Abstract Objective To present the different aspects that may be involved in the genesis and maintenance of obesity in children and adolescents. Data source Narrative review of articles published in the PubMed, Scielo, Lilacs, Scopus and Google Scholar databases, using the search terms: overweight, obesity, pre-conception, prenatal, infants, schoolchildren, children, and adolescents. The search was conducted in studies written in Portuguese, English and Spanish, including narrative, integrative or systematic reviews, meta-analyses, cross-sectional, case-control and cohort studies, published between 2003 and 2023. Data synthesis A total of 598 studies were initially screened and 60 of them, which showed the main biopsychosocial aspects related to greater risks of excessive adiposity in the pediatric age, were included in the review. The data were presented taking into account the incidence of risk factors and their consequences in six periods: pre-conception, pre-natal, infant, preschool, school age, and adolescence. Conclusions The causal factors described in the scientific literature that have been shown to be related to obesity in childhood and adolescence are presented. adolescents PubMed Scielo Lilacs databases terms overweight preconception, preconception pre conception, conception pre-conception prenatal infants schoolchildren Portuguese Spanish narrative reviews metaanalyses, metaanalyses meta analyses, analyses meta-analyses crosssectional, crosssectional cross sectional, sectional cross-sectional casecontrol case control 200 2023 59 6 them age periods natal, natal pre-natal infant preschool 20 202 5 2

Abstract In Brazil, the advent of voluntary and counseling testing (VCT) has provided many benefits in the fight against AIDS. A sectional open web survey was conducted to investigate the Brazilian LGBT+ individuals’ knowledge and perceptions of the existence of VCT centers and their associations with risk behavior and other variables of interest. The study instrument included questions on sociodemographic and behavioral variables, knowledge on VCT, access to and use of it, beliefs about HIV infection, test results, and risk perception. The Risk Behavior Score for HIV infection (RBS) was also used. A total of 1,630 volunteers participated in the survey, of whom 56.8% were men. Of these, 96.1% declared themselves as (MSM). Almost 50% of the participants had never heard about the existence of VCT, which was a higher knowledge score among MSM. A low frequency of participants had a clear perception of the risks to which they are exposed, whereas those with higher RBS were aware of the existence of VCT. As VCT is critical for the implementation of policies to combat and prevent HIV and other sexually transmitted diseases, our results can contribute to a better understanding of the influence of VCT on the frequency of testing, serological surveillance, and routine counseling for key populations. Brazil (VCT AIDS LGBT individuals interest it (RBS used 1630 1 630 1,63 568 56 8 56.8 men these 961 96 96.1 MSM . (MSM) 50 exposed diseases surveillance populations 163 63 1,6 5 56. 9 96. (MSM 16 6 1,

Resumo No Brasil, o advento dos centros de testagem e aconselhamento (CTA) trouxe muitos benefícios na luta contra a Aids. Um estudo transversal do tipo web survey foi realizado para investigar o conhecimento e as percepções dos indivíduos LGBT+ brasileiros sobre a existência dos CTAs e suas associações com comportamentos de risco e outras variáveis de interesse. O questionário incluiu questões sociodemográficas e comportamentais, conhecimento sobre o CTA, acesso e uso, crenças sobre a infecção pelo HIV, resultados de testes e percepção de risco. O escore de comportamento de risco (RBS) também foi utilizado. Participaram 1.630 voluntários (56,8% homens). Destes, 96,1% se autodeclararam homens que fazem sexo com homens (HSH). Quase 50% dos participantes não conhecem os CTAs, sendo este conhecimento maior entre os HSHs. Uma baixa frequência de participantes tem percepção clara dos riscos a que estão expostos, e os HSHs com maior pontuação no RBS estão cientes da existência dos CTAs, que são fundamentais na implementação de políticas de combate e prevenção ao HIV e outras doenças sexualmente transmissíveis. Nossos resultados contribuem para a melhor compreensão da sua influência na frequência de testagem, na vigilância do status sorológico e no aconselhamento em populações-chave. Brasil CTA (CTA Aids LGBT interesse comportamentais uso (RBS utilizado 1630 1 630 1.63 56,8% 568 56 8 (56,8 homens. . homens) Destes 961 96 96,1 HSH. HSH (HSH) 50 expostos transmissíveis populaçõeschave. populaçõeschave populações chave. chave populações-chave 163 63 1.6 56,8 5 (56, 9 96, (HSH 16 6 1. 56, (56 (5 (

Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted. reemergence re emergence vaccinepreventable preventable (VC countries 201 2021 COVID19 COVID 19 COVID-1 trend spacetime space distribution dose 1, 1 , 1) spatiotemporal spatio disposition 2015 2020 regions Northeast indicators inequality Strategy municipalities circulation however care hesitancy highlighted 20 202 COVID1 COVID- 2

Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal. (CV países 201 2021 COVID19, COVID19 COVID 19, 19 COVID-19 espaçotemporal espaço Tratase Trata se dose 1, 1 , 1) espaçotemporal, 2015 observase observa acentuandose acentuando 202 regiões Nordeste humano Família desiguais vírus básica vacina vacinal 20 COVID1 COVID-1 2 COVID-

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS). VC, , (VC) poliomyelitis concern 1 201 2021 Brazil COVID19 COVID 19 COVID-1 STI (STI analysis NeweyWest Newey West Index index Covid19 Covid Covid-1 2019 SUS. SUS . (SUS) (VC 20 202 COVID1 COVID- Covid1 Covid- (SUS 2

Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde. (CV infância sanitária 1 201 2021 COVID19, COVID19 COVID 19, 19 COVID-19 Brasil STI (STI espacial Imunização NeweyWest, NeweyWest Newey West, West Newey-West Brasileiro local Saúde Observase Observa país social 20 202 COVID1 COVID-1 2 COVID-

Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Abstract In Brazil, the advent of voluntary and counseling testing (VCT) has provided many benefits in the fight against AIDS. A sectional open web survey was conducted to investigate the Brazilian LGBT+ individuals’ knowledge and perceptions of the existence of VCT centers and their associations with risk behavior and other variables of interest. The study instrument included questions on sociodemographic and behavioral variables, knowledge on VCT, access to and use of it, beliefs about HIV infection, test results, and risk perception. The Risk Behavior Score for HIV infection (RBS) was also used. A total of 1,630 volunteers participated in the survey, of whom 56.8% were men. Of these, 96.1% declared themselves as (MSM). Almost 50% of the participants had never heard about the existence of VCT, which was a higher knowledge score among MSM. A low frequency of participants had a clear perception of the risks to which they are exposed, whereas those with higher RBS were aware of the existence of VCT. As VCT is critical for the implementation of policies to combat and prevent HIV and other sexually transmitted diseases, our results can contribute to a better understanding of the influence of VCT on the frequency of testing, serological surveillance, and routine counseling for key populations.

Resumo No Brasil, o advento dos centros de testagem e aconselhamento (CTA) trouxe muitos benefícios na luta contra a Aids. Um estudo transversal do tipo web survey foi realizado para investigar o conhecimento e as percepções dos indivíduos LGBT+ brasileiros sobre a existência dos CTAs e suas associações com comportamentos de risco e outras variáveis de interesse. O questionário incluiu questões sociodemográficas e comportamentais, conhecimento sobre o CTA, acesso e uso, crenças sobre a infecção pelo HIV, resultados de testes e percepção de risco. O escore de comportamento de risco (RBS) também foi utilizado. Participaram 1.630 voluntários (56,8% homens). Destes, 96,1% se autodeclararam homens que fazem sexo com homens (HSH). Quase 50% dos participantes não conhecem os CTAs, sendo este conhecimento maior entre os HSHs. Uma baixa frequência de participantes tem percepção clara dos riscos a que estão expostos, e os HSHs com maior pontuação no RBS estão cientes da existência dos CTAs, que são fundamentais na implementação de políticas de combate e prevenção ao HIV e outras doenças sexualmente transmissíveis. Nossos resultados contribuem para a melhor compreensão da sua influência na frequência de testagem, na vigilância do status sorológico e no aconselhamento em populações-chave.

Abstract Objectives To propose a Portuguese version of the Objective and Subjective Knowledge and HIV Testing Scale (OSK-HIV-TS), assess its content validity, and perform item analysis after administration to a sample of undergraduate students. Methods Three translators translated the OSK-HIV-TS into Portuguese. Judges evaluated each item of a consensus version of the translated instrument for semantic, idiomatic, cultural, and conceptual equivalence. A consensus committee reviewed a back-translation against the original version of the OSK-HIV-TS. Content validity was calculated with the content validity index (CVI) and item analysis was conducted using Classical Test Theory (CTT). Results The translated scale achieved semantic, idiomatic, conceptual, and cultural equivalence to the original version. A total of 491 undergraduate students participated and the distribution of students’ responses to the OSK-HIV-TS revealed a high proportion of correct answers. All items were classified as easy or very easy and only item 16 was classified having strong discrimination power according to the discrimination index. Conclusion The OSK-HIV-TS is a novel instrument in the Brazilian literature for assessing human immunodeficiency virus (HIV) knowledge and should inspire more research into HIV/acquired immunodeficiency syndrome (AIDS) behavior and associated factors, which, despite being essential and necessary, is still lacking in the Brazilian literature. OSKHIVTS, OSKHIVTS OSK TS , (OSK-HIV-TS) semantic idiomatic backtranslation back translation OSKHIVTS. TS. CVI (CVI CTT. CTT . (CTT) 49 answers 1 (HIV HIVacquired acquired AIDS (AIDS factors which necessary (OSK-HIV-TS (CTT 4

