Resumen en Portugués:

RESUMO OBJETIVO Desenvolver uma ferramenta gráfica inovadora para representar erros de Guttman e facilitar a análise da escalabilidade de instrumentos de aferição em epidemiologia. MÉTODOS Implementada em R (RStudio), a função guttemap foi desenvolvida para preencher essa lacuna. Ela oferece uma representação visual intuitiva dos erros de Guttman, com gradientes de cores que facilitam a apreciação dos instrumentos de aferição, revelando padrões internos de inconsistência. Apresenta-se a racionalidade subjacente ao mapa de erros de Guttman proposto e uma síntese comentada da rotina para sua implementação. RESULTADOS Com sete exemplos sintéticos, demonstra-se o potencial da representação gráfica na identificação de áreas problemáticas e como isso auxilia no embasamento de ajustes informados e o desenvolvimento de instrumentos mais robustos. CONCLUSÕES Com o guttemap, a análise de erros de Guttman torna-se mais acessível e interpretável, contribuindo para o aprimoramento dos instrumentos de aferição e o avanço da pesquisa epidemiológica.

Resumen en Inglés:

ABSTRACT OBJECTIVE To develop an innovative graphical tool to represent Guttman errors and facilitate scalability analysis of measurement instruments in epidemiology. METHODS Implemented in R (RStudio), the guttemap function was developed to fill this gap. It provides an intuitive visual representation of Guttman errors, with color gradients that facilitate the assessment of measurement instruments, revealing internal patterns of inconsistency. The rationale underlying the proposed Guttman error map is presented, along with an annotated summary of the routine for its implementation. RESULTS Seven synthetic examples show the potential of graphical representation in identifying problem areas and how this helps to inform adjustments and develop more robust instruments. CONCLUSIONS With guttemap, Guttman error analysis becomes more accessible and interpretable, contributing to the improvement of measurement instruments and the advancement of epidemiological research.

Resumen en Portugués:

RESUMO OBJETIVO Analisar a sustentabilidade do sistema alimentar na Região Metropolitana de Belém, a partir da interface entre políticas públicas de compras institucionais (Programa Nacional de Alimentação Escolar e Programa de Aquisição de Alimentos), considerando a produção local, o perfil dos gastos, a valorização da agricultura familiar e os princípios da justiça climática. MÉTODOS A análise do Programa Nacional de Alimentação Escolar baseou-se nos dados do Censo Escolar (perfil de escolas e estudantes) e em notas fiscais do Sistema de Gestão de Prestação de Contas (valores e tipos de alimentos da agricultura familiar), ambos de 2022. Os alimentos foram classificados em 12 grupos. A caracterização da agricultura familiar e os dados do Programa de Aquisição de Alimentos fundamentaram-se em relatórios de agricultura urbana e periurbana e em mapeamento de assentamentos. RESULTADOS A Região Metropolitana de Belém possui 929 escolas públicas e 390.552 estudantes. Em 2022, os municípios destinaram 31 milhões de reais ao Programa Nacional de Alimentação Escolar, dos quais 43,5% foram provenientes da agricultura familiar, superando a meta legal. As frutas representaram os maiores valores investidos, seguidas por verduras e temperos. No Programa de Aquisição de Alimentos, o assentamento Abril Vermelho vendeu 28 toneladas de alimentos, com destaque para grupos como frutas, legumes e tubérculos, sendo a abóbora e a raiz de mandioca os alimentos com maior volume, e a cebolinha e a pimenta os de maior valor financeiro. A produção priorizou lavouras permanentes, práticas agroecológicas e alimentos culturalmente significativos. CONCLUSÕES Os resultados evidenciam o potencial do Programa Nacional de Alimentação Escolar e do Programa de Aquisição de Alimentos na Região Metropolitana de Belém para fortalecer a agricultura familiar, promover a alimentação saudável e sustentável, valorizar produtos regionais e contribuir para a recuperação ambiental. Tais políticas representam instrumentos estratégicos para integrar segurança alimentar e justiça climática, ao promover produção local de baixo impacto, reconhecer desigualdades e ampliar a resiliência dos sistemas alimentares, alinhando-se aos objetivos da COP30.

Resumen en Inglés:

ABSTRACT OBJECTIVE To analyze the sustainability of the food system in the Belém Metropolitan Region, based on the interface between public institutional purchasing policies (National School Feeding Program and Food Acquisition Program), considering local production, the profile of spending, the appreciation of family farming, and the principles of climate justice. METHODS The analysis of the National School Feeding Program was based on data from the School Census (profile of schools and students) and invoices from the Accountability Management System (amounts and types of food from family farming), both from 2022. The food was classified into 12 groups. The characterization of family farming and the data from the Food Acquisition Program were based on reports on urban and peri-urban agriculture and the mapping of settlements. RESULTS The Belém Metropolitan Region has 929 public schools and 390,552 students. In 2022, the municipalities allocated 31 million reais to the National School Feeding Program, of which 43.5% came from family farming, exceeding the legal target. Fruit accounted for the largest amounts invested, followed by vegetables and spices. In the Food Acquisition Program, the Abril Vermelho (Red April) settlement sold 28 tons of food, especially fruit, vegetables, and tubers, with pumpkin and cassava root being the foods with the highest volume, and spring onions and pepper the ones with the highest financial value. Production prioritized permanent crops, agro-ecological practices and culturally significant foods. CONCLUSIONS The results show the potential of the National School Feeding Program and the Food Acquisition Program in the Belém Metropolitan Region to strengthen family farming, promote healthy and sustainable eating, value regional products, and contribute to environmental recovery. These policies represent strategic instruments for integrating food security and climate justice, by promoting low-impact local production, recognizing inequalities, and increasing the resilience of food systems, in line with the COP30 objectives.

Resumen en Portugués:

RESUMO OBJETIVO Avaliar a prevalência de fatores de risco e proteção para doenças crônicas não transmissíveis entre estudantes universitários brasileiros. MÉTODOS Foram utilizados dados da Pesquisa Nacional de Saúde de 2013 e 2019 para avaliar estudantes de graduação (≥ 18 anos). Fatores de risco incluíram consumo de alimentos não saudáveis, comportamento sedentário, atividade física insuficiente, consumo de álcool e de tabaco, excesso de peso e obesidade, enquanto fatores de proteção envolveram consumo de alimentos saudáveis e atividade física no lazer. Prevalências e intervalos de confiança foram descritos para cada ano, estratificadas por sexo, ocupação profissional, raça/cor da pele e faixa etária. RESULTADOS A prevalência de consumo regular de refrigerantes (homens: 27,9% para 12,5%; mulheres: 22,8% para 10,7%), de doces (homens: 27,1% para 17,6%; mulheres: 33,2% para 20,4%) e de atividade física insuficiente (homens: 37,6% para 22,7%; mulheres: 57,7% para 37,3%) diminuiu, enquanto a prevalência de consumo regular de frutas e hortaliças (homens: 16,1% para 27,2%; mulheres: 22,6% para 34%) e de atividade física no lazer (mulheres: 28,3% para 37,3%) aumentou. O consumo de feijão (65,1% para 55,8%) e a prática de atividade física no lazer (32,4% para 42,9%) aumentaram entre estudantes com ocupação. A prática de atividade física no lazer (37,2% para 46,4%) aumentou e o consumo de doces (33,7% para 17,5%) reduziu entre estudantes brancos/amarelos, enquanto o consumo de feijão diminuiu entre estudantes negros/indígenas (69,9% para 57,1%). CONCLUSÃO A prevalência da maioria dos fatores de risco diminuiu. As prevalências de consumo de frutas e hortaliças e prática de atividade física seguem baixas, mas tiveram aumento.

Resumen en Inglés:

ABSTRACT OBJECTIVE To assess the prevalence of risk and protective factors for non-communicable diseases among Brazilian university students. METHODS Data from the 2013 and 2019 National Health Survey were used to assess undergraduate students (≥ 18 years). Risk factors included consumption of unhealthy foods, sedentary behavior, insufficient physical activity, alcohol and tobacco consumption, overweight, and obesity, while protective factors involved consumption of healthy foods and leisure-time physical activity. Prevalences and confidence intervals were described for each year, stratified by sex, professional occupation, race/skin color, and age group. RESULTS The prevalence of regular consumption of soft drinks (men: 27.9% to 12.5%; women: 22.8% to 10.7%), sweets (men: 27.1% to 17.6%; women: 33.2% to 20.4%), and insufficient physical activity (men: 37.6% to 22.7%; women: 57.7% to 37.3%) decreased, while the prevalence of regular fruit and vegetable consumption (men: 16.1% to 27.2%; women: 22.6% to 34%) and leisure-time physical activity (women: 28.3% to 37.3%) increased. Regular consumption of beans (65.1% to 55.8%) and leisure-time physical activity (32.4% to 42.9%) increased among students with jobs. Leisure-time physical activity (37.2% to 46.4%) increased and sweet consumption (33.7% to 17.5%) decreased among white/Asian students, while regular consumption of beans decreased among Black/indigenous students (69.9% to 57.1%). CONCLUSION The prevalence of most risk factors decreased. The prevalence of fruit and vegetable consumption and physical activity remained low but increased.

Resumen en Portugués:

RESUMO OBJETIVO Avaliar as desigualdades territoriais na cobertura do tratamento farmacológico de primeira linha para esclerose múltipla remitente-recorrente no Sistema Único de Saúde (SUS) brasileiro em 2024, analisando a distribuição regional da cobertura, consumo e gastos, e quantificando desigualdades socioeconômicas por meio dos indicadores Slope Index of Inequality (SII) e Relative Index of Inequality (RII). MÉTODOS Estudo observacional baseado em dados administrativos do SUS, integrando informações de Autorizações de Procedimentos Ambulatoriais e estimativas epidemiológicas para calcular o consumo em doses diárias definidas e gastos per capita com medicamentos modificadores do curso da doença. O Índice de Desenvolvimento Humano estadual foi utilizado como proxy socioeconômica para o cálculo dos indicadores SII e RII, que quantificam desigualdades absolutas e relativas. RESULTADOS Em 2024, apenas 35,3% dos pacientes elegíveis receberam tratamento, com cobertura variando entre regiões (50,9% no Centro-Oeste e 34,3% no Nordeste). O SII (0,2082) e o RII (2,58) para PT/PATSUS indicaram forte desigualdade socioeconômica na cobertura. Para gastos per capita, não se observou gradiente socioeconômico consistente (SII = -99,18; RII = 0,96). O consumo em doses diárias definidas apresentou desigualdade significativa (SII = 61,65; RII = 2,50), refletindo maior intensidade terapêutica em estados com maior Índice de Desenvolvimento Humano. CONCLUSÕES O estudo evidencia limitações importantes na cobertura e equidade do tratamento de esclerose múltipla remitente-recorrente no SUS, com desigualdades estruturais associadas à posição socioeconômica regional. O uso integrado de indicadores administrativos e métricas de desigualdade (SII e RII) oferece subsídios para intervenções políticas focadas em justiça distributiva e sustentabilidade do sistema público de saúde.

Resumen en Inglés:

ABSTRACT OBJECTIVE To assess territorial inequalities in the coverage of first-line pharmacological treatment for relapsing-remitting multiple sclerosis in the Brazilian Unified Health System (SUS) in 2024, analyzing the regional distribution of coverage, consumption, and spending, and quantifying socioeconomic inequalities using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) indicators. METHODS An observational study based on administrative data from the SUS, integrating information from Outpatient Procedure Authorizations and epidemiological estimates to calculate consumption in defined daily doses and per capita expenditure on disease-modifying drugs. The state Human Development Index was used as a socioeconomic proxy to calculate the SII and RII indicators, which quantify absolute and relative inequalities. RESULTS In 2024, only 35.3% of eligible patients received treatment, with coverage varying between regions (50.9% in the Central-West and 34.3% in the Northeast). The SII (0.2082) and RII (2.58) for PT/PATSUS indicated strong socioeconomic inequality in coverage. For per capita spending, there was no consistent socioeconomic gradient (SII = -99.18; RII = 0.96). Consumption in defined daily doses showed significant inequality (SII = 61.65; RII = 2.50), reflecting greater therapeutic intensity in states with a higher Human Development Index. CONCLUSIONS The study shows important limitations in the coverage and equity of treatment for relapsing-remitting multiple sclerosis in the SUS, with structural inequalities associated with regional socioeconomic position. The integrated use of administrative indicators and inequality metrics (SII and RII) provides subsidies for policy interventions focused on distributive justice and sustainability of the public health system.

