Andréa Dâmaso Bertoldi

Desigualdades na utilização e no acesso a serviços odontológicos: uma avaliação em nível nacional

Para avaliar a situacao de utilizacao e acesso aos servicos de odontologia no Brasil e estudar diferenciais entre os estratos socioeconomicos, utilizaram-se dados da Pesquisa Nacional por Amostragem de Domicilios (PNAD) de 1998, realizada pelo IBGE. A analise, que levou em conta o desenho amostral, indicou um nivel baixo de utilizacao de servicos odontologicos. Setenta e sete por cento das criancas de 0-6 anos e 4% dos adultos de 20-49 anos nunca haviam consultado um dentista. Entre estes adultos, comparando-se os 20% mais pobres com os 20% mais ricos, observou-se que o numero de desassistidos era 16 vezes maior entre os primeiros. No grupo de 0-6 anos, as criancas ricas consultaram o dentista cinco vezes mais do que as pobres no ano anterior a entrevista. Cerca de 4% dos que procuraram atendimento odontologico nao o obtiveram, 8% dos quais entre os mais pobres e 1% entre os mais ricos. A maioria (68%) dos atendimentos do grupo mais pobre foi financiada pelo SUS, enquanto 63% deles foram pagos pelos mais ricos. As maiores desigualdades no acesso e na utilizacao de servicos odontologicos foram encontradas, exatamente, nos grupos de menor acesso ou utilizacao. A participacao do SUS nos atendimentos odontologicos e muito mais baixa do que na atencao medica.

Prevalência de sedentarismo e fatores associados em adolescentes de 10-12 anos de idade

Physical activity in adolescence is associated with several health benefits, including a direct influence on adolescent morbidity and an indirect effect on adult health mediated by physical activity levels in adulthood. This study assessed the prevalence of sedentary lifestyle and associated variables in 4,452 adolescents aged 10-12 years, belonging to the 1993 Pelotas Birth Cohort Study, representing 87.5% of the original cohort. Sedentary lifestyle, defined as < 300 minutes per week of physical activity, was reported by 58.2% (95%CI: 56.7-59.7) of the cohort. In the multivariate analysis, sedentary lifestyle was positively associated with female gender, socioeconomic status, maternal physical inactivity, and television viewing, but inversely correlated with time spent playing videogames. Adolescents with low socioeconomic status were more likely to walk or bicycle to and from school. Effective strategies against sedentary lifestyle in adolescence are needed because of its high prevalence and association with physical inactivity in adulthood.

The 2004 Pelotas birth cohort: methods and description

OBJECTIVE To describe a birth cohort which started in 2004, aiming to assess pre and perinatal conditions of the newborns, infant morbimortality, early life characteristics and outcomes, and access, use and financing of health care. METHODS All children born in the urban area of Pelotas and Capão do Leão municipalities (Southern Brazil) in 2004 were identified and their mothers invited to join the study. In the first year of the study the children were seen at birth, at three and 12 months of age. These visits involved the application of a questionnaire to the mothers including questions on health; life style; use of health services; socioeconomic situation; estimation of gestational age; anthropometric measurements on the newborn (weight, length, head, chest and abdominal circumferences); anthropometric measurements on the mother (weight and height) and assessment of infant development. RESULTS Out of the eligible infants (4,558), more than 99% were recruited to the study at birth. Follow-up rates were 96% at three months and 94% at 12 months of age. Among the initial results we highlight the following. Infant mortality rate was 19.7 per thousand, with 66% of infant deaths occurring in the neonatal period. There were frequencies of 15% premature babies and 10% low birthweight. Cesarean sections represented 45% of deliveries. CONCLUSIONS The third Pelotas birth cohort showed an infant mortality rate similar to that of 11 years ago, with most deaths occurring in the neonatal period. The rates of prematurity and cesarean sections increased substantially.

