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.

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 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 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.

RESUMO Objetivo: Estimar a prevalência de subtipos da violência e analisar alguns dos fatores demográficos, socioeconômicos e de saúde associados a Violência Contra as Mulheres (VCM) no Brasil. Métodos: Estudo epidemiológico transversal utilizando base de dados da Pesquisa Nacional de Saúde (PNS) 2019. Foram estimadas as prevalências de alguns subtipos da violência (psicológica, física e sexual) nos 12 meses anteriores a entrevista, no Brasil e nas unidades federativas. Analisou-se também algumas das características de cada subtipo. Estimou-se ainda a Razão de Prevalência bruta e ajustada por modelo multivariado segundo potenciais fatores demográficos, socioeconômicos e de saúde associados: faixa etária, escolaridade, cor da pele, local de moradia, renda domiciliar, estado civil, rede social de apoio, autoavaliação em saúde, consumo de álcool, depressão e infecções sexualmente transmissíveis (ISTs). Resultados: Em 2019, 19,38% das mulheres brasileiras relataram algum episódio de violência, sendo a violência psicológica o subtipo mais comum, tanto isolada quanto concomitante com outros subtipos. O principal agressor foi um parceiro íntimo e a maioria dos atos violentos ocorreu na residência, com mais da metade das mulheres relatando ao menos uma consequência desses atos. Mulheres mais jovens, com pior autoavaliação em saúde, consumo de álcool, depressão e diagnóstico de ISTs tiveram maior prevalência de todos os subtipos de violência. Conclusão: Uma em cada cinco mulheres brasileiras relataram algum episódio de violência nos últimos 12 meses. A VCM está positivamente associada a idades mais jovens, baixa escolaridade, cor da pele preta e parda, menor rede de apoio, além de fatores ligados a saúde, como autoavaliação em saúde, consumo de álcool, depressão e ISTs.

ABSTRACT OBJECTIVE: To estimate the prevalence of violence subtypes and analyze some demographic, socioeconomic, and health factors associated with violence against women in Brazil. METHODS: Cross-sectional epidemiological study using the 2019 National Survey of Health. The prevalences of some violence subtypes (psychological, physical, and sexual) in the 12 months prior to the interview were estimated in the country, per federative units. The characteristics of each subtype of violence were also analyzed. Additionally, the crude and adjusted prevalence ratios were estimated by a multivariate model according to the following potential demographic, socioeconomic, and health associated factors: age group, education, skin color, place of residence, household income, marital status, social support network, self-rated health, alcohol consumption, depression, and sexually transmitted infections. RESULTS: In 2019, 19.38% of Brazilian women reported experiencing violence, with psychological violence being the most common subtype both in isolation and in conjunction with other subtypes. The main aggressor was an intimate partner and most of the violent acts occurred at home, with more than half of women reporting at least one consequence of these acts. Younger women, those with worse self-rated health, alcohol consumption, depression, and sexually transmitted infections had a higher prevalence of all violence subtypes. CONCLUSION: One in five Brazilian women reported experiencing violence in the past 12 months. Violence against women is positively associated with younger ages, lower education, Black and Brown skin color, smaller support networks, and health-related factors such as self-rated health, alcohol consumption, depression, and sexually transmitted infections.

