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.

Challenges and strategies for conducting research in primary health care practice: an integrative review.

BACKGROUND: Providing accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice. OBJECTIVE: To identify challenges and strategies for conducting practice-based research in primary health care services. METHOD: An integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results. RESULTS: Out of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks. CONCLUSION: The challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

What is the influence of lifestyle habits and socioeconomic factors on the occurrence of prostate cancer in Brazil? / ¿Cuál es la influencia de los hábitos de vida y de los factores socioeconómicos en la aparición del cáncer de próstata en Brasil? / Qual a influência de hábitos de vida e fatores socioeconômicos na ocorrência de câncer de próstata no Brasil?

Objective: the investigation of physical, lifestyle and socioeconomic features that may be associated with the occurrence of prostate cancer in Brazil. Methods: a microdata base referring to the 2019 National Health Survey in Brazil was used, with the selection of 42,799 male individuals; this group was analyzed using statistical methods and machine learning modeling (logistic regression and decision tree). Results: the models applied allowed us to identify with a good level of accuracy individuals with prostate cancer diagnosis (DCP), in addition to groups with specific features more strongly associated with such a disease. Conclusion: the models indicate a significant influence of socioeconomic, physical and dietary factors on the frequency of DCP in the analyzed group. The high level of accuracy and sensitivity of the models demonstrates the potential of machine learning methods for predicting DCP.

Objetivo: investigar características físicas, de estilo de vida y socioeconómicas que pueden estar asociadas con la aparición de cáncer de próstata en Brasil. Métodos: se utilizó una base de microdatos referente a la Encuesta Nacional de Salud de 2019, con la selección de 42.799 individuos del sexo masculino; este grupo fue analizado mediante métodos estadísticos y modelado de machine learning (regresión logística y árbol de decisión). Resultados: los modelos aplicados permitieron identificar con buen nivel de exactitud a los individuos con diagnóstico de cáncer de próstata (DCP), además de grupos con características específicas más fuertemente asociadas a esta enfermedad. Conclusión: los modelos indican influencia significativa de factores socioeconómicos, físicos y dietéticos sobre la frecuencia de DCP en el grupo analizado. El alto nivel de exactitud y sensibilidad de los modelos demuestra el potencial de los métodos de machine learning para predecir la DCP.

Objetivo: investigar características físicas, de hábitos de vida e socioeconômicas que podem estar associadas à ocorrência de câncer de próstata no Brasil. Métodos: uma base de microdados referente à Pesquisa Nacional de Saúde 2019 foi utilizada, com a seleção de 42.799 indivíduos do sexo masculino; este grupo foi analisado por meio de métodos estatísticos e modelagem por machine learning (regressão logística e árvore de decisão). Resultados: os modelos aplicados permitiram identificar com bom nível de acurácia os indivíduos que receberam o diagnóstico de câncer de próstata (DCP), além de grupos com características específicas mais fortemente associados a esta doença. Conclusão: os modelos indicam uma influência significativa de fatores socioeconômicos, físicos e alimentares na frequência de DCP no grupo analisado. O alto nível de acurácia e sensibilidade dos modelos demonstra o potencial dos métodos de machine learning para a previsão de DCP.

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.

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.

What are the implications of problem-solving capacity at Primary Health Care in older adult health?

OBJECTIVE: To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. METHODS: A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). RESULTS: Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. "First contact access - use", "longitudinality" and "coordination - information system" were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. CONCLUSION: The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.

What are the implications of problem-solving capacity at Primary Health Care in older adult health?

ABSTRACT Objective To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. Methods A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). Results Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. "First contact access - use", "longitudinality" and "coordination - information system" were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. Conclusion The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.

Rede de atenção à saúde no cuidado do paciente hipertenso, município de São Paulo, Brasil / Delivery of Health Care on Arterial Hypertension patients, São Paulo, Brazil

Pretendeu-se identificar fatores limitantes e favorecedores do modelo de referência e contrarreferência adotado entre os serviços de Atenção Primária à Saúde (APS) e a Atenção Especializada (AE), no cuidado de pacientes hipertensos na Rede de Cuidados Continuados de Saúde (RAS). A população do estudo foi de 158 médicos, cadastrados em 87 equipes de saúde da família, de 25 serviços de APS do distrito de saúde do Campo Limpo, município de São Paulo. Pesquisa de caráter exploratório, descritivo, com abordagem quantitativa. Foi elaborado instrumento de pesquisa contendo identificação geral, formação, tempo de trabalho na APS e tempo de prática clínica; seguidos de 25 frases afirmativas, independentes sobre a temática, apresentadas para atender os objetivos do estudo. Foi utilizada a Escala de Likert para avaliar a concordância para as frases apresentadas. A pesquisa de campo ocorreu em abril de 2018. Participaram do estudo, de forma voluntária, 130 médicos. Foi apontada baixa interlocução entre os profissionais da APS e da AE; fragilidades no processo de trabalho das equipes de saúde da família, no que se refere à gestão da clínica e responsabilidade sanitária, apontando que questões administrativas, relacionadas aos fluxos interno e externo do paciente na RAS estão mais definidas no processo de trabalho das Unidades. Foram observadas fragilidades na integração entre a APS e a AE, apontando desafios a serem enfrentados, para a melhor integração, interlocução e qualidade do cuidado dos pacientes hipertensos.

