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Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia's health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors' knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.

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INTRODUCTION: Product design is a key tobacco industry strategy to recruit consumers and hinder cessation. An important technology in tobacco product design is the use of additives including those that create characterising flavours, that is, flavours that are perceived by taste and or smell by the user. To curb youth use, many countries are implementing policies to limit the use of flavours and other additives in tobacco products. This paper reviews the global landscape of tobacco additives policies including those focusing only on flavouring additives, updating a previous review. METHODS: We gathered additives policy data from available online sources of tobacco control policies including parties' reports to the WHO Framework Convention on Tobacco Control (where WHO refers to World Health Organization), the website Tobacco Control Laws, government websites, searches with the Google search engine and consultations with the WHO to ensure comprehensiveness of the assessment. The policies were classified according to their objective and characteristics: Labelling regulations, sales bans and tobacco product design regulations. We classified and organised the regulations according to their stated intent. RESULTS: We found that 62 countries had tobacco products' additives-related regulations at the regional, national or subnational levels. Most of these regulations focused on flavouring additives especially bans on the selling, importing and manufacturing tobacco products with characterising flavours. CONCLUSIONS: The data demonstrate various global policies addressing additives and/or flavours and a range of definitions of additives and flavours. Establishing common definitions and standards could facilitate cooperation between countries and regions.

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Background: Countries of the Caribbean Community signed the Declaration of Port of Spain in 2007 with the vision to stop the epidemic of non-communicable diseases (NCDs). The adoption of the Declaration by member states represented a regional effort, challenging governments, the private sector, and civil society to act together. Multisectoral actions in Guyana aimed at achieving this goal are the focus of this article, demonstrating the work of different actors in addressing the burden of NCDs in the country. Objective: To analyze multisectoral actions developed among five ministries for the implementation of the Declaration of Port of Spain 2007 in Guyana. Methods: This qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and conducted in five ministries (Agriculture, Education, Finance, Health, and Trade) in Georgetown, Guyana. The thematic analysis was guided by a framework consisting of four elements: context (why the policy is needed), content (what the policy is mainly about), process (how the policy was brought forward and implemented), and actors (who participates in and influences the formulation and implementation of the policy). The framework considers how these elements interconnect to shape policy development and implementation processes. Findings: Data analysis provided the researchers with insights into possible topic areas and codes for consideration during the analysis, hence a deductive approach to data analysis was used. The results highlighted the importance of coordination among government entities, national and international agencies, private actors, industry players, and civil society. Participants did not mention the use of responsibility metrics but cited mechanisms that facilitated collaboration. Conclusion: The results showed limitations in transforming multisectoral initiatives into intersectoral collaboration to achieve real integration among the different actors involved, considering the actual context and content. Actions could be more effectively implemented with significant outcomes for NCD control in Guyana.

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INTRODUCTION: Single cigarette sales at tobacco-selling points of sale (POS) may promote smoking. We explored visibility and availability of single cigarettes in POS around schools in Argentina, Guatemala, Mexico and Peru, countries where their sale is banned. METHODS: Between April and July 2023, an observational study was conducted at POS around high schools in urban and rural areas in Argentina, Guatemala, Mexico and Peru. A sampling frame of schools was generated from public registries, with schools categorised according to their socioeconomic status and randomly selected within socioeconomic strata. A total of 2081 POS were surveyed based on their proximity to these randomly selected schools. Data were collected on the visibility of single cigarettes (any cigarette sticks or open cigarette packs on display and able to be seen by customers were coded as visible) and their availability (ie, whether singles were sold, whether visible or not). RESULTS: Single cigarettes were visible in 37.2% of POS and available in most (84.9%), with neighbourhood stores the primary source. In most (84.1%) POS with visible single cigarettes, they were displayed near candy or toys. Prices of the cheapest single cigarette sticks ranged from US$0.03 in Argentina to US$0.13 in Guatemala. CONCLUSION: The findings indicate widespread availability of single cigarettes in four Latin American countries where their sale is banned. The low price of single cigarettes, and their proximity to candy/toys, may increase the appeal of smoking to youth. Stricter enforcement of bans on single cigarettes, which may serve as a gateway to experimentation and continued smoking, is needed.