Physical activity in adults from two Brazilian areas: similarities and differences

Lack of comparability has been a major limitation in studies on physical activity, due to the utilization of different methodological instruments and inconsistent cut-off points. This study aims to compare the levels of physical activity in adults from two Brazilian areas: (a) São Paulo, the richest State in the country; (b) Pelotas, a medium-sized southern Brazilian city. Both sites used cross-sectional population-based designs, with multiple-stage sampling strategies. Level of physical activity was assessed with the short version of the International Physical Activity Questionnaire. Prevalence of sedentary lifestyle was three times higher in Pelotas than in São Paulo. On the other hand, the proportion of very active subjects was significantly higher in Pelotas. The proportion of insufficiently active individuals (sedentary + irregularly active) was almost identical between the sites. Socioeconomic status was inversely related to level of physical activity in both sites. Among the insufficiently active subjects, those living in São Paulo are at least engaged in a limited amount of activity. On the other hand, among sufficiently active people, those living in Pelotas are more active.

Acesso a medicamentos de uso contínuo em adultos e idosos nas regiões Sul e Nordeste do Brasil

O objetivo deste estudo foi avaliar a prevalencia de acesso a medicamentos de uso continuo para tratar hipertensao arterial sistemica, diabetes mellitus e/ou problemas de saude mental e fatores associados. Foi desenvolvido estudo transversal no âmbito do Projeto de Expansao e Consolidacao Saude da Familia (PROESF) em 41 municipios do Sul e Nordeste do Brasil. A amostra incluiu 4.060 adultos e 4.003 idosos residentes na area das unidades basicas de saude (UBS). A prevalencia de acesso a medicamentos de uso continuo em adultos foi de 81% e em idosos, 87%. O maior acesso entre os adultos da Regiao Sul esteve associado com maior idade, melhor nivel economico, tipo de morbidade cronica e participacao em grupos na UBS; entre os adultos do Nordeste, com hipertensao arterial sistemica exclusiva ou combinada com diabetes mellitus; entre os idosos do Sul, com maior escolaridade; entre os idosos do Nordeste, com maior idade, maior escolaridade, nao fumantes, vinculo com a UBS e modelo de atencao Programa Saude da Familia (PSF). Os resultados revelam importante iniquidade em saude, reforcando a necessidade de politicas para ampliar o acesso principalmente para populacoes de menor poder aquisitivo.

Utilização dos serviços de saúde pela população coberta pela Estratégia de Saúde da Família

OBJECTIVE To analyze health service use patterns in communities covered by the Estratégia de Saúde da Família (Family Health Strategy). METHODS Population-based cross-sectional study with a sample of 2,988 individuals, of all ages, living in areas covered by the Estratégia de Saúde da Família, in the city of Porto Alegre, Southern Brazil, between July and September 2003. Pre-coded questionnaires about demographic, socioeconomic and health information were applied to all residents of selected households. Prevalence ratios and 95% confidence intervals were calculated and chi-square tests were applied in the analyses. Poisson regression was used in the multivariable analysis to control for potential confounding factors. RESULTS Females, persons aged 60 years or older, white, with better socioeconomic level, without health care plan coverage and with poor health self-perception were more likely to use the local family health unit. Regarding users of other health services, a similar pattern for sex, age and health self-perception was observed. However, greater use was found among people with better socioeconomic level and with health care plan coverage. CONCLUSIONS Use of a local family health unit was greater among people from a lower socioeconomic level and without health care plan coverage, revealing the poorer individuals to be the priority of governmental actions. Model changes made to health care with the implementation of the Estratégia Saúde da Família tend to progressively improve the health conditions of the poorer population, with consequent reduction of health inequalities.OBJETIVO: Analisar os padroes de utilizacao dos servicos de saude em comunidades cobertas pela Estrategia de Saude da Familia. METODOS: Estudo transversal de base populacional com amostra de 2.988 individuos, de todas as idades, residentes em areas de abrangencia da Estrategia de Saude da Familia, em Porto Alegre (RS), entre julho e setembro de 2003. Foram aplicados questionarios pre-codificados a todos os moradores dos domicilios sorteados sobre informacoes demograficas, socioeconomicas e de saude. Nas analises foram calculadas razoes de prevalencias, intervalos com 95% de confianca e aplicados testes do qui-quadrado. Realizou-se regressao de Poisson na analise multivariavel para possiveis fatores de confusao. RESULTADOS: Pessoas do sexo feminino, com 60 anos ou mais, com cor da pele branca, com menor nivel socioeconomico, sem cobertura por plano de saude e com autopercepcao de saude ruim tiveram maior probabilidade de utilizar a unidade de saude da familia local. Em relacao aos usuarios de outros servicos de saude, o padrao foi semelhante para as variaveis sexo, idade e autopercepcao de saude, mas foi encontrada uma maior utilizacao por pessoas com maior nivel socioeconomico e com cobertura por plano de saude. CONCLUSOES: A utilizacao da unidade de saude da familia local foi maior entre as pessoas com menor nivel socioeconomico e sem cobertura por plano de saude, indicando individuos mais pobres como prioritarios das acoes governamentais. A mudanca do modelo assistencial e a implantacao da Estrategia de Saude da Familia tendem a melhorar progressivamente as condicoes de saude da populacao mais pobre, minimizando as desigualdades em saude.

