Impairments and related social inequalities among adults: a population-based study in São Paulo city, Brazil.

The study of the association of social variables with the prevalence of impairments can provide subsidies for more adequate care and health policies for the most needy people by incorporating social aspects. This article aims to estimate the prevalence of diverse types of impairments, the degree of difficulty, limitations, and the need for help they cause and attest whether this prevalence differ by educational attainment in individuals aged 20 years or older. This is a populational cross-sectional study (2015 Health Survey of São Paulo-ISA Capital). Data from 3184 individuals were analyzed via educational attainment as exposure variable and outcome variables related to visual, hearing, intellectual, and mobility impairments. 19.9% of participants had visual, 7.8%, hearing, 2.7%, intellectual, and 7.4%, mobility impairments. Mobility and intellectual impairments limited participants' daily activities the most, 70.3% and 63.3%, respectively; who, thus, needed the most help: 48.9% and 48.5%, respectively. Lower schooling was associated with a higher prevalence of impairments, greater need for help due to visual and intellectual impairments, and greater limitations due to hearing and visual impairments.

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.

Analysis of education level in access and use of health care services, ISA-Capital, São Paulo, Brazil, 2003 and 2015.

The great socioeconomic inequality that prevails in Brazil and the existence of a national health system with universal coverage places the need to monitor the evolution and social inequities regarding access to these services. This study aims to analyze the changes in the prevalence of health care use and the extent of social inequality in the demand, use and, access, resolution of health problems, satisfaction, and health care use of Brazilian Unified National Health System (SUS) according to education levels in the population living in the urban area of the Municipality of São Paulo, in 2003 and 2015. We analyzed data from two population-based household health surveys (Health Survey in São Paulo City - ISA-Capital) from 2003 and 2015. Dependent variables related to health care use in the two weeks preceding the survey and due to diseases included demand, access, satisfaction, problem resolution, and the public or private nature of the service. Prevalence was estimated using level of education and prevalence ratios (PR) by the Poisson regression. In the period, the demand for health care, access, resolution, and use of public health care increased from 2003 to 2015. Inequities in public health care use changed from 2003 to 2015 according to level of education. We found no social inequities in health care use in the municipality of São Paulo regarding demand, access, satisfaction, and resolution according to levels of education. Results show progress in the use and resolution of health care services, as well as the strong concentration of the use of SUS by the population with lower education. Results indicate the progress that SUS has made, but also show persistent challenges in the use and access to services.

[Factors associated with inequalities in social conditions in the health of elderly white, brown and black people in the city of São Paulo, Brazil]. / Fatores associados às desigualdades das condições sociais na saúde de idosos brancos, pardos e pretos na cidade de São Paulo, Brasil.

The scope of this study is to identify determining factors of disparities in social conditions in the health of non-institutionalized elderly people in the city of São Paulo, from the standpoint of self-declaration of skin color. It is a cross-sectional study with a representative sample of 1,017 elderly participants in the "2015 Health Survey of the Municipality of São Paulo". The analysis used crude and adjusted Poisson regression models, reporting the prevalence ratio and 95% confidence intervals as a measure of association between the variables. In the adjusted analysis, brown and black skin color was positively associated with worse schooling, negative self-assessment of health status, health insurance and access to public health services. On the one hand, black skin color was no longer associated with the lowest income, however, it was associated with arterial hypertension. On the other hand, brown skin color was associated with low income, but not with arterial hypertension. Elderly black and brown people had worse health conditions, less access to private health services and socioeconomic resources. These results are compatible with the hypothesis of structural racism in São Paulo's society and may inform social health policies aimed at promoting health and social justice.

O objetivo deste estudo é identificar fatores determinantes das disparidades das condições sociais na saúde de idosos não institucionalizados na cidade de São Paulo, sob a perspectiva da autodeclaração da cor da pele. Estudo transversal com amostra representativa de 1.017 idosos participantes do "Inquérito de Saúde do Município de São Paulo 2015". A análise utilizou modelos de regressão de Poisson brutas e ajustadas, relatando a razão de prevalências e seus intervalos de 95% de confiança como medida de associação entre as variáveis. Na análise ajustada, a cor da pele parda e preta associou-se, positivamente, com a pior escolaridade, a autoavaliação do estado de saúde negativa, o plano de saúde e o acesso ao serviço de saúde público. De um lado, a cor da pele preta perdeu a associação com a pior renda, no entanto, associou-se com a hipertensão arterial. De outro lado, a cor da pele parda não se associou com a hipertensão arterial, mas com a renda baixa. Idosos pretos e pardos tiveram menos acesso a recursos socioeconômicos, às piores condições de saúde e, também, a serviços de saúde privados. Esses resultados são compatíveis com a hipótese de racismo estrutural na sociedade paulistana e podem instruir políticas sociais na saúde dirigidas à promoção de saúde e justiça social.