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(1) Background: Physical inactivity is a recognized global problem, with schools identified by UNESCO and WHO as critical settings for intervention. Despite existing efforts, the prevalence of physical inactivity remains high. This study aims to explore the potential of the concept of body practices as a novel framework to address physical inactivity within school contexts, potentially offering an alternative to traditional intervention models. (2) Methods: This study carried out a systematic review of the concept of body practices to understand its use in the scientific literature. (3) Results: The results indicate that (a) the definition of the concept that the authors used is broad; (b) the problems they face are varied, such as the life cycle, negative emotions, gender, physical inactivity, well-being, and social problems; (c) the research methodologies are predominantly quantitative; (d) and the intervention in schools focuses on students, but not on the entire school community. (4) Conclusions: this concept has great potential for use in initiatives and/or policies that seek to address physical inactivity in the school context.

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Rare diseases (RD) are individually rare, although encompass a significant proportion of the population, affecting not only the individuals but also their families. In Brazil RD is defined by the Ministry of Health as a disorder that affects up to 65 individuals in 100,000, or 1.3 individuals in every 2,000. In this review the environment that led to the publication of a National Policy for Comprehensive Care for People of Rare Disease in 2014, a national plan with the aim to decrease morbidity and mortality of RD, improving the care of people with RD in the public health system are described. The process that finally led to such policy took over a decade, moving forward not only due to technical needs, but having patient organizations as essential actors and advocates. Specialized centers in RD were licensed and, since its publication, 33 centers have been accredited; such process, however, has been slow and concentrated in specific regions and larger cities of the country. Despite the incorporation of genetic tests in 2014 and exome sequencing later in 2020, many genetic tests are not offered by specialized centers, with unequal availability across the country. Public health system in Brazil uses ICD-10 for disease coding, preventing appropriate epidemiologic knowledge of RD in Brazil. Incorporation of new technologies as orphan drugs has been in place and regulation for expedite licensing for new RD drugs were issued, although high cost and availability to RD population has been a challenge.

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The growth in population, economic expansion, and urban dynamism has collectively driven a surge in the use of public and private transport, resulting in increased energy consumption in this sector. Consequently, the transport sector requires an energy transition to meet mobility demands, foster economic growth, and achieve emission reduction. The main objective of this article is to systematically review the literature on energy transition in transportation, categorizing research, identifying barriers, and providing analysis to guide future steps, with a special focus on developing countries. The methodology used in this study follows a sequence for a systematic review based on an evidence-informed approach and specific guidelines for systematic reviews, exploring the concepts, methodologies, and policies within the context of the energy transition, considering transport modes and geographical scope. The findings indicate that electricity is the predominant energy source in this transition, although its prevalence varies by transport mode. Biofuels present an alternative, primarily contributing to emission reduction associated with fossil fuel use. Natural gas emerges as a cost-effective option for heavy transport, while hydrogen represents another alternative, with the challenge of developing recharging infrastructure. Determinants of this transition include recharging infrastructure, tax and nontax incentives, public policies, the generation of electric power from renewable sources, and the management of battery life cycles from mineral extraction to disposal.

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PURPOSE: Although mental disorders are common in the workplace, they often go unnoticed. There is frequently a gap in the recognition and effective management of these disorders, leading to delayed recovery and worsening conditions. This study evaluates the level of Mental Health Literacy (MHL) among employees of the Finance and Planning Departments in the Federal District, Brazil, and proposes preventive measures and de-stigmatization strategies for mental health in the workplace. METHODS: MHL among active employees was assessed using the Mental Health Literacy Scale (MHLS), developed by O'Connor and Casey (2015) and validated for Brazilian Portuguese by Buta et al. (2024). The data analysis included descriptive and inferential statistics, with nonparametric tests used to compare MHL across different groups. RESULTS: The results showed that 27.6% of participants had adequate literacy, 67.9% had problematic levels, and 4.5% had inadequate levels. Women were observed to have higher literacy levels than men. Additionally, significant variations in literacy levels were noted among individuals with different health conditions; those diagnosed with cancer, depression, or other illnesses had higher literacy than those without diagnosed conditions. CONCLUSION: To address MHL challenges, educational actions such as awareness campaigns, training, and consultancy programs are essential.

