New approaches to second-degree burn healing: Polyvinyl alcohol membrane loaded to arnica combined to laser therapy.

Second-degree burns require greater care, as the damage is more extensive and worrisome and the use of a biomaterial can help in the cell repair process, with better planning, low cost, and better accessibility. Arnica has anti-inflammatory and analgesic properties in skin lesions treatments and laser therapy is another therapeutic alternative for burns. Evaluate the effects of arnica incorporated into PVA associated or not with low intensity laser on burns in rats. PVA and PVA with arnica (PVA+A) were obtained and characterized physicochemically. Through in vivo studies, the effects of PVA and PVA+A with or without the application of laser on the lesions allowed histological and immunohistochemical analyzes. PVA+A was biocompatible and with sustained release of the active, being a promising pharmacological tool and confirmed that laser therapy was effective in accelerating the healing process, due to its potential biomodulator, improving inflammatory aspects, promoting rapid healing in skin lesions.

Testing, Inequities and Vulnerability of Adolescents to Sexually Transmitted Infections.

Sexually transmitted infections (STIs) should form part of the comprehensive healthcare agenda for adolescents and young people (A&Y) and testing plays a strategic role in STI prevention. However, little attention has been paid to the social and programmatic obstacles to this practice among A&Y. The aim of this study is to describe the prevalence of testing for syphilis and HIV reported by a group of A&Y, analyzing its relationship with variables potentially indicative of inequities related to vulnerability to STIs. This was a cross-sectional survey applied to students at public high schools in three cities in the state of São Paulo, Brazil. The responses of 369 young people who reported having started sexual life were analyzed. The analysis included description of the frequencies of demographic and socioeconomic variables and their associations with testing for syphilis and HIV through the chi-square test. The concentration index (CI) was also calculated, with construction of the respective concentration curve for the associated variables. Positive associations were found between occurrence of testing and living in homes with up to three inhabitants, living in a marital situation with a regular or committed partnership, previous use of primary care services and previous use of hospitals or emergency services. The concentration curve for testing STIs showed significant contributions from the associated variables. The findings indicated that situations of inequity need to be addressed in order to reduce A&Y's vulnerability to STIs.

Encontros e desencontros entre projetos pedagógicos de cursos de Medicina e Diretrizes Curriculares Nacionais: percepções de professores / Convergence and gaps between medical courses educational projects and the National Curriculum Guidelines: university professors' perceptions / Encuentros y desencuentros entre proyectos pedagógicos de cursos de Medicina y Directrices Curriculares Nacionales: percepciones de profesores

Compreender a consolidação das Diretrizes Curriculares Nacionais (DCN) demanda contextualizar a realidade de cada instituição. Sua implantação pressupõe (re) orientação do processo de formação na Saúde, com integração entre Projeto Pedagógico do Curso (PPC), Sistema Único de Saúde (SUS) e envolvimento docente. Para captar a percepção docente sobre o alinhamento entre PPC e DCN, realizou-se estudo exploratório com metodologia qualitativa e os docentes respondendo a um questionário. Utilizou-se análise de conteúdo para construção de categorias temáticas. Os docentes de uma escola reconhecem que o PPC não está alinhado às DCN. Revelam trabalho docente determinado por perfil profissional e pessoal. Em outra escola, cuja reforma curricular já adota metodologia de ensino-aprendizagem ativa, os docentes se sentem apropriados às DCN. Concluímos, portanto, que as mudanças no PPC são processos que demandam tempo, dedicação e comunicação, ou seja, maior mudança na instituição de ensino. (AU)

To understand the National Curriculum Guidelines (NCG) it is necessary to contextualize the reality of each educational institution. The effective implementation of the guidelines requires the (re)orientation of the health education process; promoting integration between the course educational project (CEP); Brazilian National Health System (SUS) and professor engagement. We conducted a qualitative exploratory study using questionnaires to capture professors' perceptions of the alignment between medicine CEPs and the NCG. Content analysis was performed to develop thematic categories. The professors at one school acknowledged that the CEP and NCG were not aligned and their responses revealed that teaching is determined by each professor's professional and personal background. In another school whose curriculum reform adopted active teaching-learning methodologies, the professors felt a sense of ownership in relation to the NCG. We therefore conclude that the CEP change process requires time, dedication and effective communication or, in other words, greater change within the education institution. (AU)

Comprender la consolidación de las Directrices Curriculares Nacionales demanda poner en contexto la realidad de cada institución. Su implantación presupone una (re)orientación del proceso de formación en la salud, con integración entre Proyecto Pedagógico del Curso, Sistema Brasileño de Salud (SUS) y envolvimiento docente. Para captar la percepción docente sobre el alineamiento entre PPC y DCN, se realizó un estudio exploratorio, con metodología cualitativa, en el que los docentes respondieron a un cuestionario. Se utilizó un análisis de contenido para la construcción de categorías temáticas. Los docentes de una escuela reconocen que el PPC no está alineado a las DCN. Revelan un trabajo docente determinado por perfil profesional y personal. En otra escuela, cuya reforma curricular ya adopta la metodología de enseñanza-aprendizaje activa, los docentes se sienten apropiados de las DCN. Concluimos, por lo tanto, que los cambios en los PPC son procesos que demandan tiempo, dedicación y comunicación, es decir, un mayor cambio en la institución de enseñanza. (AU)

Patient's perception of the communication of clinical doctors and surgeons in a university hospital / Percepção de pacientes sobre a comunicação de médicos clínicos e cirurgiões em hospital universitário

