The Brazilian primary health care response to the COVID-19 pandemic: individual and collective approaches.

Objectives: Brazil's PHC wide coverage has a potential role in the fight against COVID, especially in less developed regions. PHC should deal with COVID-19 treatment; health surveillance; continuity of care; and social support. This article aims to analyze PHC performance profiles during the pandemic, in these axes, comparing the five Brazilian macro-regions. Methods: A cross-sectional survey study was carried out, using stratified probability sampling of PHC facilities (PHCF). A Composite Index was created, the Covid PHC Index (CPI). Factor analysis revealed that collective actions contrastingly behaved to individual actions. We verified differences in the distributions of CPI components between macro-regions and their associations with structural indicators. Results: Nine hundred and seven PHCF participated in the survey. The CPI and its axes did not exceed 70, with the highest value in surveillance (70) and the lowest in social support (59). The Individual dimension scored higher in the South, whereas the Collective dimension scored higher in the Northeast region. PHCF with the highest CPI belong to municipalities with lower HDI, GDP per capita, population, number of hospitals, and ICU beds. Conclusion: The observed profiles, individually and collectively-oriented, convey disputes on Brazilian health policies since 2016, and regional structural inequalities.

Assessment of initial SARS-CoV-2 seroprevalence in the most affected districts in the municipality of São Paulo, Brazil.

BACKGROUND: São Paulo city has been one of the regions most affected by the COVID-19 pandemic in Brazil. Frequent asymptomatic and oligosymptomatic infections and poor access to diagnostic tests make serosurveys crucial to monitor the magnitude of the epidemic and to inform public health policies, such as vaccination plans. OBJECTIVES: To estimate, early in the epidemic, the seroprevalence of antibodies to SARS-CoV-2 in adults living in the six most affected districts in São Paulo city, and to assess potential associated risk factors. METHODS: This was a cross-sectional population-based survey of 1,152 households randomly selected from 72 census tracts. During the period May 4-12, 2020, 463 participants completed a questionnaire on sociodemographic characteristics and history of symptoms in the past two weeks, and provided a blood sample. Prevalence of SARS-CoV-2 antibodies was the outcome of interest and was estimated based on results of two immunoassays, Maglumi SARS-CoV-2 chemiluminescence assay Immunoglobulin (Ig) M (IgM) and IgG, and Roche electrochemiluminescence assay total Ig. Serum samples reactive to either assay were considered positive. RESULTS: Weighted overall seroprevalence was 6% (95%CI 3.9-8.3%). No association was observed between seropositivity and sex, age group or education level. Participants who reported black and brown skin color showed a 2.7 fold higher prevalence than people with white skin (p = 0.007). Among the 30 seropositive individuals, 14 (46.6%) reported no COVID-19 compatible symptoms in the past two weeks. CONCLUSION: This study represents the first assessment of SARS-CoV-2 seroprevalence in the city of São Paulo and 6% is the baseline estimate of a series of population-based seroprevalence surveys. Serological screening using sound serological assays is the key tool to monitoring temporal and geographic changes in the spread of the virus through an important epicenter of the COVID-19 pandemic in Brazil. Ultimately, it may inform prevention and control efforts.

Changes in total physical activity, leisure and commuting in the largest city in Latin America, 2003-2015.

OBJECTIVE: To analyze the prevalence of physical inactivity and the average time of practice of total physical activity and by domains (leisure and commuting), according to gender, age group and schooling, between 2003 and 2015, in residents of the urban area of the city of São Paulo. METHODS: Data from Household Health Surveys in the Municipality of São Paulo (2003: n = 2,514; 2015: n = 4,043). The International Physical Activity Questionnaire was used to measure total, leisure, and commuting physical activity. Results were presented in < 10 minute/week periods, physical inactivity and minutes/week, according to evaluation period, sex, age and schooling. RESULTS: Prevalence of < 10 minutes/week periods in 2003 and 2015 were: 22.5 and 28.9% for the total; 56.7 and 58.3% for leisure; and 35.2 and 39.9% for commuting, with significant change only in the total item, among adolescents (10.3 to 18.8%). For physical inactivity, prevalence rates were: 54.9 and 61.6% (total); 78.2 and 78.9% (leisure); and 72 and 79.9% (commuting), with significant changes only for commuting among adults (67.8 to 77.4%). For the average in minutes per week, in total, there was a significant decrease for female adolescents (138.2 minute/week) and adults with 0-8 (122.6 minutes/week) and 9-11 years (96.7 minutes/week) years of schooling; in commuting, there was a reduction for female adolescents (95 minutes/week); and male adults (95 minutes/week) and female adults (82 minutes/week). CONCLUSIONS: There were no reductions in the prevalence of < 10 min/week periods or leisure physical inactivity. Commuting physical inactivity has become even more common.

Assessment of initial SARS-CoV-2 seroprevalence in the most affected districts in the municipality of São Paulo, Brazil

ABSTRACT Background: São Paulo city has been one of the regions most affected by the COVID-19 pandemic in Brazil. Frequent asymptomatic and oligosymptomatic infections and poor access to diagnostic tests make serosurveys crucial to monitor the magnitude of the epidemic and to inform public health policies, such as vaccination plans. Objectives: To estimate, early in the epidemic, the seroprevalence of antibodies to SARS-CoV-2 in adults living in the six most affected districts in São Paulo city, and to assess potential associated risk factors. Methods: This was a cross-sectional population-based survey of 1,152 households randomly selected from 72 census tracts. During the period May 4-12, 2020, 463 participants completed a questionnaire on sociodemographic characteristics and history of symptoms in the past two weeks, and provided a blood sample. Prevalence of SARS-CoV-2 antibodies was the outcome of interest and was estimated based on results of two immunoassays, Maglumi SARS-CoV-2 chemiluminescence assay Immunoglobulin (Ig) M (IgM) and IgG, and Roche electrochemiluminescence assay total Ig. Serum samples reactive to either assay were considered positive. Results: Weighted overall seroprevalence was 6% (95%CI 3.9-8.3%). No association was observed between seropositivity and sex, age group or education level. Participants who reported black and brown skin color showed a 2.7 fold higher prevalence than people with white skin (p = 0.007). Among the 30 seropositive individuals, 14 (46.6%) reported no COVID-19 compatible symptoms in the past two weeks. Conclusion: This study represents the first assessment of SARS-CoV-2 seroprevalence in the city of São Paulo and 6% is the baseline estimate of a series of population-based seroprevalence surveys. Serological screening using sound serological assays is the key tool to monitoring temporal and geographic changes in the spread of the virus through an important epicenter of the COVID-19 pandemic in Brazil. Ultimately, it may inform prevention and control efforts.