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This paper presents a critical review of key issues related to the emergence of new networks for the spread of zoonotic diseases amid the mass extinction of species. Zoonotic and infectious diseases account for approximately 70% of new and existing diseases affecting humans and animals. The initial section argues that the term "zoonoses" should not be confined to single-cause events within veterinary medicine. Instead, zoonoses should be viewed as complex, systemic phenomena shaped by interrelated factors, including environmental, sociocultural, and economic elements, influenced by anthropogenic climate change. The second section presents bioethical principles and potential strategies for those engaged in zoonotic disease prevention. The third section uses the slaughter of animals in disaster settings as a case study to illustrate the need for further clarification of normative and interspecies justice conflicts in One Health ethics. This section concludes with an outlook on "zoonoethics". Section four develops the analysis of the interlinked elements that trigger zoonoses and examines antimicrobial resistance (AMR) from an ethical and political standpoint, concluding with policy recommendations for addressing AMR. Section five offers a critical reflection, integrating contributions from zoonoethics, human ecology, and the ecotheological turn. Finally, section six concludes with a call to action and policy recommendations for an inclusive, intercultural, and gender-sensitive One Health approach.

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Introduction: The COVID-19 pandemic had a great impact on several public sectors worldwide, requiring the implementation of public policies in an organized way to contain and control the disease. Thus, this study aimed to analyze public policies to face the COVID-19 pandemic in the State of Paraná, Brazil. Methods: This was a cross-sectional, retrospective, quantitative survey carried out with data from March 2020 to March 2022 in the twenty-two municipalities that host the local health regions. Data collection was documentary, carried out from the municipal Portal da Transparência website, which is dedicated to making public all expenditures, and epidemiological bulletins released by the Health Department of the state of Paraná. The variables analyzed were New Cases and Deaths, Mortality and Lethality Coefficient, Incidence Rate, Vaccination Coverage, Number of Hospital and ICU beds exclusive to COVID-19, Settled Expenses destined for COVID-19 and coping measures, namely, the Declaration of Public Health Emergency, Curfew, Mandatory use of masks, Businesses closure, Teleworking of risk groups, and Suspension of activities with crowds and of classes. After collection, data underwent descriptive analysis, and subsequently, the correlation of variables was analyzed using the Spearman test. Multiple linear regression was applied using the variable selection method called best subset selection (BSS). The dependent variables listed were incidence rate, new cases and new deaths. Results: The results showed that coping measures, as well as the application of resources for the pandemic, were implemented heterogeneously in the municipalities studied, and the progression of the disease, the distribution of beds and vaccination occurred unevenly and may be a reflection of the limited Brazilian national governance. An important correlation was observed between the incidence rate and new deaths with vaccination coverage. In addition, the regression model showed that measures such as mandatory use of masks, closure of shops, suspension of classes, and curfew showed important correlations with the variables incidence rate, cases, and new deaths. Discussion: The study highlighted the importance of carrying out a robust analysis of public policies to face emergencies of global importance so that government entities are prepared for future crises of great repercussions, such as the COVID-19 pandemic.

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Objectives: Aiming to disseminate information related to suicide prevention in Brazil, the "Setembro Amarelo" campaign has been conducted since 2015. The objective of this study is to assess the association between this campaign and elderly suicide rates over a 12-year period. Methods: Data were gathered from the Mortality Information System and the Notifiable Diseases Information System, established by public institutions in Brazil. An interrupted time-series framework was applied to assess the association between the "Setembro Amarelo" campaign and suicide mortality rates in the elderly population (60 et plus) in the southeastern region of Brazil. We consider three monthly outcomes: all suicides, suicides in males and suicide in females. We operationalize the campaign assuming three effects: short-term, declining and sustained. The period of analysis was from 2011-2022. Results: The suicide-mortality rate over time has remained stable; the average rate in the pre-campaign period was 0.028 and increased slightly to 0.035. Regardless of the campaign's operationalization and the outcome used, results show no significant associations between the campaign and elderly suicide rates. The campaign was associated with non-significant decreased effects of 15% (P=0.532) in the short term, and 16% (P=0.446) assuming the campaign was sustained. Conclusions: There is a lack of association between the campaign and suicide rates, among the elderly in Brazil's southeastern region. As suicide is complex and multifactorial, more research is needed. The campaign, while raising awareness and reducing stigma, may not reduce suicides. To reduce the suicide rate in the elderly requires addressing social, economic and cultural factors, multisectoral interventions, and upholding basic human rights.