Abstract: Introduction: The way information is transmitted is of crucial importance in the doctor-patient relationship, as good communication reduces complaints about inadequate practices and patient concerns and improves treatment adherence and health recovery. However, patient dissatisfaction on this subject is not unusual. Objectives: The objective of this work was to evaluate the perception of patients admitted to a Hospital Complex about the communication of clinical doctors and surgeons during the hospitalization period. Method: Cross-sectional, descriptive, analytical inquiry study, with the application of a questionnaire with questions about physicians' general communication. The instrument was built by the researchers and was answered by 120 adult patients. The sample was defined by convenience and stratified by medical and surgical clinic. Frequency and statistical analyses were performed on the obtained results. Results: Of 120 patients, 53.33%(n=64) were admitted to the Surgical Clinic and 46.67%(n=56) to the Medical Clinic. Of this total, 57.5%(n=69) had high school to college/university education. Patients reported more negative than positive responses to the following questions: information about the side effects of medications (66%), advice on post-surgical procedures (68.75%) and information on health promotion and prevention in the hospital environment (63.33%). The surgical clinic had significantly lower proportions of positive responses for: The doctor said their name (p <0.01; crude OR: 0.33; 95% CI 0.15-0.76); The patient was informed about how their treatment would be conducted (p=0.02; crude OR: 0.38; 95% CI 0.17-0.87); and the patient was informed about the need to undergo tests (p=0.02; crude OR 0.40; 95% CI 0.18-0.90), which remained significant after adjustment for certain confounding factors. There were no significant differences regarding the other questions. When analyzing the question: "What grade would you give to the doctor's general communication?" a significantly higher value (p=0.007) was given to the Medical Clinic (average 4.46±0.76) when compared to the Surgical Clinic (average 4±1.19). Conclusion: The doctor-patient communication showed significant deficits. Therefore, it is necessary for medical schools to offer students the development of this competence. Additionally, for an adequate generalization of the obtained results, new studies need to be carried out at different levels of medical care.

Resumo: Introdução: A maneira de transmitir informações é essencial na relação médico-paciente, pois a boa comunicação reduz queixas por práticas inadequadas e preocupações dos pacientes, e melhora a adesão aos tratamentos e a recuperação da saúde. Porém, não são raras as insatisfações dos pacientes sobre esse assunto. Objetivo: O objetivo deste trabalho foi avaliar a percepção dos pacientes internados em um complexo hospitalar sobre a comunicação de médicos clínicos e cirurgiões durante o período de internação. Método: Trata-se de estudo transversal, descritivo e analítico, do tipo inquérito, com aplicação de um questionário com perguntas sobre a comunicação geral do médico. O instrumento foi construído pelos pesquisadores e respondido por 120 pacientes adultos. A amostra foi definida por conveniência, estratificada por clínica médica e cirúrgica. Realizaram-se análises de frequência e estatística dos resultados encontrados. Resultados: Dos 120 pacientes, 53,33% (n = 64) foram internados na clínica cirúrgica e 46,67% (n = 56) na clínica médica. Desse total, 57,5% (n = 69) tinham escolaridade que variava de ensino médio a superior. Os pacientes relataram respostas mais negativas do que positivas em questões referentes a: informações sobre os efeitos colaterais dos medicamentos (66%), orientações de procedimentos pós-cirúrgicos (68,75%) e informações sobre promoção e prevenção da saúde no ambiente hospitalar (63,33%). A clínica cirúrgica teve proporções de respostas positivas significativamente menores para: "O médico disse o nome dele" (p < 0,01; OR bruta 0,33; IC95% 0,15-0,76); "O paciente foi informado sobre como será seu tratamento" (p = 0,02; OR bruta 0,38; IC95% 0,17-0,87); e "O paciente foi informado sobre a necessidade de realizar exames" (p = 0,02; OR bruta 0,40; IC95% 0,18-0,90), que se mantiveram significativas após o ajuste por determinados fatores intervenientes. Não se observaram diferenças significativas para as demais questões. Na análise da questão "Que nota você daria para a comunicação geral do médico? ", verificou-se valor significativamente maior (p = 0,007) para a clínica médica (média 4,46 ± 0,76) quando comparada à clínica cirúrgica (média 4 ± 1,19). Conclusão: A comunicação médico-paciente apresentou déficits significativos. Por isso, é necessário que as escolas médicas ofereçam para os discentes o desenvolvimento dessa competência. Além disso, para uma generalização adequada dos resultados encontrados, novos estudos precisam ser realizados em níveis diferentes do cuidado médico.

Care seeking behavior of people with common mental disorders in São Paulo-Brazil.

BACKGROUND: Mental health in developing countries is a keen area for improvements. Epidemiological research in this field helps to reinforce information, generate hypothesis and guide police makers. This study intends to analyze patterns of care seeking among cases of common mental disorders (CMD) in São Paulo city in 2015. METHODS: The data is from the population-based survey ISA-Capital 2015 and the screening for common mental disorders follows the Self-reporting questionnaire (SRQ-20). The study analyses care seeking according to sociodemographic and health conditions. RESULTS: The prevalence of CMD was 19.7% (95% CI 18.2-21.4%). There was a higher prevalence of CMD among who sought care in last 30 days (25.4%). Among CMD cases, care seeking presented significant different prevalence ratio (PR) for: women (PR 1.13; 95% CI 1.05-1.2); age 60 years or more (PR 1.13; 95% CI 1.05-1.22) and 30-44 years (PR 1.10; 95% CI 1.01-1.2); brown skin (PR 0.92; 95% CI 0.86-0.97); single or divorced (PR 0.93; 95% CI 0.89-0.99); unemployed (PR 1.06; 95% CI 1.01-1.12); last 15 days referred morbidity (PR 1.3; 95% CI 1.2-1.34); physical disability (PR 1.11; 95% CI 1.06-1.18); and chronic disease (PR 1.15; 95% CI 1.07-1.24). CONCLUSION: Identifying vulnerable groups and developing proper public health actions is important to promote equity accessibility. Analysing care seeking behavior among people with CMD is a strong contribution.

[Prevalence of common mental disorders and associated factors in urban residents of São Paulo, Brazil]. / Prevalência de transtornos mentais comuns e fatores associados em moradores da área urbana de São Paulo, Brasil.