Changes in total physical activity, leisure and commuting in the largest city in Latin America, 2003-2015 / Mudanças na atividade física total, de lazer e deslocamento na maior cidade da América Latina, 2003-2015

ABSTRACT: Objective: To analyze the prevalence of physical inactivity and the average time of practice of total physical activity and by domains (leisure and commuting), according to gender, age group and schooling, between 2003 and 2015, in residents of the urban area of the city of São Paulo. Methods: Data from Household Health Surveys in the Municipality of São Paulo (2003: n = 2,514; 2015: n = 4,043). The International Physical Activity Questionnaire was used to measure total, leisure, and commuting physical activity. Results were presented in < 10 minute/week periods, physical inactivity and minutes/week, according to evaluation period, sex, age and schooling. Results: Prevalence of < 10 minutes/week periods in 2003 and 2015 were: 22.5 and 28.9% for the total; 56.7 and 58.3% for leisure; and 35.2 and 39.9% for commuting, with significant change only in the total item, among adolescents (10.3 to 18.8%). For physical inactivity, prevalence rates were: 54.9 and 61.6% (total); 78.2 and 78.9% (leisure); and 72 and 79.9% (commuting), with significant changes only for commuting among adults (67.8 to 77.4%). For the average in minutes per week, in total, there was a significant decrease for female adolescents (138.2 minute/week) and adults with 0-8 (122.6 minutes/week) and 9-11 years (96.7 minutes/week) years of schooling; in commuting, there was a reduction for female adolescents (95 minutes/week); and male adults (95 minutes/week) and female adults (82 minutes/week). Conclusions: There were no reductions in the prevalence of < 10 min/week periods or leisure physical inactivity. Commuting physical inactivity has become even more common.

RESUMO: Objetivo: Analisar a prevalência de inatividade física e o tempo médio de prática de atividade física total e por domínios (lazer e deslocamento), de acordo com sexo, faixa etária e escolaridade, em residentes de área urbana do munícipio de São Paulo, entre os anos de 2003 e 2015. Métodos: Utilizaram-se dados dos Inquéritos Domiciliares de Saúde no Município de São Paulo (2013: n = 2.514; 2015: n = 4.043). O International Physical Activity Questionnaire foi utilizado para mensurar a atividade física total, de lazer e deslocamento. Resultados foram apresentados em períodos de < 10 minutos/semana, inatividade física e minutos/semana, conforme período de avaliação, faixa etária, sexo e escolaridade. Resultados: As prevalências dos períodos < 10 minutos/semana em 2003 e 2015 foram 22,5 e 28,9% para total; 56,7 e 58,3% para lazer; e 35,2 e 39,9% para deslocamento, com mudança significativa no total em adolescentes, de 10,3 para 18,8%. Para inatividade física, as prevalências foram 54,9 e 61,6% para total; 78,2 e 78,9% para lazer; e 72 e 79,9% para deslocamento, com mudanças significativas no deslocamento em adultos, de 67,8 para 77,4%. Para as médias de atividade física total, houve diminuição significativa para adolescentes do sexo feminino (138,2 minutos/semana) e adultos com escolaridade de 0-8 (122,6 minutos/semana) e 9-11 anos (96,7 minutos/semana); no deslocamento, houve diminuição para adolescentes do sexo feminino (95 minutos/semana) e adultos do sexo masculino (95 minutos/semana) e feminino (82 minutos/semana). Conclusão: Não foram encontradas diminuições na prevalência dos períodos < 10 minutos/semana e na inatividade física no lazer. A inatividade física no deslocamento ficou ainda maior.

Demographic, socioeconomic and lifestyle factors associated with sugar-sweetened beverage intake: a population-based study.

INTRODUCTION: The intake of sugar-sweetened beverages (SSB) varies according to the characteristics of the population. OBJECTIVE: To investigate the SSB intake and demographic, socioeconomic and lifestyle factors associated with its consumption in adolescents, adults, and older adults in São Paulo. METHODS: Data were drawn from the Health Survey of São Paulo, a cross-sectional population-based study including 1,662 individuals aged 12 years or more. SSB were classified into six groups: sugar-sweetened sodas, sweetened coffee and tea, sweetened milk and dairy products, sweetened fruit juice, sweetened fruit drink, and total SSB. The association of each group with demographic, socioeconomic and lifestyle variables was assessed using linear regression models. RESULTS: The mean SSB intake was 668.4 mL in adolescents, 502.6 mL in adults, and 358.2 mL in elderly adults. Sodas and sweetened coffee and tea represented had the greatest contribution to energy intake. SSB consumption was lower among female sex and higher among overweight adolescents, among sufficiently active adults, and among lower household per capita income older adults. Consumption of SSB was high, particularly among adolescents. Public policies are required in order to decrease the consumption of these beverages. CONCLUSION: Age group, sex, household per capita income, and body mass index status were associated with SSB intake.