Resumen en Portugués:

RESUMO OBJETIVO: Analisar a classificação de risco de transmissão de doenças imunopreveníveis por vacinação nos municípios do estado de São Paulo (SP) e verificar a influência do porte populacional no risco de transmissão de doenças imunopreveníveis (RTDI) antes e depois da implementação do Microplanejamento para as Atividades de Vacinação de Alta Qualidade. MÉTODOS: Estudo epidemiológico, com delineamento ecológico, realizado com dados secundários de cobertura vacinal de nove imunobiológicos recomendados para o calendário vacinal de crianças menores de dois anos e da taxa de abandono para as vacinas de multidoses na mesma faixa etária no estado de SP, abrangendo os anos de 2022 e 2023. Após o cálculo de todos os indicadores, os municípios foram classificados conforme o risco de transmissão de doenças imunopreveníveis por vacinação. RESULTADOS: As análises dos indicadores de cobertura vacinal, taxa de abandono, homogeneidade de cobertura vacinal entre vacinas em menores de dois anos e indicador RTDI para menores ou igual a um ano revelaram que, em 2022, a vacina contra rotavírus humano apresentou a maior proporção de municípios que atingiram a meta de cobertura, com 46%, seguida pela vacina meningocócica (39%). No ano de 2023, a vacina contra rotavírus humano manteve-se com a maior proporção de municípios que atingiram a meta de cobertura (68%), seguida pela vacina pneumocócica (57%). Com relação ao RTDI, nos municípios de grande porte, o risco alto caiu de 100% para 91,2%, enquanto em municípios de médio porte houve redução de 90,8 para 66,7% e, nos de pequeno porte, de 68,3 para 56%. CONCLUSÃO: Existem desafios no estado quanto à classificação de RTDI por vacinação, especialmente em municípios de médio e grande porte. A utilização de indicadores de imunização por municípios pode ser bastante válida para a proposição de intervenções em saúde, visando ao aumento das coberturas vacinais.

Resumen en Inglés:

ABSTRACT OBJECTIVE: To analyze the risk classification of transmission of vaccine-preventable diseases in the municipalities of the state of São Paulo (SP) and to assess the influence of population size on the risk of transmission of vaccine-preventable diseases (RTDI) before and after the implementation of Microplanning for High-Quality Vaccination Activities. METHODS: This is an epidemiological study with an ecological design, conducted using secondary data on vaccination coverage for nine immunobiologicals recommended in the immunization schedule for children under two years of age. It also examines dropout rates for multi-dose vaccines within the same age group in the state of São Paulo, covering the years 2022 and 2023. Following the calculation of all indicators, municipalities were classified according to their risk of transmission for vaccine-preventable diseases. RESULTS: Analyses of vaccination coverage indicators, dropout rates, homogeneity of vaccination coverage among vaccines for children under two years of age, and the RTDI indicator for children aged one year or younger revealed that, in 2022, the human rotavirus vaccine had the highest proportion of municipalities reaching the coverage target (46%), followed by the meningococcal vaccine (39%). In 2023, the human rotavirus vaccine maintained the highest proportion of municipalities reaching the target (68%), followed by the pneumococcal vaccine (57%). Regarding the RTDI, in large municipalities, high risk fell from 100% to 91.2%, while in medium-sized municipalities there was a reduction from 90.8% to 66.7%, and in small municipalities, from 68.3% to 56%. CONCLUSION: Challenges remain within the state regarding the RTDI classification for vaccination, particularly in medium-sized and large municipalities. The use of immunization indicators at the municipal level can be highly effective for proposing health interventions aimed at increasing vaccination coverage.

Resumen en Portugués:

RESUMO OBJETIVO Descrever e analisar os arranjos de regulação empregados para a ampliação do acesso a leitos e serviços de saúde durante a covid-19. MÉTODOS Estudo parte de pesquisa Programa Pesquisa para o SUS financiada pela Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp) e da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde do Ministério da Saúde (Sctie-MS), utilizando métodos mistos, investigou a gestão do cuidado em rede para enfrentar a covid-19 em São Paulo. Dados foram coletados via questionário eletrônico, enviado a gestores de 645 municípios entre novembro de 2021 e fevereiro de 2022, com apoio do Conselho dos Secretários Municipais de Saúde de São Paulo (Cosems-SP). As respostas foram analisadas quantitativa e qualitativamente, com foco na regulação do acesso à saúde. RESULTADOS Foram coletadas 255 respostas válidas (39,5% dos municípios paulistas). A maioria dos municípios regulou leitos covid-19 pela central de regulação estadual (58%) e enfrentou dificuldades de acesso (53,7%), insuficiência de leitos e 68,6% dificuldades para internação. A criação de novos serviços foi relatada por 83,1%, e 70,0% implementaram fluxos específicos para ampliar o acesso. No acesso ambulatorial, 54,5% usaram múltiplas estratégias de regulação. Recursos financeiros foram suficientes para 54,0% dos municípios e 86,3% enfrentaram dificuldades na aquisição de insumos. Associações estatísticas significativas foram observadas entre porte municipal e variáveis de regulação. CONCLUSÃO A pandemia de covid-19 destacou a importância da regulação de leitos e a desigualdade na distribuição entre os setores público e privado. Este estudo identificou desafios como a insuficiência de leitos, dificuldades na internação de pacientes e a redução de serviços ambulatoriais. Municípios de grande porte ampliaram leitos por meio de hospitais de campanha e acordos com hospitais privados. Já os pequenos e médios adotaram estratégias regionais e protocolos múltiplos. A articulação regional e a regulação estadual foram cruciais na gestão da resposta, mas as dificuldades com insumos e recursos humanos impactaram o acesso. A incorporação de mecanismos digitais e novas estratégias de regulação foram importantes, apesar dos desafios estruturais e políticos que agravaram a resposta emergencial.

Resumen en Inglés:

ABSTRACT OBJECTIVE To describe and analyze the regulatory arrangements used to expand access to beds and health services during Covid-19. METHODS This study, part of the Research for the SUS Program funded by Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp) and the Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde do Ministério da Saúde (Sctie-MS) Fapesp/Sctie used mixed methods to investigate the management of network care to face Covid-19 in São Paulo. Data was collected via an electronic questionnaire sent to managers in 645 municipalities between November 2021 and February 2022, with the support of the São Paulo Council of Municipal Health Secretaries (COSEMS-SP). The responses were analyzed quantitatively and qualitatively, with a focus on regulating access to healthcare. RESULTS 255 valid responses were collected (39.5% of São Paulo municipalities). Most municipalities regulated Covid-19 beds through the state regulation center (58%) and faced difficulties with access (53.7%), insufficient beds and 68.6% difficulties with hospitalization. The creation of new services was reported by 83.1%, and 70.0% implemented specific flows to expand access. In outpatient access, 54.5% used multiple regulation strategies. Financial resources were sufficient for 54.0% of the municipalities and 86.3% faced difficulties in acquiring supplies. Statistically significant associations were observed between municipal size and regulation variables. CONCLUSION The Covid-19 pandemic has highlighted the importance of bed regulation and the unequal distribution between the public and private sectors. This study identified challenges such as insufficient beds, difficulties in admitting patients, and a reduction in outpatient services. Large municipalities have expanded beds through field hospitals and agreements with private hospitals. Small and medium-sized municipalities adopted regional strategies and multiple protocols. Regional coordination and state regulation were crucial in managing the response, but difficulties with supplies and human resources impacted on access. The incorporation of digital mechanisms and new regulatory strategies was important, despite the structural and political challenges that aggravated the emergency response.

Resumen en Portugués:

RESUMO OBJETIVO Avaliar o impacto das Redes Regionais de Atenção à Saúde (RRAS) e da Regulação de Oncologia na acessibilidade geográfica ao tratamento oncológico dos principais tipos de câncer no estado de São Paulo. MÉTODOS Estudo antes-depois, comparando os triênios anterior (2007–2009) e posterior (2017–2019) à implementação das políticas. Utilizaram-se dados do Registro Hospitalar de Câncer de São Paulo para analisar indicadores de deslocamento e atração de pacientes para cirurgia, radioterapia ou quimioterapia em seis tipos de câncer: estômago, colorretal, pulmão, mama feminina, colo do útero e próstata. As RRAS foram adotadas como unidades geográficas de análise, e os deslocamentos inter-RRAS foram categorizados em quartis (< 25%, 25%–49%, 50%–74% e ≥ 75%). Análise temporal foi realizada por mapas temáticos (QGIS, versão 3.28) e teste de qui-quadrado (α = 5%). RESULTADOS Aproximadamente 25% dos pacientes se deslocaram para tratamento. As RRAS 6 (Capital), 9 (Bauru) e 13 (Ribeirão Preto) mantiveram-se como polos de atração. No Norte e Noroeste, as RRAS 11 e 12 apresentaram redução nos deslocamentos para todos os tipos de câncer; na RRAS 10, a queda ocorreu para tumores colorretal e pulmão. No Sudeste, as RRAS 3 e 5 não possuem serviços habilitados, exigindo deslocamentos, enquanto as RRAS 1, 2 e 4 mantiveram elevados percentuais. No Leste, as RRAS 14 a 17 registraram redução dos deslocamentos, exceto para câncer de pulmão. No Sul, os deslocamentos aumentaram nas RRAS 7 e 8. No geral, houve redução nos deslocamentos para câncer de colo do útero e próstata, e aumento para pulmão, especialmente cirurgia. CONCLUSÃO A implementação das RRAS e da Regulação de Oncologia alterou a acessibilidade geográfica de forma heterogênea: houve melhora no Norte e Noroeste, piora no Sul, e estabilidade dos polos de referência. Destaca-se a necessidade de aperfeiçoamentos no planejamento regional, com atenção às desigualdades territoriais, ao tipo de tumor e à modalidade terapêutica.

Resumen en Inglés:

ABSTRACT OBJECTIVE To assess the impact of Redes Regionais de Atenção à Saúde (RRAS - Regional Health Care Network) and Oncology Regulation on geographical accessibility to oncology treatment for the main types of cancer in the state of São Paulo. METHODS A before-after study comparing the three-year periods before (2007–2009) and after (2017–2019) the policies were implemented. Data from the São Paulo Hospital Cancer Registry were used to analyze indicators of displacement and attraction of patients for surgery, radiotherapy, or chemotherapy in six types of cancer: stomach, colorectal, lung, female breast, cervix, and prostate. The RRAS were adopted as the geographical units of analysis, and inter-RRAS displacements were categorized into quartiles (< 25%, 25%–49%, 50%–74%, and ≥ 75%). Temporal analysis was carried out using thematic maps (QGIS, version 3.28) and the chi-squared test (α = 5%). RESULTS Approximately 25% of patients traveled for treatment. RRAS 6 (Capital), 9 (Bauru), and 13 (Ribeirão Preto) remained the centers of attraction. In the North and Northwest, RRAS 11 and 12 showed a reduction in displacements for all types of cancer; in RRAS 10, the drop occurred for colorectal and lung tumors. In the Southeast, RRAS 3 and 5 do not have qualified services, requiring displacements, while RRAS 1, 2, and 4 maintained high percentages. In the East, RRAS 14 to 17 saw a reduction in displacements, except for lung cancer. In the South, displacements increased in RRAS 7 and 8. Overall, there was a reduction in displacements for cervical and prostate cancer, and an increase for lung cancer, especially for surgery. CONCLUSION The implementation of the RRAS and Oncology Regulation altered geographic accessibility in a heterogeneous way: there was an improvement in the North and Northwest, a worsening in the South, and stability in the reference centers. There is a need to improve regional planning, paying attention to territorial inequalities, the type of tumor, and the therapeutic modality.

