[Multimorbidity and utilization of health services in the city of São Paulo, Brazil: prevalence and associated factors]. / Multimorbidade e utilização de serviços de saúde no município de São Paulo, Brasil: prevalência e fatores associados.

The scope of this paper was to estimate the prevalence of multimorbidity in the city of São Paulo and to verify the factors associated with the utilization of the health services. It involved a population based cross-sectional study based on data from the Health Survey in the city of São Paulo, in which descriptive analysis was conducted, and logistic regression models were developed using multimorbidity and sociodemographic independent variables, living conditions and use of health services as the outcome. A total of 3,184 individuals aged 20 years or older participated, with a mean age of 43.8 years. The prevalence of multimorbidity was 50.7% among women, 62.5% among those who reported some health problem and 55.1% among those who had recourse to health services in the last 2 weeks. A higher prevalence was identified among those who used the health service due to a mental health problem (66.1%), and in those who reported higher health expenditures in the preceding month (55.4%). Multimorbidity was more frequently associated with aging, in the population with a higher economic status, with worse self-rated health, who frequented health services for 6 months or less, who reported a health problem, or who had a health plan and opted for polypharmacy.

O objetivo foi estimar a prevalência de multimorbidade no município de São Paulo e verificar os fatores associados à utilização de serviços de saúde. Estudo transversal de base populacional a partir do Inquérito de Saúde do Município de São Paulo (ISA-Capital 2015), em que foi realizada análise descritiva e foram elaborados modelos de regressão logística utilizando como desfecho a multimorbidade e variáveis independentes sociodemográficas, de condições de vida e utilização de serviços de saúde. Participaram 3.184 indivíduos com 20 anos ou mais, idade média de 43,8 anos. A prevalência de multimorbidade foi de 50,7% entre as mulheres, 62,5% entre os que relataram algum problema de saúde e 55,1% entre os que utilizaram serviços de saúde nas duas últimas semanas. Foi identificada maior prevalência nos indivíduos que usaram serviço de saúde por problema de saúde mental (66,1%) e que informaram maiores despesas com saúde no último mês (55,4%). A multimorbidade foi mais frequente com o envelhecimento, na população com nível econômico mais elevado, com pior autoavaliação de saúde, que utilizou serviços de saúde há seis meses ou menos, que relatou problema de saúde, que tinha plano de saúde e fazia uso da polifarmácia.

Multimorbidity patterns and associated factors in a megacity: a cross-sectional study.

OBJECTIVE: To identify empirical patterns of multimorbidity and quantify their associations with socioeconomic, behavioral characteristics, and health outcomes in the megacity of São Paulo. METHODS: This was a cross-sectional study conducted through household interviews with residents aged 20 years or older in urban areas (n = 3,184). Latent class analysis was used to identify patterns among the co-existence of 22 health conditions. Age-adjusted prevalence ratios were estimated using Poisson regression. RESULTS: The analysis of latent classes showed 4 patterns of multimorbidity, whereas 58.6% of individuals were classified in the low disease probability group, followed by participants presenting cardiovascular conditions (15.9%), respiratory conditions (12.8%), and rheumatic, musculoskeletal, and emotional conditions (12.8%). Older individuals, with lower schooling and lower household income, presented higher multimorbidity prevalence in cardiovascular, respiratory, rheumatic, musculoskeletal, and emotional conditions patterns compared with the low disease probability pattern. CONCLUSION: The results showed four distinct patterns of multimorbidity in the megacity population, and these patterns are clinically recognizable and theoretically plausible. The identification of trends between patterns would make it feasible to estimate the magnitude of the challenge for the organization of health care policies.

Physical activity among older adults with multimorbidity: Evidence from a population-based health survey.