Demographic, socioeconomic and lifestyle factors associated with sugar-sweetened beverage intake: a population-based study / Fatores demográficos, socioeconômicos e de estilo de vida associados ao consumo de bebidas açucaradas: um estudo de base populacional

ABSTRACT: Introduction: The intake of sugar-sweetened beverages (SSB) varies according to the characteristics of the population. Objective: To investigate the SSB intake and demographic, socioeconomic and lifestyle factors associated with its consumption in adolescents, adults, and older adults in São Paulo. Methods: Data were drawn from the Health Survey of São Paulo, a cross-sectional population-based study including 1,662 individuals aged 12 years or more. SSB were classified into six groups: sugar-sweetened sodas, sweetened coffee and tea, sweetened milk and dairy products, sweetened fruit juice, sweetened fruit drink, and total SSB. The association of each group with demographic, socioeconomic and lifestyle variables was assessed using linear regression models. Results: The mean SSB intake was 668.4 mL in adolescents, 502.6 mL in adults, and 358.2 mL in elderly adults. Sodas and sweetened coffee and tea represented had the greatest contribution to energy intake. SSB consumption was lower among female sex and higher among overweight adolescents, among sufficiently active adults, and among lower household per capita income older adults. Consumption of SSB was high, particularly among adolescents. Public policies are required in order to decrease the consumption of these beverages. Conclusion: Age group, sex, household per capita income, and body mass index status were associated with SSB intake.

RESUMO: Introdução: A ingestão de bebidas açucaradas varia de acordo com as características da população. Objetivos: Investigar o consumo de bebidas açucaradas e os fatores demográficos, socioeconômicos e de estilo de vida associados ao seu consumo em adolescentes, adultos e idosos residentes em São Paulo. Métodos: Foram utilizados dados do Inquérito de Saúde de São Paulo, estudo transversal de base populacional, incluindo 1.662 indivíduos com 12 anos ou mais. As bebidas açucaradas foram classificadas em seis grupos: refrigerantes, cafés e chás adoçados, leite e produtos lácteos adoçados, sucos de fruta natural adoçados, sucos de fruta artificial adoçados e bebidas açucaradas totais. A associação de cada grupo com variáveis demográficas, socioeconômicas e de estilo de vida foi determinada por meio de modelos de regressão linear. Resultados: A ingestão média de bebidas açucaradas foi 668,4 mL em adolescentes, 502,6 mL em adultos e 358,2 mL em idosos. Refrigerantes e cafés e chás adoçados foram os grupos com a maior contribuição para a ingestão energética. O consumo de bebidas açucaradas foi menor entre as mulheres e maior entre os adolescentes com excesso de peso, entre adultos suficientemente ativos e entre os idosos de menor renda familiar per capita. O consumo de bebidas açucaradas foi elevado, particularmente entre adolescentes. Políticas públicas são necessárias a fim de reduzir o consumo dessas bebidas. Conclusão: Faixa etária, sexo, renda familiar per capita e índice de massa corporal foram associadas ao consumo de bebidas açucaradas.

Determinants of inequalities in the quality of Brazilian diet: trends in 12-year population-based study (2003-2015).

BACKGROUND: Recent studies have explored the influence of socioeconomic inequalities on the diet quality. However, there is lack of evidence regarding the level of inequalities in dietary quality and its main contributing factors from population-based follow-up studies. The primary objective of this study was to investigate the level and the determinants of inequalities in diet quality in a representative sample of adolescents, adults and older adults resident in São Paulo, Brazil. METHODS: Data from the Health Survey of São Paulo (ISA-Capital) were analyzed for 2003 (n = 2398), 2008 (n = 1662) and 2015 (n = 1742) surveys. Information on food consumption was obtained through 24-h dietary recall, and diet quality was assessed based on the Revised Brazilian Healthy Eating Index (BHEI-R). The descriptive variables were compared using 95% confidence interval. The scores of BHEI-R and its components were compared across age groups and year. The association between socioeconomic inequalities and diet quality was based on the estimation of concentration index. RESULTS: We observed that the BHEI-R scores gradually improved over 12-years, with older adults showing the greatest improvement. The increase in overall population score was observed for total fruits, whole fruits, whole grains, oils and sodium. The main contributor to socioeconomic inequality in diet quality in 2003 was ethnic group, and in 2008 and 2015, it was per capita household income; age was a persistent factor of inequality in the population over the years. Concentration indices indicated that lower income individuals had higher BHEI-R scores in 2003; however, there was a shift in favor of higher income individuals in 2008 and 2015. CONCLUSIONS: Changes in the patterns of determination of inequalities according to age, ethnic group or income during the period analyzed show the existence of ongoing process of contribution of demographic and socioeconomic factors in the diet quality of individuals in a large urban center.

Young women's contraceptive practices: a household survey in the city of São Paulo, Brazil. / Práticas contraceptivas de mulheres jovens: inquérito domiciliar no Município de São Paulo, Brasil.

The last decade has witnessed initiatives to expand access to contraceptives in Brazil. However, the last population-based study on contraception was undertaken in 2006. A household survey in 2015 investigated contraceptive practices in women 15 to 44 years of age living in the city of São Paulo. The current study selected data on young women 15 to 19 years of age. The objectives were to identify the prevalence of contraception, the contraceptives used, sources, and differences in contraceptive practices. The young women are part of a probabilistic study sample. Differences in contraception use were compared by multiple logistic regression analysis. A total of 633 young women were interviewed, of whom 310 (48.5%) were sexually initiated. Of these, 60% reported emergency contraception use at least once in their lives. Emergency contraception use was directly proportional to age and lifetime number of partners. Prevalence of contraception was 81%. The odds of current contraception use were higher among young women residing in the health district of the city with the better social conditions, Catholics, those who reported sexual relations in the previous 30 days, and those with history of an obstetrics and gynaecology visit in the previous year, and inversely proportional to the lifetime number of sex partners. Male condoms and the pill were the most common methods (28.2% and 23%). Most of the women purchased their contraceptives in retail pharmacies (75.2%), and the Brazilian Unified National Health System (SUS) was only a significant source for injectable hormonal contraceptives. Government support for women's sexual and reproductive rights is still insufficient.