Studies in developing countries report a steady increase in mental disorders, with major social and economic repercussions. The current study proposes to analyze the prevalence of common mental disorders (CMDs) and associated factors in urban residents of São Paulo, Brazil. Based on data collected in the Health Survey in São Paulo City (ISA-Capital) in 2015, the study identified the presence of CMDs using the Self-Reporting Questionnaire (SRQ-20). The association of CMDs with sociodemographic variables and health conditions was analyzed as relative frequency, corrected by the respective weights resulting from cluster sampling, estimating the prevalence and 95% confidence intervals (95%CI) and assessing the association's significance by the chi-square test, corrected by the F distribution. Prevalence of CMDs was 19.7% (95%CI: 18.2-21.4), higher in women (24.3%); persons 60 years or older (25.3%); followers of the African-Brazilian umbanda or candomblé religions (37.8%); widows/widowers (30.4%); individuals that had never attended school (31.4%); unemployed (28.3%); those with family income up to one minimum wage (28.8%); individuals that reported illness in the previous 15 days (36.9%); those with physical disabilities (21.6%); mental or intellectual disabilities (44.4%); emotional or mental problems (48.9%); headache (33.63%); and individuals with one or more chronic diseases (24.1%). The information in this study reaffirms the relevance of the prevalence of CMDs and their association with the most vulnerable social groups, corroborating the need to implement public measures in mental health.

Estudos realizados nos países em desenvolvimento descrevem um aumento progressivo dos transtornos mentais, com grandes repercussões sociais e econômicas. O presente estudo se propõe a analisar a prevalência dos transtornos mentais comuns (TMC) e seus fatores associados nos moradores da área urbana da cidade de São Paulo, Brasil. A partir dos dados levantados pelo Inquérito de Saúde do Município de São Paulo (ISA-Capital) de 2015, foi identificada a presença de TMC com a utilização do Self-Reporting Questionnaire (SRQ-20). A associação de TMC com as variáveis sociodemográficas e de condições de saúde foi analisada pela frequência relativa, corrigida pelos respectivos pesos decorrentes de uma amostragem de conglomerados, estimando-se a prevalência e intervalos de 95% de confiança (IC95%) em cada situação e avaliando-se a significância da associação pelo qui-quadrado corrigido pela distribuição F. A prevalência de TMC encontrada foi de 19,7% (IC95%: 18,2-21,4), sendo maior nas seguintes categorias: mulheres (24,3%); pessoas com 60 anos ou mais (25,3%); praticantes da umbanda/candomblé (37,8%); viúvos (30,4%); quem nunca frequentou a escola (31,4%); inativos/desempregados (28,3%); e quem possuía renda familiar de até um salário mínimo (28,8%). Em relação às variáveis de condição de saúde, a prevalência de TMC foi maior nos indivíduos que referiram: morbidade nos últimos 15 dias (36,9%); deficiência física (21,6%); deficiência mental ou intelectual (44,4%); problema emocional ou mental (48,9%); cefaleia (33,63%); e nos portadores de uma ou mais doenças crônicas (24,1%). As informações desta pesquisa reafirmam a relevância da prevalência de TMC assim como sua associação com os grupos sociais mais vulneráveis, o que reforça a necessidade da implementação de medidas públicas de saúde mental.

Estudios realizados en los países en desarrollo describen un aumento progresivo de los trastornos mentales, con grandes repercusiones sociales y económicas. El presente estudio se propone analizar la prevalencia de los trastornos mentales comunes (TMC) y sus factores asociados en los habitantes del área urbana de la ciudad de São Paulo, Brasil. A partir de los datos recabados por la Encuesta de Salud en el Municipio de São Paulo (ISA-Capital) de 2015, se identificó la presencia de TMC con la utilización del Self-Reporting Questionnaire (SRQ-20). La asociación de TMC con las variables sociodemográficas y de condiciones de salud se analizó a través de la frecuencia relativa, corregida por los respectivos pesos derivados de una muestra de conglomerados, estimándose la prevalencia y intervalos de confianza (IC95%) y evaluándose la significancia de la asociación por el chi-cuadrado, corregido por la distribución F. La prevalencia de TMC encontrada fue de 19,7% (IC95%: 18,2-21,4), siendo mayor en mujeres (24,3%); personas con 60 años o más (25,3%); practicantes de umbanda/candomblé (37,8%); viudos (30,4%); que nunca asistieron a la escuela (31,4%); inactivos/desempleados (28,3%); quienes tenía una renta familiar de hasta un salario mínimo (28,8%); individuos que informaron morbilidad durante los últimos 15 días (36,9%); deficiencia física (21,6%); deficiencia mental o intelectual (44,4%); problema emocional o mental (48,9%); cefalea (33,63%); y en los portadores de una o más enfermedades crónicas (24,1%). La información de esta investigación reafirma la relevancia de la prevalencia de TMC, así como su asociación con los grupos sociales más vulnerables, lo que refuerza la necesidad de la implementación de medidas públicas de salud mental.

Prevalência de transtornos mentais comuns e fatores associados em moradores da área urbana de São Paulo, Brasil / Prevalence of common mental disorders and associated factors in urban residents of São Paulo, Brazil / Prevalencia de trastornos mentales comunes y factores asociados en residentes del área urbana de São Paulo, Brasil

Resumo: Estudos realizados nos países em desenvolvimento descrevem um aumento progressivo dos transtornos mentais, com grandes repercussões sociais e econômicas. O presente estudo se propõe a analisar a prevalência dos transtornos mentais comuns (TMC) e seus fatores associados nos moradores da área urbana da cidade de São Paulo, Brasil. A partir dos dados levantados pelo Inquérito de Saúde do Município de São Paulo (ISA-Capital) de 2015, foi identificada a presença de TMC com a utilização do Self-Reporting Questionnaire (SRQ-20). A associação de TMC com as variáveis sociodemográficas e de condições de saúde foi analisada pela frequência relativa, corrigida pelos respectivos pesos decorrentes de uma amostragem de conglomerados, estimando-se a prevalência e intervalos de 95% de confiança (IC95%) em cada situação e avaliando-se a significância da associação pelo qui-quadrado corrigido pela distribuição F. A prevalência de TMC encontrada foi de 19,7% (IC95%: 18,2-21,4), sendo maior nas seguintes categorias: mulheres (24,3%); pessoas com 60 anos ou mais (25,3%); praticantes da umbanda/candomblé (37,8%); viúvos (30,4%); quem nunca frequentou a escola (31,4%); inativos/desempregados (28,3%); e quem possuía renda familiar de até um salário mínimo (28,8%). Em relação às variáveis de condição de saúde, a prevalência de TMC foi maior nos indivíduos que referiram: morbidade nos últimos 15 dias (36,9%); deficiência física (21,6%); deficiência mental ou intelectual (44,4%); problema emocional ou mental (48,9%); cefaleia (33,63%); e nos portadores de uma ou mais doenças crônicas (24,1%). As informações desta pesquisa reafirmam a relevância da prevalência de TMC assim como sua associação com os grupos sociais mais vulneráveis, o que reforça a necessidade da implementação de medidas públicas de saúde mental.

