[This corrects the article DOI: 10.1371/journal.pone.0332883.].

ABSTRACT This essay analyzes the role of complementarity among public policies as a driver of social transformation in contexts marked by deep structural inequalities, such as Brazil. Drawing on a critical and interdisciplinary approach, it argues that isolated or fragmented public policies have limited effects on social mobility and on overcoming inequities. The concept of complementarity is examined across its technical, institutional, and normative dimensions and is understood as a synergistic articulation among different policies and sectors aimed at promoting social justice. As empirical evidence, the essay refers to a report by the Organisation for Economic Co-operation and Development (OECD), which estimates that up to nine generations are required for children from the poorest families in Brazil to reach the national average income level. Theoretical contributions from authors such as Fraser, Sen, Rawls, and Dworkin are discussed, alongside concrete examples of complementary public policies in Brazil and internationally. The essay concludes that the institutionalization of complementarity is a fundamental condition for public policies to acquire transformative capacity and for the State to fully exercise its role as a promoter of equity and citizenship.

OBJECTIVE:This study analyzes temporal trends in occupational cancer mortality in Brazil and its federative units from 1990 to 2023, focusing on regional and gender disparities. METHODS:We conducted an ecological time-series analysis using data from the Global Burden of Disease (GBD) database. We included deaths from malignant neoplasms attributable to occupational exposures and calculated age-standardized mortality rates. We applied segmented regression with the Joinpoint Regression Program (version 5.4) to estimate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) for Brazil and its states, stratified by sex. RESULTS:Occupational cancer mortality declined nationally (AAPC = -1.08; 95% CI: -1.37 to -0.85), with a more substantial decrease among men. Marked regional differences emerged: the South, Southeast, and Midwest regions showed consistent declines, while several states in the North and Northeast exhibited stable or rising rates, especially among women. Part of the observed recent decline coincided with the COVID-19 pandemic (2019-2023), suggesting potential underdiagnosis or underreporting. CONCLUSION:Brazil has experienced a national decline in occupational cancer mortality; however, regional and gender inequalities persist. Territorial, economic, and occupational contexts shape these differences. Strengthening surveillance systems, updating exposure registries, and developing policies sensitive to regional and gender disparities may contribute to improving occupational cancer prevention and control.

RESUMO Este ensaio crítico-propositivo tem como objetivo requalificar o papel dos indicadores de iniquidade no ciclo de formulação, monitoramento, avaliação e auditoria das políticas públicas de saúde, argumentando que tais indicadores devem ser compreendidos como instrumentos centrais de auditoria substantiva e de responsabilização democrática. O método empregado consiste em uma análise conceitual e normativa, apoiada em revisão crítica da literatura nacional e internacional sobre desigualdades em saúde, avaliação de políticas públicas e justiça distributiva, complementada por evidências empíricas sele-cionadas estrategicamente para fins ilustrativos. Sustenta-se que avaliações baseadas predominantemente em indicadores médios tendem a produzir cegueira institucional diante de desigualdades persistentes, limitando a capacidade do Estado de identificar falhas distributivas e orientar correções redistributivas. Argumenta-se que a incorporação sistemática de indicadores de iniquidade nos processos de auditoria permite deslocar o enfoque do controle procedimental para uma lógica orientada à equidade, à melhoria das políticas e à geração de valor público. Conclui-se que, em contextos marcados por desigualdades estruturais e baixa mobilidade social, a ausência desses indicadores nos sistemas de auditoria representa uma limitação institucional relevante, reforçando a necessidade de sua adoção como critério substantivo de qualidade na avaliação das políticas públicas de saúde.