Fatores associados às desigualdades das condições sociais na saúde de idosos brancos, pardos e pretos na cidade de São Paulo, Brasil / Factors associated with inequalities in social conditions in the health of elderly white, brown and black people in the city of São Paulo, Brazil

Resumo O objetivo deste estudo é identificar fatores determinantes das disparidades das condições sociais na saúde de idosos não institucionalizados na cidade de São Paulo, sob a perspectiva da autodeclaração da cor da pele. Estudo transversal com amostra representativa de 1.017 idosos participantes do "Inquérito de Saúde do Município de São Paulo 2015". A análise utilizou modelos de regressão de Poisson brutas e ajustadas, relatando a razão de prevalências e seus intervalos de 95% de confiança como medida de associação entre as variáveis. Na análise ajustada, a cor da pele parda e preta associou-se, positivamente, com a pior escolaridade, a autoavaliação do estado de saúde negativa, o plano de saúde e o acesso ao serviço de saúde público. De um lado, a cor da pele preta perdeu a associação com a pior renda, no entanto, associou-se com a hipertensão arterial. De outro lado, a cor da pele parda não se associou com a hipertensão arterial, mas com a renda baixa. Idosos pretos e pardos tiveram menos acesso a recursos socioeconômicos, às piores condições de saúde e, também, a serviços de saúde privados. Esses resultados são compatíveis com a hipótese de racismo estrutural na sociedade paulistana e podem instruir políticas sociais na saúde dirigidas à promoção de saúde e justiça social.

Abstract The scope of this study is to identify determining factors of disparities in social conditions in the health of non-institutionalized elderly people in the city of São Paulo, from the standpoint of self-declaration of skin color. It is a cross-sectional study with a representative sample of 1,017 elderly participants in the "2015 Health Survey of the Municipality of São Paulo". The analysis used crude and adjusted Poisson regression models, reporting the prevalence ratio and 95% confidence intervals as a measure of association between the variables. In the adjusted analysis, brown and black skin color was positively associated with worse schooling, negative self-assessment of health status, health insurance and access to public health services. On the one hand, black skin color was no longer associated with the lowest income, however, it was associated with arterial hypertension. On the other hand, brown skin color was associated with low income, but not with arterial hypertension. Elderly black and brown people had worse health conditions, less access to private health services and socioeconomic resources. These results are compatible with the hypothesis of structural racism in São Paulo's society and may inform social health policies aimed at promoting health and social justice.

Social inequalities in access to cancer screening and early detection: A population-based study in the city of São Paulo, Brazil.

OBJECTIVE: This study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from 2003 to 2015 according to education level. METHOD: This is a cross-sectional population-based study conducted with data from the 2003, 2008, and 2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios. RESULTS: The proportion of Pap smears remained stationary at a high level (>89%) throughout the study period, while access to mammography and PSA tests significantly increased in the 2003‒2015 period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period 2003‒2015. CONCLUSIONS: The inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group.

Analysis of education level in access and use of health care services, ISA-Capital, São Paulo, Brazil, 2003 and 2015 / Análise da escolaridade no acesso e utilização de serviços de saúde, ISA-Capital, São Paulo, Brasil, 2003 e 2015 / Análisis de la educación en el acceso y el uso de los servicios de salud, ISA-Capital, São Paulo, Brasil, 2003 y 2015

The great socioeconomic inequality that prevails in Brazil and the existence of a national health system with universal coverage places the need to monitor the evolution and social inequities regarding access to these services. This study aims to analyze the changes in the prevalence of health care use and the extent of social inequality in the demand, use and, access, resolution of health problems, satisfaction, and health care use of Brazilian Unified National Health System (SUS) according to education levels in the population living in the urban area of the Municipality of São Paulo, in 2003 and 2015. We analyzed data from two population-based household health surveys (Health Survey in São Paulo City - ISA-Capital) from 2003 and 2015. Dependent variables related to health care use in the two weeks preceding the survey and due to diseases included demand, access, satisfaction, problem resolution, and the public or private nature of the service. Prevalence was estimated using level of education and prevalence ratios (PR) by the Poisson regression. In the period, the demand for health care, access, resolution, and use of public health care increased from 2003 to 2015. Inequities in public health care use changed from 2003 to 2015 according to level of education. We found no social inequities in health care use in the municipality of São Paulo regarding demand, access, satisfaction, and resolution according to levels of education. Results show progress in the use and resolution of health care services, as well as the strong concentration of the use of SUS by the population with lower education. Results indicate the progress that SUS has made, but also show persistent challenges in the use and access to services.