Abstract: Studies in developing countries report a steady increase in mental disorders, with major social and economic repercussions. The current study proposes to analyze the prevalence of common mental disorders (CMDs) and associated factors in urban residents of São Paulo, Brazil. Based on data collected in the Health Survey in São Paulo City (ISA-Capital) in 2015, the study identified the presence of CMDs using the Self-Reporting Questionnaire (SRQ-20). The association of CMDs with sociodemographic variables and health conditions was analyzed as relative frequency, corrected by the respective weights resulting from cluster sampling, estimating the prevalence and 95% confidence intervals (95%CI) and assessing the association's significance by the chi-square test, corrected by the F distribution. Prevalence of CMDs was 19.7% (95%CI: 18.2-21.4), higher in women (24.3%); persons 60 years or older (25.3%); followers of the African-Brazilian umbanda or candomblé religions (37.8%); widows/widowers (30.4%); individuals that had never attended school (31.4%); unemployed (28.3%); those with family income up to one minimum wage (28.8%); individuals that reported illness in the previous 15 days (36.9%); those with physical disabilities (21.6%); mental or intellectual disabilities (44.4%); emotional or mental problems (48.9%); headache (33.63%); and individuals with one or more chronic diseases (24.1%). The information in this study reaffirms the relevance of the prevalence of CMDs and their association with the most vulnerable social groups, corroborating the need to implement public measures in mental health.

Resumen: Estudios realizados en los países en desarrollo describen un aumento progresivo de los trastornos mentales, con grandes repercusiones sociales y económicas. El presente estudio se propone analizar la prevalencia de los trastornos mentales comunes (TMC) y sus factores asociados en los habitantes del área urbana de la ciudad de São Paulo, Brasil. A partir de los datos recabados por la Encuesta de Salud en el Municipio de São Paulo (ISA-Capital) de 2015, se identificó la presencia de TMC con la utilización del Self-Reporting Questionnaire (SRQ-20). La asociación de TMC con las variables sociodemográficas y de condiciones de salud se analizó a través de la frecuencia relativa, corregida por los respectivos pesos derivados de una muestra de conglomerados, estimándose la prevalencia y intervalos de confianza (IC95%) y evaluándose la significancia de la asociación por el chi-cuadrado, corregido por la distribución F. La prevalencia de TMC encontrada fue de 19,7% (IC95%: 18,2-21,4), siendo mayor en mujeres (24,3%); personas con 60 años o más (25,3%); practicantes de umbanda/candomblé (37,8%); viudos (30,4%); que nunca asistieron a la escuela (31,4%); inactivos/desempleados (28,3%); quienes tenía una renta familiar de hasta un salario mínimo (28,8%); individuos que informaron morbilidad durante los últimos 15 días (36,9%); deficiencia física (21,6%); deficiencia mental o intelectual (44,4%); problema emocional o mental (48,9%); cefalea (33,63%); y en los portadores de una o más enfermedades crónicas (24,1%). La información de esta investigación reafirma la relevancia de la prevalencia de TMC, así como su asociación con los grupos sociales más vulnerables, lo que refuerza la necesidad de la implementación de medidas públicas de salud mental.

Equity in the coverage of health expenses by the Brazilian Unified Health System for people with signs of common mental disorders in the city of São Paulo. / Equidade na cobertura dos gastos com saúde pelo Sistema Único de Saúde de pessoas com indicativos de transtornos mentais comuns no município de São Paulo.

INTRODUCTION: The objective of this investigation was to check equity in coverage/complementation of health expenses by the Brazilian Unified Health System (SUS) for people with signs of common mental disorders, in 2008, in the city of São Paulo, Brazil. METHODS: Cross-sectional study with data from the 2008 São Paulo Health Survey. Individuals aged 16 or older and with signs of common mental disorders were selected and evaluated with the Self-Reporting Questionnaire (SRQ-20). The following aspects were analyzed: demand for SUS, coverage of health expenses by SUS, and health expenses in the previous month, withal according to sociodemographic and health conditions. RESULTS: The search for SUS services was lower among white people with higher per capita incomes, in a stable union, and with higher education degrees. Coverage by SUS was lower for people aged between 45 and 59 years and aged 60 years or older, with higher per capita incomes, with high or technical school, and college degrees. Subjects who spent more on family health were 60 years or older, white, with high per capita income, in a stable union, and with a college degree. CONCLUSIONS: Among people with signs of common mental disorders, SUS mainly services and covers the expenses of the poorer population with lower educational level; therefore coverage is unequal and favors who needs it the most. However, considering age, inequity became explicit, since SUS was shown to offer wider coverage of health expenses to the youngest population.

INTRODUÇÃO: O objetivo deste trabalho foi verificar a equidade na cobertura/complementação dos gastos com saúde pelo Sistema Único de Saúde (SUS) de pessoas com indicativos de transtornos mentais comuns (TMC), no ano de 2008, no município de São Paulo. MÉTODOS: Foi realizado um estudo de corte transversal a partir dos dados do Inquérito de Saúde no Município de São Paulo de 2008 (ISA-Capital 2008). Os sujeitos incluídos na pesquisa tinham 16 anos de idade ou mais e indicativos de TMC, avaliados por meio do instrumento Self-Reporting Questionnaire (SRQ-20). Foram analisados: a procura pelo SUS, a cobertura dos gastos com saúde pelo SUS e os gastos com saúde no último mês, correlacionando-os com aspectos sociodemográficos e de condições de saúde. RESULTADOS: A procura pelo SUS foi menor entre as pessoas de cor branca, renda per capita elevada, com união estável e Ensino Superior. A cobertura pelo SUS foi menor entre as faixas etárias de 45 a 59 anos e de 60 anos ou mais, com renda per capita elevada, Ensino Médio ou Técnico e Ensino Superior. As pessoas que gastaram mais com a saúde da família foram aquelas com idade igual ou superior a 60 anos, de cor branca, renda per capita mais elevada, com união estável e Ensino Superior. CONCLUSÕES: Foi observado que o SUS atende e cobre os gastos majoritariamente daqueles com renda per capita e escolaridade mais baixas, denotando uma cobertura desigual que favorece os mais necessitados. Porém, considerando o fator idade, ficou explícita uma situação de iniquidade, pois foi constatada maior cobertura dos gastos em saúde pelo SUS para a população mais jovem.