Resumo Objetivo O presente artigo apresenta uma revisão de literatura sobre amicrobiota do leite materno e a influência da epigenética na suscetibilidade à COVID-19. Métodos Revisão de literatura. Resultados A amamentação transfere microbiota, nutrientes, diversos glóbulos brancos, prebióticos, hormônios e anticorpos para o bebê, os quais proporcionam proteção imunológica de curto e longo prazo contra diversas doenças infecciosas, gastrointestinais e respiratórias. As poucas evidências disponíveis mostram que o leite materno transportamuito raramente o vírus SARS-CoV-2, emesmo nestes casos, ele foi descartado como fonte de contágio. Conclusão Os estudos revisados mostram evidências de um efeito benéfico da amamentação e destacam sua importância na atual pandemia devido ao reforço imunológico que ela proporciona. Os indivíduos amamentados mostraram melhor resposta clínica devido à influência sobre a microbiota, e à contribuição nutricional e imunológica proporcionada pelo leite materno, em comparação com aqueles que não o foram.

Abstract Objective The present article presents a literature review concerning the microbiota of breast milk and the influence of epigenetics in the susceptibility to COVID-19. Methods A literature review. Results Breastfeeding transfers microbiota, nutrients, diverse white blood cells, prebiotics, hormones, and antibodies to the baby, which provide short- and longterm immunological protection against several infectious, gastrointestinal, and respiratory illnesses. The little evidence available shows that breast milk very rarely carries the SARS-CoV-2 virus, and even in those cases, it has been discarded as the source of contagion. Conclusion The reviewed studies show evidence of a beneficial effect of breastfeeding and highlights its importance on the current pandemic due to the immune reinforcement that it provides. Breastfed individuals showed better clinical response due to the influence on the microbiota and to the nutritional and immune contribution provided by breast milk, compared with those who were not breastfed.

Abstract Objective: To determine the prevalence of vitamin A deficiency (VAD) and serum concentrations of retinol, correlating them with IGF-1 concentrations in preschoolers with DS. Methods: Cross-sectional study was conducted on 47 children with DS aged 24 to 72 months, in Ribeirão Preto, Brazil. VAD was determined by the relative dose-response (RDR) test. Retinol serum concentration ≤ 0.70 μmol/L and IGF-1 serum concentration below the 3rd percentile for sex and age were considered to represent deficiency. C-reactive protein (CRP) was determined at the beginning of the study. Weight, height, and information about fever and/or diarrhea were obtained at the beginning of the study. Results: VAD prevalence was 25.5% (12/47), and 74.5% (35/47) of the children had deficient retinol before the intervention. CRP was not associated with VAD. Mean IGF-1 were 103.5 ng/mL (SD = 913) for the group with VAD and 116.3 ng/mL (SD = 54.9) for the group with no VAD (p-value = 0.85); 8.5% (4/47) of the children showed deficient IGF-1, but without VAD. No association was observed between VAD and IGF-1 deficiency. A moderate positive correlation was observed between pre-intervention retinol and IGF-1 (ρ = 0.37; p-value = 0.01). Conclusion: a high prevalence of VAD and deficient retinol was observed and there was a positive correlation between serum retinol and IGF-1.

Resumo Introdução As fraturas de fêmur são uma das causas principais de morbidade e mortalidade, principalmente entre as pessoas idosas. Objetivo Examinar o efeito da sazonalidade nas hospitalizações devido à fratura do fêmur entre residentes do estado do Rio Grande do Sul, sul do Brasil, de 2008 a 2019. Métodos Trata-se de um estudo ecológico baseado em dados secundários do Sistema de Informação Hospitalar do SUS (SIH/SUS). Um total de 74.374 relatórios de internações hospitalares foi considerado. O modelo aditivo generalizado (GAM) foi usado para avaliar a sazonalidade da série temporal, com estratificação por sexo e grupos etários e considerando a média mensal de eventos de fraturas do fêmur por dia como uma variável dependente. Resultados Descreveu-se uma incidência consideravelmente maior de fraturas do fêmur em mulheres com 70 anos de idade ou mais. Entre as pessoas com menos de 50 anos de idade, não há um efeito sazonal aparente. Homens com idade de 70 anos ou mais e mulheres com 50 anos ou mais têm maior frequência de hospitalizações devido a fraturas do fêmur nos meses mais frios. Conclusão Entre as pessoas mais idosas, as fraturas do fêmur ocorreram mais frequentemente durante o inverno em comparação ao verão. Isto reafirma os resultados de outros estudos, embora as razões para esta variação sazonal sejam incertas. O conhecimento destas variações sazonais pode ajudar no planejamento da assistência médica no sistema público de saúde.