Iniciativas para ampliar o acesso a contraceptivos ocorreram no Brasil na última década. No entanto, o último estudo de base populacional sobre anticoncepção foi realizado em 2006. Um inquérito domiciliar investigou a prática contraceptiva de mulheres com 15 a 44 anos, residentes no Município de São Paulo em 2015. Para o presente trabalho, foram selecionados os dados relativos às jovens com idade entre 15 e 19 anos. Foram objetivos: identificar a prevalência da anticoncepção, os contraceptivos adotados, suas fontes de obtenção e os diferenciais no uso da contracepção. As jovens integram a amostra probabilística do estudo. Diferenciais do uso de contracepção foram avaliados por meio de regressão logística múltipla. Foram entrevistadas 633 jovens, das quais, 310 (48,5%) haviam iniciado atividade sexual. Dessas, 60% relataram uso de contracepção de emergência pelo menos uma vez na vida. Esse uso foi diretamente proporcional à idade e ao número de parceiros na vida. A prevalência da anticoncepção foi de 81%. A chance de estar usando contraceptivo foi maior entre as residentes na região de saúde com melhor desenvolvimento social, as católicas, as que tiveram relação sexual nos últimos 30 dias e as que realizaram consulta ginecológica no último ano. Foi inversamente proporcional ao número de parceiros na vida. Preservativo masculino e pílula foram os métodos mais frequentes (28,2% e 23%). A maioria das mulheres comprou o contraceptivo na rede comercial de farmácias (75,2%), o Sistema Único de Saúde (SUS) foi fonte significativa apenas para a obtenção do anticoncepcional hormonal injetável. O apoio do Estado ao exercício dos direitos sexuais e reprodutivos segue insuficiente.

En la última década hubo en Brasil iniciativas para ampliar el acceso a anticonceptivos. No obstante, el último estudio de base poblacional sobre anticoncepción se realizó en 2006. Una encuesta domiciliaria investigó la práctica contraceptiva de mujeres de 15 a 44 años, residentes en el municipio de São Paulo en 2015. Para el presente estudio, se seleccionaron los datos relativos a las jóvenes con edad entre 15 y 19 años. Los objetivos fueron: identificar la prevalencia de la anticoncepción, los métodos anticonceptivos adoptados, sus fuentes de obtención y los diferenciales en el uso de métodos anticonceptivos. Las jóvenes integran la muestra probabilística del estudio. Los diferenciales del uso de métodos anticonceptivos fueron evaluados mediante regresión logística múltiple. Se entrevistaron a 633 jóvenes, de las cuales 310 (48,5%) habían comenzado su actividad sexual. De éstas, un 60% informaron el uso de métodos anticonceptivos de emergencia por lo menos una vez en la vida. Este uso fue directamente proporcional a la edad y al número de parejas en su vida. La prevalencia de métodos anticonceptivos fue de un 81%. La oportunidad de estar usando algún método anticonceptivo fue mayor entre las residentes en la región de salud con un mejor desarrollo social, las católicas, las que tuvieron relaciones sexuales en los últimos 30 días y las que fueron a una consulta ginecológica durante el último año. Fue inversamente proporcional al número de parejas en su vida. El preservativo masculino y la píldora fueron los métodos más frecuentes (28,2% y 23% respectivamente). La mayoría de las mujeres compró el contraceptivo en la red comercial de farmacias (75,2%), el Sistema Único de Salud (SUS) fue una fuente significativa solamente para la obtención del anticonceptivo hormonal inyectable. El apoyo del Estado al ejercicio de los derechos sexuales y reproductivos sigue siendo insuficiente.

2015 Health Survey of São Paulo with Focus in Nutrition: Rationale, Design, and Procedures.

This paper describes the design, sampling methods, and data collection procedures, with particular focus on dietary data, used for the 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo, 2015 ISA-Capital) with Focus in Nutrition Study (2015 ISA-Nutrition). The ISA is a household cross-sectional, population-based survey that uses complex, stratified, multistage sampling to create a representative sample of residents from urban São Paulo, Brazil. The 2015 ISA-Nutrition comprised a sub-sample of the 2015 ISA-Capital and intended to include 300 adolescents (aged 12 to 19 years), 300 adults (aged 20 to 59 years), and 300 older adults (aged ≥60 years). From February 2015 to February 2016, 1737 individuals answered the first 24-h dietary recall (24HR), and 901 individuals consented to have their blood sample collected, to undergo anthropometric and blood pressure assessment, and to answer the second 24HR. The 2015 ISA-Nutrition aims to evaluate lifestyle-related modifiable factors in São Paulo's residents, as well as their association with biochemical and genetic markers, and environmental aspects related to cardiometabolic risk factors. This paper concludes that 2015 ISA-Nutrition may provide valuable insights into the cardiometabolic risk factors in a big city in an upper middle-income country and contribute to the formulation of health and nutritional policies.

