\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{CLIMACTERIC SYNDROME, QUALITY OF LIFE, ANXIETY AND DEPRESSION DISORDERS
DURING THE COVID-19 PANDEMIC: A CROSS-SECTIONAL STUDY OF RIO DE
JANEIRO'S PRIMARY HEALTHCARE SETTING}



\author[1]{Fabiana Balbino}%
\author[1]{Cláudia Moraes}%
\author[2]{Cláudia Messias}%
\author[1]{Christiano Machado}%
\affil[1]{Estácio de Sá University}%
\affil[2]{Federal Fluminense University}%


\vspace{-1em}



  
  \date{May 24, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Objective: To evaluate the intensity of climacteric symptoms and
possible associations with sociodemographic variables, anxiety,
depression, and quality of life in women between 40 and 65 years old who
sought attendance in a primary health care setting in the city of Rio de
Janeiro, Brazil during the COVID-19 pandemic. Design: An observational
cross-sectional study. Setting: a municipal health care facility (MHF)
in Rio de Janeiro, Brazil. Sample: 138 women (age = 51.4 \selectlanguage{ngerman}± 7.1 years
old) seeking health services from June to August 2020. Methods: A
cross-sectional approach was developed using self-reported
questionnaires. Main outcome measures: Sociodemographic and economic
aspects, the Blatt and Kupperman Menopausal Index (BKMI), the
WHOQOL-BREF for quality of life, and the Hospital Anxiety and Depression
Scale (HADS). Results: Ninety-six percent of the women had moderate to
accentuated climacteric symptoms. Women with severe menopausal symptoms
tended to have higher HADS scores (p \textless{} 0.05). There was a
significant association between BKMI scores and education levels (p =
0.04). All illiterate women had moderate or severe climacteric symptoms.
Proportionately, women who have completed high school had less marked
intensity than those with moderate schooling. Moreover, most women with
severe or moderate climacteric intensity levels presented ``highly
likely'' incidence of anxiety. Conclusions: This is the first report to
highlight climacteric and menopausal effects on women's health status
during the COVID-19 pandemic, which is an aggravating factor for the
emergence of emotional changes resulting from sanitation, social
isolation, and socioeconomic uncertainties.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Hosted file}

\verb`Paper_EnglishEdited_2021_FINAL.docx`  available at \url{https://authorea.com/users/737306/articles/712377-climacteric-syndrome-quality-of-life-anxiety-and-depression-disorders-during-the-covid-19-pandemic-a-cross-sectional-study-of-rio-de-janeiro-s-primary-healthcare-setting}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure1/Figure1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure2/Figure2}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