A grande iniquidade socioeconômica que prevalece no Brasil e a existência de um sistema nacional de saúde com cobertura universal torna necessário o acompanhamento da evolução e das iniquidades sociais no acesso aos serviços. Analisar as mudanças na prevalência do uso de serviços de saúde e o grau de iniquidade social considerando a demanda, o uso e acesso, resolução de problemas de saúde, satisfação e utilização dos serviços de saúde do Sistema Único de Saúde (SUS), segundo o nível de escolaridade, na população residente na zona urbana do Município de São Paulo, em 2003 e 2015. Foram analisados dados de dois inquéritos domiciliares de saúde de base populacional (Inquérito de Saúde do Município de São Paulo - ISA-Capital) de 2003 e 2015. As variáveis dependentes relacionadas à utilização de serviços de saúde nas duas semanas anteriores à pesquisa e devido à presença de alguma doença incluem: demanda, acesso, satisfação, resolução do problema e a natureza pública ou privada do serviço. A prevalência foi estimada por meio da escolaridade e das razões de prevalência (RP) por regressão de Poisson. Entre 2003 e 2015, a demanda por cuidados de saúde, acesso, resolutividade e utilização de serviços públicos de saúde aumentou. As iniquidades no uso da saúde pública mudaram de 2003 para 2015 quando se trata do nível de escolaridade. Não foram encontradas iniquidades sociais na utilização dos serviços de saúde no Município de São Paulo em termos de demanda, acesso, satisfação e resolutividade, segundo o nível de escolaridade. Os resultados mostram avanços na utilização e resolutividade dos serviços de saúde, bem como uma forte concentração do uso do SUS pela população com menor nível de escolaridade. Os resultados indicam os avanços do SUS, mas também mostram que ainda há desafios no uso e acesso aos serviços.

La gran desigualdad socioeconómica que prevalece en Brasil y la existencia de un sistema nacional de salud con cobertura universal hace necesario el seguimiento de la evolución y de las desigualdades sociales en el acceso a los servicios. Analizar los cambios en la prevalencia del uso de servicios de salud y el grado de desigualdad social considerando la demanda, el uso y acceso, resolución de problemas de salud, satisfacción y utilización de los servicios de salud del Sistema Único de Salud brasileño (SUS), según el nivel de educación, en la población residente en la zona urbana del Municipio de São Paulo, en 2003 y 2015. Se analizaron los datos de dos encuestas de salud domiciliaria de base poblacional (Encuesta de Salud en el Municipio de São Paulo - ISA-Capital) de 2003 y 2015. Las variables dependientes relacionadas con el uso de los servicios de salud en las dos semanas anteriores a la investigación y debido a la presencia de alguna enfermedad incluyen: la demanda, el acceso, la satisfacción, la resolución del problema y la naturaleza pública o privada del servicio. La prevalencia se estimó mediante la educación y las razones de prevalencia (RP) mediante regresión de Poisson. Entre 2003 y 2015, aumentó la demanda de atención médica, el acceso, la resolución y el uso de los servicios de salud pública. Las desigualdades en el uso de la salud pública cambiaron de 2003 a 2015 en lo que respecta al nivel de educación. No fueron encontradas desigualdades sociales en la utilización de los servicios de salud en el municipio de São Paulo en términos de demanda, acceso, satisfacción y resolutividad, según el nivel de educación. Los resultados muestran avances en la utilización y la resolutividad de los servicios de salud, así como una fuerte concentración del uso del SUS por parte de la población con menor nivel de educación. Los resultados indican los avances del SUS, pero también muestran que todavía hay desafíos en el uso y acceso a los servicios.

Social inequalities in access to cancer screening and early detection: A population-based study in the city of São Paulo, Brazil

Abstract Objective: This study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from 2003 to 2015 according to education level. Method: This is a cross-sectional population-based study conducted with data from the 2003, 2008, and 2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios. Results: The proportion of Pap smears remained stationary at a high level (>89%) throughout the study period, while access to mammography and PSA tests significantly increased in the 2003-2015 period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period 2003-2015. Conclusions: The inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group.