Práticas contraceptivas de mulheres jovens: inquérito domiciliar no Município de São Paulo, Brasil / Prácticas anticonceptivas en mujeres jóvenes: encuesta domiciliaria en el municipio de São Paulo, Brasil / Young women's contraceptive practices: a household survey in the city of São Paulo, Brazil

Iniciativas para ampliar o acesso a contraceptivos ocorreram no Brasil na última década. No entanto, o último estudo de base populacional sobre anticoncepção foi realizado em 2006. Um inquérito domiciliar investigou a prática contraceptiva de mulheres com 15 a 44 anos, residentes no Município de São Paulo em 2015. Para o presente trabalho, foram selecionados os dados relativos às jovens com idade entre 15 e 19 anos. Foram objetivos: identificar a prevalência da anticoncepção, os contraceptivos adotados, suas fontes de obtenção e os diferenciais no uso da contracepção. As jovens integram a amostra probabilística do estudo. Diferenciais do uso de contracepção foram avaliados por meio de regressão logística múltipla. Foram entrevistadas 633 jovens, das quais, 310 (48,5%) haviam iniciado atividade sexual. Dessas, 60% relataram uso de contracepção de emergência pelo menos uma vez na vida. Esse uso foi diretamente proporcional à idade e ao número de parceiros na vida. A prevalência da anticoncepção foi de 81%. A chance de estar usando contraceptivo foi maior entre as residentes na região de saúde com melhor desenvolvimento social, as católicas, as que tiveram relação sexual nos últimos 30 dias e as que realizaram consulta ginecológica no último ano. Foi inversamente proporcional ao número de parceiros na vida. Preservativo masculino e pílula foram os métodos mais frequentes (28,2% e 23%). A maioria das mulheres comprou o contraceptivo na rede comercial de farmácias (75,2%), o Sistema Único de Saúde (SUS) foi fonte significativa apenas para a obtenção do anticoncepcional hormonal injetável. O apoio do Estado ao exercício dos direitos sexuais e reprodutivos segue insuficiente.

En la última década hubo en Brasil iniciativas para ampliar el acceso a anticonceptivos. No obstante, el último estudio de base poblacional sobre anticoncepción se realizó en 2006. Una encuesta domiciliaria investigó la práctica contraceptiva de mujeres de 15 a 44 años, residentes en el municipio de São Paulo en 2015. Para el presente estudio, se seleccionaron los datos relativos a las jóvenes con edad entre 15 y 19 años. Los objetivos fueron: identificar la prevalencia de la anticoncepción, los métodos anticonceptivos adoptados, sus fuentes de obtención y los diferenciales en el uso de métodos anticonceptivos. Las jóvenes integran la muestra probabilística del estudio. Los diferenciales del uso de métodos anticonceptivos fueron evaluados mediante regresión logística múltiple. Se entrevistaron a 633 jóvenes, de las cuales 310 (48,5%) habían comenzado su actividad sexual. De éstas, un 60% informaron el uso de métodos anticonceptivos de emergencia por lo menos una vez en la vida. Este uso fue directamente proporcional a la edad y al número de parejas en su vida. La prevalencia de métodos anticonceptivos fue de un 81%. La oportunidad de estar usando algún método anticonceptivo fue mayor entre las residentes en la región de salud con un mejor desarrollo social, las católicas, las que tuvieron relaciones sexuales en los últimos 30 días y las que fueron a una consulta ginecológica durante el último año. Fue inversamente proporcional al número de parejas en su vida. El preservativo masculino y la píldora fueron los métodos más frecuentes (28,2% y 23% respectivamente). La mayoría de las mujeres compró el contraceptivo en la red comercial de farmacias (75,2%), el Sistema Único de Salud (SUS) fue una fuente significativa solamente para la obtención del anticonceptivo hormonal inyectable. El apoyo del Estado al ejercicio de los derechos sexuales y reproductivos sigue siendo insuficiente.

The last decade has witnessed initiatives to expand access to contraceptives in Brazil. However, the last population-based study on contraception was undertaken in 2006. A household survey in 2015 investigated contraceptive practices in women 15 to 44 years of age living in the city of São Paulo. The current study selected data on young women 15 to 19 years of age. The objectives were to identify the prevalence of contraception, the contraceptives used, sources, and differences in contraceptive practices. The young women are part of a probabilistic study sample. Differences in contraception use were compared by multiple logistic regression analysis. A total of 633 young women were interviewed, of whom 310 (48.5%) were sexually initiated. Of these, 60% reported emergency contraception use at least once in their lives. Emergency contraception use was directly proportional to age and lifetime number of partners. Prevalence of contraception was 81%. The odds of current contraception use were higher among young women residing in the health district of the city with the better social conditions, Catholics, those who reported sexual relations in the previous 30 days, and those with history of an obstetrics and gynaecology visit in the previous year, and inversely proportional to the lifetime number of sex partners. Male condoms and the pill were the most common methods (28.2% and 23%). Most of the women purchased their contraceptives in retail pharmacies (75.2%), and the Brazilian Unified National Health System (SUS) was only a significant source for injectable hormonal contraceptives. Government support for women's sexual and reproductive rights is still insufficient.

Adolescent pregnancy and transition to adulthood in young users of the SUS.

OBJECTIVE: The objective of this study is to contextualize adolescent pregnancy from milestones associated with the process of transition from youth to adulthood. METHODS: This is a cross-sectional study conducted with 200 adolescents, users of the Brazilian Unified Health System. The sample size for the estimation of proportions has been calculated assuming a population ratio of 0.50 and 95% confidence level. The dependent variables - planned pregnancy, living with a partner, and having left the parents' house - have been considered as markers of transition from dependence to independence, from youth to adulthood. In the analysis of the associated factors, we have used the Poisson model with robust variance. RESULTS: Average age was 17.3 years, and most adolescents lived with a partner; approximately half of the adolescents got pregnant from their first partner and the average age of first sexual intercourse was 14.6 years. Only 19% of the adolescents were studying and most dropped out of school before the beginning of the pregnancy. In the bivariate and multiple analysis, we could see that the relationship with a partner for more than two years was associated with the three dependent variables. CONCLUSIONS: The path of transition to adulthood has been the establishment of a link with a partner and consequent pregnancy, suggesting a clear pattern of male guardianship. The changing role of women in society observed in recent decades, which means choosing a professional career, defining the number of children, and choosing their partner(s), has not reached these young persons. OBJETIVO: Contextualizar a gestação em adolescentes a partir de marcos associados ao processo de transição da juventude para a vida adulta. MÉTODOS: Estudo transversal realizado com 200 adolescentes usuárias do Sistema Único de Saúde. O tamanho da amostra para a estimação de proporções foi calculado considerando uma proporção populacional de 0,50, e nível de confiança de 95%. As variáveis dependentes - gestação planejada, morar com o parceiro e ter saído da casa dos pais - foram consideradas marcadores da transição da dependência para a independência, da juventude para a vida adulta. Na análise dos fatores associados, utilizou-se o modelo de Poisson com variância robusta. RESULTADOS: A idade média foi 17,3 anos, a maioria coabitava com o companheiro; aproximadamente metade engravidou do primeiro parceiro e a idade média da primeira relação sexual foi 14,6 anos. Apenas 19% das jovens estudavam e o abandono escolar foi, na maior parte, anterior ao início da gestação. Nas análises bivariadas e na análise múltipla, observou-se que relacionar-se com o parceiro há mais de dois anos se associou às três variáveis dependentes. CONCLUSÕES: O caminho de transição para a vida adulta foi o estabelecimento de um vínculo com um parceiro e consequente maternidade, sugerindo padrão claro de tutela masculina. A mudança do papel da mulher na sociedade observada nos últimas décadas, que implica optar por uma carreira profissional, definir número de filhos e escolher o(s) parceiro(s),não chegou a parcela dessas jovens.