Background: Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. High-income countries such as Denmark achieved sustained reductions, whereas middle-income countries such as Brazil continue to face high mortality and disability, reflecting distinct stages of the epidemiological transition. Objectives: To describe and compare temporal trends in age-standardized mortality and disability-adjusted life years (DALYs) due to CVD in Brazil and Denmark from 1990 to 2021, focusing on magnitude, stability, and inflection points. Methods: We conducted an ecological time-series study using Global Burden of Disease (GBD) 2021 estimates. Age-standardized mortality and DALY rates per 100,000 inhabitants were analyzed for Brazil and Denmark. Joinpoint regression identified changes in trends, estimating annual percentage change (APC) for each segment and average annual percentage change (AAPC) across the period. Analyses assumed Poisson distribution with robust variance and Monte Carlo permutation tests. Results: Between 1990 and 2021, CVD mortality declined by 53.9% in Brazil (AAPC: -2.4%; 95% CI: -2.7 to-2.1) and 69.7% in Denmark (AAPC: -3.6%; 95% CI: -3.9 to-3.2). DALY rates fell by 51.0% in Brazil (AAPC: -2.1%; 95% CI: -2.4 to-1.9) and 69.6% in Denmark (AAPC: -3.5%; 95% CI: -3.8 to-3.1). Denmark showed faster and more consistent reductions, with parallel declines in mortality and DALYs. In Brazil, mortality decreased more sharply than DALYs, suggesting persistent disability. Trend stability also differed: Brazil presented two joinpoints for each indicator, while Denmark exhibited only one. Conclusions: Both countries substantially reduced CVD burden, but disparities widened. Denmark's experience reflects stable prevention, acute care, and rehabilitation strategies. Brazil's progress, though significant, was uneven and limited by inequalities and slower declines in disability. Integrated policies are needed to ensure equitable and sustained reductions.

The cancer transition framework describes the shift from infection-related cancers, such as cervical cancer, to cancers more commonly observed in high human development settings, such as breast cancer, as societies develop. Brazil, with marked regional disparities in health and socioeconomic indicators, offers a unique context to analyze how this transition unfolds unevenly across subnational regions. This study aimed to describe and compare levels and temporal trends in age-standardized mortality rates for breast and cervical cancer across Brazilian macroregions from 1980 to 2021, and to contextualize these patterns in relation to global Sociodemographic Index (SDI) group profiles. We conducted an ecological analytical study with time series analysis of breast (C50) and cervical cancer (C53) mortality in Brazil from 1980 to 2021. Data were retrieved from the Global Burden of Disease (GBD) study, stratified by the five Brazilian macroregions and compared with global Sociodemographic Index (SDI) groups. We applied Joinpoint regression models to identify inflection points in mortality trends and estimated the Annual Percentage Change (APC) with 95

Introdução: Estudos europeus atestaram a tridimensionalidade e a apropriada confiabilidade do instrumento EORTC QLQ-FA12 para aferição da fadiga relacionada ao câncer. Objetivo: Avaliar a estrutura dimensional e a consistência interna da versão brasileira do EORTC QLQ-FA12. Método: Estudo transversal com 278 pacientes em um Centro de Assistência de Alta Complexidade em Oncologia localizado no Rio de Janeiro, Brasil. Realizou-se análise fatorial confirmatória empregando o estimador Weighted Least Squares Mean and Variance Adjusted e matrizes de correlações policóricas. Testaram-se modelos de equação estrutural exploratórios seguindo métodos de análise fatorial confirmatória e uso da rotação oblíqua geomin. Os Comparative Fit Index, Tucker-Lewis Index e Root Mean Square Error of Approximation (RMSEA) avaliaram a qualidade do ajuste do modelo. A consistência interna foi avaliada pela confiabilidade composta e correlações entre dimensões foram examinadas para investigar validade fatorial discriminante. Resultados: A análise fatorial confirmatória da estrutura tridimensional, mesmo com o RMSEA limítrofe, demonstrou bom ajustamento estatístico geral, cargas fatoriais variando de 0,608 a 0,873 nas dimensões originais, adequada consistência interna e aceitável validade fatorial discriminante. Porém, nos modelos de equação estrutural exploratórios, essa estrutura exibiu cargas fatoriais cruzadas, além de um RMSEA fronteiriço. A consistência interna foi considerada adequada e a correlação entre dimensões, aceitável. Conclusão: A versão brasileira do EORTC QLQ-FA12 parece ser tridimensional, com todos os itens representando coerentemente o construto fadiga relacionada ao câncer.