INTRODUCTION: The promotion of physical activity has been recognized as an important component in the management and prevention of multimorbidity, a condition that is increasing prevalent worldwide, including in Brazil. However, there is a scarcity of studies exploring the disparity in physical activity levels between individuals with and without multimorbidity. Therefore, the study aimed to estimate the prevalence of multimorbidity and physical activity among older adults, as well as analyze the relationship of a sufficient level of physical activity and multimorbidity, while considering sociodemographic characteristics of residents in São Paulo, Brazil. MATERIALS AND METHODS: Data from 1.019 participants aged 60 years or older (59.7% female; mean age 69.7±7.7) were collected from the Health Survey (ISA-Capital, 2015) conducted in the city of São Paulo, Brazil. We defined multimorbidity as the presence of two or more chronic conditions, and for physical activity, classified a sufficient level (≥150 min/week). Prevalence Ratios (PR) with 95% Confidence Intervals (95%CI) were estimated using univariate and multivariate Poisson regression to examine the relationship between multimorbidity and sufficient level of physical activity. RESULTS: 67.7% of the participants lived with multimorbidity, while 30.1% had achieved a sufficient level of physical activity. There was a higher prevalence of sufficient level of physical activity among older adults with two (PR = 1.38; 95%CI 1.02-1.88) and four (PR = 1.37; 95%CI 1.00-1.87) chronic conditions. Older adults with multimorbidity who were 70 years or older (PR = 1.77; 95%IC 1.13-2.77), female (PR = 1.65; 95%CI 1.16-2.36), without a partner (PR = 1.43; 95%IC 1.03-1.99), and had a per capita income of 1 to 2.5 (PR = 1.83; 95%IC 1.00-3.33) were more likely to achieve a sufficient level of physical activity compared to their peers without multimorbidity. CONCLUSIONS: The study highlights sociodemographic disparities in the sufficient level of physical activity among multimorbidity, suggesting the importance of considering these factors when planning public policies aimed at promoting physical activity.

Multimorbidity patterns and associated factors in a megacity: a cross-sectional study

ABSTRACT OBJECTIVE To identify empirical patterns of multimorbidity and quantify their associations with socioeconomic, behavioral characteristics, and health outcomes in the megacity of São Paulo. METHODS This was a cross-sectional study conducted through household interviews with residents aged 20 years or older in urban areas (n = 3,184). Latent class analysis was used to identify patterns among the co-existence of 22 health conditions. Age-adjusted prevalence ratios were estimated using Poisson regression. RESULTS The analysis of latent classes showed 4 patterns of multimorbidity, whereas 58.6% of individuals were classified in the low disease probability group, followed by participants presenting cardiovascular conditions (15.9%), respiratory conditions (12.8%), and rheumatic, musculoskeletal, and emotional conditions (12.8%). Older individuals, with lower schooling and lower household income, presented higher multimorbidity prevalence in cardiovascular, respiratory, rheumatic, musculoskeletal, and emotional conditions patterns compared with the low disease probability pattern. CONCLUSION The results showed four distinct patterns of multimorbidity in the megacity population, and these patterns are clinically recognizable and theoretically plausible. The identification of trends between patterns would make it feasible to estimate the magnitude of the challenge for the organization of health care policies.

Multimorbidade e utilização de serviços de saúde no município de São Paulo, Brasil: prevalência e fatores associados / Multimorbidity and utilization of health services in the city of São Paulo, Brazil: prevalence and associated factors

Resumo O objetivo foi estimar a prevalência de multimorbidade no município de São Paulo e verificar os fatores associados à utilização de serviços de saúde. Estudo transversal de base populacional a partir do Inquérito de Saúde do Município de São Paulo (ISA-Capital 2015), em que foi realizada análise descritiva e foram elaborados modelos de regressão logística utilizando como desfecho a multimorbidade e variáveis independentes sociodemográficas, de condições de vida e utilização de serviços de saúde. Participaram 3.184 indivíduos com 20 anos ou mais, idade média de 43,8 anos. A prevalência de multimorbidade foi de 50,7% entre as mulheres, 62,5% entre os que relataram algum problema de saúde e 55,1% entre os que utilizaram serviços de saúde nas duas últimas semanas. Foi identificada maior prevalência nos indivíduos que usaram serviço de saúde por problema de saúde mental (66,1%) e que informaram maiores despesas com saúde no último mês (55,4%). A multimorbidade foi mais frequente com o envelhecimento, na população com nível econômico mais elevado, com pior autoavaliação de saúde, que utilizou serviços de saúde há seis meses ou menos, que relatou problema de saúde, que tinha plano de saúde e fazia uso da polifarmácia.