Resumen en Inglés:

ABSTRACT OBJECTIVE: To evaluate changes in the trend of tuberculosis mortality in Brazil over recent decades and assess the impact of the Covid-19 pandemic on this indicator. METHODS: We analyzed the national and regional time series of tuberculosis mortality from 2000 to 2023 using joinpoint regression. To assess the pandemic’s impact, we applied two interrupted time series (ITS) approaches: segmented linear regression and the AutoRegressive Integrated Moving Average with eXogenous variables (ARIMAX model). We also used Autoregressive Integrated Moving Average (ARIMA) modeling to estimate excess tuberculosis deaths linked to the pandemic and to forecast mortality trends through 2030. RESULTS: An increase in tuberculosis mortality was observed starting in 2021, reaching 2.4 deaths per 100 thousand people in both 2022 and 2023 — similar to rates observed in 2011. This represents a reversal in the declining trend seen throughout the 2000s and 2010s, affecting all macroregions. The annual percentage change from 2019 to 2023 was +6.5% (95% confidence interval — 95%CI 4.42 to 9.98), contrasting with an average decline of -1.93% (95%CI -2.19 to -1.69) over the full period. Both ITS models consistently demonstrated a detrimental long-term reversal of the mortality trend after the pandemic. While a precise level change was not apparent using traditional segmented regression, the ARIMAX-based analysis successfully isolated a significant acute and lagged effect (β = +0.211; p = 0.0029). We estimated 6,540 excess tuberculosis deaths in Brazil between 2020 and 2023 (95%CI 3,950 to 9,130). The forecasting model with the pandemic effect projected higher mortality rates from 2024 to 2030, while the counterfactual scenario showed a continued decline. CONCLUSIONS: The Covid-19 pandemic had a substantial negative impact on tuberculosis mortality in Brazil, representing a setback in achieving national and global elimination targets.

Resumen en Inglés:

ABSTRACT OBJECTIVE: To psychometrically validate the Spanish version of the Paykel Suicidal Behavior Scale in the Mexican adolescent population, and to establish an optimal cut-off point to identify risk of suicidal behavior in school contexts. METHODS: A cross-sectional study was conducted in 2022 with a non-probabilistic sample of 1,407 students from eight public high schools in the state of Morelos, Mexico. The mean age was 17 years, 58.7% were female and 41.3% were male. The students completed an online questionnaire that included the Paykel Suicidal Behavior Scale, the Center for Epidemiological Studies Depression Scale, and the Depression Anxiety and Stress Scale. A confirmatory factor analysis, item response theory, factorial invariance analysis (by sex, gender identity, and school grade), divergent validity analysis, and ROC curves were applied in this study. RESULTS: The confirmatory factor analysis was found to be acceptable. The factor loadings ranged from 0.799 to 0.938. Item discrimination parameters were elevated (2.33 to 6.63), with difficulties ranging from 0.17 to 1.11. Factor invariance was confirmed in all subgroups. The divergent validity of the Paykel Suicidal Behavior Scale was satisfactory, as evidenced by its moderate correlations with the Epidemiological Studies Depression Scale (r = 0.507), depression (r = 0.644), anxiety (r = 0.570), and stress (r = 0.541). ROC analysis identified an optimal cutoff point of ≥ 1.0, with sensitivity of 75.93% and specificity of 76.54%. CONCLUSION: The Mexican version of the Paykel Suicidal Behavior Scale demonstrates robust psychometric properties, including validity, reliability, and factorial invariance in the adolescent school population. The scale’s brevity, clarity, and ease of application make it an effective tool for school screening, allowing for timely detection and referral to mental health services. Its use is recommended in adolescent suicide prevention programs in educational contexts in Mexico.

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ABSTRACT OBJECTIVE: To evaluate access to treatment for cervical (CVC), colorectal (CRC), thyroid (CT), and central nervous system (CCNS) cancers that differ in incidence, prognosis, early detection program, and in their requirements for high-complexity and technologically advanced treatments METHODS: Data from Integrador RHC INCA (2013–2022) were extracted. Sociodemographic and clinic characteristics and time diagnosis-to-treatment were analyzed using multinomial logistic regression and cumulative incidence function RESULTS: 395,225 cases of cancers were identified, CRC = 168,951, CVC = 141,189, CT = 57,755 and CCNS = 27,330. Patients with CCNS and CRC had higher cumulative probability (CPob) of treatment initiation within 60 days compared to CVC/CT. The North region was less likely to receive treatment within 30 days for all cancers (odds ratio — OR: CCNS = 0.34; CVC = 0.30; CT = 0.17; CRC = 0.49). Radiotherapy showed a lower chance of earlier treatment for all cancers (94% lower CCNS; CVC = 48%; CRC = 81%). There was a greater chance of treatment initiation within 30 days for patients with higher education for CVC (OR = 1.42); CT (OR = 2.09). White individuals demonstrated a consistently higher CPob of treatment initiation at 60 days for all cancers compared to Black (CCNS: 60% versus 49%; CVC: 37% versus 29%; CT: 32% versus 21%; CRC: 52% versus 45%). For CT, males had a higher CPob of treatment 37% in males compared to 30% in females at 60 days). For CRC, CPob of treatment initiation at 60 days was higher among individuals at younger (60% compared to 46% for those aged > 69 years) and clinical stage IV (56% compared to stage 1 — 45%). CONCLUSION: In Brazil, patients requiring multimodal treatments or therapies demanding technology, such as radiotherapy or chemotherapy, faced longer delays. Regional and sociodemographic disparities persist, with timely access to cancer treatment limited in socioeconomically disadvantaged regions, such as the North and Northeast, among Black patients and individuals with lower education.

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RESUMO OBJETIVO Analisar o papel do racismo na saúde bucal e no acesso a serviços odontológicos, considerando duas vias de impacto: o racismo estrutural e o racismo interpessoal. MÉTODOS Estudo transversal com 686 estudantes de graduação, que analisou duas categorias de desfechos: os relacionados à saúde bucal (autopercepção, comprometimento da saúde bucal e perda dentária) e os relacionados ao acesso/à percepção da qualidade de serviços odontológicos (acesso aos serviços, uso recente e avaliação do atendimento). As exposições foram raça/cor, discriminação racial e caracterização do ambiente de vizinhança. Foram estimadas as razões de prevalência através de regressão de Poisson com variância robusta, com ajustes orientados por diagramas acíclicos direcionados. RESULTADOS Pretos e pardos apresentaram maior prevalência de autopercepção negativa (pretos: RP = 1,56; IC95% 1,14–2,13; pardos: RP = 1,53; IC95% 1,14–2,05), perda dentária (pretos: RP = 1,99; IC95% 1,33–2,97), falta de acesso aos serviços odontológicos (pretos: RP = 3,08; IC95% 1,06–8,95; pardos: RP = 3,78; IC95% 1,49–9,59) e avaliação negativa do atendimento (pretos: RP = 1,63; IC95% 1,08–2,45; pardos: RP = 1,64; IC95% 1,12–2,39). Discriminação racial se associou à falta de acesso (RP = 4,34; IC95% 1,45–12,95), ao não uso recente dos serviços (RP = 1,74; IC95% 1,31–2,31) e à avaliação negativa do atendimento (RP = 1,51; IC95% 1,01–2,25). E residir em vizinhanças com menos problemas físicos e sociais foi associado à menor prevalência de autopercepção negativa (RP = 0,70; IC95% 0,54–0,90), ao comprometimento da saúde bucal (RP = 0,87; IC95% 0,76–0,99), à falta de acesso (RP = 0,42; IC95% 0,18–0,98) e à avaliação negativa do atendimento (RP = 0,56; IC95% 0,40–0,79). CONCLUSÕES Os achados evidenciaram que o racismo impacta a saúde bucal por vias estruturais e interpessoais e destacam a urgência de estratégias amplas e eficazes para reduzir as iniquidades que afetam os grupos racializados.

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ABSTRACT OBJECTIVE To analyze the role of racism in oral health and access to dental services, considering two impact pathways: structural racism and interpersonal racism. METHODS A cross-sectional study with 686 undergraduate students, which analyzed two categories of outcomes: those related to oral health (self-perception, oral health impairment, and tooth loss) and those related to access to/perception of the quality of dental services (access to services, recent use, and evaluation of care). Exposures were race/color, racial discrimination, and characterization of the neighborhood environment. Prevalence ratios were estimated using Poisson regression with robust variance, with adjustments guided by directed acyclic diagrams. RESULTS Black and brown people had a higher prevalence of negative self-perception (black: PR = 1.56; 95%CI 1.14–2.13; brown: PR = 1.53; 95%CI 1.14–2.05), tooth loss (black: PR = 1.99; 95%CI 1.33–2.97), lack of access to dental services (black: PR = 3.08; 95%CI 1.06–8.95; brown: PR = 3.78; 95%CI 1.49–9.59), and negative evaluation of care (black: PR = 1.63; 95%CI 1.08–2.45; brown: PR = 1.64; 95%CI 1.12–2.39). Racial discrimination was associated with lack of access (PR = 4.34; 95%CI 1.45–12.95), recent non-use of services (PR = 1.74; 95%CI 1.31–2.31) and negative evaluation of care (PR = 1.51; 95%CI 1.01–2.25). And living in neighborhoods with fewer physical and social problems was associated with a lower prevalence of negative self-perception (PR = 0.70; 95%CI 0.54–0.90), compromised oral health (PR = 0.87; 95%CI 0.76–0.99), lack of access (PR = 0.42; 95%CI 0.18–0.98), and negative evaluation of care (PR = 0.56; 95%CI 0.40–0.79). CONCLUSIONS The findings show that racism impacts oral health through structural and interpersonal channels and highlight the urgency of broad and effective strategies to reduce the inequities affecting racialized groups.

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RESUMO OBJETIVO Identificar as variáveis sociodemográficas e clínicas que influenciaram os custos diários de crianças e adolescentes que ficaram em acolhimento noturno em Centros de Atenção Psicossocial Infantojuvenis tipo III ou em internação na referência hospitalar ou de emergência e urgência na perspectiva da sociedade no ano de 2023. MÉTODOS Trata-se de uma análise de custos retrospectiva. Foram coletados os custos diretos e indiretos. Para mensuração dos custos, foi empregada técnica mista, priorizando a abordagem de microcusteio e, para valoração, o método bottom-up. Fatores que influenciaram os custos foram avaliados com modelos estatísticos univariados. RESULTADOS O estudo incluiu 399 usuários. O custo médio total foi de R$ 6.704,38 (US$ 1.149,99) e o custo médio diário foi de R$ 1.097,97 (US$ 188,33). Houve significância estatística na correlação entre custo diário e idade, raça, subgrupo diagnóstico, encaminhamento para o serviço de atendimento e motivo de busca por cuidado. A variável com maior variação positiva no custo diário foi buscar o serviço por uso de drogas (R$ 125,82; US$ 21,58), enquanto a com maior variação negativa no custo diário foi ter sido encaminhado por outro serviço (R$ 139,86; US$ 23,99). CONCLUSÕES A fim de usar de forma mais eficiente os recursos disponíveis, cabe à rede de cuidados em saúde mental infantojuvenil investir no cuidado precoce de crianças e adolescentes, especialmente os mais vulnerabilizados e que possam ter problemas com o uso de drogas, além de incentivar cada vez mais a articulação entre serviços.

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ABSTRACT OBJECTIVE To identify the sociodemographic and clinical variables that influenced the daily costs of children and adolescents who stayed overnight in Type III Centro de Atenção Psicossocial Infantojuvenil (CAPSij - Child and Adolescent Psychosocial Care Center) or in hospital reference or emergency and urgent care from the perspective of society in the year 2023. METHODS This is a retrospective cost analysis. Direct and indirect costs were collected. A mixed technique was used to measure costs, prioritizing the micro-costing approach and the bottom-up method for valuation. Factors influencing costs were evaluated using univariate statistical models. RESULTS The study included 399 users. The average total cost was R$ 6,704.38 (US$ 1,149.99) and the average daily cost was R$ 1,097.97 (US$ 188.33). There was statistical significance in the correlation between daily cost and age, race, diagnostic subgroup, referral to the service, and reason for seeking care. The variable with the greatest positive variation in daily cost was seeking care for drug use (R$ 125.82; US$ 21.58), while the variable with the greatest negative variation in daily cost was being referred by another service (R$ 139.86; US$ 23.99). CONCLUSIONS To make more efficient use of available resources, it is up to the child and adolescent mental health care network to invest in the early care of children and adolescents, especially those who are most vulnerable and who may have problems with drug use, and to increasingly encourage coordination between services.