Prevalência de sobrepeso em adolescentes: um estudo de base populacional em uma cidade no Sul do Brasil

The prevalence of overweight and its association with demographic, socioeconomic, behavioral, and biological variables were evaluated. The sample included 810 adolescents (10-19 years of age) living in the urban area of Pelotas, a southern Brazilian city. Overweight was defined as a body mass index >= the 85th percentile, according to sex and age, and compared to the First National Health and Nutrition Examination Survey, following the WHO recommendation for adolescents. A clustering sampling strategy was used, and both the crude and adjusted analyses (Poisson Regression) took this strategy into account. The prevalence of overweight was 19.3% (95%CI: 16.6-22.0) and there was no difference between the sexes. The following groups presented a greater probability of being overweight: those classified in the wealthiest socioeconomic groups, those who had dieted to lose weight within the previous 3 months, those who watch 4 or more hours of television per day, and those who have less than 3 regular meals per day. After stratification by gender, high socioeconomic level was associated with greatest risk of overweight among boys. Dieting to lose weight during the previous 3 months, 4 or more hours of television viewing per day, and less than 3 formal meals per day were risk factors for overweight among girls.

Medicine access and utilization in a population covered by primary health care in Brazil

OBJECTIVES To describe medicine utilization and access in a population covered by the Family Health Program (PSF) in Brazil. METHODS Cross-sectional study with a random sample of 2988 individuals living in areas covered by 45 PSF clinics. Medicine utilization in the 15 days prior to the interview was assessed, as well as lack of access to medicines (proportion of people with medicines needed but not used), and lack of free access through the PSF (proportion of medicines used which had to be purchased). RESULTS Overall, 54.5% (95% CI 50.6; 58.4) of individuals used at least one medicine in the 15-day period and 3.6% reported failing to use a needed medicine. Of all medicines used, 41.5% were paid for out-of-pocket (25.5% among the poorest families), and 51.0% were obtained for free from the PSF. Almost 90% of the medicines prescribed by PSF physicians were provided for free by the PSF. CONCLUSION Although medicine access was high, individuals paid out-of-pocket for a substantial proportion of the medicines used. Lack of availability in PSF facilities and prescribing by non-PSF providers seem to contribute to the need for out-of-pocket purchases, and thus can be targeted for improvement through PSF policies.