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With the growing concerns about the protection of ecosystem functions and services, governments have developed public policies and organizations have produced an awesome volume of digital data freely available through their websites. On the other hand, advances in data acquisition through remote sensed sources and processing through geographic information systems (GIS) and statistical tools, allowed an unprecedent capacity to manage ecosystems efficiently. However, the real-world scenario in that regard remains paradoxically challenging. The reasons can be many and diverse, but a strong candidate relates with the limited engagement among the interest parties that hampers bringing all these assets into action. The aim of the study is to demonstrate that management of ecosystem services can be significantly improved by integrating existing environmental policies with environmental big data and low-cost GIS and data processing tools. Using the Upper Rio das Velhas hydrographic basin located in the state of Minas Gerais (Brazil) as example, the study demonstrated how Principal Components Analysis based on a diversity of environmental variables assembled sub-basins into urban, agriculture, mining and heterogeneous profiles, directing management of ecosystem services to the most appropriate officially established conservation plans. The use of GIS tools, on the other hand, allowed narrowing the implementation of each plan to specific sub-basins. This optimized allocation of preferential management plans to priority areas was discussed for a number of conservation plans. A paradigmatic example was the so-called Conservation Use Potential (CUP) devoted to the protection of aquifer recharge (provision service) and control of water erosion (regulation service), as well as to the allocation of uses as function of soil capability (support service). In all cases, the efficiency gains in readiness for plans' implementation and economy of resources were prognosed as noteworthy.

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One Health (OH) is an integrative approach to human, animal, and environmental health and can be used as a comprehensive indicator for comparative purposes. Although an OH index has been proposed for comparing cities, states, and countries, to date, no practical study has compared countries using this approach. Accordingly, this study aimed to assess OH initiatives using a survey with a veterinary public health focus. The questionnaire contained 104 quantitative questions and was sent to representatives of governmental institutions of 32 countries in the Americas. After exclusion criteria were considered, a total of 35 questionnaires from 17 countries were analyzed, with country names remaining undisclosed during the statistical analyses to protect potentially sensitive information. Principal component analysis (PCA) of health parameters in Latin America and the Caribbean (LAC) as a function of country perception (self-vector) showed that food safety was ranked higher than public policies (p = 0.009), and that both (p = 0.003) were ranked higher than institutional routines related to zoonosis programs. National policies in accordance with international standards, regulations, recommendations, and guidelines was considered the standout topic for public policy, with higher-ranking topics including standard. Meanwhile, challenging topics included tools, preparedness, governance, and research. Food safety showed both strengths and challenges in the coordination of its activities with other sectors. Food safety communication was scored as a strength, while foodborne diseases prevention was ranked as a challenge. Institutional routines for zoonosis maintained both strong and challenging topics in the execution and implementation of attributions and daily routine. Thus, the survey showed that topics such as access to and compliance with international guidelines and intercountry integration were ranked higher than in-country articulation, particularly among food safety, zoonoses, and environmental institutions.