RESUMO Esta resenha analisa criticamente a segunda edição do livro ‘Monitoramento e avaliação de programas sociais: uma introdução aos conceitos e técnicas’, de Paulo de Martino Jannuzzi, situando a obra no debate contemporâneo sobre avaliação de políticas públicas no Brasil e no cenário internacional. Argumenta-se que o autor se consolida como referência no campo do Monitoramento e da Avaliação (M&A) ao articular rigor conceitual, domínio técnico sobre indicadores sociais e experiência institucional na gestão pública. O texto percorre os principais eixos do livro - representação de programas, avaliação, monitoramento, métodos e institucionalização de sistemas de M&A -, destacando o papel central do Mapa de Processos e Resultados (MaPR). Em diálogo crítico com autores clássicos do campo, como Vedung, Rossi e Freeman, Patton e Weiss, a resenha evidencia a contribuição original de Jannuzzi ao traduzir debates internacionais para as especificidades do Estado brasileiro. Conclui-se que a obra ultrapassa o caráter de manual técnico e afirma-se como reflexão estratégica sobre avaliação, decisão pública e capacidade estatal.

Objetivo: identificar fatores associados à fadiga relacionada ao câncer. Metodologia: estudo transversal realizado num centro de alta complexidade em oncologia localizado na capital do Rio de Janeiro, Brasil. Entrevistas e consultas aos prontuários ocorreram entre maio/2023 e janeiro/2024. A fadiga relacionada ao câncer foi aferida pelo EORTC QLQ-FA12. Para investigar sua associação com fatores clínicos e sociodemográficos, estimaram-se razões de chance e intervalos de confiança de 95% por meio de regressão logística. Resultados: a fadiga relacionada ao câncer foi identificada em 25,54% dos 278 participantes. Uma consistente associação com pior performance status foi demonstrada, com razões de chances iguais a 3,26 (fadiga global), 5,53 (fadiga física), 2,41 (fadiga emocional) e 2,39 (fadiga cognitiva). Conclusão: como existe associação entre fadiga relacionada ao câncer e pior performance status, pacientes com com baixa capacidade de realizar suas atividades diárias devem ter a presença de fadiga investigada, e vice-versa.

RESUMO Este ensaio analisa o papel da complementaridade entre políticas públicas como vetor de transformação social em contextos marcados por profundas desigualdades estruturais, como o brasileiro. A partir de uma abordagem crítica e interdisciplinar, argumenta-se que políticas públicas isoladas ou fragmentadas têm efeitos limitados sobre a mobilidade social e a superação das iniquidades. O conceito de complementaridade é explorado em suas dimensões técnica, institucional e normativa, sendo compre-endido como articulação sinérgica entre diferentes políticas e setores, com vistas à promoção da justiça social. Utiliza-se como evidência empírica o relatório da Organisation for Economic Co-operation and Development (OECD), que estima serem necessárias até nove gerações para que os filhos das famílias mais pobres no Brasil alcancem a renda média nacional. São discutidas as contribuições teóricas de autores como Fraser, Sen, Rawls e Dworkin, além de exemplos concretos de políticas públicas complementares no Brasil e no exterior. Conclui-se que a institucionalização da complementaridade é uma condição fun-damental para que as políticas públicas adquiram densidade transformadora e para que o Estado exerça plenamente sua função de promotor de equidade e cidadania.