Vaccination coverage and use of the Brazilian Health System for vaccination against influenza and pneumonia in adults and elderly with self-reported diabetes, municipality of São Paulo, 2003, 2008 and 2015. / Cobertura vacinal e utilização do SUS para vacinação contra gripe e pneumonia em adultos e idosos com diabetes autorreferida, no município de São Paulo, 2003, 2008 e 2015.

OBJECTIVE: to estimate the vaccination coverage against influenza and pneumonia and to analyze the utilization of Brazilian National Health System-SUS for vaccination in adults and elderly with self-reported diabetes in São Paulo, Brazil, in 2003, 2008 and 2015. METHODS: Cross-sectional studies with data from the ISA-Capital (population-based household surveys). RESULTS: 3,357, 3,271 and 4,043 were interviewed in 2003, 2008 and 2015; the prevalence of diabetes mellitus were 5.0% (2003), 6.4% (2008) and 7.7% (2015); fewer than half of people with diabetes, vaccinated against influenza (47.2%) and pneumonia (17.9%) in 2003, with a small increase in 2015 (59.2% and 26.1%, respectively); the majority of people who are vaccinated against influenza and pneumonia used SUS, 88.7% (2003) and 97.2% (2015) for influenza; 84.7% (2003) and 94.5% (2015) for pneumonia, without difference among age, sex, education level and ethnicity. CONCLUSION: despite the low vaccination coverage against influenza and pneumonia in the population with diabetes mellitus since 2003 the utilization of SUS to vaccination has been progressively expanding.

Equidade na cobertura dos gastos com saúde pelo Sistema Único de Saúde de pessoas com indicativos de transtornos mentais comuns no município de São Paulo / Equity in the coverage of health expenses by the Brazilian Unified Health System for people with signs of common mental disorders in the city of São Paulo

RESUMO: Introdução: O objetivo deste trabalho foi verificar a equidade na cobertura/complementação dos gastos com saúde pelo Sistema Único de Saúde (SUS) de pessoas com indicativos de transtornos mentais comuns (TMC), no ano de 2008, no município de São Paulo. Métodos: Foi realizado um estudo de corte transversal a partir dos dados do Inquérito de Saúde no Município de São Paulo de 2008 (ISA-Capital 2008). Os sujeitos incluídos na pesquisa tinham 16 anos de idade ou mais e indicativos de TMC, avaliados por meio do instrumento Self-Reporting Questionnaire (SRQ-20). Foram analisados: a procura pelo SUS, a cobertura dos gastos com saúde pelo SUS e os gastos com saúde no último mês, correlacionando-os com aspectos sociodemográficos e de condições de saúde. Resultados: A procura pelo SUS foi menor entre as pessoas de cor branca, renda per capita elevada, com união estável e Ensino Superior. A cobertura pelo SUS foi menor entre as faixas etárias de 45 a 59 anos e de 60 anos ou mais, com renda per capita elevada, Ensino Médio ou Técnico e Ensino Superior. As pessoas que gastaram mais com a saúde da família foram aquelas com idade igual ou superior a 60 anos, de cor branca, renda per capita mais elevada, com união estável e Ensino Superior. Conclusões: Foi observado que o SUS atende e cobre os gastos majoritariamente daqueles com renda per capita e escolaridade mais baixas, denotando uma cobertura desigual que favorece os mais necessitados. Porém, considerando o fator idade, ficou explícita uma situação de iniquidade, pois foi constatada maior cobertura dos gastos em saúde pelo SUS para a população mais jovem.

ABSTRACT: Introduction: The objective of this investigation was to check equity in coverage/complementation of health expenses by the Brazilian Unified Health System (SUS) for people with signs of common mental disorders, in 2008, in the city of São Paulo, Brazil. Methods: Cross-sectional study with data from the 2008 São Paulo Health Survey. Individuals aged 16 or older and with signs of common mental disorders were selected and evaluated with the Self-Reporting Questionnaire (SRQ-20). The following aspects were analyzed: demand for SUS, coverage of health expenses by SUS, and health expenses in the previous month, withal according to sociodemographic and health conditions. Results: The search for SUS services was lower among white people with higher per capita incomes, in a stable union, and with higher education degrees. Coverage by SUS was lower for people aged between 45 and 59 years and aged 60 years or older, with higher per capita incomes, with high or technical school, and college degrees. Subjects who spent more on family health were 60 years or older, white, with high per capita income, in a stable union, and with a college degree. Conclusions: Among people with signs of common mental disorders, SUS mainly services and covers the expenses of the poorer population with lower educational level; therefore coverage is unequal and favors who needs it the most. However, considering age, inequity became explicit, since SUS was shown to offer wider coverage of health expenses to the youngest population.

Cobertura vacinal e utilização do SUS para vacinação contra gripe e pneumonia em adultos e idosos com diabetes autorreferida, no município de São Paulo, 2003, 2008 e 2015 / Cobertura de vacunación y uso del sistema público de salud brasileño para vacunación contra gripe y neumonía en adultos y ancianos con diabetes autorreferida, en la ciudad de São Paulo, 2003, 2008 y 2015 / Vaccination coverage and use of the Brazilian Health System for vaccination against influenza and pneumonia in adults and elderly with self-reported diabetes, municipality of São Paulo, 2003, 2008 and 2015

Objetivo: estimar a cobertura vacinal contra gripe e pneumonia e a utilização do SUS para vacinação em adultos e idosos com diabetes autorreferida em São Paulo, SP, Brasil, em 2003, 2008 e 2015. Métodos: painel de estudos transversais do ISA-Capital. Resultados: entrevistaram-se 3.357, 3.271 e 4.043 pessoas em 2003, 2008 e 2015; as prevalências de diabetes mellitus foram de 5,0% (2003), 6,4% (2008) e 7,7% (2015); menos da metade das pessoas com diabetes vacinou-se contra gripe (47,2%) e pneumonia (17,9%) em 2003, com pequeno aumento em 2015 (59,2% e 26,1%, respectivamente); a maioria da população que se vacinou contra gripe e pneumonia o fez pelo SUS, 88,7% (2003) e 97,2% (2015) para gripe e 84,7% (2003) e 94,5% (2015) para pneumonia, sem diferença entre idade, sexo, escolaridade e raça. Conclusão: embora as coberturas vacinais tenham sido baixas na população com diabetes, a utilização do SUS foi elevada entre os vacinados.