The Brazilian congresses of epidemiology.

This paper deals with the first ten epidemiology conferences held by ABRASCO between 1990 and 2017. OBJECTIVE: To provide historical records of these events, highlighting the context in which they were conceived, the chosen themes and their role in the national and international epidemiological landscape, the venues, and the presidents of the different editions. METHODS: Data were extracted from printed and electronic proceedings, with some data gaps that could not be filled. RESULTS: The numbers and characteristics of different activities are also presented, with emphasis on conferences and roundtables, lectures, panels and debates, and the collaboration of the academic and professional community for coordinated communications and posters outlining a wide range of themes and approaches. This paper keeps record of most of the activities carried out. CONCLUSIONS: The authors are aware that the record presented is a pale picture of the real meaning of these meetings in which the development of epidemiology was being built, in an articulation between scholars and health services and as a cooperation between national researchers and our companions and friends who work in foreign institutions all around the world.

Overview of Cardiovascular Disease Risk Factors in Adults in São Paulo, Brazil: Prevalence and Associated Factors in 2008 and 2015

Abstract Background Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in Brazil. Objective To provide population-based data on prevalence and factors associated with CVD risk factors. Methods Individuals aged ≥20 years from two editions of the cross-sectional Health Survey of São Paulo focusing on Nutrition (ISA-Nutrition), performed in Sao Paulo city in 2008 (n=590) and 2015 (n=610), were evaluated for: obesity, central obesity, waist/height ratio, high blood pressure (HBP), dyslipidemia, diabetes, and number of CVD risk factors ≥3. Prevalence was estimated according to complex survey procedures. Factors associated with cardiovascular risk factors were assessed using logistic regression, with statistical significance of p<0.05. Results Obesity and older age were associated with higher odds of all cardiovascular risk factors investigated, except for dyslipidemia. HBP was positively associated with being Black/Brown and negatively associated with being physicaly active in leisure time. Women were more likely to have increased adiposity indicators and three or more cardiovascular risk factors than men. Those with higher education had lower chances of having diabetes, HBP and dyslipidemia, and those with higher income had higher chances of having three or more risk factors. Former smokers had higher odds of diabetes, obesity, and high waist/height ratio, and smokers had higher odds of high non-HDL cholesterol levels. From 2008 to 2015, there was an increase (p<0.001) in the prevalence of diabetes (6.9% to 17.3%), HBP (31.9% to 41.8%), dyslipidemia (51.3% to 67.6%), and number of CVD risk factors ≥3 (18.9% to 34.1%). Conclusion This study shows increasing prevalence of CVD risk factors in adult population in Sao Paulo and may support the definition of target groups and priority actions on CVD prevention and treatment.

Differences in Cost-Effectiveness of Adherence to Nutritional Recommendations: Why, Where, and What?

Cost-effectiveness analysis of diets may comprise an important tool to promote food security; however, studies show divergent evidence regarding the relationship between diet quality and cost in diverse populations. Thus, this study assesses differences in cost-effectiveness ratios regarding adherence to nutritional recommendations using data representative of the population level in Sao Paulo municipality, Brazil. Information from adolescents and adult individuals (n = 1742) was used to estimate diet quality and cost in 2015. Differences in cost-effectiveness ratios were investigated through application of two diet quality indexes and exploration of individuals' personal and contextual characteristics. Results indicated that higher diet cost was associated with higher adherence to nutritional recommendations at the national level and inversely associated with adherence to international recommendations. Purchasing foods in street markets was linked to healthier diets at lower costs, and protein consumption was associated with higher diet cost regardless of diet quality; however, diet quality was linked to type of protein consumed by individuals. Differences in cost-effectiveness ratios were attributable to methodological choices in measuring dietary quality (why); individuals' personal and contextual characteristics, in particular, access to retail equipment (where); and certain food choices (what). Therefore, cost-effectiveness analyses should be tailored to policy goals and local environments to ensure proper assessment of nutrition programs and to foster improvements in nutritional diet quality at lower cost.

The Brazilian congresses of epidemiology / Os congressos brasileiros de epidemiologia

ABSTRACT: This paper deals with the first ten epidemiology conferences held by ABRASCO between 1990 and 2017. Objective: To provide historical records of these events, highlighting the context in which they were conceived, the chosen themes and their role in the national and international epidemiological landscape, the venues, and the presidents of the different editions. Methods: Data were extracted from printed and electronic proceedings, with some data gaps that could not be filled. Results: The numbers and characteristics of different activities are also presented, with emphasis on conferences and roundtables, lectures, panels and debates, and the collaboration of the academic and professional community for coordinated communications and posters outlining a wide range of themes and approaches. This paper keeps record of most of the activities carried out. Conclusions: The authors are aware that the record presented is a pale picture of the real meaning of these meetings in which the development of epidemiology was being built, in an articulation between scholars and health services and as a cooperation between national researchers and our companions and friends who work in foreign institutions all around the world.