Abstract Introduction Femoral fractures are a major cause of morbidity and mortality, mainly among older people. Objective To examine the effect of seasonality on hospitalizations due to femur fracture among people residing in the Rio Grande do Sul state, southern Brazil, from 2008 to 2019. Methods Ecological study based on secondary data from the SUS Hospital Information System (SIH/SUS). A total of 74,374 reports of hospital admissions was considered. The generalized additive model (GAM) approach was employed to assess the seasonality of the time series, with stratification by sex and age groups and considering the monthly average number of events of femoral fractures per day as a dependent variable. Results A considerably higher incidence of femoral fractures in women aged 70 years or more was described. Among people aged less than 50 years, there is not an apparent seasonal effect. Men aged 70 years or older and women aged 50 years or older have a higher frequency of hospitalizations due to femur fractures in the colder months. Conclusion Among older people, more femoral fractures occurred during the winter compared to summer. This supports findings from other studies, although reasons for this seasonal variation are uncertain. The knowledge of these seasonal variations can help to plan the health care in the public health system.

Abstract Diabetes is a self-managed condition with knowledge, attitudes and practices that can influence the overall treatment and outcomes delay the complications of diabetes. However, the few reported studies published point out that: low education level, poor adherence to pharmacotherapy and diet recommendations, infrequent monitoring of blood glucose, and insulin dosage regimen are associated with higher hemoglobin levels. This study aimed to assess the knowledge, adherence medication, and complexity of pharmacotherapy in T1DM patients in Brazil. A cross-sectional study was conducted involving 156 T1DM patients who were attending in primary care. Logistic regression analyses were conducted to assess the variables associated with glycemic control. The overall assessments of T1DM patients for the glycemic control were bad (121, 77.6%). However, T1DM patients with high MedTake Test (OR=2.4, CI=1.1-5.7) and Morisky-Green Test (OR= 2.5, CI=1.1-6.1), and in the use of dosage insulin (>40 units, OR=0.3, CI=0.1-0.7) and postprandial glucose (100-125mg/dl, OR=3.8, CI=1.1-14.6) had better glycemic control compared to uncontrolled patients. Glycemic control in Brazilians adults with T1DM is low. We suggested the screening patients with low MedTake and Morisky-Green Tests, increasing patient knowledge as part of a complex intervention that may lead to substantially improved treatment outcomes in primary care. selfmanaged self managed diabetes However level recommendations levels medication TDM T DM Brazil crosssectional cross sectional 15 care 121, 121 (121 77.6%. 776 77.6% . 77 6 77.6%) OR=2.4, OR24 OR 2 4 (OR=2.4 CI=1.15.7 CI1157 CI CI=1.1 5.7 1 5 7 CI=1.1-5.7 MoriskyGreen Morisky Green OR= (OR 25 2.5 CI=1.16.1, CI1161 6.1 , CI=1.1-6.1) >40 40 (>4 units OR03 0 3 OR=0.3 CI=0.10.7 CI0107 CI=0.1 0.7 CI=0.1-0.7 100125mg/dl, 100125mgdl mgdl 100 125mg/dl, 125mg dl mg (100-125mg/dl OR38 8 OR=3.8 CI=1.114.6 CI11146 14.6 14 CI=1.1-14.6 Tests 12 (12 77.6 OR=2.4 OR2 (OR=2. CI=1.15. CI115 CI11 CI=1. 57 5. CI=1.1-5. 2. 16 CI=1.16.1 CI116 61 6. CI=1.1-6.1 >4 (> OR0 OR=0. 10 CI=0.10. CI010 CI01 CI=0. 07 0. CI=0.1-0. 100125mg 100125mg/dl 125mgdl 125mg/dl OR3 OR=3. 114 CI=1.114. CI1114 146 14. CI=1.1-14. (1 77. OR=2. (OR=2 CI=1.15 CI1 CI=1 CI=1.1-5 CI=1.16. CI=1.1-6. > ( OR=0 CI=0.10 CI0 CI=0 CI=0.1-0 OR=3 11 CI=1.114 CI111 CI=1.1-14 OR=2 CI= CI=1.1- CI=1.16 CI=1.1-6 CI=0.1- CI=1.11 CI=1.1-1