Objetivo: estimar la cobertura de vacunas contra gripe y neumonía y la utilización del Sistema Único de Salud-SUS para vacunación en adultos y ancianos con diabetes autorreferida en la ciudad de São Paulo, Brasil, en 2003, 2008 y 2015. Métodos: datos del ISA-Capital. Resultados: entrevistados 3.357, 3.271 y 4.043 personas en 2003, 2008 y 2015; las prevalencias de diabetes mellitus fueron de 5,0% (2003), 6,4% (2008) y 7,7% (2015); menos de la mitad de las personas con diabetes mellitus se vacunaron contra gripe (47,2%) y neumonía (17,9%) en 2003, con un pequeño aumento en 2015 (59,2% y 26,1%, respectivamente); la mayoría de la población que se vacunó contra gripe y neumonía lo hizo a través del SUS: 88,7% (2003) y el 97,2% (2015) para la gripe y 84,7% (2003) y 94,5% (2015) para neumonía, sin diferencia entre edad, sexo, escolaridad y raza. Conclusión: Aunque las coberturas fueron bajas en la población con diabetes, la utilización del SUS fue elevada entre los vacunados.

Objective: to estimate the vaccination coverage against influenza and pneumonia and to analyze the utilization of Brazilian National Health System-SUS for vaccination in adults and elderly with self-reported diabetes in São Paulo, Brazil, in 2003, 2008 and 2015. Methods: Cross-sectional studies with data from the ISA-Capital (population-based household surveys). Results: 3,357, 3,271 and 4,043 were interviewed in 2003, 2008 and 2015; the prevalence of diabetes mellitus were 5.0% (2003), 6.4% (2008) and 7.7% (2015); fewer than half of people with diabetes, vaccinated against influenza (47.2%) and pneumonia (17.9%) in 2003, with a small increase in 2015 (59.2% and 26.1%, respectively); the majority of people who are vaccinated against influenza and pneumonia used SUS, 88.7% (2003) and 97.2% (2015) for influenza; 84.7% (2003) and 94.5% (2015) for pneumonia, without difference among age, sex, education level and ethnicity. Conclusion: despite the low vaccination coverage against influenza and pneumonia in the population with diabetes mellitus since 2003 the utilization of SUS to vaccination has been progressively expanding.

Use, access, and equity in health care services in São Paulo, Brazil.

The study analyzed how socioeconomic factors are associated with seeking, access, use, and quality of health care services in São Paulo, Brazil. Data were obtained from two household health surveys in São Paulo. We used logistic regression to analyze associations between socioeconomic factors and seeking, access, use, and quality of health care services. Access to health care services was high among those who sought it (94.91% in 2003 and 94.98% in 2008). The proportion of access to and use of health care services did not change significantly from 2003 to 2008. Use of services in the public sector was more frequent in lower socioeconomic groups. There were some socioeconomic differences in seeking health care and resolution of health problems. The study showed almost universal access to health care services, but the results suggest problems in quality of services and differences in quality experienced by lower socioeconomic groups, who mostly use the Brazilian Unified National Health System (SUS).

Use, access, and equity in health care services in São Paulo, Brazil / Uso, acesso e equidade nos serviços de saúde em São Paulo, Brasil / Uso, acceso y equidad en los servicios de salud en São Paulo, Brasil

Abstract: The study analyzed how socioeconomic factors are associated with seeking, access, use, and quality of health care services in São Paulo, Brazil. Data were obtained from two household health surveys in São Paulo. We used logistic regression to analyze associations between socioeconomic factors and seeking, access, use, and quality of health care services. Access to health care services was high among those who sought it (94.91% in 2003 and 94.98% in 2008). The proportion of access to and use of health care services did not change significantly from 2003 to 2008. Use of services in the public sector was more frequent in lower socioeconomic groups. There were some socioeconomic differences in seeking health care and resolution of health problems. The study showed almost universal access to health care services, but the results suggest problems in quality of services and differences in quality experienced by lower socioeconomic groups, who mostly use the Brazilian Unified National Health System (SUS).

Resumo: O estudo analisou os fatores socioeconômicos associados à procura, acesso, uso e qualidade dos serviços de assistência à saúde em São Paulo, Brasil. Os dados foram obtidos a partir de dois inquéritos domiciliares de saúde em São Paulo. A regressão logística foi utilizada para analisar as associações entre fatores socioeconômicos e a procura, acesso, uso e qualidade dos serviços de assistência à saúde. O acesso aos serviços de assistência à saúde era alto entre aqueles que procuravam (94,91% em 2003 e 94,98% em 2008). A proporção de acesso e uso dos serviços de assistência à saúde não mudou de maneira significativa entre 2003 e 2008. O use de serviços no setor público era mais frequente nos extratos socioeconômicos mais baixos. Houve algumas diferenças na procura de assistência e na resolução dos problemas de saúde. O estudo mostrou acesso quase universal aos serviços de assistência à saúde, mas os resultados sugerem problemas na qualidade dos serviços e diferenças na qualidade vivenciada pelos grupos socioeconômicos mais baixos, a maioria dos quais utilizavam o Sistema Único de Saúde (SUS).