Adolescent pregnancy and transition to adulthood in young users of the SUS / Gravidez na adolescência e transição para a vida adulta em jovens usuárias do SUS

ABSTRACT OBJECTIVE The objective of this study is to contextualize adolescent pregnancy from milestones associated with the process of transition from youth to adulthood. METHODS This is a cross-sectional study conducted with 200 adolescents, users of the Brazilian Unified Health System. The sample size for the estimation of proportions has been calculated assuming a population ratio of 0.50 and 95% confidence level. The dependent variables – planned pregnancy, living with a partner, and having left the parents’ house – have been considered as markers of transition from dependence to independence, from youth to adulthood. In the analysis of the associated factors, we have used the Poisson model with robust variance. RESULTS Average age was 17.3 years, and most adolescents lived with a partner; approximately half of the adolescents got pregnant from their first partner and the average age of first sexual intercourse was 14.6 years. Only 19% of the adolescents were studying and most dropped out of school before the beginning of the pregnancy. In the bivariate and multiple analysis, we could see that the relationship with a partner for more than two years was associated with the three dependent variables. CONCLUSIONS The path of transition to adulthood has been the establishment of a link with a partner and consequent pregnancy, suggesting a clear pattern of male guardianship. The changing role of women in society observed in recent decades, which means choosing a professional career, defining the number of children, and choosing their partner(s), has not reached these young persons.

RESUMO OBJETIVO Contextualizar a gestação em adolescentes a partir de marcos associados ao processo de transição da juventude para a vida adulta. MÉTODOS Estudo transversal realizado com 200 adolescentes usuárias do Sistema Único de Saúde. O tamanho da amostra para a estimação de proporções foi calculado considerando uma proporção populacional de 0,50, e nível de confiança de 95%. As variáveis dependentes – gestação planejada, morar com o parceiro e ter saído da casa dos pais – foram consideradas marcadores da transição da dependência para a independência, da juventude para a vida adulta. Na análise dos fatores associados, utilizou-se o modelo de Poisson com variância robusta. RESULTADOS A idade média foi 17,3 anos, a maioria coabitava com o companheiro; aproximadamente metade engravidou do primeiro parceiro e a idade média da primeira relação sexual foi 14,6 anos. Apenas 19% das jovens estudavam e o abandono escolar foi, na maior parte, anterior ao início da gestação. Nas análises bivariadas e na análise múltipla, observou-se que relacionar-se com o parceiro há mais de dois anos se associou às três variáveis dependentes. CONCLUSÕES O caminho de transição para a vida adulta foi o estabelecimento de um vínculo com um parceiro e consequente maternidade, sugerindo padrão claro de tutela masculina. A mudança do papel da mulher na sociedade observada nos últimas décadas, que implica optar por uma carreira profissional, definir número de filhos e escolher o(s) parceiro(s),não chegou a parcela dessas jovens.

[Comparison of prevalence estimates for health indicators in Campinas, São Paulo State, Brazil, in 2001-2002 (ISA-SP) and 2008-2009 (ISA-Camp)]. / Comparação das estimativas de prevalência de indicadores de saúde no Município de Campinas, São Paulo, Brasil, nos anos de 2001/2002 (ISA-SP) e 2008/2009 (ISA-Camp).

The aim of the study was to compare prevalence estimates of health indicators for adults living in Campinas, São Paulo State, using data from two household surveys (ISA-SP 2001-2002 and ISA-Camp 2008-2009), analyzing data from 941 and 2,637 individuals 18 years and older, respectively. Socio-demographic variables were used to characterize the study population. Prevalence rates and 95% confidence intervals were estimated, and comparisons were performed by prevalence ratios adjusted for sex, age, and education, obtained by Poisson regression with robust variance. Statistically significant differences were observed for prevalence of morbidity, medication, smoking, and lifetime Pap smear and mammogram. Surveillance of health indicators by repeated surveys in the same population can facilitate monitoring goals and objectives by providing support to plan public health interventions.