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Migration, from rural to urban settings is a common phenomenon in Latin America, due to social, economic, political, and other factors. Young people in search of economic and educational opportunities, financial, and social stability, have been migrating to larger urban centers, thus crafting important shifts in rural labor, generational transfer, and domestic economies. Through a systematic literature review of scientific literature, and documents from public institutions and international organizations, published between 2012 and 2022, this article addresses rural-urban migration of youth in Colombia and Guatemala's cattle sector, particularly identifying (i) driving factors, (ii) their impacts on cattle farming, and (iii) public policies implemented to counteract prejudicial effects. Results show that unemployment, lack of educational opportunities, and insecurity are the main reasons for youth migration to cities or abroad, with Mexico, the United States, and Spain being the most common destinations. Additionally, impacts on the cattle sector include shortage of labor and a perfectible generational transfer, hindering the modernization of the industry and investments in climate change adaptation and mitigation strategies. Despite various implemented public policies, the results are partial, and the issue of accelerated youth migration remains relevant. Consequently, without more effective measures adopted by national governments, the cattle sector will lag behind its regional and international competitors, deterring the achievement of the Sustainable Development Goals. As the main contribution of the study, the analysis of migration is highlighted based on its effects on a specific economic sector and not focused on its causes, as evidenced in a wide range of literature.

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The purpose of this text is to point out the contradiction existing in Chilean educational public policy regarding the curricular reform that converted the subjects of Physical Education and Health, History, Arts, and Religion into optional subjects for the 3rd and 4th years of high school. As far as Physical Education is concerned, scientific evidence shows that such conversion to the status of optional subject goes against the policies of other executive ministries and against the possibilities of reversing the statistics that show Chile as one of the countries in America with the highest percentage of overweight and obese children and adolescents.

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BACKGROUND: Rates of exclusive breastfeeding fall below recommended levels, particularly among women in paid employment. In Mexico, more than half of women are in informal employment, meaning they lack many of the protections that may support breastfeeding. METHODS: In-depth interviews with 15 key informants representing government agencies (n = 6 organizations), NGOs (n = 4), international organizations (n = 2), and academia (n = 2) in Mexico. Interviews were conducted between March and June 2023. To understand and describe barriers to breastfeeding among informally employed women in Mexico according to key informants and the current and potential policies to address these barriers, we conducted a qualitative thematic analysis. RESULTS: Current policies to promote, protect, and support breastfeeding predominantly apply to all employed women, but respondents expressed concern that they did not provide adequate protection for women in informal employment. Additional themes concerned the need for relevant programs to be institutionalized and coordinated, discussions of breastfeeding as a right, and the legal equivalence (whether true in practice or not) of formal and informal workers. CONCLUSIONS: Women employed in Mexico's informal sector face a dearth of maternity protections. According to key informants, few policies exist to promote, protect, and support breastfeeding among employed women, in general, but the economic vulnerability and challenging working conditions of women in informal employment exacerbates their situation. The lack of access to formal labor protections, such as paid maternity leave, creates a significant barrier to breastfeeding for women in the informal sector. Recommendations include short-term policies to fill gaps in social protection for informally employed women, as well as longer-term solutions such as the development of universal social protection programs and supporting formalization.

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OBJECTIVE: Although Brazil became the first country worldwide to ban the sale of all tobacco products with any additive that could alter their flavours and tastes in 2012, its implementation was effectively halted by tobacco industry lawsuits, including a constitutional challenge filed in the Federal Supreme Court in 2013. This study aimed at examining, for the first time in the country, the evolution over time of the new registrations of tobacco products with additives that would have been banned if not for the tobacco industry's interference ('counterfactual scenario'). METHODS: We used the newly available public database on the registration of tobacco products developed by the Health Regulatory Agency (from 2008 onwards). All types of tobacco products intended for the domestic market that contained 'banned additives in a counterfactual scenario' and were registered between January 1 and December 31 of each year were selected. RESULTS: Between 2012 and 2023, a total of 1112 new registrations of tobacco products with 'banned additives' were recorded. The spread of hookah tobacco registrations started in 2014, and by 2023, the cumulative incidence of registrations containing 'banned additives' was 641. Both manufactured cigarettes and hookah products reached their peaks in new registrations in 2020. CONCLUSIONS: After 12 years since the resolution intended to ban all additives that change the aroma and taste of tobacco products in Brazil, primarily to prevent smoking initiation, the tobacco industry's interference continues to successfully block its implementation. Countries facing similar challenges in tobacco control could consider generating comparable national data that might help expose the adverse impacts of tobacco industry interference on public health.