RESUMO: O artigo trata dos primeiros dez congressos de epidemiologia realizados pela Associação Brasileira de Saúde Coletiva, entre 1990 e 2017. Objetivo: O objetivo do artigo é prover um registro histórico desses eventos destacando o contexto no qual eles foram concebidos, os temas adotados e seu sentido quanto ao panorama nacional e internacional da disciplina, as sedes e os presidentes das diferentes edições. Métodos: Os dados foram extraídos dos anais impressos ou eletrônicos dos congressos, havendo alguns lapsos nos dados que não puderam ser preenchidos. Resultados: São também apresentados os números e as características das diferentes atividades, com destaque para conferências e mesas-redondas, palestra, painéis e debates e para a colaboração da comunidade acadêmica e profissional para comunicações coordenadas e pôsteres, traçando um amplo painel de temas e abordagens. O artigo registra a maioria das atividades desenvolvidas. Conclusão: Os autores têm consciência de que o registro apresentado é uma pálida imagem do real significado desses encontros, nos quais o desenvolvimento da epidemiologia foi sendo construída na articulação entre a academia e os serviços de saúde e na cooperação entre pesquisadores nacionais e nossos colegas e amigos que atuam em instituições estrangeiras em diferentes partes do mundo.

Health Science, Technology and Innovation Policy (ST&I/H): an update for debate. / Política de Ciência, Tecnologia e Inovação em Saúde (CT&I/S): uma atualização para debate.

The text presents an updated proposal for a Health Science, Technology and Innovation Policy in Brazil, following the huge political turmoil in the country since 2019 and the COVID-19 pandemic since 2020. The proposal is presented in five sections: Scientific Research; Productive Innovation; Health Technology Assessment and Incorporation; Intellectual Property in Health; New challenges posed by the Pandemic. The authors take part in the Advisory Committee in Science, Technology and Innovation of the Brazilian Association of Collective Health.

O texto contém uma proposta atualizada de política de Ciência, Tecnologia e Inovação em Saúde no Brasil e a pertinência da atualização decorre do desastre nas atividades nesse terreno verificadas no país desde o início do atual governo federal em 2019, bem como dos desafios colocados pela emergência da pandemia COVID-19 desde 2020. Ele está organizado em cinco seções, a saber: Pesquisa em Saúde; Inovação Produtiva; Avaliação e Incorporação de Tecnologias em Saúde; Propriedade Intelectual em Saúde; Novos desafios colocados pela Pandemia. Os autores fazem parte do Comitê de Assessoramento em Ciência, Tecnologia e Inovação da Abrasco.

Política de Ciência, Tecnologia e Inovação em Saúde (CT& I/S): uma atualização para debate / Health Science, Technology and Innovation Policy (ST& I/H): an update for debate

Resumo O texto contém uma proposta atualizada de política de Ciência, Tecnologia e Inovação em Saúde no Brasil e a pertinência da atualização decorre do desastre nas atividades nesse terreno verificadas no país desde o início do atual governo federal em 2019, bem como dos desafios colocados pela emergência da pandemia COVID-19 desde 2020. Ele está organizado em cinco seções, a saber: Pesquisa em Saúde; Inovação Produtiva; Avaliação e Incorporação de Tecnologias em Saúde; Propriedade Intelectual em Saúde; Novos desafios colocados pela Pandemia. Os autores fazem parte do Comitê de Assessoramento em Ciência, Tecnologia e Inovação da Abrasco.

Abstract The text presents an updated proposal for a Health Science, Technology and Innovation Policy in Brazil, following the huge political turmoil in the country since 2019 and the COVID-19 pandemic since 2020. The proposal is presented in five sections: Scientific Research; Productive Innovation; Health Technology Assessment and Incorporation; Intellectual Property in Health; New challenges posed by the Pandemic. The authors take part in the Advisory Committee in Science, Technology and Innovation of the Brazilian Association of Collective Health.

Use of medicines in São Paulo, Brazil, and State Health Care Coverage, 2003 and 2015.