Abstract The scope of this paper was to estimate the prevalence of multimorbidity in the city of São Paulo and to verify the factors associated with the utilization of the health services. It involved a population based cross-sectional study based on data from the Health Survey in the city of São Paulo, in which descriptive analysis was conducted, and logistic regression models were developed using multimorbidity and sociodemographic independent variables, living conditions and use of health services as the outcome. A total of 3,184 individuals aged 20 years or older participated, with a mean age of 43.8 years. The prevalence of multimorbidity was 50.7% among women, 62.5% among those who reported some health problem and 55.1% among those who had recourse to health services in the last 2 weeks. A higher prevalence was identified among those who used the health service due to a mental health problem (66.1%), and in those who reported higher health expenditures in the preceding month (55.4%). Multimorbidity was more frequently associated with aging, in the population with a higher economic status, with worse self-rated health, who frequented health services for 6 months or less, who reported a health problem, or who had a health plan and opted for polypharmacy.

Atuação do fisioterapeuta nos Núcleos Ampliados de Saúde da Família e Atenção Básica no estado de Sergipe / The physiotherapist in the Expanded Family Health and Primary Care Centers of Sergipe

O objetivo é analisar as características socioeconômicas, de qualificação e a atuação dos fisioterapeutas nos Núcleos Ampliados de Saúde da Família e Atenção Básica em Sergipe. Trata-se de um estudo transversal com caráter quali-quantitativo, com abordagens descritiva e analítica. A amostra foi de 13 fisioterapeutas com predomínio de mulheres, brancas, nascidas em capitais de estados e com 12 ou mais anos de formadas. Com relação às ferramentas tecnológicas do Núcleo Ampliado de Saúde da Família, o apoio matricial foi a única utilizada por todos os participantes. As visitas domiciliares (61,5%) foram as atividades mais realizadas, sendo que dessas, 84,6% ocorreram em equipe e para a população idosa. As ações semanais tinham ênfase na promoção da saúde e prevenção de doenças (69,2%). Quanto ao processo de trabalho, 76,92% relataram que não havia avaliação conjunta entre o Núcleo e gestores, mesma frequência dos que relataram não haver interação entre o Núcleo e o Conselho Municipal de Saúde. Todos afirmaram que ocorria articulação entre o Núcleo e a Equipe de Saúde Família, sendo reconhecido por 53,85% que essa articulação era estabelecida de forma satisfatória. Também foi observada deficiência nos conhecimentos a respeito do Núcleo Ampliado de Saúde da Família e a carência na oferta de capacitações.

The aim is to analyze the socioeconomic characteristics, qualification and the performance of physical therapists in the Family Health and Primary Care Extended Centers in Sergipe. This is a cross-sectional study with a qualitative and quantitative character, with descriptive and analytical approaches. The sample consisted of 13 physiotherapists in which predominantly white women, born in capital and aged 12 or more years since graduation. Regarding the Family Health and Primary Care Extended Centers technological tools, matrix support was the only one used by all participants. Home visits (61.5%) were the most performed activities, of which 84.6% occurred in teams for the elderly population. The weekly actions had an emphasis on health promotion and disease prevention (69.2%). In the work process, 76.9% reported that there was no joint assessment between Family Health and Primary Care Extended Center and manager. The same frequency between Family Health Team and Primary Care Extended Center and municipal health council. Between the Family Health and Primary Care Extended Center and the Family Health Team, all physical therapists reported occurring. There was also a lack of knowledge about the Family Health and Primary Care Extended Center and a lack of training provision.