Redução das desigualdades sociais na utilização de serviços odontológicos no Brasil entre 1998 e 2008

OBJETIVO: Analisar o acesso e utilizacao de servicos odontologicos no Brasil. METODOS: Foram utilizados os dados da Pesquisa Nacional por Amostra de Domicilios de 2003 e 2008, comparando-os com os de 1998. Investigaram-se as variaveis de acesso e uso de servicos odontologicos nas idades de tres, seis, nove, 12, 15 e 19 anos e no primeiro (Q1) e no quinto (Q5) quintis de renda familiar per capita. As analises consideraram o desenho amostral complexo. RESULTADOS: A proporcao de pessoas que nunca consultaram o dentista diminuiu (18,7% em 1998, 15,9% em 2003 e 11,7% em 2008). Houve importante reducao na diferenca absoluta de nao utilizacao do servico odontologico a partir dos nove anos entre Q1 e Q5 de 1998 a 2008, diminuindo para cerca de metade aos 15 (30,3 pontos percentuais - pp para 16,1 pp) e aos 19 anos (20,4 pp para 9,9 pp). As razoes entre Q1 e Q5 para consulta recente ao dentista diminuiram em todas as idades, principalmente entre zero e seis anos (Q5/Q1 de 3,2 para 2,6); a utilizacao do Sistema Unico de Saude para atendimento odontologico aumentou nos Q1 e Q5, com reducao na razao entre os grupos Q1/Q5 de cerca de 20%. A utilizacao do Sistema Unico de Saude para atendimento odontologico aumentou cerca de 8% no Q1 e 35% no Q5 entre 2003 e 2008. CONCLUSOES: Houve avanco consideravel na reducao das desigualdades no acesso e aumento na utilizacao de servicos odontologicos no Brasil entre 1998 e 2008. Entretanto, as iniquidades entre os grupos sociais ainda e expressiva.OBJECTIVE To analyze access to and utilization of dental care services in Brazil. METHODS We used data from the 2003 and 2008 Brazilian National Household Surveys, which we compared to data from the 1998 survey. We investigated access and utilization variables at ages three, six, nine, 12, 15, and 19 years in the first (Q1) and fifth (Q5) quintiles of per capita family income. All analyses took into account the complex sampling strategy. RESULTS The proportion of subjects that had never seen a dentist decreased during the period (18.7% in 1998, 15.9% in 2003 and 11.7% in 2008). There was an important reduction in the absolute difference in failure to use dental care services after age nine years between Q1 and Q5 from 1998 to 2008, which decreased to about half its value at 15 (30.3 percentage points - pp to 16.1 pp) and 19 years (20.4 pp to 9.9 pp). Q5/Q1 ratios for recent dental appointments fell across all age groups, especially between zero and six years (Q5/Q1 from 3.2 to 2.6); utilization of the National Health Care System for dental care increased in Q1 and Q5, with a reduction in the Q1/Q5 ratio of approximately 20%. Use of the National Health Care System for dental care increased by approximately 8% in Q1 and 35% in Q5 between 2003 and 2008. CONCLUSIONS There have been considerable advances in terms of reducing inequalities in access to, and increasing the utilization of, dental care services in Brazil between 1998 and 2008. However, inequality between social groups remains substantial.

Sintomas de doenças sexualmente transmissíveis em adultos: prevalência e fatores de risco

OBJECTIVE To evaluate the prevalence of sexually transmitted disease (STD) symptoms and associated risk factors in an adult population. METHODS A population-based cross-sectional study was conducted among residents of the metropolitan area of Pelotas, Brazil. Subjects were 20 years old or more. A self-administered questionnaire was used to gather information about sexual behavior and STD symptoms. Multivariate analysis was undertaken using logistic regression. RESULTS The prevalence of STDs was 13.5%. A higher risk of STDs was found in non-white younger women with more sexual partners and who did not use condoms in their last sexual relationship. Among men, early initiation of sexual activity and anal sex were positively associated with the outcome. Higher risks were found among women with lower schooling. CONCLUSIONS The present study identified a significant prevalence of STD symptoms in this population and showed differences in risk factors according to gender. Since many STDs are asymptomatic and symptomatic cases are often either not perceived as disease by patients or not diagnosed in health services, the actual prevalence may be even greater. The study results suggest that cohabitation with a sexual partner does not reduce the risk of STDs in this population and showed sex differences for risk factors, both of which should be taken into account while approaching this issue.