Comparação das estimativas de prevalência de indicadores de saúde no Município de Campinas, São Paulo, Brasil, nos anos de 2001/2002 (ISA-SP) e 2008/2009 (ISA-Camp) / Comparison of prevalence estimates for health indicators in Campinas, São Paulo State, Brazil, in 2001-2002 (ISA-SP) and 2008-2009 (ISA-Camp) / Comparación de las estimaciones de prevalencia en los indicadores de salud en Campinas, São Paulo, Brasil, durante los años 2001/2002 (ISA-SP) y 2008/2009 (ISA-Camp)

O objetivo do estudo foi comparar estimativas da prevalência de indicadores de saúde para adultos residentes em Campinas, São Paulo, Brasil, utilizando dados de inquéritos domiciliares realizados em diferentes períodos de tempo (ISA-SP 2001/2002 e ISA-Camp 2008/2009), com amostras de 941 e 2.637 indivíduos de 18 anos e mais, respectivamente. Variáveis sociodemográficas caracterizaram a população estudada. Foram estimadas prevalências e seus respectivos intervalos de 95% de confiança e as comparações foram realizadas pelas razões de prevalência ajustadas por sexo, idade e escolaridade, obtidas pela regressão de Poisson com variância robusta. Diferenças estatisticamente significantes foram observadas para as prevalências de: morbidade referida, uso de medicamentos, percentual dos que nunca fumaram, realização dos exames de Papanicolaou e de mamografia, alguma vez na vida. O acompanhamento de indicadores de saúde por inquéritos repetidos em uma mesma população pode facilitar o monitoramento de objetivos e metas fornecendo subsídios ao planejamento de ações em saúde.

The aim of the study was to compare prevalence estimates of health indicators for adults living in Campinas, São Paulo State, using data from two household surveys (ISA-SP 2001-2002 and ISA-Camp 2008-2009), analyzing data from 941 and 2,637 individuals 18 years and older, respectively. Socio-demographic variables were used to characterize the study population. Prevalence rates and 95% confidence intervals were estimated, and comparisons were performed by prevalence ratios adjusted for sex, age, and education, obtained by Poisson regression with robust variance. Statistically significant differences were observed for prevalence of morbidity, medication, smoking, and lifetime Pap smear and mammogram. Surveillance of health indicators by repeated surveys in the same population can facilitate monitoring goals and objectives by providing support to plan public health interventions.

El objetivo del estudio fue comparar las estimaciones de prevalencia en los indicadores de salud para los adultos que viven en Campinas, São Paulo, Brasil, con datos de encuestas de diferentes períodos de tiempo (ISA-SP 2001/2002 y ISA-Camp 2008/2009), con muestras de 941 y 2.637 personas de 18 años y más, respectivamente. Las variables sociodemográficas caracterizaron a la población de estudio. Se estimaron la prevalencia y sus respectivos intervalos de confianza del 95% y las comparaciones se realizaron por razones de prevalencia ajustadas por sexo, edad y educación, obtenidas mediante la regresión de Poisson. Se observaron diferencias estadísticas en la prevalencia de morbilidad, uso de medicamentos, el porcentaje de quienes nunca habían fumado, la realización de citologías vaginales y mamografías, en algún momento de sus vidas. El seguimiento de los indicadores de salud, a través de encuestas repetidas en la misma población, puede facilitar el seguimiento de las metas y objetivos y contribuir a la planificación de acciones de salud.

Comparison of estimates of population-based surveys.

OBJECTIVE: To compare estimates obtained through household and telephone surveys for monitoring, intervention and development of health policies. METHODS: The study analyzed data from 2,526 and 1,900 individuals aged 18 and over, living in Campinas, SP, interviewed by the household survey (ISACamp) and by the telephone survey (Vigitel), respectively. Sex, age and schooling were used to characterize the studied population. Prevalence estimates and 95% confidence intervals were utilized in the analysis. The estimates of the sociodemographic characteristics of the population were compared by t-test for two independent samples and the comparison of the other estimates, according to the type of survey, was performed using Poisson regression. RESULTS: No statistically significant differences were found between the estimates obtained by the two surveys analyzed for overall prevalence of: overweight/obesity, smoking status, mammography in the prior year and Pap smear at least once in life. However, for the estimates of worse perceived health status, health plan affiliation, mammography at least once in life and Pap smear in the prior year, significant differences were found, with a tendency to overestimate data from the telephone survey, except in the case of worse perceived health status. CONCLUSIONS: These findings point to the need for further studies, which may contribute to a better understanding of the differences, given that telephone surveys can provide quick and essential information for monitoring modifiable risk factors for the assessment of interventions and to develop policies promoting health in Brazil.

Comparação de estimativas de inquéritos de base populacional / Comparison of estimates of population-based surveys / Comparación de estimativas de pesquisas de base poblacional

OBJETIVO: Comparar estimativas obtidas de inquéritos domiciliar e telefônico para monitoramento, intervenção e desenvolvimento de políticas de saúde. MÉTODOS: Foram utilizados dados de 2.526 e 1.900 indivíduos de 18 anos e mais, residentes em Campinas, entrevistados pelo inquérito domiciliar e pelo telefônico, respectivamente. As variáveis sexo, faixa etária e escolaridade foram utilizadas para caracterizar a população estudada. Foram calculadas as prevalências e seus respectivos intervalos de confiança de 95%. As estimativas das características sociodemográficas da população foram comparadas pelo teste t. A comparação das estimativas das demais variáveis, segundo o tipo de inquérito, foi feita pela regressão de Poisson. RESULTADOS: Não foram encontradas diferenças estatisticamente significantes entre as estimativas obtidas pelos dois inquéritos para as prevalências globais de: sobrepeso/obesidade, tabagismo, realização de mamografia no ano prévio e de Papanicolaou alguma vez na vida. Para pior saúde percebida, filiação a plano médico de saúde, realização do exame de mamografia alguma vez e de Papanicolaou no ano prévio, observaram-se diferenças significantes, com tendência de superestimação pelos dados do inquérito telefônico, exceto para pior saúde percebida. CONCLUSÕES: Para melhor compreensão das diferenças observadas, outros estudos serão necessários, pois as pesquisas telefônicas podem fornecer informações rápidas e essenciais para o monitoramento de fatores de risco modificáveis, para a avaliação de intervenções e para o desenvolvimento de políticas de promoção à saúde no País.