Multimorbidade no município de São Paulo (SP): prevalência, padrões e fatores associados / Multimorbidity in the city of São Paulo (SP): prevalence, patterns and associated factors

Introdução - Multimorbidade compreende a combinação de duas ou mais condições em saúde e é apontada como prioridade nas agendas dos formuladores de políticas públicas. A prevalência de multimorbidade varia amplamente e há carência de estudos sobre a combinação de diferentes condições em saúde e seus impactos na organização das ações e serviços em saúde. Os inquéritos locais são essenciais para estimar a magnitude do problema da multimorbidade, por possibilitarem identificar as consequências para o estado de saúde dos indivíduos, fundamentar a elaboração de diretrizes clínicas e o planejamento de ações e serviços de saúde. Objetivo - Estimar a prevalência e identificar padrões de multimorbidade no município de São Paulo (SP) e a associação com condições socioeconômicas, de saúde, estilo de vida e utilização de serviços de saúde. Métodos - Trata-se de um estudo transversal realizado por meio de entrevistas domiciliares com residentes em setores de situação urbana no município de São Paulo. Para a análise de dados foram obtidas estimativas de prevalência e intervalos de confiança (95%) e utilizados os modelos de regressão de Poisson e análise de classe latente (LCA) por meio do programa R e do módulo de análise complexa (survey) do pacote estatístico STATA, considerando o peso amostral e os aspectos relacionados ao desenho complexo da amostra: sorteio de conglomerados e estratificação. Resultados - Participaram 3.184 indivíduos com 20 anos ou mais, com idade média de 43,8 anos. A prevalência de multimorbidade foi de 42,2%. No manuscrito 1 foi identificada associação com o sexo feminino, envelhecimento, menor renda familiar, relato de problema de saúde nas últimas duas semanas e nos que utilizaram um serviço de saúde por problema de saúde emocional. A multimorbidade também estava associada com ter plano de saúde, com despesas com saúde e polifarmácia. No 2º manuscrito, a associação foi identificada nos indivíduos que referiram ter pelo menos o ensino superior incompleto, que foram classificados como obesos pelo Índice de Massa Corporal e que apresentaram transtorno mental comum. Além das associações com sexo, idade, renda e estado de saúde identificados no manuscrito 1. No 3º manuscrito, a análise de classes latente identificou quatro padrões de multimorbidade com 58,6% dos indivíduos na classe com baixa probabilidade de doença, seguido por condições cardiovasculares (15,9%), respiratórias (12,8%) e reumatológicas, musculoesqueléticas e emocionais (12,8%). Os indivíduos mais velhos, com menor escolaridade e menor renda familiar dessas três últimas classes apresentaram prevalências de multimorbidade maiores quando comparado aos com baixa probabilidade de doença. Conclusões - Estimou-se a prevalência de multimorbidade em uma megacidade como São Paulo e foram identificados aspectos negativos em saúde que estão associados à multimorbidade. Ademais, distinguiram-se grupos de indivíduos com combinações de condições em saúde. O conhecimento da carga e da complexidade do problema no município pode subsidiar a reorganização da atenção à saúde para os indivíduos com multimorbidade, pois é premente garantir o acesso a ações e serviços adequados às suas necessidades, como a transição para uma abordagem interprofissional centrada na pessoa.