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Lucía Vivanco Muñoz es terapeuta ocupacional, egresada de la Universidad de Chile en 1983 y una de las primeras en incursionar en la Terapia Ocupacional social y comunitaria en Chile. En esta entrevista, realizada por su colega Débora Grandón, analiza el desarrollo de la Terapia Ocupacional social y comunitaria a través de su incursión, a finales de la década de 1980 y durante los años 90, en áreas no tradicionales de la Terapia Ocupacional, como el acompañamiento a personas viviendo con VIH-SIDA, la desinstitucionalización de niñeces vulneradas y la reinserción en sus familias y comunidades. También, colaboró en el diseño de políticas públicas para la superación de la pobreza desde el Estado chileno y en otros países, en su rol de consultora para el Banco Mundial. Actualmente, es académica de la Escuela de Terapia Ocupacional en la Universidad de Santiago de Chile -USACH. Esta experiencia como iniciadora de áreas de práctica hoy instituidas en el ejercicio de la profesión tiene un relevante valor histórico y constituye un aporte significativo al desarrollo de estos campos y a la formación de nuevas generaciones.

Lucía Vivanco Muñoz is an occupational therapist who graduated from the University of Chile in 1983 and is one of the pioneers in the development of a social and community Occupational Therapy in Chile. In this interview, conducted by her colleague Débora Grandón, she analyzes the development of a social and community Occupational Therapy throughout her involvement at the end of the 1980s and during the 1990s in non-traditional areas such as accompanying people living with HIV/AIDS, the deinstitutionalization of vulnerable children, and their reintegration into their families and communities. She also participated in designing public policies for overcoming poverty within the Chilean government and other countries in her role as a consultant for the World Bank. She is currently an academic at the School of Occupatio-nal Therapy at the University of Santiago de Chile -USACH. This experience as an initiator of areas of practice established today in the exercise of the profession has a relevant historical value and constitutes a significant contribution to the development of these fields and the training of new generations

Lucía Vivanco Muñoz é terapeuta ocupacional, formada pela Universidade do Chile em 1983, e uma das primeiras a se aventurar na Terapia Ocupacional social e comunitária no Chile. Nesta entrevista, conduzida por sua colega Débora Grandón, se analisa o desenvolvimento da Terapia Ocupacional social e comunitária por meio de sua incursão no final dos anos 80 e durante os anos 90, em áreas não tradicionais da Terapia Ocupacional, como o acompanhamento de pessoas vivendo com HIV-AIDS, a desinstitucionalização de crianças em situação de vulnerabilidade e a reintegração em suas famílias e comunidades. Além disso, colaborou no desenho de políticas públicas para a superação da pobreza no Estado chileno e em outros países, atuando como consultora para o Banco Mundial. Atualmente, é professora na Escola de Terapia Ocupacional da Universidade de Santiago do Chile - USACH. A experiência da professora como pioneira em áreas de prática, hoje instituídas no exercício da profissão, tem um valor histórico relevante e constitui uma contribuição significativa para o desenvolvimento desses campos e para a formação de novas gerações

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Low serum 25(OH)D levels (< 30 nmol/L) have been associated with increased depressive symptom scores over time, and it is believed that functionality may play a mediating role in the relationship between 25(OH)D and depressive symptoms. To comprehend the association between these factors could have significant implications for public health policy. The aim of this study was to verify the association between simultaneous vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling older adults. This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), collected between 2015 and 2016. The outcomes were functional disability assessed through basic activities of daily living (ADL) and instrumental activities of daily living (IADL). The exposures were vitamin D insufficiency (< 30 nmol/L) and depressive symptoms (≥ 4 points in 8-item version of the Center for Epidemiological Studies-Depression). Crude and adjusted Poisson regression was performed to estimate associations. A total of 1781 community-dwelling older adults included in this study, 14.6% had disability in ADL and 47.9% in IADL; 59.7% had vitamin D insufficient levels, and 33.2% depressive symptoms. The concomitant presence of vitamin D insufficient and depressive symptoms increased the prevalence of ADL by 2.20 (95% CI: 1.25; 3.86) and IADL by 1.54 (95% CI: 1.24; 1.91), respectively. Therefore, preventive strategies to keep older adults physically and socially active, with a good level of vitamin D, are essential to avoid depression and functional disability.

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