Resumen: El estudio analizó los factores socioeconómicos asociados a la búsqueda, acceso, uso y calidad de los servicios de asistencia a la salud en São Paulo, Brasil. Los datos fueron obtenidos a partir de dos encuestas domiciliarias de salud en São Paulo. La regresión logística se utilizó para analizar las asociaciones entre factores socioeconómicos y la búsqueda, acceso, uso y calidad de los servicios de asistencia a la salud. El acceso a los servicios de asistencia a la salud era alto entre aquellos que lo buscaban (94,91% en 2003 y 94,98% en 2008). La proporción de acceso y uso de los servicios de asistencia a la salud no se vio modificado de manera significativa entre 2003 y 2008. El uso de servicios en el sector público era más frecuente en los estratos socioeconómicos más bajos. Hubo algunas diferencias en la búsqueda de asistencia y en la resolución de los problemas de salud. El estudio mostró un acceso casi universal a los servicios de asistencia a la salud, pero los resultados sugieren problemas en la calidad de los servicios y diferencias en la calidad experimentada por los grupos socioeconómicos más bajos, la mayoría de los cuales utilizaban el Sistema Único de Salud (SUS).

Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003-2008.

BACKGROUND: Access to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the "Smiling Brazil" Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003. METHOD: Data was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to 2008 regarding socioeconomic characteristics and dental health service use were explored. RESULTS: Overall, dental health service use increased between 2003 and 2008 and was at both time points more common among those who had higher income, better education, better housing conditions, private health care plans and were Caucasian. Inequalities in use of dental health care did not decrease over time. Among the reasons for not seeking dental care, not having teeth and financial difficulty were more common in lower socioeconomic groups, while thinking it was unnecessary was more common in higher socioeconomic groups. CONCLUSIONS: The Brazilian oral health policy is still in a period of expansion and seems to have contributed slightly to increased dental health service use, but has not influenced socioeconomic inequalities in the use of these services. Acquiring deeper knowledge about inequalities in dental health service use will contribute to better understanding of potential barriers to reducing them.

Use of generic drugs in São Paulo city, Brazil, in 2003: a population-based study. / Utilização de medicamentos genéricos no município de São Paulo em 2003: estudo de base populacional.

OBJECTIVE: to analyze the use and perception of generic drugs by people with diabetes and hypertension in São Paulo City, Brazil, considering the Brazilian Generic Drug Policy. METHODS: this was a cross-sectional study using data from a household health survey (ISA-Capital) in 2003; analysis was performed on knowledge regarding generic drugs and on the association between their use and sociodemographic and socio-economic characteristics. RESULTS: 603 people with hypertension and diabetes were included in the study, low use of generic drugs was found (33.3% and 26.3, respectively) and low cost was the major reported advantage of generic drugs (71.0% and 71.1%, respectively); there was no statistically significant difference between the use of generic medication and age, sex or schooling. CONCLUSION: low cost and there being no difference between generic drug use and education level strengthen the importance of generic drugs for promoting equity and universal access to medication.

Utilização de medicamentos genéricos no município de São Paulo em 2003: estudo de base populacional / Uso de medicamentos genéricos en San Paulo, Brasil, en 2003: estudio de base poblacional / Use of generic drugs in São Paulo city, Brazil, in 2003: a population-based study

OBJETIVO: analisar a utilização e a percepção sobre medicamentos genéricos pela população com diabetes e hipertensão na cidade de São Paulo, considerando-se a Política de Medicamentos Genéricos no Brasil. MÉTODOS: estudo transversal com dados do Inquérito de Saúde do Município de São Paulo (ISA-Capital), coletados em 2003; foi analisado o conhecimento sobre medicamentos genéricos e a associação entre utilização desses medicamentos e características sociodemográficas e socioeconômicas. RESULTADOS: foram incluídos 603 participantes; entre hipertensos e diabéticos, foi encontrada baixa utilização de medicamento genérico (33,3% e 26,3%, respectivamente) e a principal vantagem atribuída ao medicamento genérico foi o baixo custo (71,0% e 71,1%, respectivamente); não houve diferença estatisticamente significativa entre uso de medicamento genérico e idade, sexo ou escolaridade. CONCLUSÃO: o baixo custo e não haver diferença entre uso do genérico e escolaridade reforçam a importância do medicamento genérico para a promoção da equidade e do acesso universal a medicamentos.

OBJETIVO: analizar el uso de medicamentos genéricos en la población con diabetes e hipertensión en São Paulo, Brasil, considerando la política de medicamentos genéricos en Brasil. MÉTODOS: estudio transversal con datos de la Encuesta en Salud del municipio de São Paulo (ISA-Capital), colectados en 2003; se analizó el conocimiento sobre medicamentos genéricos y la asociación entre el uso de estos y las características sociodemográficas y socioeconómicas de la población. RESULTADOS: incluimos 603 participantes, entre hipertensos y diabéticos se encontró un uso escaso de genéricos (33,3% y 26,3%, respectivamente) y la principal ventaja atribuida al medicamento genérico fue el bajo costo (71,0% y 71,1%, respectivamente); no hubo diferencia entre el uso de medicación genérica y la edad, sexo o educación. CONCLUSIÓN: el bajo costo y ninguna diferencia entre el uso de genérico y educación refuerza la importancia de los genéricos para la promoción de la equidad y el acceso universal a los medicamentos.

OBJECTIVE: to analyze the use and perception of generic drugs by people with diabetes and hypertension in São Paulo City, Brazil, considering the Brazilian Generic Drug Policy. METHODS: this was a cross-sectional study using data from a household health survey (ISA-Capital) in 2003; analysis was performed on knowledge regarding generic drugs and on the association between their use and sociodemographic and socio-economic characteristics. RESULTS: 603 people with hypertension and diabetes were included in the study, low use of generic drugs was found (33.3% and 26.3, respectively) and low cost was the major reported advantage of generic drugs (71.0% and 71.1%, respectively); there was no statistically significant difference between the use of generic medication and age, sex or schooling. CONCLUSION: low cost and there being no difference between generic drug use and education level strengthen the importance of generic drugs for promoting equity and universal access to medication.

Access to medication in the Public Health System and equity: populational health surveys in São Paulo, Brazil.