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RESUMO OBJETIVO Descrever o perfil socioeconômico e de atuação dos ambulantes, bem como o perfil de comercialização de alimentos, segundo o processamento industrial, no entorno de escolas privadas nas capitais brasileiras. MÉTODOS Estudo transversal com ambulantes no entorno imediato de uma amostra probabilística nacional de escolas privadas brasileiras. Foram incluídas escolas de ensino fundamental e/ou médio, participantes do Estudo Comercialização de Alimentos em Escolas Brasileiras. Aplicou-se questionário previamente validado para caracterizar trabalhador, infraestrutura e disponibilidade de alimentos. Os alimentos foram classificados segundo o sistema NOVA. Comparações entre macrorregiões (Norte, Nordeste, Centro-Oeste, Sudeste e Sul) e portes de ponto de venda (menor: 1–3 itens; intermediário: 4–13 itens; maior: ≥ 14 itens) foram avaliadas pelo teste de Kruskal–Wallis. RESULTADOS Foi mapeado o comércio informal de alimentos e bebidas no entorno imediato de 2.180 escolas privadas, totalizando 699 ambulantes. Predominaram homens (57,8%), pessoas negras (68,8%), com ensino médio completo (35,8%) e que subsistiam da informalidade (91,4%), em carrinhos e barracas, por falta de oportunidade no mercado formal (52,5%). A mediana de itens ultraprocessados superou em cerca de duas vezes a de alimentos in natura, minimamente processados ou processados e preparações baseadas neles (2,17; IC95% 1,90–2,45). Pontos comerciais de porte maior concentraram mais ultraprocessados em todas as regiões, exceto no Nordeste, onde essa predominância já ocorria no porte intermediário (3,32; IC95% 2,88–3,75). A menor razão de ultraprocessados foi observada no Sul (0,21; IC95% 0,05–0,37) e a maior, no Nordeste (3,32; IC95% 2,88–3,75). CONCLUSÃO O comércio ambulante no entorno de escolas privadas brasileiras reflete desigualdades estruturais e expande-se comercialmente na oferta de ultraprocessados para crianças e adolescentes. Recomenda-se sua inclusão como componente indissociável na avaliação do ambiente alimentar escolar, para subsidiar políticas que conciliam geração de renda e promoção da alimentação saudável.

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ABSTRACT OBJECTIVE To describe the socioeconomic profile and activity of street vendors, as well as the profile of food sales, according to industrial processing, in the vicinity of private schools in Brazilian state capitals. METHODS Cross-sectional study with street vendors in the immediate vicinity of a national probability sample of Brazilian private schools. Elementary and/or high schools participating in the Food Marketing in Brazilian Schools Study were included. A previously validated questionnaire was applied to characterize workers, infrastructure and food availability. Food was classified according to the NOVA system. Comparisons between macro-regions (North, Northeast, Central-West, Southeast, and South) and sizes of point of sale (smallest: 1–3 items; intermediate: 4–13 items; largest: ≥ 14 items) were evaluated using the Kruskal-Wallis test. RESULTS The informal food and beverage trade in the immediate vicinity of 2,180 private schools was mapped, totaling 699 street vendors. There was a predominance of men (57.8%), black people (68.8%), those with completed secondary education (35.8%), and those who worked informally (91.4%), in carts and stalls, due to a lack of opportunity in the formal market (52.5%). The median number of ultra-processed items was about twice that of in natura, minimally processed, or processed foods and preparations based on them (2.17; 95%CI 1.90–2.45). Larger outlets concentrated more ultra-processed foods in all regions, except in the Northeast, where this predominance already occurred in intermediate-sized outlets (3.32; 95%CI 2.88–3.75). The lowest ratio of ultra-processed foods was observed in the South (0.21; 95%CI 0.05–0.37) and the highest in the Northeast (3.32; 95%CI 2.88–3.75). CONCLUSION Street vending around Brazilian private schools reflects structural inequalities and expands commercially in the supply of ultra-processed foods to children and adolescents. We recommend its inclusion as an inseparable component in the evaluation of the school food environment, to support policies that reconcile income generation and the promotion of healthy eating.

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RESUMO OBJETIVO Avaliar a evolução do custo de uma proposta de cesta básica saudável e sustentável, nacional e para as regiões metropolitanas, entre 2009 e 2024. MÉTODOS Foram utilizados dados de aquisição de alimentos (quantidades e valores pagos) provenientes das Pesquisas de Orçamentos Familiares de 2008–2009 e 2017–2018. Os grupos de alimentos que compõem as cestas foram baseados na dieta planetária Eat-Lancet e em instrumentos regulatórios oficiais. O Índice de Preço ao Consumidor Amplo referente aos alimentos e grupos de alimentos foi utilizado para atualização mensal dos preços dos itens consumidos pela população brasileira no contexto das Pesquisas de Orçamentos Familiares que compõem a cesta básica proposta. Descontou-se a inflação acumulada no período para comparação de valores monetários ao longo do tempo, calculando-se o valor real das cestas básicas. RESULTADOS O custo real da cesta básica nacional proposta manteve-se relativamente estável entre 2009 e 2012, apresentando posterior tendência de crescimento até início de 2017, incluindo crescimento mais expressivo entre 2018 e 2024. Padrão similar foi observado nas cestas básicas das regiões metropolitanas. O custo (adulto/mês) representou em média 26% do salário-mínimo vigente em cada ano do período de análise e 19% da renda per capita média nacional entre 2010 e 2023. A participação dos grupos de alimentos no custo da cesta proposta manteve-se estável no período. CONCLUSÃO Houve um aumento no custo real da cesta básica saudável e sustentável proposta em nível nacional e regional, particularmente a partir de 2018. Ademais, o valor da cesta básica saudável e sustentável apresentou tendência de aumento em relação à renda média per capita da população, especialmente a partir de 2018.

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ABSTRACT OBJECTIVE To evaluate the evolution of the cost of a proposed healthy and sustainable basic food basket, nationally and for metropolitan regions, between 2009 and 2024. METHODS Food purchase data (quantities and amounts paid) from the 2008–2009 and 2017–2018 Pesquisas de Orçamentos Familiares (POF - Household Budget Surveys) were used. The food groups that make up the baskets were based on the Eat-Lancet planetary diet and official regulatory instruments. The Broad Consumer Price Index for foods and food groups was used to update the monthly prices of the items consumed by the Brazilian population in the context of the POFs that make up the proposed basic food basket. The accumulated inflation over the period was discounted to compare monetary values over time, calculating the real value of the basic food baskets. RESULTS The real cost of the proposed national basic food basket remained relatively stable between 2009 and 2012, showing a subsequent upward trend until early 2017, including more significant growth between 2018 and 2024. A similar pattern was observed in the basic food baskets of the metropolitan regions. The cost (adult/month) represented on average 26% of the minimum wage in force in each year of the analysis period and 19% of the national average per capita income between 2010 and 2023. The share of food groups in the cost of the proposed basket remained stable over the period. CONCLUSION There has been an increase in the real cost of the proposed healthy and sustainable basic food basket at national and regional level, particularly since 2018. Moreover, the value of the healthy and sustainable basic food basket showed an upward trend in relation to the average per capita income of the population, especially since 2018.

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RESUMO OBJETIVO Investigar a associação entre o conhecimento em alimentação segundo o nível de processamento dos alimentos e a adesão às recomendações do Guia Alimentar para a População Brasileira. MÉTODOS Estudo realizado com uma subamostra da coorte NutriNet-Brasil baseada em cotas (n = 1.053). A adesão ao Guia foi avaliada por meio de uma escala de práticas alimentares (24 itens), que gera um escore que varia de 0 a 72. Para avaliar o conhecimento, os participantes indicaram em uma escala de 1 a 10 o quão saudáveis consideram cada item em uma lista de 12 alimentos em quatro categorias (frutas, carnes, laticínios e grãos), incluindo três grupos da classificação de alimentos Nova: in natura ou minimamente processados (G1); processados (G3); e, ultraprocessados (G4). Para gerar o escore (0 a 8), dois pontos foram atribuídos em cada categoria quando a opção G1 foi avaliada como mais saudável que a G3, e ambas como mais saudáveis que a G4. Na análise, ponderação amostral foi utilizada para aproximar a distribuição da amostra do perfil da população brasileira. A associação entre o escore de conhecimento e a adesão ao Guia foi testada por meio de regressão linear com ajuste para variáveis sociodemográficas, socioeconômicas e de comportamento. RESULTADOS A média do escore de adesão ao Guia foi 43,1 (DP = 9,29) e o de conhecimento foi 5,4 (DP = 1,2). No modelo bruto, para cada um ponto de aumento de conhecimento, a adesão ao Guia aumentou, em média, 0,8 pontos (p = 0,002). A associação permaneceu significativa no modelo ajustado, mas o coeficiente foi reduzido para 0,6 (p = 0,020) com a inclusão no modelo de variáveis socioeconômicas. CONCLUSÃO O maior conhecimento para reconhecer os alimentos ultraprocessados como menos saudáveis está associado à maior adesão às práticas alimentares recomendadas pelo Guia Alimentar para a População Brasileira, reforçando a importância da disseminação das recomendações.

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ABSTRACT OBJECTIVE To investigate the association between food knowledge according to the level of food processing and adherence to the recommendations of the Dietary Guidelines for the Brazilian Population. METHODS This study was carried out with a subsample of the NutriNet-Brazil cohort based on quotas (n = 1,053). Adherence to the Guide was assessed using a scale of dietary practices (24 items), which generates a score ranging from 0 to 72. To assess knowledge, participants indicated on a scale of 1 to 10 how healthy they considered each item on a list of 12 foods in four categories (fruit, meat, dairy products and grains), including three groups from the Nova food classification: fresh or minimally processed (G1); processed (G3); and ultra-processed (G4). To generate the score (0 to 8), two points were assigned in each category when option G1 was evaluated as healthier than G3, and both as healthier than G4. In the analysis, sample weighting was used to bring the distribution of the sample closer to the profile of the Brazilian population. The association between the knowledge score and adherence to the Guide was tested using linear regression with adjustment for sociodemographic, socioeconomic and behavioral variables. RESULTS The mean score for adherence to the Guide was 43.1 (SD = 9.29) and the mean score for knowledge was 5.4 (SD = 1.2). In the crude model, for every one point increase in knowledge, adherence to the Guide increased by an average of 0.8 points (p = 0.002). The association remained significant in the adjusted model, but the coefficient was reduced to 0.6 (p = 0.020) with the inclusion of socioeconomic variables in the model. CONCLUSION Greater knowledge to recognize ultra-processed foods as less healthy is associated with greater adherence to the dietary practices recommended by the Dietary Guidelines for the Brazilian Population, reinforcing the importance of disseminating the recommendations.

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RESUMO OBJETIVO O estudo investigou a prevalência de violência por parceiro íntimo na vida em mulheres de 20 a 69 anos, residentes na zona urbana de São Leopoldo (RS) e os fatores associados. MÉTODOS Trata-se de estudo transversal de base populacional, no qual foram entrevistadas 1.113 mulheres. O desfecho foi o autorrelato de violência por parceiro íntimo na vida e avaliou-se variáveis sociodemográficas, saúde física, mental e comportamentos. Realizou-se uma análise estratificada por geração etária. RESULTADOS Verificou-se prevalência de 17,9% (IC95% 15,6–20,1) de violência por parceiro íntimo na amostra. Na análise ajustada, associaram-se ao desfecho a menor classe econômica, ter tido infecções sexualmente transmissíveis na vida e a presença de transtornos mentais comuns. Na análise estratificada, mulheres entre 20 e 39 anos tiveram 13,7% (IC95% 10,5–16,8) de violência por parceiro íntimo na vida, com quase três vezes mais probabilidade entre aquelas com transtornos mentais comuns. Já nas mulheres com 40 anos ou mais a prevalência foi de 20,7% (IC95% 17,6–23,8), sendo que aquelas com classe econômica mais baixa, solteiras, divorciadas ou viúvas, com autorrelato de infecções sexualmente transmissíveis e presença de transtornos mentais comuns tiveram mais probabilidade do desfecho. Análises interseccionais secundárias revelaram maior prevalência de violência por parceiro íntimo entre mulheres pretas ou pardas com baixa escolaridade (RP = 1,67; IC95% 1,14–2,45) e brancas com baixa escolaridade (RP = 1,58; IC95% 1,14–2,19), comparadas às brancas com maior escolaridade. CONCLUSÕES O estudo demonstrou alta prevalência de violência por parceiro íntimo na vida, o que reforça a necessidade de políticas públicas que melhorem as condições socioeconômicas das mulheres, bem como programas integrados de prevenção à violência de gênero que incorporem cuidados em saúde mental no acolhimento às vítimas.