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 Analisar a eficiência na atenção primária à saúde das capitais brasileiras no período 2008–2019, considerando o modelo de gestão: administração pública direta ou administração cedida a terceiros. MÉTODOS Estudo de propósito avaliativo, objetivo analítico, com dados secundários de acesso público, analisados em recorte transversal (2019) e longitudinal (2008, 2012, 2016 e 2019). Para caracterizar as cidades e sua atenção primária à saúde, utilizaram-se dados demográficos, socioeconômicos e sete indicadores relacionados à atenção primária à saúde (cobertura em atenção básica, internações por condições sensíveis à atenção básica, cura de tuberculose, mortalidade infantil, materna e prematura por condições crônicas, incidência de sífilis congênita). A esses indicadores foram acrescidos os de gastos em saúde e em atenção primária à saúde e realizou-se a análise envoltória de dados voltada a outputs (sem admitir redução de gastos) para cálculo da eficiência em 2008, 2012, 2016 e 2019. Com o índice de Malmquist, buscou-se identificar possíveis ganhos de produtividade entre 2008 e 2019. RESULTADOS Quatro capitais identificadas como de administração cedida a terceiros (São Paulo, Rio de Janeiro, Porto Alegre e Fortaleza) não obtiveram maior eficiência perante a administração pública direta, tampouco evoluíram quando comparados os seus próprios resultados no tempo. Em 2019, e na abordagem longitudinal, apenas capitais de gestão por administração pública direta obtiveram índice máximo de eficiência relativa na comparação entre as capitais. Doze capitais em administração pública direta mantiveram-se eficientes em todos os anos, ao passo que as em administração cedida a terceiros apresentaram, consistentemente, ineficiência fraca em atenção primária à saúde, ou seja, no período estudado, a relação entre investimentos na atenção primária à saúde e resultados obtidos é inferior ao alcançado pelas capitais eficientes. CONCLUSÕES Não encontramos evidências de ganhos de eficiência com a adoção de administração cedida a terceiros. Ressalte-se que a eficiência produtiva não representa, necessariamente, o atendimento de necessidades de saúde.

ABSTRACT OBJECTIVE To analyze efficiency in primary health care in Brazilian state capitals in the period 2008–2019, considering the management model: direct public administration or administration assigned to third parties. METHODS This is an evaluative study with an analytical objective, using publicly available secondary data, analyzed cross-sectionally (2019) and longitudinally (2008, 2012, 2016, and 2019). Demographic and socioeconomic data and seven indicators related to primary health care were used to characterize the cities and their primary health care (primary care coverage, hospitalizations for primary care-sensitive conditions, tuberculosis cures, infant, maternal, and premature mortality due to chronic conditions, incidence of congenital syphilis). To these indicators were added health and primary health care expenditures and data envelopment analysis focused on outputs (without admitting a reduction in expenditures) to calculate efficiency in 2008, 2012, 2016, and 2019. The Malmquist index was used to identify possible productivity gains between 2008 and 2019. RESULTS Four capitals identified as being managed by third parties (São Paulo, Rio de Janeiro, Porto Alegre, and Fortaleza) did not achieve greater efficiency compared to direct public administration, nor did they evolve when comparing their own results over time. In 2019, and in the longitudinal approach, only capitals managed by direct public administration obtained the maximum relative efficiency index in the comparison between capitals. Twelve capitals with direct public administration remained efficient in all years, while those with third-party administration consistently showed weak inefficiency in primary health care, i.e. in the period studied, the relationship between investments in primary health care and results obtained is lower than that achieved by the efficient capitals. CONCLUSIONS We found no evidence of efficiency gains with the adoption of third-party management. It should be noted that productive efficiency does not necessarily mean that health needs are met.

ABSTRACT OBJECTIVES: To investigate the association between unplanned pregnancy and use of modern contraceptive methods at 3-, 12-, and 24-months postpartum using an intersectional approach for examining inequalities, in the 2015 Pelotas birth cohort, Brazil. METHODS: We evaluated the use of modern contraceptives after delivery, comparing women who had planned and unplanned pregnancies in 2015. The number of women included in this study was: 4,021, 3,687, and 3,558, at 3-, 12-, and 24-month postpartum follow-ups, respectively. Analyses were restricted to women who needed contraception by the time of each postpartum follow-up interview. Sociodemographic indicators were also investigated. Descriptive (absolute and relative frequencies), bivariate, and multivariate statistical analyses were conducted. These analyses included the main exposure and the sociodemographic variables. In the three follow-up interviews, double stratification was used to investigate for intersectionalities between pregnancy planning and family income, and pregnancy planning and living with partner. RESULTS: Women who had unplanned pregnancies presented the lowest use of modern contraceptives. A negative association between unplanned pregnancy and use of modern contraception was found at 3- (PR = 0.97, 95%CI: 0.95–0.99) and 24-months postpartum (PR = 0.96, 95%CI: 0.94–0.98). In general, women who did not live with a partner, with lower schooling level, and who were 35 or older presented lower use of modern contraception. Women who had unplanned pregnancies with lower family income and who did not live with a partner presented a lower prevalence of modern contraceptive use. CONCLUSIONS: Despite the possible benefits of the use of modern contraception in the postpartum period, women who had unplanned pregnancies presented the lowest prevalence. No consistent pattern was identified for this association over time. It is necessary to consider important sociodemographic factors such as living with partner as well as possible pathways to reduce inequalities.