Maternal mortality reflects the quality of obstetric care and the efficiency of health systems. Brazil faced structural challenges even before the pandemic, with marked regional disparities. COVID-19 worsened the scenario, increasing maternal mortality due to direct complications of the virus and the overload of health services, which hindered access to prenatal care, safe delivery, and emergency obstetric services. This study aimed to assess state-level temporal trajectories of maternal mortality in Brazil, with emphasis on the pandemic shock, post-pandemic recovery, and the persistence of interstate inequalities. We analyzed annual maternal mortality ratios (MMR) for Brazil, the 26 states, and the Federal District from 2000 to 2023 using interrupted time-series segmented regression. Segmented models estimated the pre-pandemic trend, the immediate level change in 2020, the slope change during 2020–2022, and the early recovery phase from 2022 onward, with Newey–West robust standard errors. To assess changes in territorial inequality over time, we calculated the median absolute deviation (MAD), coefficient of variation (CV), and p90/p10 ratio across federative units. Before 2020, maternal mortality in Brazil showed stagnation, with persistent interstate disparities already evident. Segmented regression identified a modest but significant pre-pandemic upward trend, a marked worsening during the COVID-19 period, and an early post-pandemic decline. However, inequality widened substantially during the pandemic, and the subsequent decline did not fully restore the previous territorial pattern. State-level analyses confirmed marked heterogeneity in baseline levels. The recovery observed in the post-pandemic period suggests health system resilience, but regional disparities remain stark and still threaten progress toward SDG 3.1. Meeting SDG 3.1 will require targeted action in historically vulnerable states, stronger prenatal and obstetric care networks, and improved surveillance of maternal deaths.

Objective: The aim of this study was to estimate the impact of deaths of despair (DoD) on life expectancy at birth and by sex in Brazil in 2019, as well as the contribution of different age groups to this loss. Methods: We used life tables from the Brazilian Institute of Geography and Statistics and cause-specific mortality data by age and sex from the Mortality Information System. A cause-deleted life table methodology was applied, assuming independence between DoD and other causes of death. The difference in life expectancy with and without DoD was decomposed by age using Arriaga's method. DoD included deaths from suicide, intentional or accidental poisoning, and mental and behavioral disorders due to substance use. Results: In 2019, there were 23,391 DoD in Brazil (1.73% of all deaths), 89% of which were due to suicide. Removing these deaths would increase life expectancy by 0.43 years for men and 0.12 years for women, with men experiencing a 3.5 times greater impact. The 35-49 age group had the highest relative contribution, especially among men, where DoD accounted for up to 9.7% of the loss in life expectancy. The impact was more concentrated and earlier in men and more diffuse among women. Conclusion: Although lower in absolute numbers, DoD have a measurable impact on life expectancy, especially among young men. These findings highlight the need for public policies focused on suicide prevention and addressing the social determinants that sustain despair.

OBJECTIVE:To analyze the effect of the COVID-19 pandemic on mortality by cardiovascular disease (CVD) subgroups in Brazil, considering sex and age group. METHODS:Ecological time-series study with secondary data from the Mortality Information System for the period 2000-2022. Age-adjusted mortality rates per 100,000 inhabitants were calculated and joinpoint regression models were used to estimate rate trends. RESULTS:Mortality from CVD in Brazil between 2000 and 2022 showed a decrease in ischemic heart disease (IHD) and cerebrovascular disease (CBVD), while other CVD showed an unstable behavior, increasing after 2020. The reduction in IHD was more pronounced until 2020, decelerating thereafter. CBVD continued to decline but at a slower pace. Other CVD, after a downward trend, showed a significant increase (+3.8% per year), possibly because of the pandemic. Women had a greater reduction in mortality, especially due to IHD. Intermediate age groups (40-59 years) showed a decrease until 2020 but recorded increases after this period, reinforcing the impact of the pandemic. In 2021, all subgroups showed excess mortality: 8% for CBVD and IHD, and 15% for other CVD. In 2022, this pattern intensified, with values of 16% (CBVD), 18% (IHD) and 23% (other CVD). CONCLUSION:The COVID-19 pandemic significantly impacted CVD mortality in Brazil, changing trends according to age group, sex and disease subgroup. The study points to an inflection in mortality rates during the pandemic, highlighting the need for further investigations to understand the mechanisms involved.