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ABSTRACT OBJECTIVE The study investigated the lifetime prevalence of intimate partner violence among women aged 20 to 69 years residing in the urban area of São Leopoldo (RS) and associated factors. METHODS This was a population-based cross-sectional study in which 1,113 women were interviewed. The outcome was self-reported lifetime intimate partner violence, and sociodemographic, physical and mental health, and behavioral variables were assessed. A stratified analysis by age group was performed. RESULTS The prevalence of intimate partner violence in the sample was 17.9% (95%CI 15.6–20.1). In the adjusted analysis, the outcome was associated with lower socioeconomic status, a history of sexually transmitted infections, and the presence of common mental disorders. In the stratified analysis, women aged 20–39 years had a 13.7% (95%CI 10.5–16.8) lifetime prevalence of intimate partner violence, with nearly three times the likelihood among those with common mental disorders. Among women aged 40 years or older, the prevalence was 20.7% (95%CI 17.6–23.8), with those in the lowest socioeconomic class, who were single, divorced, or widowed, who self-reported sexually transmitted infections, and who had common mental disorders being more likely to experience the outcome. Secondary intersectional analyses revealed a higher prevalence of intimate partner violence among Black or Brown women with low educational attainment (PR = 1.67; 95%CI 1.14–2.45) and White women with low educational attainment (PR = 1.58; 95%CI 1.14–2.19), compared to white women with higher educational attainment. CONCLUSIONS The study demonstrated a high lifetime prevalence of intimate partner violence, reinforcing the need for public policies that improve women’s socioeconomic conditions, as well as integrated gender-based violence prevention programs that incorporate mental health care in the support provided to victims.

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RESUMO OBJETIVO Comparar dois métodos de avaliação do ganho de peso gestacional (GPG) entre gestantes adultas com sobrepeso atendidas na Atenção Primária à Saúde. MÉTODOS Trata-se de uma análise secundária de um ensaio clínico randomizado e controlado, realizado entre 2018 e 2021, com 260 gestantes com sobrepeso em acompanhamento pré-natal em unidades básicas de saúde do município de Ribeirão Preto, São Paulo. As participantes foram alocadas em dois grupos: intervenção (receberam aconselhamento nutricional individualizado – GI) ou controle (receberam apenas orientações nutricionais usuais do pré-natal – GC). O GPG foi classificado segundo as diretrizes norte-americanas da National Academy of Medicine (NAM) e de acordo com as recomendações das curvas brasileiras. Para avaliar a concordância entre os métodos, empregou-se o coeficiente de concordância de kappa e, para a classificação do ganho ponderal (adequado, insuficiente ou excessivo), utilizaram-se os critérios adotados por cada método. Modelos de regressão logística foram empregados para analisar a associação entre os grupos (GI e GC) e os dois métodos empregados na avaliação do GPG. RESULTADOS Observou-se concordância moderada entre os métodos, com um padrão de discordância que indica possível subestimação do GPG pelas diretrizes da NAM. Gestantes do GI apresentaram maior chance de GPG insuficiente pelo método brasileiro (RC = 2,87; IC95% 0,88–9,25) e menor chance de ganho excessivo pelo método norte-americano (RC = 0,63; IC95% 0,34–1,17), em comparação às mulheres do GC, embora ambos sem significância estatística. CONCLUSÃO As curvas brasileiras mostraram-se mais apropriadas para a classificação do GPG em gestantes brasileiras com sobrepeso, refletindo melhor o monitoramento do peso durante o pré-natal. Sua adoção pode favorecer a identificação precoce de inadequações no GPG e, consequentemente, contribuir para a qualificação da assistência pré-natal.

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ABSTRACT OBJECTIVE To compare two methods for assessing gestational weight gain (GWG) among overweight adult pregnant women receiving care in Primary Health Care. METHODS This is a secondary analysis of a randomized controlled clinical trial conducted between 2018 and 2021 involving 260 overweight pregnant women receiving prenatal care at primary health care centers in the municipality of Ribeirão Preto, São Paulo. Participants were assigned to two groups: intervention (received individualized nutritional counseling— GI) or control (received only standard prenatal nutritional guidance—GC). Prenatal weight gain (PWG) was classified according to the U.S. guidelines of the National Academy of Medicine (NAM) and in accordance with Brazilian growth curve recommendations. To assess agreement between the methods, the kappa coefficient was used, and for the classification of weight gain (adequate, insufficient, or excessive), the criteria adopted by each method were used. Logistic regression models were employed to analyze the association between the groups (IG and GC) and the two methods used in the assessment of PWG. RESULTS Moderate agreement was observed between the methods, with a pattern of disagreement indicating possible underestimation of GPG by the NAM guidelines. Pregnant women in the GI had a higher likelihood of insufficient GPG according to the Brazilian method (OR = 2.87; 95%CI 0.88–9.25) and a lower likelihood of excessive weight gain according to the US method (OR = 0.63; 95%CI 0.34–1.17), compared to women in the GC, although neither finding was statistically significant. CONCLUSION The Brazilian curves proved to be more appropriate for classifying GPG in overweight Brazilian pregnant women, better reflecting weight monitoring during prenatal care. Their adoption may facilitate the early identification of GPG inadequacies and, consequently, contribute to improving the quality of prenatal care.

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RESUMO OBJETIVO Analisar de que maneira diferentes governos subnacionais, partindo de diretrizes nacionais comuns, desenvolveram modelos próprios de regulação do acesso à atenção especializada, com distintos graus de inovação, institucionalização e integração da telessaúde. MÉTODO Estudo descritivo e exploratório, de abordagem qualitativa, que analisa de forma comparada a implementação da regulação do acesso à atenção especializada. Dados coletados por meio de análise documental, revisão da literatura e, em alguns casos, entrevistas com atores-chave, consolidados em descrições detalhadas de cada cenário, para composição do corpus da pesquisa. Análise realizada com a aplicação do Consolidated Framework for Implementation Research (CFIR). Foram selecionadas as experiências dos municípios de Curitiba (PR), Belo Horizonte (MG), Porto Alegre (RS) e São Paulo (SP) e dos estados do Ceará, Santa Catarina, Rio Grande do Sul e do Distrito Federal. RESULTADOS As oito experiências brasileiras de regulação ambulatorial se caracterizam pela diversidade nos modelos organizacionais, graus de institucionalização da teleconsultoria e integração entre níveis de atenção. A adoção de tecnologias, protocolos de regulação do acesso e sistemas informatizados variou entre os locais, influenciada por fatores estruturais, normativos e contextuais. A teleconsultoria, quando integrada, qualificou os encaminhamentos e aumentou a resolutividade na atenção primária, mas sua implementação permanece desigual no território nacional. CONCLUSÃO A implementação da regulação do acesso à atenção especializada no SUS variou conforme capacidades institucionais, organizacionais e tecnológicas. Foram identificadas fragilidades na integração entre sistemas de informação em saúde na organização e oferta da atenção especializada com desigualdades estruturais, na governança com baixa padronização de protocolos, integração limitada entre Atenção Primária à Saúde e atenção especializada e resistência profissional a mudanças. Territórios com melhores resultados integraram a teleconsultoria à regulação ambulatorial, protocolos clínicos e de acesso adotaram sistemas de informação em saúde integrados com recursos de inteligência analítica e diretrizes regulatórias institucionalizadas. O CFIR evidenciou a influência de contextos, atores e processos, reforçando a importância de diretrizes nacionais para aperfeiçoar as organizações locais.

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ABSTRACT OBJECTIVE To analyze how different subnational governments, based on common national guidelines, have developed their own models for regulating access to specialized care, with varying degrees of innovation, institutionalization, and integration of telehealth. METHOD A descriptive and exploratory study with a qualitative approach that comparatively analyzes the implementation of regulations governing access to specialized care. Data were collected through document analysis, literature review, and, in some cases, interviews with key stakeholders, consolidated into detailed descriptions of each scenario to form the research corpus. Analysis was conducted using the Consolidated Framework for Implementation Research (CFIR). Experiences were selected from the municipalities of Curitiba (PR), Belo Horizonte (MG), Porto Alegre (RS), and São Paulo (SP), as well as the states of Ceará, Santa Catarina, Rio Grande do Sul, and the Federal District. RESULTS The eight Brazilian experiences with outpatient regulation are characterized by diversity in organizational models, degrees of institutionalization of teleconsultation, and integration across levels of care. The adoption of technologies, access regulation protocols, and computerized systems varied across locations, influenced by structural, regulatory, and contextual factors. When integrated, teleconsultation improved the quality of referrals and increased problem-solving capacity in primary care, but its implementation remains uneven across the country. CONCLUSION The implementation of access regulation to specialized care in the Unified Health System varied according to institutional, organizational, and technological capacities. Weaknesses were identified in the integration of health information systems in the organization and delivery of specialized care, with structural inequalities; in governance, with low standardization of protocols; limited integration between Primary Health Care and specialized care; and professional resistance to change. Regions with better outcomes integrated teleconsultation into outpatient regulation; clinical and access protocols adopted health information systems integrated with analytical intelligence resources and institutionalized regulatory guidelines. The CFIR highlighted the influence of contexts, actors, and processes, reinforcing the importance of national guidelines for improving local organizations.

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ABSTRACT OBJECTIVE To quantify the total expenditure on hospitalizations due to headache disorders within the Brazilian Unified Health System (SUS) and to identify the sociodemographic, clinical, and regional factors associated with the average expenditure per hospitalization. METHODS This observational study used SIH-SUS data from 2008 to 2023. Expenditures were inflation-adjusted and categorized by sex, age, and ICD-10 diagnosis. Given the extreme positive asymmetry of the expenditure data, a Generalized Linear Model with a Gamma family and log link function was used to identify adjusted expenditure multipliers. RESULTS Total expenditure reached BRL 77,643,809.55. The highest volume was concentrated among females (65.7%) and the 19–59 age group (66.1%). The Generalized Linear Model revealed that patients aged 60 years or older had a 21% higher expenditure multiplier (multiplier = 1.21) per event. The South Region showed a structurally 73.7% higher expenditure multiplier (Multiplier = 1.737) per event, even after adjustment for complexity. Vascular headache not elsewhere classified (247.2% higher) and status migrainosus (124.8% higher) were the costliest diagnoses. Crude rate analysis showed the South Region with the highest utilization rate (108.0 hospitalizations per 100,000 inhabitants). CONCLUSION The high adjusted expenditure multipliers in the South/Southeast and the long median stays in the North/Northeast point to structural inequalities in the cost and timeliness of care provision. Public policies must reinforce specialized outpatient management to reduce high-cost hospitalizations and promote equitable resource allocation.

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RESUMO OBJETIVO Descrever as características do ambiente construído em microescala e verificar diferenças conforme a região de moradia e variáveis sociais e demográficas entre adultos em São Paulo, Brasil. MÉTODOS Trata-se de uma análise transversal com 1.434 adultos da coorte ISA–Atividade Física e Ambiente. As características do ambiente foram avaliadas pelo método Microscale Audit of Pedestrian Streetscapes (MAPS Global) a partir de imagens do Google Earth em rotas de 400m–700m dos endereços georreferenciados dos participantes. Para análise, foram aplicados testes U de Mann-Whitney para dois grupos independentes e Kruskal-Wallis para três ou mais grupos, seguido do pós-teste de Dunn, para verificar diferenças nos escores médios do ambiente segundo coordenadorias de saúde, sexo, idade, escolaridade e cor da pele. RESULTADOS O entorno das residências na região Centro-Oeste apresentou os maiores escores gerais (p < 0,001). Indivíduos com maior escolaridade, autodeclarados brancos ou amarelos e com 60 anos ou mais residiam em áreas com melhores escores de estética, aspectos sociais, presença de árvores, coberturas aéreas, calçadas, cruzamentos e escore geral do ambiente (p < 0,001). Em contrapartida, pessoas com menor escolaridade e autodeclaradas pretas ou pardas viviam em áreas com piores condições de calçadas (p < 0,001). CONCLUSÃO Conclui-se que as condições de microescala foram melhores no entorno das residências em regiões centrais e para indivíduos com maior escolaridade, pele branca ou amarela e mais velhos, ressaltando a necessidade de políticas públicas para um planejamento urbano mais equitativo e inclusivo.