ABSTRACT OBJECTIVE: To explore the spatial distribution of bacille Calmette-Guerin (BCG) vaccination coverage and tuberculosis cases in Brazilian children under the age of ten in the last two decades. METHODS: This is a population-based ecological study using data from the Sistema de Informação de Agravos de Notificação (SINAN – Information System for Notifiable Diseases) from January 2001 to December 2022. We investigated tuberculosis incidence and vaccination coverage in all Brazilian municipalities. Spatial dependence was analyzed by the Global Moran Index and Local Indicators of Spatial Association (LISA). Joinpoint regression was used to assess trends in tuberculosis and BCG rates over time. RESULTS: The results indicated 39,840 pediatric tuberculosis cases, with 60.65% in children under the age of five. The highest incidence rates were in the states of Amazonas, Mato Grosso, and Rio de Janeiro. Spatial analysis showed significant positive spatial autocorrelation in pediatric tuberculosis cases, with high-high clusters in several states and municipalities. Tuberculosis cases in children under five have been declining since 2000 but rose in 2020 (APC = 26.64; p-value = 0.032). An earlier increase was observed in children up to ten years old, starting six years prior. CONCLUSION: The study highlights the decline in BCG vaccination coverage below 90%, with the most significant drop in 2020, particularly in the Northeast. The findings underscore the need for high maintain vaccination coverage and robust public health policies to mitigate tuberculosis in children. Addressing these issues requires targeted public health interventions, especially in regions with higher tuberculosis burdens.

ABSTRACT OBJECTIVE To analyze efficiency in primary health care in Brazilian state capitals in the period 2008–2019, considering the management model: direct public administration or administration assigned to third parties. METHODS This is an evaluative study with an analytical objective, using publicly available secondary data, analyzed cross-sectionally (2019) and longitudinally (2008, 2012, 2016, and 2019). Demographic and socioeconomic data and seven indicators related to primary health care were used to characterize the cities and their primary health care (primary care coverage, hospitalizations for primary care-sensitive conditions, tuberculosis cures, infant, maternal, and premature mortality due to chronic conditions, incidence of congenital syphilis). To these indicators were added health and primary health care expenditures and data envelopment analysis focused on outputs (without admitting a reduction in expenditures) to calculate efficiency in 2008, 2012, 2016, and 2019. The Malmquist index was used to identify possible productivity gains between 2008 and 2019. RESULTS Four capitals identified as being managed by third parties (São Paulo, Rio de Janeiro, Porto Alegre, and Fortaleza) did not achieve greater efficiency compared to direct public administration, nor did they evolve when comparing their own results over time. In 2019, and in the longitudinal approach, only capitals managed by direct public administration obtained the maximum relative efficiency index in the comparison between capitals. Twelve capitals with direct public administration remained efficient in all years, while those with third-party administration consistently showed weak inefficiency in primary health care, i.e. in the period studied, the relationship between investments in primary health care and results obtained is lower than that achieved by the efficient capitals. CONCLUSIONS We found no evidence of efficiency gains with the adoption of third-party management. It should be noted that productive efficiency does not necessarily mean that health needs are met.