Introduction - Multimorbidity is the co-occurrence of two or more health conditions and features as a priority on the agenda of policymakers. The prevalence of multimorbidity varies widely. There is a lack of studies on the combination of different health conditions and their impact on the proposition of health policies and services. Local surveys are important to estimate the extent of the problem of multimorbidity since they allow the identification of health outcomes, support the development of clinical guidelines and the planning of suitable health policies and services. Objective - Estimating the prevalence and identifying multimorbidity patterns in the city of São Paulo (SP) and their association with the variables: socioeconomic situation, health, lifestyle, and utilization of health services. Methods - This was a cross-sectional study conducted through people living in households in urban areas of São Paulo City. For data analysis, prevalence and confidence interval estimates (95%) were obtained and Poisson regression and latent class analysis (ACL) models were built using the software R and the complex analysis module (survey) of the STATA statistical application, comprising the sample weight and aspects related to the complex design of the sample: clustering and stratification. Results - The 3,184 respondents were aged 20 years or older, with a mean age of 43.8. The prevalence of multimorbidity was 42.2%. Manuscript 1 described associations with the variables: gender, age, low family income, reported health problems during the two weeks before the survey, and utilization of health services to treat emotional problems. Multimorbidity was also associated with paying private health insurance and spending with health and polypharmacy. In the second manuscript, associations were found among respondents who reported having at least an incomplete college education, who were classified as obese according to their body mass index, and who suffered from common mental disorders in addition to the associations with gender, age, income, and health status described by Manuscript 1. In the third manuscript, the latent class analysis identified four patterns of multimorbidity by having 58.6% of the respondents in the class with a low probability of disease, followed by cardiovascular (15.9%), respiratory (12.8%), and rheumatologic, musculoskeletal, and emotional disorders (12.8%). Old people with low schooling and low family income from the latter three classes had a higher prevalence of multimorbidity incidence in the latter three groups than did people with a low probability of diseases. Conclusions - The prevalence of multimorbidity in the megacity of São Paulo was estimated, and it allowed the identification of negative health aspects associated with multimorbidity. In addition, groups of respondents with combinations of health conditions were also distinguished. Awareness of the burden and complexity of the local problem can support the reorganization of health care for multimorbidity patients, given the urgent need to ensure access to policies and services that meet their needs, such as the transition to a person-centered interprofessional approach.

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.

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.

Distribuição do investimento público na assistência fisioterapêutica ambulatorial, Brasil, 2000 a 2006 / Distribution of public investments in physical therapy in outpatient care, Brazil, 2000 to 2006

INTRODUÇÃO: O estudo da distribuição dos recursos financeiros no âmbito das atividades fisioterapêuticas na esfera do SUS é uma importante ferramenta para gestão dos serviços, assim como dos recursos financeiros, humanos e físicos. OBJETIVO: Determinar o perfil de distribuição dos recursos destinados à cobertura dos gastos com atendimento em fisioterapia no nível secundário de atenção à saúde, nas regiões do Brasil, de 2000 a 2006. MATERIAIS E MÉTODOS: Série histórica com dados a respeito do pagamento de atendimento em fisioterapia no setor secundário nas diversas regiões do país. Os dados foram coletados no site do DATASUS. Foi feita uma análise per capita considerando-se as informações populacionais disponibilizadas pelo IBGE. Efetuou-se análise descritiva e análise de correlação de Pearson. RESULTADOS: A região Nordeste apresentou maior investimento per capita no período estudado, R$ 0,4713; e a região Norte a menor, R$ 0,2834. O investimento municipal foi o que mais se ampliou em todas as regiões, houve incremento no valor total de recursos empregados no custeio de sessões de fisioterapia, de 2000 a 2006. CONCLUSÃO: O investimento de recursos financeiros em fisioterapia no nível secundário de atendimento à saúde mostrou padrões diferentes nas diversas regiões do Brasil, com maior contraste entre a região Nordeste e a Norte, com o maior e o menor investimento per capita, respectivamente.

INTRODUCTION: The study of the distribution of financial resources within the physiotherapy activities in the sphere of SUS is an important tool for management services as well as financial, human and physical resources. OBJECTIVE: To determine the profile of distribution of resources to cover costs of physical therapy sessions in a secondary level of health care in different Brazilian geographic areas. MATERIALS AND METHODS: Time series analysis of physical therapy session payments in the secondary level was accomplished from 2000 to 2006. Data were collected from DATASUS website. Per capita analysis was performed based on population information provided by IBGE. Descriptive analysis and Pearson's correlation were carried out. RESULTS: Northeast region showed the greatest per capita investment in the studied period (R$ 0.4713), while the North region had the smallest one (R$ 0.2834). From 2000 to 2006, the city's financial investments in this field increased in all Brazilian regions and the total of resources used to afford physical therapy sessions costs was increased. CONCLUSION: The investment of resources in physical therapy in a secondary level of health care showed different patterns different Brazilian geographic areas.