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ABSTRACT OBJECTIVE To describe the characteristics of the built environment at the micro-scale and to examine differences according to residential area and social and demographic variables among adults in São Paulo, Brazil. METHODS This is a cross-sectional study involving 1,434 adults from the ISA–Physical Activity and Environment cohort. Environmental characteristics were assessed using the Microscale Audit of Pedestrian Streetscapes (MAPS Global) method based on Google Earth images along 400–700-meter routes centered on the participants’ georeferenced addresses. For the analysis, Mann-Whitney U tests were used for two independent groups and Kruskal-Wallis tests for three or more groups, followed by Dunn’s post-hoc test, to assess differences in mean scores by health coordination unit, sex, age, educational level, and skin color. RESULTS The surroundings of residences in the Central-West region had the highest overall scores (p < 0.001). Individuals with higher education levels, who self-identified as White or Asian, and those aged 60 years or older resided in areas with better scores for aesthetics, social aspects, presence of trees, canopy cover, sidewalks, intersections, and overall environmental score (p < 0.001). In contrast, people with lower educational attainment and those who self-identified as Black or Brown lived in areas with poorer sidewalk conditions (p < 0.001). CONCLUSION It is concluded that micro-scale conditions were better in the vicinity of residences in central regions and for individuals with higher education, White or Asian skin color, and older age, highlighting the need for public policies aimed at more equitable and inclusive urban planning.

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RESUMO OBJETIVO Investigar a associação entre perda auditiva e equilíbrio postural em adultos e idosos participantes do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). MÉTODOS Estudo transversal com dados da quarta onda (2020–2025) do ELSA-Brasil, no centro de São Paulo. Foram analisadas variáveis sociodemográficas, clínicas e audiológicas. A perda auditiva foi definida pela média dos limiares tonais (> 25 dBNA) em diferentes critérios: PTA (0,5 kHz–2 kHz), speech-frequency PTA (0,5 kHz–4 kHz) e high-frequency PTA (3 kHz–8 kHz), considerando melhor e pior orelha. O equilíbrio foi avaliado pelo teste de Romberg modificado, em quatro condições progressivas (olhos abertos em superfície firme, olhos fechados em superfície firme, olhos abertos em superfície maleável e olhos fechados em superfície maleável), com classificação binária (passou/falhou). O desfecho foi o desempenho no teste de equilíbrio. RESULTADOS Foram avaliados 540 participantes, em sua maioria mulheres, autodeclarados brancos, média de idade de 63,1 anos, Índice de Massa Corporal (IMC) médio de 28,4 kg/m2, com escolaridade superior e renda entre R$ 1.245,00 e R$ 3.319,00. A taxa de falha no equilíbrio foi de 13,3%. A prevalência de perda auditiva variou de 13,7% a 59,8%, dependendo do critério adotado. Observou-se associação entre perda auditiva e pior desempenho no teste de equilíbrio, sobretudo para high-frequency PTA. Nos modelos de regressão logística, houve associação significativa entre a variável explicativa idade e falha no teste de equilíbrio. Após exclusão da variável idade, houve associação para perda auditiva, IMC, escolaridade e renda. CONCLUSÃO Houve associação entre perda auditiva e pior desempenho no equilíbrio. A maior proporção de falhas foi para o critério de perda auditiva que incluiu as frequências altas. A idade foi a variável explicativa mais relevante no desempenho no teste de equilíbrio, além da perda auditiva, escolaridade, renda e IMC, enfatizando a necessidade da visão multifatorial dessa função.

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ABSTRACT OBJECTIVE To investigate the association between hearing loss and postural balance in adults and the elderly participating in the Estudo Longitudinal da Saúde do Adulto (ELSA-Brazil - Longitudinal Study of Adult Health). METHODS Cross-sectional study with data from the fourth wave (2020–2025) of ELSA-Brazil, in the center of São Paulo. Sociodemographic, clinical, and audiological variables were analyzed. Hearing loss was defined by the average of the tonal thresholds (> 25 dBHL) in different criteria: PTA (0.5 kHz-2kHz), speech-frequency PTA (0.5 kHz-4kHz), and high-frequency PTA (3 kHz-8kHz), considering the better and the worst hearing ear. Balance was assessed using the modified Romberg test, in four progressive conditions (eyes open on a firm surface, eyes closed on a firm surface, eyes open on a soft surface, and eyes closed on a soft surface), with a binary classification (pass/fail). The outcome was performance in the balance test. RESULTS A total of 540 participants were assessed, mostly women, self-declared white, mean age of 63.1 years, mean Body Mass Index (BMI) of 28.4 kg/m2, with higher education and income between R$ 1,245.00 and R$ 3,319.00. The rate of balance failure was 13.3%. The prevalence of hearing loss ranged from 13.7% to 59.8%, depending on the criteria used. There was an association between hearing loss and worse performance in the balance test, especially for high-frequency PTA. In the logistic regression models, there was a significant association between the explanatory variable age and failure in the balance test. After excluding the age variable, there was an association for hearing loss, BMI, schooling, and income. CONCLUSION There was an association between hearing loss and poorer balance performance. The highest proportion of failures was for the hearing loss criterion that included high frequencies. Age was the most relevant explanatory variable in balance test performance, in addition to hearing loss, schooling, income, and BMI, emphasizing the need for a multifactorial view of this function.

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ABSTRACT OBJECTIVE: To examine the association between age at menarche and general and/or abdominal obesity in Brazilian women aged ≥ 50 years. METHODS: Cross-sectional study conducted with data from the second wave of the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Saúde dos Idosos Brasileiros(ELSI-Brazil, 2019–2021), in a nationally representative sample of community-dwelling individuals aged ≥ 50 years. Self-reported age at menarche was categorized as ≤ 12 years, 13–15 years, and ≥ 16 years. General obesity was defined as a body mass index of ≥ 30 kg/m2, and abdominal obesity as a waist circumference of ≥ 88 cm. The variables were combined into "general or abdominal obesity" and "general and abdominal obesity". Multinomial logistic regression adjusted for sociodemographic and lifestyle characteristics was used. RESULTS: Among the 4,229 participants, 41.1% (95% confidence interval —95%CI 37.9–44.3) reported menarche at ≤ 12 years and 9.3% (95%CI 8.0–10.9) at ≥ 16 years. The prevalence of general or abdominal obesity was 36.6% (95%CI 33.7–39.5), while the prevalence of general and abdominal obesity was 35.0% (95%CI 32.5–37.7). After adjustments, women with age at menarche of ≤ 12 and 13–15 years had, respectively, 84% (odds ratio — OR = 1.84; 95%CI 1.14–2.98) and 64% (OR = 1.64; 95%CI 1.04–2.57) greater odds of general and abdominal obesity compared with those with menarche at ≥ 16 years. There was no significant association between age at menarche and general or abdominal obesity. CONCLUSION: Menarche before age 16 is associated with a higher odds of general and abdominal obesity combined, but not in isolation, suggesting its potential as a relevant marker for the formulation of public policies aimed at preventing obesity in girls from school age onwards.

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ABSTRACT OBJECTIVE: To develop and apply composite indices to assess immediate losses caused by hydrological disasters in Brazil between 2000 and 2023, with a focus on human losses and damages to health infrastructure. METHODS: Data were obtained from the Integrated Disaster Information System, which consolidates national records of hydrological disasters. Seven indicators were selected for the Human Loss Index and four for the Health Infrastructure Loss Index. Indicators were normalized using Min-Max procedures and weighted through a combined Analytic Hierarchy Process and entropy method. The General Severity Index was calculated as the arithmetic mean of Human Loss Index and Health Infrastructure Loss Index, stratified into four levels of severity. Spatial and temporal analyses were conducted to identify critical regions and municipalities. RESULTS: The findings reveal significant heterogeneity in disaster impacts across time and space. Human losses exhibited greater variability than health infrastructure losses, with notable peaks in 2006, 2011, 2015, and 2019. Infrastructure damages were less frequent but highly disruptive, especially in 2012, 2019, and 2023. Municipalities in the Amazon region, particularly Japurá and Atalaia do Norte, registered the highest combined indices, reflecting compounded vulnerabilities from geographic isolation, fragile infrastructure, and socioeconomic inequalities. High General Severity Index scores were concentrated in the North, while human losses were more widely distributed, including along the densely populated southeastern coast. Results confirm that small and socioeconomically vulnerable municipalities are disproportionately affected, with limited institutional capacity to respond. CONCLUSIONS: Hydrological disasters in Brazil are strongly mediated by social inequalities, deficient urban planning, and weak preventive policies. Human and infrastructure losses disproportionately affect vulnerable populations, particularly in the North, where access to health services is precarious. The findings emphasize the need for territorially integrated strategies that combine climate adaptation, poverty reduction, and investments in resilient public health infrastructure.

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ABSTRACT OBJECTIVE: To assess progress, challenges, and enabling factors for building climate-resilient and low-carbon health systems across Latin America and the Caribbean, a region facing accelerating climate-sensitive health burdens amidst persistent health system fragilities. METHODS: We conducted an explanatory, sequential, mixed-methods study integrating quantitative analysis of the Pan American Health Organisation Climate Change and Health surveys from 2021/2022 (n = 24 countries) and 2023/2024 (n = 27 countries) with semi-structured interviews involving four countries demonstrating progress (Argentina, Chile, Jamaica, Peru). Quantitative data were analysed descriptively across three sub-regions (Caribbean, Central America, South America). Qualitative data underwent two-stage coding (deductive and inductive) with three-researcher consensus to identify barriers, enablers, and lessons learned. RESULTS: By 2023/2024, 93% of countries had designated climate-health focal points (71% in 2021/2022). However, implementation gaps persist: less than 50% of countries had integrated climate change into national health reports; 22%–40% developed national climate-health strategies; and vulnerability assessments rarely informed policy. Access to international climate finance remained inequitable. Whilst 60%–74% developed disaster preparedness plans, only 30%–44% implemented public health communication campaigns. Training focused on environmental health personnel, with doctors, nurses, and planning staff minimally engaged. Qualitative analysis revealed interconnected barriers: climate change perceived as distant rather than urgent, competing priorities overwhelming decision-makers, institutional silos, and misalignment between available training and local needs. Key enablers included linking climate action to established health priorities, institutionalising responsibilities through formal mechanisms, multi-stakeholder engagement, and committed individuals with diplomatic skills navigating cross-sectoral dynamics. CONCLUSION: Latin America and the Caribbean countries are establishing foundations for climate-resilient and low-carbon health systems, but translating governance progress into sustained implementation requires addressing systemic barriers through institutionalisation beyond political cycles, tailored capacity building, and innovative financing mechanisms. These findings inform guidance for health systems strengthening amidst accelerating climate change.

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ABSTRACT OBJECTIVE This study aimed to cross-culturally adapt the Problem Gambling Severity Index (PGSI) into Brazilian Portuguese and to conduct a preliminary assessment of its content and face validity. METHODS The adaptation process followed internationally recognized guidelines and included several stages: initial translation, translation synthesis, back-translation, review by a committee of experts, evaluation by an expert panel of 11 specialists, pre-test with participants from the general population, and final revision. The Content Validity Index (CVI), Clarity Index (CI), and Content Validity Ratio (CVR) were calculated based on the experts’ evaluations. As a first step, establishing semantic and content validity is essential before broader psychometric testing can be meaningfully conducted in the target population. RESULTS The adapted PGSI demonstrated strong content validity, with all items reaching a CVI of 0.90 or higher and an overall mean of 0.98. The CI ranged from 2.63 to 2.90, and the CVR indicated high agreement regarding the essentiality of the items. Face validity testing with 33 participants from the general population revealed that all items were rated as understandable or entirely understandable by most participants (84.9% to 100%). Expert feedback was also used to refine the wording of items, particularly to distinguish between “gaming” and “gambling” in the Brazilian context. CONCLUSION The Brazilian Portuguese version of the PGSI presented robust preliminary evidence of semantic, conceptual, and cultural adequacy. This version fills a critical methodological gap and provides a culturally appropriate screening and monitoring tool for use in clinical and research settings in Brazil, supporting prevention and public health monitoring of gambling-related harms, including financial impacts. Future studies will evaluate additional psychometric properties further to consolidate its use in clinical and epidemiological contexts.