RESUMO OBJETIVO Analisar a eficiência na atenção primária à saúde das capitais brasileiras no período 2008–2019, considerando o modelo de gestão: administração pública direta ou administração cedida a terceiros. MÉTODOS Estudo de propósito avaliativo, objetivo analítico, com dados secundários de acesso público, analisados em recorte transversal (2019) e longitudinal (2008, 2012, 2016 e 2019). Para caracterizar as cidades e sua atenção primária à saúde, utilizaram-se dados demográficos, socioeconômicos e sete indicadores relacionados à atenção primária à saúde (cobertura em atenção básica, internações por condições sensíveis à atenção básica, cura de tuberculose, mortalidade infantil, materna e prematura por condições crônicas, incidência de sífilis congênita). A esses indicadores foram acrescidos os de gastos em saúde e em atenção primária à saúde e realizou-se a análise envoltória de dados voltada a outputs (sem admitir redução de gastos) para cálculo da eficiência em 2008, 2012, 2016 e 2019. Com o índice de Malmquist, buscou-se identificar possíveis ganhos de produtividade entre 2008 e 2019. RESULTADOS Quatro capitais identificadas como de administração cedida a terceiros (São Paulo, Rio de Janeiro, Porto Alegre e Fortaleza) não obtiveram maior eficiência perante a administração pública direta, tampouco evoluíram quando comparados os seus próprios resultados no tempo. Em 2019, e na abordagem longitudinal, apenas capitais de gestão por administração pública direta obtiveram índice máximo de eficiência relativa na comparação entre as capitais. Doze capitais em administração pública direta mantiveram-se eficientes em todos os anos, ao passo que as em administração cedida a terceiros apresentaram, consistentemente, ineficiência fraca em atenção primária à saúde, ou seja, no período estudado, a relação entre investimentos na atenção primária à saúde e resultados obtidos é inferior ao alcançado pelas capitais eficientes. CONCLUSÕES Não encontramos evidências de ganhos de eficiência com a adoção de administração cedida a terceiros. Ressalte-se que a eficiência produtiva não representa, necessariamente, o atendimento de necessidades de saúde.

ABSTRACT OBJECTIVES To investigate the relationship between vaccination coverage indicators and the structure of primary care for immunization in Brazilian municipalities. METHODS This was a time series ecological study using data from the National Immunization Program Information System (SI-PNI) and the National Program for Improving Primary Care Access and Quality (PMAQ) over three evaluation cycles. A total of 13 variables were assessed, five of which related to the structure of basic health units (BHU) and eight to the availability of immunobiologicals. Analyses of comparisons, associations, and longitudinal models were carried out to assess the influence of these indicators on vaccination coverage levels. RESULTS The variables and indicators related to the structure of BHUs, the availability of immunobiologicals in Brazilian municipalities and vaccination coverage showed significant variations over the cycles. BHU structures ranged from fair to good, with lower percentages in Cycle 1 and increases in Cycles 2 and 3 for most of the variables analyzed. The availability of immunobiologicals also improved over the cycles, despite a few exceptions. Indicators of adequate vaccination coverage increased from Cycle 1 to Cycle 2 but decreased in Cycle 3. Improvements in the structure of the BHU and the availability of immunobiologicals were associated with higher adequate vaccination coverage. Keeping the availability of immunobiologicals fixed at good, the chance of having adequate coverage is 86.28% higher for a good structure compared to a poor one. CONCLUSIONS Changes in the structure of municipal BHUs and in the availability of immunobiologicals over the cycles evaluated were identified and were associated with higher vaccination coverage when they occurred simultaneously (good availability of immunobiologicals and regular or good structure in BHUs). This highlights the importance of the quality of primary care in achieving vaccination coverage targets in Brazilian municipalities.

RESUMO OBJETIVO Investigar a relação entre os indicadores de cobertura vacinal e a estrutura da atenção primária para imunização nos municípios brasileiros. MÉTODOS Trata-se de um estudo ecológico temporal que utilizou dados do Sistema de Informação do Programa Nacional de Imunizações (SI-PNI) e do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ) ao longo de três ciclos de avaliação. Ao todo, foram avaliadas 13 variáveis, sendo cinco relacionadas à estrutura das unidades básicas de saúde (UBS) e oito à disponibilidade de imunobiológicos. Foram realizadas análises de comparações, associações e modelos longitudinais para avaliar a influência desses indicadores nos níveis de cobertura vacinal. RESULTADOS As variáveis e os indicadores relacionados à estrutura das UBS, à disponibilidade de imunobiológicos nos municípios brasileiros e às coberturas vacinais apresentaram variações significativas ao longo dos ciclos. As estruturas das UBS variaram de regular a boa, com percentuais mais baixos no Ciclo 1 e aumentos nos Ciclos 2 e 3 para a maioria das variáveis analisadas. A disponibilidade de imunobiológicos também melhorou ao longo dos ciclos, apesar de algumas exceções. Os indicadores de cobertura vacinal adequada aumentaram do Ciclo 1 para o Ciclo 2, mas diminuíram no Ciclo 3. Melhorias na estrutura das UBS e na disponibilidade de imunobiológicos foram associadas a maiores coberturas vacinais adequadas. Mantendo a disponibilidade de imunobiológicos fixa como boa, a chance de ter cobertura adequada é 86,28% maior para uma estrutura boa em comparação a uma ruim. CONCLUSÕES Mudanças na estrutura das UBS municipais e na disponibilidade de imunobiológicos ao longo dos ciclos avaliados foram identificas e elas foram associadas a uma maior cobertura vacinal quando ocorreram simultaneamente (boa disponibilidade de imunobiológicos e estrutura regular ou boa nas UBS). Destaca-se a importância da qualidade da atenção primária para o alcance das metas de cobertura vacinal nos municípios brasileiros.