OBJECTIVES: To analyze the use and acquisition of medicines in São Paulo, Brazil, in 2003 and 2015, according to sociodemographic factors, socioeconomic status, and health conditions of the population. METHODS: Data were obtained from population health surveys "ISA-Capital". Descriptive analysis, bivariate analysis, and logistic regression models were used to evaluate the use of medicines and coverage by the Brazilian Unified Health System (SUS) according to socioeconomic status and health conditions in two periods: 2003 and 2015. RESULTS: From 2003 to 2015, the surveys showed an increase in the income and education level of the study population. There was no increase in the prevalence of chronic diseases and use of medicines from 2003 to 2015. The provision of medicines by SUS was higher in 2015 than in 2003, and the coverage by SUS was higher in the population with lower education level and income in both 2003 and 2015. CONCLUSIONS: The use of medicines, mainly for chronic disease control, did not change over the years, and there was an increase in SUS coverage for medicines during 2003-2015 in all population groups, with a greater impact on the lower socioeconomic status population. The programs of the provision of medicines implanted since 2003 had influenced the greater SUS coverage for medicines and in the reduction of inequalities in access to medicines.

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.

[The relevance of Public Health Journals in informing research, education, health services, and citizenship]. / Relevância dos periódicos de saúde coletiva em informar a pesquisa, a educação, os serviços de saúde e a cidadania.

This text presents in a synthetic manner the discussions of the working group of the same name, held during the international conference commemorating the twenty years of the SciELO Program. The objective is to inform the Public Health professional field about chronic problems affecting scientific periodicals in Brazil - financing, classification of journals, the impact of published works, among others.

Esse texto apresenta de modo sintético, as discussões do grupo de trabalho de mesmo nome, realizadas durante a conferência internacional comemorativa dos vinte anos do Programa SciELO. O objetivo é informar o meio profissional da saúde coletiva sobre problemas crônicos das publicações científicas no Brasil ­ financiamento, classificação das revistas, impacto dos trabalhos publicados, entre outros.

Relevância dos periódicos de saúde coletiva em informar a pesquisa, a educação, os serviços de saúde e a cidadania / The relevance of Public Health Journals in informing research, education, health services, and citizenship

Resumo Esse texto apresenta de modo sintético, as discussões do grupo de trabalho de mesmo nome, realizadas durante a conferência internacional comemorativa dos vinte anos do Programa SciELO. O objetivo é informar o meio profissional da saúde coletiva sobre problemas crônicos das publicações científicas no Brasil - financiamento, classificação das revistas, impacto dos trabalhos publicados, entre outros.

Abstract This text presents in a synthetic manner the discussions of the working group of the same name, held during the international conference commemorating the twenty years of the SciELO Program. The objective is to inform the Public Health professional field about chronic problems affecting scientific periodicals in Brazil - financing, classification of journals, the impact of published works, among others.

Mix of destinations and sedentary behavior among Brazilian adults: a cross-sectional study.

BACKGROUND: Sedentary behavior is influenced by contextual, social, and individual factors, including the built environment. However, associations between the built environment and sitting time have not been extensively investigated in countries with economies in transition such as Brazil. The objective of this study is to examine the relationship between sitting-time and access to a mix of destinations for adults from Sao Paulo city, Brazil. METHODS: This study uses data from the Health Survey of Sao Paulo. Sedentary behavior was assessed by a questionnaire using two questions: total sitting time in minutes on a usual weekday; and on a usual weekend day. The mix of destinations was measured by summing the number of facilities (comprising bus stops, train/subway stations, parks, squares, public recreation centres, bike paths, primary health care units, supermarkets, food stores, bakeries, and coffee-shops) within 500 m of each participant's residence. Minutes of sitting time in a typical weekday and weekend day were the outcomes and the mix of destinations score in 500 m buffers was the exposure variable. Associations between the mix of destinations and sitting time were examined using multilevel linear regression: these models accounted for clustering within census tracts and households and adjusted for environmental, sociodemographic, and health-related factors. RESULTS: After adjustment for covariates, the mix of destinations was inversely associated with minutes of sitting time on a weekday (ß=- 8.8, p=0.001) and weekend day (ß=- 6.1, p=0.022). People who lived in areas with a greater mix of destinations had shorter average sitting times. CONCLUSION: Greater mix of destinations within 500 m of peoples' residences was inversely associated with sitting time on a typical weekday and weekend day. In Latin American cities like Sao Paulo built environments more favorable for walking may contribute to reducing sedentary behavior and prevent associated chronic disease.