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RESUMO OBJETIVO Avaliar a disponibilidade de estabelecimentos saudáveis e não saudáveis no Brasil e, com isso, mapear desertos e pântanos alimentares. Analisar os mapas de desertos e pântanos de forma integrada a indicadores de desigualdade social. MÉTODOS Dados da Relação Anual de Informações Sociais (RAIS, 2022), integrados aos perfis de consumo da Pesquisa de Orçamentos Familiares (POF, 2017–2018), foram utilizados para classificar os estabelecimentos segundo o Guia Alimentar para a População Brasileira. Em escala municipal, estimou-se a densidade de estabelecimentos com perfil saudável e não saudável para os municípios brasileiros. Em escala intramunicipal, foram identificados desertos e pântanos em municípios urbanos com mais de 300 mil habitantes, cruzando os resultados com indicadores de renda do Cadastro Único. RESULTADOS Em nível municipal, observou-se que as regiões Norte e Nordeste concentram a maioria dos municípios com baixa densidade de estabelecimentos saudáveis, enquanto Sul e Sudeste apresentam maiores densidades de estabelecimentos não saudáveis. Em escala intramunicipal, cerca de 25 milhões de pessoas residem em desertos alimentares, o que corresponde a 32,3% da população dos 91 municípios analisados e, aproximadamente, 15 milhões vivem em pântanos alimentares (19% da população). Entre os indivíduos do Cadastro Único com renda per capita inferior a meio salário-mínimo, 38% vivem em desertos alimentares e 10% em pântanos. CONCLUSÃO Os resultados evidenciam a sobreposição entre vulnerabilidade socioeconômica e ambientes alimentares adversos, reforçando a urgência de políticas públicas voltadas à regulação do ambiente alimentar, ao fortalecimento de equipamentos públicos de abastecimento e à promoção da equidade territorial no acesso a alimentos saudáveis.

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ABSTRACT OBJECTIVE To assess the availability of healthy and unhealthy food establishments in Brazil and, thereby, map food deserts and food swamps. To analyze maps of food deserts and food swamps in conjunction with indicators of social inequality. METHODS Data from the Relação Anual de Informações Sociais (RAIS, 2022), integrated with consumption profiles from the Pesquisa de Orçamentos Familiares (POF, 2017–2018), were used to classify establishments according to the Dietary Guidelines for the Brazilian Population. At the municipal level, the density of establishments with healthy and unhealthy profiles was estimated for Brazilian municipalities. At the intramunicipal level, food deserts and food swamps were identified in urban municipalities with more than 300,000 inhabitants, by cross-referencing the results with income indicators from the Cadastro Único. RESULTS At the municipal level, it was observed that the North and Northeast regions concentrate most municipalities with low densities of healthy establishments, while the South and Southeast have higher densities of unhealthy establishments. At the intramunicipal level, approximately 25 million people reside in food deserts, corresponding to 32.3% of the population of the 91 municipalities analyzed, and approximately 15 million live in food swamps (19% of the population). Among individuals in the Cadastro Único with a per capita income below half the minimum wage, 38% live in food deserts and 10% in food swamps. CONCLUSION The results highlight the overlap between socioeconomic vulnerability and adverse food environments, reinforcing the urgency of public policies aimed at regulating the food environment, strengthening public food supply infrastructure, and promoting territorial equity in access to healthy foods.

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RESUMO OBJETIVO Propor o framework Health Research Standard Process for Artificial Intelligence, adaptado da abordagem Cross-Industry Standard Process for Data Mining e aplicá-lo por meio de técnicas de séries temporais e inteligência artificial na análise dos dados do Sistema de Informação de Agravos de Notificação sobre violência contra mulheres em São Paulo, explorando dimensões sociodemográficas, espaciais e preditivas. MÉTODOS A metodologia foi adaptada às pesquisas em saúde, substituindo a etapa original do Business Understanding por Research Understanding ao incorporar elementos técnico-científicos essenciais. Foram analisadas 80.148 notificações de violência contra mulheres entre 20 e 59 anos, residentes no município de São Paulo, no período de 2013 a 2023. As análises incluíram estatísticas descritivas, cálculo de razões de prevalência, decomposição e modelagem preditiva de séries temporais capturando tendências e sazonalidade, e análise geoespacial das notificações. RESULTADOS Observou-se padrões temporais e características sociodemográficas das vítimas, com tendências crescentes nas notificações de violência física, psicológica e sexual após 2015 e comportamento sazonal. Entre as associações, identificou-se aumento de 32% na prevalência de violência sexual quando o agressor estava sob efeito de álcool e risco 2,47 vezes maior de violência sexual entre gestantes. A distribuição geoespacial revelou concentrações de notificações em áreas periféricas do município, como a zona sul, leste e central. A modelagem preditiva indicou que a tendência de aumento persistirá nos próximos 24 meses, com estimativas de taxas alcançando até 12 casos por 100.000 habitantes. CONCLUSÃO A aplicabilidade do Health Research Standard Process for Artificial Intelligence foi eficaz como modelo para análises de dados e desenvolvimento de algoritmos preditivos em saúde pública. Foi possível propor uma matriz metodológica replicável para futuras pesquisas e intervenções baseadas em evidências.

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ABSTRACT OBJECTIVE To propose the Health Research Standard Process for Artificial Intelligence framework, adapted from the Cross-Industry Standard Process for Data Mining approach, and apply it using time series and artificial intelligence techniques to analyze data from the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) on violence against women in São Paulo, exploring sociodemographic, spatial, and predictive dimensions. METHODS The methodology was adapted to health research, replacing the original Business Understanding stage with Research Understanding by incorporating essential technical-scientific elements. We analyzed 80,148 reports of violence against women aged between 20 and 59 living in the city of São Paulo between 2013 and 2023. The analyses included descriptive statistics, calculation of prevalence ratios, decomposition and predictive modeling of time series capturing trends and seasonality, and geospatial analysis of notifications. RESULTS We observed temporal patterns and sociodemographic characteristics of the victims, with increasing trends in reports of physical, psychological, and sexual violence after 2015 and seasonal behavior. Among the associations, there was a 32% increase in the prevalence of sexual violence when the aggressor was under the influence of alcohol and a 2.47 times greater risk of sexual violence among pregnant women. The geospatial distribution revealed concentrations of notifications in peripheral areas of the municipality, such as the south, east, and central zones. Predictive modeling indicated that the upward trend will persist over the next 24 months, with estimated rates reaching up to 12 cases per 100,000 inhabitants. CONCLUSION The applicability of the Health Research Standard Process for Artificial Intelligence was effective as a model for data analysis and the development of predictive algorithms in public health. It was possible to propose a replicable methodological matrix for future research and evidence-based interventions.

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RESUMO OBJETIVO Comparar o desempenho de diferentes algoritmos de Survival Machine Learning (SML) na predição da sobrevida de pacientes com câncer. MÉTODOS Utilizaram-se dados do Registro Hospitalar de Câncer do Estado de São Paulo, contemplando os cinco tipos de câncer mais incidentes (mama, próstata, pulmão, colorretal e colo do útero). Foram avaliados seis algoritmos: Gradient Boosting Survival (GBS), Random Survival Forest (RSF), Support Vector Machine Survival (SVM-Survival), XGBoost Cox, XGBoost Accelerated Failure Time (AFT) e LightGBM. O desempenho foi medido pelas métricas Concordance Index (C-Index), C-Index IPCW e Integrated Brier Score (IBS). RESULTADOS O modelo XGBoost AFT apresentou os melhores resultados de C-Index para mama (0,7845), pulmão (0,7368), colorretal (0,7618) e colo do útero (0,7726), enquanto o GBS foi superior para próstata (0,7574). O estadiamento clínico foi consistentemente a variável mais importante, segundo a análise de explicabilidade. CONCLUSÃO Os algoritmos de SML demonstraram bom desempenho preditivo, independentemente do tipo de câncer, do tamanho amostral e da proporção de censura. Esses modelos mostram potencial para subsidiar o planejamento oncológico e apoiar decisões estratégicas na organização das redes de atenção ao câncer.

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ABSTRACT OBJECTIVE To compare the performance of different Survival Machine Learning (SML) algorithms in predicting the survival of cancer patients. METHODS Data from the Registro Hospitalar de Câncer do Estado de São Paulo (São Paulo State Cancer Registry Hospital) were used, covering the five most incident types of cancer (breast, prostate, lung, colorectal and cervix). Six algorithms were evaluated: Gradient Boosting Survival (GBS), Random Survival Forest (RSF), Support Vector Machine Survival (SVM-Survival), XGBoost Cox, XGBoost Accelerated Failure Time (AFT), and LightGBM. Performance was measured by the Concordance Index (C-Index), C-Index IPCW and Integrated Brier Score (IBS) metrics. RESULTS The XGBoost AFT model showed the best C-Index results for breast (0.7845), lung (0.7368), colorectal (0.7618), and cervix (0.7726), while GBS was superior for prostate (0.7574). Clinical staging was consistently the most important variable, according to the explainability analysis. CONCLUSION The SML algorithms showed good predictive performance, regardless of cancer type, sample size and censoring proportion. These models show potential for subsidizing cancer planning and supporting strategic decisions in the organization of cancer care networks.

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RESUMO OBJETIVO Investigar um foco de leishmaniose visceral canina e a circulação de Leishmania nas espécies de flebotomíneos em área periurbana do município de São Paulo. MÉTODOS Doze cães foram avaliados quanto à infecção por Leishmania e foram realizadas coletas de flebotomíneos com armadilhas de Shannon e luminosas do tipo CDC. A presença do parasito nas fêmeas de flebotomíneos capturados foi analisada por método molecular. RESULTADOS Dos cães analisados, quatro foram soropositivos tanto no teste sorológico rápido quanto por ELISA para Le. infantum. Entre 8.354 flebotomíneos capturados, Nyssomyia whitmani predominou na área (98,2%) e foi detectado DNA de Le. infantum e Le. braziliensis em fêmeas desta espécie, indicando a potencial participação no ciclo de transmissão do agente da leishmaniose visceral. CONCLUSÃO Os achados do presente estudo demonstram a ocorrência de um foco de leishmaniose visceral canina no distrito de Perus, município de São Paulo, caracterizado pela presença de cães infectados por Le. infantum e potencial transmissão associada ao flebotomíneo Ny. whitmani. Também reforça a importância da vigilância entomológica de vetores suscetíveis e da integração de informações em um enfoque de uma só saúde, visando a detecção precoce de potenciais focos de transmissão.

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ABSTRACT OBJECTIVE To investigate an outbreak of canine visceral leishmaniasis and the circulation of Leishmania in phlebotomine species in a peri-urban area in the municipality of São Paulo. METHODS Twelve dogs were assessed for Leishmania infection and sandflies were collected using Shannon and CDC light traps. The presence of the parasite in the captured female sandflies was analyzed by molecular method. RESULTS Of the dogs analyzed, four were seropositive both in the rapid serological test and by ELISA for Le. infantum. Among the 8,354 phlebotomines captured, Nyssomyia whitmani predominated in the area (98.2%) and DNA from Le. infantum and Le. braziliensis was detected in females of this species, indicating potential participation in the transmission cycle of the visceral leishmaniasis agent. CONCLUSION The findings of this study demonstrate the occurrence of an outbreak of canine visceral leishmaniasis in the Perus district, in the municipality of São Paulo, characterized by the presence of dogs infected with Le. infantum and potential transmission associated with the phlebotomine Ny. whitmani. It also reinforces the importance of entomological surveillance of susceptible vectors and the integration of information in a one health approach, with a view to the early detection of potential transmission foci.

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RESUMO OBJETIVO Analisar os indicadores de qualidade da alimentação complementar infantil segundo características socioeconômicas em Cruzeiro do Sul, Acre, Amazônia Ocidental Brasileira. MÉTODOS Trata-se de análise transversal aninhada à coorte de nascimentos MINA-Brasil (n = 971), com dados dos seguimentos de um (n = 774) e dois (n = 854) anos. O consumo alimentar foi avaliado por recordatório de 24 horas para construção dos indicadores de qualidade da alimentação complementar infantil, adaptados das recomendações da Organização Mundial da Saúde: diversidade mínima alimentar, consumo de carnes e/ou ovos, consumo de alimentos ultraprocessados e zero consumo de frutas e vegetais. Variáveis socioeconômicas, neonatais e de morbidades foram analisadas segundo modelo conceitual hierárquico (níveis distal, intermediário e proximal). As associações foram estimadas por regressão de Poisson com variância robusta e ajuste múltiplo; variáveis foram selecionadas com base em pressupostos teóricos ou associação com p < 0,10 em cada nível. RESULTADOS Quanto ao consumo de carnes/ovos, 79,0% das crianças de um ano e 89,9% das crianças de dois anos consumiram ao menos um alimento desse grupo no dia anterior. Altas frequências de alimentos ultraprocessados foram observadas no primeiro (89,1%) e no segundo ano (94,6%). O indicador diversidade mínima alimentar no primeiro ano foi menos frequente entre crianças de famílias com menores índices de riqueza (menor terço: RP = 0,74; IC95% 0,63–0,86) e cujas mães não exerciam atividade remunerada (RP = 0,87; IC95% 0,80–0,95). O zero consumo de frutas e vegetais foi mais prevalente entre famílias com menor riqueza (menor terço: RP = 4,89; IC95% 2,90–8,24). CONCLUSÃO Os resultados evidenciam a influência dos fatores socioeconômicos sobre os padrões alimentares infantis, reforçando a importância de estratégias intersetoriais para promoção da segurança alimentar e nutricional.