ABSTRACT OBJECTIVES: To investigate the association between unplanned pregnancy and use of modern contraceptive methods at 3-, 12-, and 24-months postpartum using an intersectional approach for examining inequalities, in the 2015 Pelotas birth cohort, Brazil. METHODS: We evaluated the use of modern contraceptives after delivery, comparing women who had planned and unplanned pregnancies in 2015. The number of women included in this study was: 4,021, 3,687, and 3,558, at 3-, 12-, and 24-month postpartum follow-ups, respectively. Analyses were restricted to women who needed contraception by the time of each postpartum follow-up interview. Sociodemographic indicators were also investigated. Descriptive (absolute and relative frequencies), bivariate, and multivariate statistical analyses were conducted. These analyses included the main exposure and the sociodemographic variables. In the three follow-up interviews, double stratification was used to investigate for intersectionalities between pregnancy planning and family income, and pregnancy planning and living with partner. RESULTS: Women who had unplanned pregnancies presented the lowest use of modern contraceptives. A negative association between unplanned pregnancy and use of modern contraception was found at 3- (PR = 0.97, 95%CI: 0.95–0.99) and 24-months postpartum (PR = 0.96, 95%CI: 0.94–0.98). In general, women who did not live with a partner, with lower schooling level, and who were 35 or older presented lower use of modern contraception. Women who had unplanned pregnancies with lower family income and who did not live with a partner presented a lower prevalence of modern contraceptive use. CONCLUSIONS: Despite the possible benefits of the use of modern contraception in the postpartum period, women who had unplanned pregnancies presented the lowest prevalence. No consistent pattern was identified for this association over time. It is necessary to consider important sociodemographic factors such as living with partner as well as possible pathways to reduce inequalities.

ABSTRACT OBJECTIVE: To explore the spatial distribution of bacille Calmette-Guerin (BCG) vaccination coverage and tuberculosis cases in Brazilian children under the age of ten in the last two decades. METHODS: This is a population-based ecological study using data from the Sistema de Informação de Agravos de Notificação (SINAN – Information System for Notifiable Diseases) from January 2001 to December 2022. We investigated tuberculosis incidence and vaccination coverage in all Brazilian municipalities. Spatial dependence was analyzed by the Global Moran Index and Local Indicators of Spatial Association (LISA). Joinpoint regression was used to assess trends in tuberculosis and BCG rates over time. RESULTS: The results indicated 39,840 pediatric tuberculosis cases, with 60.65% in children under the age of five. The highest incidence rates were in the states of Amazonas, Mato Grosso, and Rio de Janeiro. Spatial analysis showed significant positive spatial autocorrelation in pediatric tuberculosis cases, with high-high clusters in several states and municipalities. Tuberculosis cases in children under five have been declining since 2000 but rose in 2020 (APC = 26.64; p-value = 0.032). An earlier increase was observed in children up to ten years old, starting six years prior. CONCLUSION: The study highlights the decline in BCG vaccination coverage below 90%, with the most significant drop in 2020, particularly in the Northeast. The findings underscore the need for high maintain vaccination coverage and robust public health policies to mitigate tuberculosis in children. Addressing these issues requires targeted public health interventions, especially in regions with higher tuberculosis burdens.

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.