uso.

ABSTRACT Objective To estimate the prevalence of and factors associated with the use of methylphenidate for cognitive enhancement among undergraduate students. Methods Simple random sample of students of the Universidade Federal de Minas Gerais (n=438), invited to answer an online questionnaire about the use of methylphenidate. Data collection occurred from September 2014 to January 2015. The sample was described by means of proportions, means and standard deviations. A multivariate analysis was performed using the Classification and Regression Tree algorithm to classify the cases of use of methylphenidate for cognitive enhancement in groups, based on the exposure variables. Results Out of 378 students included, 5.8% (n=22) reported using methylphenidate for cognitive enhancement; in that, 41% (9/22) in the 4 weeks prior to the survey. The housing situation was the variable most often associated with the use of methylphenidate for cognitive enhancement. Eleven students reported using methylphenidate for cognitive enhancement and other purposes 4 weeks prior to the survey, 27% of whom had no medical prescription to purchase it. Conclusion The use of methylphenidate for cognitive enhancement is frequent among Brazilian undergraduate students and should be considered a serious public health problem, especially due to risks of harm and adverse effects associated with its use.

Abstract INTRODUCTION: Rapid and accurate tuberculosis detection is critical for improving patient diagnosis and decreasing tuberculosis transmission. Molecular assays can significantly increase laboratory costs; therefore, the average time and economic impact should be evaluated before implementing a new technology. The aim of this study was to evaluate the cost and average turnaround time of smear microscopy and Xpert assay at a university hospital. METHODS: The turnaround time and cost of the laboratory diagnosis of tuberculosis were calculated based on the mean cost and activity based costing (ABC). RESULTS: The average turnaround time for smear microscopy was 16.6 hours while that for Xpert was 24.1 hours. The Xpert had a mean cost of USD 17.37 with an ABC of USD 10.86, while smear microscopy had a mean cost of USD 13.31 with an ABC of USD 6.01. The sensitivity of smear microscopy was 42.9% and its specificity was 99.1%, while the Xpert assay had a sensitivity of 100% and a specificity of 96.7%. CONCLUSIONS: The Xpert assay has high accuracy; however, the turnaround time and cost of smear microscopy were lower than those of Xpert.

RESUMO: Introdução: A Estratégia de Saúde da Família (ESF) deve ser o primeiro contato do Sistema Único de Saúde (SUS). Contudo dois modelos de atenção operam concomitantemente no âmbito da Atenção Primária à Saúde (APS): a ESF e o modelo tradicional. A expansão da ESF tem sido lenta e heterogênea em muitos municípios, tornando fundamental a condução de avaliações comparativas de atributos relacionados à qualidade dos modelos da APS. Objetivo: Comparar o desempenho dos modelos de atenção da APS de acordo com a percepção dos profissionais de saúde. Métodos: Estudo transversal com gestores e profissionais de saúde da APS do município de Divinópolis, Minas Gerais. Dados foram coletados por meio do Primary Care Assessment Tool. O desempenho dos modelos foi estimado por meio do Índice de Atenção Primária à Saúde (IAPS geral e específico). Regressão logística politômica univariada foi conduzida para comparação do desempenho dos modelos da APS de acordo com os atributos. A força da associação foi estimada por meio do odds ratio com intervalo de confiança de 95%. Resultados: Três gestores e 81 profissionais de saúde participaram do estudo. A ESF obteve melhor avaliação do que o modelo tradicional com relação ao IAPS geral e aos atributos vínculo, elenco de serviços, enfoque familiar e formação profissional. Conclusão: A ESF obteve escores superiores aos do modelo tradicional, entretanto ainda não atingiu o seu desempenho esperado. Esse cenário aponta para a necessidade de ampliação da cobertura da ESF e para a melhoria da qualidade das unidades de ESF existentes no Brasil.

ABSTRACT: Introduction: The Family Health Strategy (FHS) should be first-contact care in the Brazilian Health System. However, Primary Health Care (PHC) still encompasses two models: the FHS and the traditional health care facilities. The expansion of the FHS has been slow and heterogeneous in many cities, rendering a comparative evaluation of key quality-related elements of PHC models crucial. Objective: To compare the performance of PHC models as perceived by health professionals. Methods: A cross-sectional study involving managers and health professionals from PHC of a medium-size city in South-eastern Brazil. Data were collected by applying the Primary Care Assessment Tool. The performance was estimated through primary health care indexes (general and partial PHCI by attributes). Univariate polytomous logistic regression was performed to compare care model performances according to their attributes. Strength of association was estimated by odds ratio with 95% confidence interval. Results: Three managers and 81 health professionals participated in the study. The FHS had a better index rating than the traditional care model for general PHCI and for the attributes longitudinality, comprehensiveness, family focus and professional level. Conclusion: Although the FHS attained higher scores compared to the traditional model, it has not yet achieved the performance expected. This scenario points to the need for increased FHS cover and quality improvements at the existing units.

RESUMO: Introdução: A Estratégia de Saúde da Família (ESF) deve ser o primeiro contato do Sistema Único de Saúde (SUS). Contudo dois modelos de atenção operam concomitantemente no âmbito da Atenção Primária à Saúde (APS): a ESF e o modelo tradicional. A expansão da ESF tem sido lenta e heterogênea em muitos municípios, tornando fundamental a condução de avaliações comparativas de atributos relacionados à qualidade dos modelos da APS. Objetivo: Comparar o desempenho dos modelos de atenção da APS de acordo com a percepção dos profissionais de saúde. Métodos: Estudo transversal com gestores e profissionais de saúde da APS do município de Divinópolis, Minas Gerais. Dados foram coletados por meio do Primary Care Assessment Tool. O desempenho dos modelos foi estimado por meio do Índice de Atenção Primária à Saúde (IAPS geral e específico). Regressão logística politômica univariada foi conduzida para comparação do desempenho dos modelos da APS de acordo com os atributos. A força da associação foi estimada por meio do odds ratio com intervalo de confiança de 95%. Resultados: Três gestores e 81 profissionais de saúde participaram do estudo. A ESF obteve melhor avaliação do que o modelo tradicional com relação ao IAPS geral e aos atributos vínculo, elenco de serviços, enfoque familiar e formação profissional. Conclusão: A ESF obteve escores superiores aos do modelo tradicional, entretanto ainda não atingiu o seu desempenho esperado. Esse cenário aponta para a necessidade de ampliação da cobertura da ESF e para a melhoria da qualidade das unidades de ESF existentes no Brasil.

ABSTRACT: Introduction: The Family Health Strategy (FHS) should be first-contact care in the Brazilian Health System. However, Primary Health Care (PHC) still encompasses two models: the FHS and the traditional health care facilities. The expansion of the FHS has been slow and heterogeneous in many cities, rendering a comparative evaluation of key quality-related elements of PHC models crucial. Objective: To compare the performance of PHC models as perceived by health professionals. Methods: A cross-sectional study involving managers and health professionals from PHC of a medium-size city in South-eastern Brazil. Data were collected by applying the Primary Care Assessment Tool. The performance was estimated through primary health care indexes (general and partial PHCI by attributes). Univariate polytomous logistic regression was performed to compare care model performances according to their attributes. Strength of association was estimated by odds ratio with 95% confidence interval. Results: Three managers and 81 health professionals participated in the study. The FHS had a better index rating than the traditional care model for general PHCI and for the attributes longitudinality, comprehensiveness, family focus and professional level. Conclusion: Although the FHS attained higher scores compared to the traditional model, it has not yet achieved the performance expected. This scenario points to the need for increased FHS cover and quality improvements at the existing units.