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ABSTRACT OBJECTIVE To analyze Complementary Feeding Quality Indicators according to socioeconomic characteristics in Cruzeiro do Sul, Acre, Western Brazilian Amazon. METHODS This is a cross-sectional analysis nested within the MINA - Brazil birth cohort (n = 971), using data from the 1-year (n = 774) and 2-year (n = 854) follow-up visits. Dietary intake was assessed using a 24-hour recall to construct the Complementary Feeding Quality Indicators, adapted from World Health Organization recommendations: minimum dietary diversity, meat and/or egg consumption, ultra-processed food consumption, and zero fruit and vegetable consumption . Socioeconomic, neonatal, and morbidity variables were analyzed according to a hierarchical conceptual model (distal, intermediate, and proximal levels). Prevalence ratios (PR) were estimated using Poisson regression with robust variance and multiple adjustment; variables were selected based on theoretical assumptions or an association with p < 0.10 at each level. RESULTS Regarding meat and egg consumption, 79.0% of 1-year-old children and 89.9% of 2-year-old children consumed at least one food item from this group the previous day. High frequencies of ultra-processed food consumption were observed in the first (89.1%) and second (94.6%) years of life. The minimum dietary diversity indicator in the first year was less frequent among children from families with lower wealth indices (lowest tertile: PR = 0.74; 95%CI 0.63–0.86) and whose mothers were not engaged in paid work (PR = 0.87; 95%CI 0.80–0.95). Zero fruits and vegetables consumption was more prevalent among children from families with lower wealth indices (lowest tertilel: PR = 4.89; 95%CI 2.90–8.24). CONCLUSION The results highlight the influence of socioeconomic factors on children’s dietary patterns, reinforcing the importance of intersectoral strategies to promote food and nutritional security.

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RESUMO OBJETIVO Descrever o padrão de uso de medicamentos que os indivíduos com covid-19 usaram para tratar a doença no Brasil, segundo a área de residência, características demográficas, socioeconômicas, religião e nível de confiança em cientistas. MÉTODOS Inquérito Nacional Epicovid 2.0 (2024) em 133 municípios. A análise incluiu participantes que relataram ter sofrido episódio de covid-19. Avaliou-se o uso de antibióticos, azitromicina, antitérmicos, cloroquina e ivermectina, além dos desfechos compostos: uso de cloroquina e/ou ivermectina; cloroquina, ivermectina e/ou azitromicina (CIA); e uso de qualquer medicamento. Foram estimadas a frequência de uso e os intervalos de confiança de 95%, considerando o desenho amostral complexo e a ponderação da amostra RESULTADOS A frequência de uso de qualquer medicamento para tratar covid-19 foi de 63,0% (IC95% 60,0–65,9). Os antitérmicos foram os mais utilizados (53,7%), seguidos por antibióticos (36,2%) e azitromicina (27,2%). O uso isolado de ivermectina foi relatado por 23,6% e o de cloroquina, por 12,1%; o uso de ivermectina e/ou cloroquina atingiu 27,8% e o CIA, 39,0%. No geral, o consumo de medicamentos foi mais frequente nas regiões Norte, Nordeste e Centro-Oeste e entre mulheres. O uso concentrou-se entre adultos de 40–59 anos, pessoas com baixa escolaridade e menor renda. Pessoas autodeclaradas pretas e pardas relataram maior consumo de cloroquina. Uso de cloroquina, ivermectina e combinações destes medicamentos foi mais comum entre evangélicos (0,05 < p < 0,1) e entre pessoas que consultaram médicos (p < 0,001). Participantes que relataram desconfiar de cientistas relataram maior uso de cloroquina e de cloroquina/ivermectina em comparação com os que relataram confiar em cientistas. CONCLUSÃO Quatro em cada dez pessoas que relataram episódios de covid-19, para tratar a doença, consumiram medicamentos não recomendados pela ciência. O uso de medicamentos tendeu a ser mais frequente entre mulheres, na metade norte do Brasil, entre evangélicos e pessoas de menor renda e escolaridade. Esses grupos devem ser priorizados em campanhas futuras sobre o uso adequado de medicamentos.

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ABSTRACT OBJECTIVE To describe the patterns of medication use among individuals with Covid-19 to treat the disease in Brazil, according to area of residence, demographic and socioeconomic characteristics, religion, and level of trust in scientists. METHODS Epicovid 2.0 National Survey (2024) in 133 municipalities. The analysis included participants who reported having had an episode of Covid-19. The use of antibiotics, azithromycin, antipyretics, chloroquine, and ivermectin was assessed, in addition to the composite outcomes: use of chloroquine and/or ivermectin; chloroquine, ivermectin, and/or azithromycin (CIA); and use of any medication. The frequency of use and 95% confidence intervals were estimated, considering the complex sampling design and sample weighting RESULTS The frequency of use of any medication to treat Covid-19 was 63.0% (95%CI 60.0–65.9). Antipyretics were the most commonly used (53.7%), followed by antibiotics (36.2%) and azithromycin (27.2%). The isolated use of ivermectin was reported by 23.6% and that of chloroquine by 12.1%; the use of ivermectin and/or chloroquine reached 27.8% and that of CIA, 39.0%. Overall, medication use was more frequent in the North, Northeast, and Central-West regions and among women. Use was concentrated among adults aged 40–59, people with low educational attainment, and those with lower incomes. Self-identified black and brown individuals reported higher use of chloroquine. Use of chloroquine, ivermectin, and combinations of these medications was more common among evangelicals (0.05 < p < 0.1) and among people who consulted doctors (p < 0.001). Participants who reported distrusting scientists reported higher use of chloroquine and chloroquine/ivermectin compared to those who reported trusting scientists. CONCLUSION Four out of ten people who reported episodes of Covid-19 consumed medications not recommended by science to treat the disease. Medication use tended to be more frequent among women, in the northern half of Brazil, among evangelicals, and among people with lower income and education levels. These groups should be prioritized in future campaigns on the appropriate use of medications.

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RESUMO OBJETIVO Analisar como as configurações comunicativas são abordadas nos estudos empíricos sobre a hesitação vacinal infantil, com ênfase nas estratégias e meios comunicacionais utilizados, bem como nas formas pelas quais esses elementos influenciam as decisões de pais e cuidadores. MÉTODOS Revisão de escopo, conduzida em cinco bases de dados (Scopus, Web of Science, PubMed, SciELO e Lilacs), sobre hesitação vacinal infantil e estratégias comunicacionais, com artigos publicados entre 2015 e 2017, nos idiomas inglês, português, espanhol e francês. Foram incluídos estudos empíricos sobre vacinação infantil, com a idade das crianças determinada pelo próprio autor do estudo. Para a análise das informações extraídas por cinco pesquisadores de forma independente, foi realizada síntese temática, com base em uma matriz de codificação, que categorizou os achados em temas centrais. A análise foi orientada teoricamente com base no conceito de configurações comunicativas de Hepp e Hasebrink. RESULTADOS Foram analisados 22 estudos, os quais foram majoritariamente realizados nos Estados Unidos (n = 9), envolvendo principalmente pais/cuidadores e profissionais de saúde. As redes sociais destacaram-se como mídia central, com papel ambivalente: como meio de desinformação, mas também de mensagens pró-vacina. Estratégias com mensagens científicas claras, a ferramenta Motive e a análise de discursos antivacina mostraram-se promissoras para aumentar a intenção de vacinar. Relações de confiança entre médicos e famílias e a personalização das mensagens foram identificadas como fundamentais. CONCLUSÃO A comunicação em saúde é fundamental no enfrentamento da hesitação vacinal infantil. Os estudos avaliados indicam que estratégias integradas, combinando políticas públicas baseadas em evidências com comunicação personalizada e culturalmente sensível são essenciais para promover adesão à vacinação e maior confiança nas vacinas.

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ABSTRACT OBJECTIVE To analyze how communicative configurations are addressed in empirical studies on childhood vaccine hesitancy, with an emphasis on the strategies and communication channels used, as well as on how these elements influence parents’ and caregivers’ decisions. METHODS A scoping review was conducted across five databases (Scopus, Web of Science, PubMed, SciELO, and LILACS) on childhood vaccine hesitancy and communication strategies, including articles published between 2015 and 2017 in English, Portuguese, Spanish, and French. Empirical studies on childhood vaccination were included, with children’s age as defined by the study authors. Data extracted independently by five researchers were analyzed through thematic synthesis, based on a coding matrix that categorized findings into core themes. The analysis was theoretically guided by Hepp and Hasebrink’s concept of communicative configurations. RESULTS Twenty-two studies were analyzed, mostly conducted in the United States (n = 9), primarily involving parents/caregivers and healthcare professionals. Social media emerged as a central medium, with an ambivalent role: as a source of misinformation, but also a channel for pro-vaccine messages. Strategies featuring clear scientific messages, the MOTIVE tool, and analyses of anti-vaccine discourses were promising in increasing vaccination intention. Trust-based relationships between physicians and families and message tailoring were identified as fundamental. CONCLUSION Health communication is essential for addressing childhood vaccine hesitancy. The reviewed studies indicate that integrated strategies combining evidence-based public policies with personalized and culturally sensitive communication are key to promoting vaccine uptake and increasing confidence in vaccines.

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ABSTRACT Brazil is increasingly experiencing severe climate events, including extreme droughts, wildfires, floods, and heatwaves, driven by both excessive rainfall and prolonged dry periods. These disasters have resulted in significant environmental, economic, and social losses, deepening inequality and fuelling public health crises. Climate change is disproportionately affecting vulnerable populations and contributing to the rise of disease outbreaks such as dengue and Oropouche fever. Brazil's vulnerability stems from its diverse ecosystems, heavy reliance on agriculture and hydropower, and its critical role in global climate dynamics due to widespread deforestation. This paper examines the country's future challenges and outlines strategies to address extreme weather events, including the development of climate adaptation policies, enhanced deforestation monitoring, and strengthened disaster preparedness. To improve resilience, Brazil must invest in comprehensive risk assessments, the integration of disaster risk indicators, and the establishment of a national climate-disaster reporting system to better anticipate, mitigate, and manage the impacts of extreme climate events.

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RESUMO A hesitação vacinal é um desafio global à saúde pública e suas características mudam conforme o contexto social e epidemiológico. Neste comentário, busca-se estimular o debate sobre o caráter dinâmico da definição e dos determinantes da hesitação vacinal, especialmente após a pandemia de covid-19 e com o aumento do acesso da população a novas formas de busca de informação, como a inteligência artificial. A produção científica sobre a hesitação vacinal infantil no Brasil antes de 2016 era focada em famílias de alta renda. Após 2016, houve aumento da produção sobre a hesitação vacinal, considerando o modelo de determinantes da Organização Mundial da Saúde de 2014. Após o início da pandemia, destaca-se o aumento expressivo de estudos sobre desinformação e politização da vacina. Atualmente, põem-se em reflexão o uso da inteligência artificial generativa, cada vez mais frequente na busca de informações sobre vacinas.

Resumen en Inglés:

ABSTRACT Vaccine hesitancy is a global public health challenge, and its characteristics change according to the social and epidemiological context. This commentary seeks to stimulate debate on the dynamic nature of the definition and determinants of vaccine hesitancy, especially in the wake of the Covid-19 pandemic and the population’s increased access to new forms of information-seeking, such as artificial intelligence. Scientific production on childhood vaccine hesitancy in Brazil before 2016 was focused on high-income families. After 2016, there was an increase in production on vaccine hesitancy, considering the World Health Organization’s 2014 determinants model. After the start of the pandemic, there was a significant increase in studies on disinformation and the politicization of the vaccine. Currently, the use of generative artificial intelligence, which is increasingly common in the search for information on vaccines, is being considered.