INTRODUCTION: Since 2003, the access to medication has been increasing in Brazil and particularly in São Paulo. The present study aimed to analyze the access to medication obtained in the public sector and the socioeconomic differences in this access in 2003 and 2008. Also, we explored the difference in access to medication from 2003 to 2008. METHOD: Data were obtained from two cross-sectional population-based household surveys from São Paulo, Brazil (ISA-Capital 2003 and ISA-Capital 2008). Concentration curve and concentration index were calculated to analyze the associations between socioeconomic factors and access to medication in the public sector. Additionally, the differences between 2003 and 2008 regarding socioeconomic characteristics and access to medication were studied. RESULTS: Access to medication was 89.55% in 2003 and 92.99% in 2008, and the proportion of access to medication did not change in the period. Access in the public sector increased from 26.40% in 2003 to 48.55% in 2008 and there was a decrease in the concentration index between 2003 and 2008 in access to medication in the public sector. CONCLUSIONS: The findings indicate an expansion of Brazilian Unified Health System (Sistema Único de Saúde ) users, with the inclusion of people of higher socioeconomic position in the public sector. As the SUS gives more support to people of lower socioeconomic position in terms of medication provision, the SUS tends to equity. Nevertheless, universal coverage for medication and equity in access to medication in the public sector are still challenges for the Brazilian public health system.

Access to medication in the Public Health System and equity: populational health surveys in São Paulo, Brazil / Acesso a medicamentos pelo Sistema Único de Saúde e equidade: inquéritos de base populacional em São Paulo, Brasil

ABSTRACT: Introduction: Since 2003, the access to medication has been increasing in Brazil and particularly in São Paulo. The present study aimed to analyze the access to medication obtained in the public sector and the socioeconomic differences in this access in 2003 and 2008. Also, we explored the difference in access to medication from 2003 to 2008. Method: Data were obtained from two cross-sectional population-based household surveys from São Paulo, Brazil (ISA-Capital 2003 and ISA-Capital 2008). Concentration curve and concentration index were calculated to analyze the associations between socioeconomic factors and access to medication in the public sector. Additionally, the differences between 2003 and 2008 regarding socioeconomic characteristics and access to medication were studied. Results: Access to medication was 89.55% in 2003 and 92.99% in 2008, and the proportion of access to medication did not change in the period. Access in the public sector increased from 26.40% in 2003 to 48.55% in 2008 and there was a decrease in the concentration index between 2003 and 2008 in access to medication in the public sector. Conclusions: The findings indicate an expansion of Brazilian Unified Health System (Sistema Único de Saúde ) users, with the inclusion of people of higher socioeconomic position in the public sector. As the SUS gives more support to people of lower socioeconomic position in terms of medication provision, the SUS tends to equity. Nevertheless, universal coverage for medication and equity in access to medication in the public sector are still challenges for the Brazilian public health system.

RESUMO: Introdução: Desde 2003, o acesso da população a medicamentos tem aumentado no Brasil e particularmente em São Paulo. O estudo visou analisar o acesso a medicamentos obtidos do setor público e as desigualdades socioeconômicas nesse acesso em 2003 e em 2008. Método: Os dados são provenientes dos inquéritos domiciliares de saúde ISA-Capital, realizados na cidade de São Paulo em 2003 e em 2008. Foi feita Regressão Logística para analisar os fatores associados ao acesso a medicamentos. A análise das desigualdades no acesso a medicamentos foi feita a partir da Curva de Concentração e Índice de Concentração. Adicionalmente, as diferenças entre os anos de 2003 e 2008 com relação às características socioeconômicas e ao acesso a medicamentos foram estudadas. Resultados: O acesso a medicamentos foi 89,55% em 2003 e 92,99% em 2008. O acesso a medicamentos pelo setor público aumentou de 26,40% em 2003 para 48,55% em 2008 e foi maior na população com menor poder aquisitivo, porém houve mudança no índice de concentração entre 2003 e 2008. Conclusões: Os achados indicam a expansão da clientela do Sistema Único de Saúde na cobertura de medicamentos, com a entrada da população com maior poder aquisitivo no setor público. O acesso continua maior na população com menor poder aquisitivo, o que sugere que o SUS tenta a equidade na provisão de medicamentos. Entretanto, a cobertura universal para gastos com medicamentos essenciais e a equidade no acesso a medicamentos pelo setor público ainda são desafios para o SUS.

Family clustering of secondary chronic kidney disease with hypertension or diabetes mellitus. A case-control study.

In Brazil hypertension and type 2 diabetes mellitus are responsible for 60% of cases of end-stage renal disease in renal replacement therapy. In the United States studies have identified family clustering of chronic kidney disease, predominantly in African-Americans. A single Brazilian study observed family clustering among patients with chronic kidney disease when compared with hospitalized patients with normal renal function. This article aims to assess whether there is family clustering of chronic kidney disease in relatives of individuals in renal replacement therapy caused by hypertension and/or diabetes mellitus. A case-control study with 336 patients in renal replacement therapy with diabetes mellitus or hypertension for at least 5 years (cases) and a control matched sample group of individuals with hypertension or diabetes mellitus and normal renal function (n = 389). Individuals in renal replacement therapy (cases) had a ratio of 2.35 (95% CI 1.42-3.89, p < 0.001) versus the control group in having relatives with chronic renal disease, irrespective of race or causative illness. There is family clustering of chronic kidney disease in the sample studied, and this predisposition is irrespective of race and underlying disease (hypertension or diabetes mellitus).

Coverage by the public health services of medication and vaccines for the population with diabetes mellitus.

This study analyzed the coverage by the public health service of expenses with medication and vaccines for the adult population of São Paulo with self-reported diabetes mellitus in 2003 and the implications for access to medicines and vaccination campaigns programs. Data were collected by the Multicenter Health Survey of São Paulo. The Unified Health System (SUS) was widely used by the population for vaccination against influenza and pneumonia and there was significant private sector participation for coverage of expenses with medication, with an estimated coverage of 38% by SUS. There were no significant differences in the prevalence of use of public services for vaccination among the categories of variables studied, suggesting a universal distribution of vaccination by the public health service. Unlike vaccinations, in 2003 the coverage of medication expenses by the public health service was recent in Brazil, which may explain the low level of coverage. An analysis of coverage of vaccination and medication expenses in diabetes mellitus population since 2003 may contribute to be the basis for policies to broaden access of the population to health services.