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Cardiometabolic multimorbidity and care experiences in primary healthcare among Brazilian adults aged 50 and over (ELSI-Brazil)

Background: Population aging and the rising burden of non-communicable diseases have increased the prevalence of cardiometabolic multimorbidity (CM-MM) among older adults. Patient-reported experience measures (PREMs) are recognized as essential components of healthcare quality assessment, yet evidence on primary care experiences among individuals with CM-MM remains scarce. Objective: To analyze primary care experiences according to the presence of cardiometabolic multimorbidity among Brazilians aged 50 years and older. Methods: Cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021; n = 9,949). CM-MM was defined as the self-reported coexistence of two or more of the following conditions: hypertension, diabetes mellitus, dyslipidemia, acute myocardial infarction, and stroke. Primary care experiences were assessed using a validated 12-item instrument organized into four domains: first-contact access, longitudinality, communication, and care coordination. Associations were estimated using Poisson regression adjusted for sociodemographic, health conditions, and healthcare utilization variables, with stratified analysis by Family Health Strategy (FHS) coverage. Results: CM-MM prevalence was 25.5%, with a progressive increase by age and an inverse gradient by education. Individuals with CM-MM reported significantly more positive experiences in longitudinality (mean index 2.53 vs. 2.34; adjusted PR = 1.22; 95%CI 1.12-1.33; p < 0.001) and, to a lesser extent, in communication (mean index 2.68 vs. 2.58; adjusted PR = 1.10; 95%CI 1.00-1.20; p = 0.041). No statistically significant differences were found in first-contact access or care coordination. After stratified by FHS coverage, the observed differences in longitudinality and communication were no longer statistically significant. Conclusions: CM-MM was associated with more positive primary care experiences in longitudinality and communication. The absence of differentiated experiences in first-contact access and coordination highlights structural gaps in primary care responsiveness to individuals with greater clinical complexity. Keywords: Multimorbidity; Cardiometabolic diseases; Primary Care; Patient-reported experience measures; Older adults; ELSI-Brazil.

The BD-LSC Dataset: Facilitating the Benchmarking of Models for Lexical Semantic Change Detection in Slang and Standard Usage

Automatic semantic change detection aims to identify how word meanings shift over time, offering insights into both linguistic and societal change. Despite recent progress in computational lexical semantic change (LSC), existing benchmarks and methods struggle to capture bi-directional semantic change, particularly cases where words simultaneously gain and lose senses. This problem is especially challenging for words that have both slang and standard meanings. To address these gaps, we introduce two complementary benchmark datasets. The Bi-Directional Lexical Semantic Change (BD-LSC) dataset captures sense gain, sense loss, and stability across three time periods, enabling the study of complex semantic trajectories. The SlangTrack Word Sense Disambiguation (ST-WSD) dataset provides fine-grained, instance-level sense annotations for words combining slang and standard usages, supporting systematic benchmarking of WSD and semantic change detection models. Using these benchmarks, we systematically evaluate models across different methodological families: unsupervised clustering using contextualised embeddings, supervised machine learning, transformer-based models, and state-of-the-art large language models. Among the evaluated systems, the few-shot GPT-4o model achieved the strongest aggregate performance on Exact Sense Match (ESM) and multi-label accuracy; however, Macro-F1 scores near 0.5 across all systems show that rare slang senses remain difficult, which we identify as the central open challenge.