OBJECTIVE: To compare estimates obtained through household and telephone surveys for monitoring, intervention and development of health policies. METHODS: The study analyzed data from 2,526 and 1,900 individuals aged 18 and over, living in Campinas, SP, interviewed by the household survey (ISACamp) and by the telephone survey (Vigitel), respectively. Sex, age and schooling were used to characterize the studied population. Prevalence estimates and 95% confidence intervals were utilized in the analysis. The estimates of the sociodemographic characteristics of the population were compared by t-test for two independent samples and the comparison of the other estimates, according to the type of survey, was performed using Poisson regression. RESULTS: No statistically significant differences were found between the estimates obtained by the two surveys analyzed for overall prevalence of: overweight/obesity, smoking status, mammography in the prior year and Pap smear at least once in life. However, for the estimates of worse perceived health status, health plan affiliation, mammography at least once in life and Pap smear in the prior year, significant differences were found, with a tendency to overestimate data from the telephone survey, except in the case of worse perceived health status. CONCLUSIONS: These findings point to the need for further studies, which may contribute to a better understanding of the differences, given that telephone surveys can provide quick and essential information for monitoring modifiable risk factors for the assessment of interventions and to develop policies promoting health in Brazil.

OBJETIVO: Comparar estimativas obtenidas de pesquisas domiciliar y telefónica para monitoreo, intervención y desarrollo de políticas de salud. MÉTODOS: Se utilizaron datos de 2.526 y 1.900 individuos de 18 años y más residentes en Campinas, Brasil, entrevistados por pesquisa domiciliar y telefónica, respectivamente. Las variables sexo, grupo etario y escolaridad se utilizaron para caracterizar la población estudiada. Se calcularon las prevalencias y sus respectivos intervalos de confianza de 95%. Las estimativas de las características sociodemográficas de la población se compararon usando el teste t de Student. La comparación de las estimativas de las variables restantes, según el tipo de pesquisa, se hizo a través de la regresión de Poisson. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre las estimativas obtenidas por las dos pesquisas para las prevalencias globales de: sobrepeso/obesidad, tabaquismo, realización de mamografía en el año anterior y de Papanicolaou alguna vez en la vida. Para peor salud percibida, afiliación a plano medico de salud, realización del examen de mamografía alguna vez y de Papanicolaou en el año previo, se observaron diferencias significativas, con tendencia de sobrestimación por los datos de la pesquisa telefónica, excepto para peor salud percibida. CONCLUSIONES: Para mejor comprensión de las diferencias observadas, otros estudios serán necesarios, ya que las pesquisas telefónicas pueden suministrar informaciones rápidas y esenciales para el monitoreo de factores de riesgo modificables, para la evaluación de intervenciones y para el desarrollo de políticas de promoción de la salud en el país.

Sentimento de felicidade em idosos: uma abordagem epidemiológica, ISA-Camp 2008 / Happiness in the elderly: an epidemiological approach in the ISA-Camp 2008 study

O objetivo foi detectar fatores associados à felicidade na população idosa. O estudo é do tipo transversal, de base populacional, com dados de 1.431 idosos do ISA-Camp 2008. A amostragem foi probabilística, por conglomerado e em dois estágios. Foram estimadas as prevalências do sentimento de felicidade por todo o tempo, segundo variáveis sociais, demográficas, de comportamentos e condições de saúde. Os idosos que se sentem felizes por maior tempo são os casados, os que trabalham, são ativos ou insuficientemente ativos no lazer, ingerem bebida alcoólica ocasionalmente, consomem frutas, legumes e verduras todos os dias, não são obesos, apresentam um tempo de sono < 10 horas e dormem bem. As maiores prevalências do maior tempo de felicidade estão nos idosos que não apresentam doenças, que avaliam melhor a própria saúde e apresentam menos incapacidades. O sentimento de felicidade relaciona-se fortemente com vários indicadores de saúde, sugerindo a adequação do uso complementar do indicador para a avaliação de programas de promoção da saúde de idosos.

The objective was to identify factors associated with happiness in the elderly. A cross-sectional, population-based study was conducted in 1,431 elderly under the ISA-Camp 2008 project. The survey used a two-stage probabilistic cluster sample. Prevalence of happiness was measured over time according to socio-demographics variables, health behaviors, and health conditions. High prevalence of happiness was associated with: marital status (married), active working, activity and insufficient leisure-time activity, occasional consumption of alcoholic beverages, daily consumption of fruit, vegetables, and leafy vegetables, normal body mass index, and sleeping less than 10 hours/night and sleeping well. The highest prevalence of long-term happiness was observed among elderly with no reported illness, with better self-rated health, and with less disability. Happiness was strongly related to health indicators, suggesting the adequacy of complementary use of this indicator for evaluating health promotion programs in the elderly.

[Access to the Family Healthcare Program in an area with "extensive" coverage of the private healthcare system]. / Acesso realizado ao Programa de Saúde da Família em área com "alta" cobertura do subsistema privado.

The access profile to the various services offered by the Family Health Program (PSF) in an area with extensive private health system coverage is studied in the city of Santo André, state of São Paulo. The sample was studied in two phases based on the assumption that the use of the activities offered by the Family Health Program is not uniform. Residual, full and partial population groups were therefore considered. Interviews were conducted with 175 individuals and the registered population is composed of full (0.5%), partial (31.0%) and residual (68.5%) users. In the bivariate analysis, significant differences were observed between partial and residual groups in relation to age, income, employment, affiliation to the private subsystem and years of schooling. However, the ratios of prevalence when estimated by the Poisson multiple model indicate that the factors that influence the access profile of the PSF activities are private subsystem membership and income. This highlights the fact that some services offered do not reach more than 20% of the population. Despite the immense potential of innovative proposals incorporated by the PSF, this study shows that there is selective use of its activities by the population, strongly influenced by private subsystem affiliation and income.