It is intended to identify limiting and favorable factors of the reference and counter-reference model adopted between the PHC services and the Specialized Care (SC|), in the care of hypertensive patients. The study population consisted of 158 doctors, registered in 87 family health teams of 25 from PHC services in the health district of Campo Limpo, municipality of São Paulo, Brazil. Exploratory, descriptive research with a quantitative approach. A research instrument was prepared containing general identification, training, working time in the PHC and clinical practice time; followed by 25 affirmative sentences. The Likert Scale was used to assess the agreement for the sentences presented. Data was collected in April 2018. 130 physicians participated in the study. Low interlocution was pointed out between PHC and SC professionals; weaknesses in the work process of family health teams, regarding to clinic management and health responsibility, pointing out that administrative issues related to the patient's internal and external flows in the health care services are more defined in the work process of the Units. Weaknesses were observed in the integration between PHC and SC, with challenges to be faced, for better integration, dialogue and quality of care for hypertensive patients. It is proposed that further studies be carried out in the territory, considering other professional categories, as well in Specialized Health Care Services.

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.

Factors Associated with SARS-CoV-2 Infection among Oral Health Team Professionals

ABSTRACT Objective: To analyze the factors associated with the SARS-CoV-2 infection among oral health professionals. Material and Methods: This was a cross-sectional study in the city of São Paulo, São Paulo State, Brazil. Professionals from three different categories were included: dental surgeons (DS), dental assistants (DA), and dental hygienists (DH). A questionnaire was created on a digital platform and sent via institutional email to each subject. The questionnaire contained 32 questions about sociodemographic, work, and behavior factors. The data about SARS-CoV-2 infection was confirmed through RT-PCR exams. Descriptive (absolute and relative frequencies) and inferential analyses (chi-squared or Fisher's exact test) (p<0.05) were performed. Results: There was a SARS-CoV-2 infection prevalence of 3.8% for DS, 30.0% for DH, and 33.3% for DA. SARS-CoV-2 was associated with a lower income (p=0.027), a lower education level (p=0.011), the category of technical professionals (DA and DH) (p=0.025), and using public transportation to commute to work (p=0.009). Conclusion: Sociodemographic factors like lower income and education levels and work factors like job category and public transportation were associated with COVID-19 among professionals on the oral health teams.

Risk assessment for oral urgent treatment in Primary Healthcare: a cross-sectional study.

BACKGROUND: The World Health Organization has advocated for the integration of dental care into the primary healthcare (PHC) setting, including oral urgent treatment (OUT). However, the knowledge necessary for OUT implementation in this setting is still limited. Thus, this study aimed to describe the impact of the implementation of oral disease risk assessment tools for oral health management in PHC. METHODS: This was a cross-sectional study that included individuals served by a single public PHC unit, with integrated oral healthcare teams, located in the south region of the city of São Paulo, Brazil, between April of 2015 and March of 2017. Data were collected from dental records. Three co-primary endpoints: same day treatment offered, first future appointment scheduled fulfilled, and treatment plan completed were compared before and after the implementation of oral disease risk assessment for OUT. RESULTS: A total of 1214 individuals that sought OUT, 599 before and 615 after the implementation of oral disease risk assessment for OUT were included in the study. All three co-primary endpoints had significant changes after the implementation of oral disease risk assessment for OUT. Individuals were significantly more likely to be offered same day treatment after (39.9%; 95% CI:36.0-43.9%) than before (9.4%; 95% CI: 7.2-12.0%), to fulfill their first future appointment scheduled after (34.9%; 95% CI:31.1-38.8%) than before (20.7%; 95% CI: 17.5-24.2%), and to have their treatment plan completed after (14.3%; 95% CI:11.6-17.4%) than before (10.0%; 95% CI: 7.7-12.7%) the intervention. CONCLUSIONS: This study provided evidence of the positive impact oral disease risk assessment tools could have in the organization of OUT in PHC settings.

Correction: Leisure-time physical activity and sports in the Brazilian population: A social disparity analysis.

[This corrects the article DOI: 10.1371/journal.pone.0225940.].

Leisure-time physical activity and sports in the Brazilian population: A social disparity analysis.

OBJECTIVES: To estimate the prevalence of leisure-time physical activity (LTPA) or sports in the Brazilian population according to demographic and income variables. METHODS: Data from 60,202 Brazilian individuals (18 years and over) were analyzed, belonging to the National Health Survey 2013 sample. The prevalence of different modalities of LTPA and sports was estimated according to age, sex, skin color and income. The adjusted prevalence ratios were estimated by Poisson regression. RESULTS: Of every thousand Brazilians, 695 do not practice LTPA or sports. Walking is the most practiced LTPA (98/1000), followed by soccer (68/1000) and weight training (45/1000). For poor and black men, the most frequent LTPA was soccer, and, for women, gymnastics and walking. The prevalence of weight training and gymnastics was higher for white people compared with black people. All LTPA practices were more prevalent in individuals with higher income, except for soccer. Running on a treadmill and weight training had, respectively, 24.7 and 6.4 times higher prevalence in the richer quartile. CONCLUSIONS: The study allowed identifying the type of LTPA and sport reported as the most frequent by the Brazilian population according to age, sex, skin color, and income, detecting strong social disparities in these practices.

Social inequalities in the prevalence of indicators of active aging in the Brazilian population: National Health Survey, 2013. / Desigualdades sociais na prevalência de indicadores de envelhecimento ativo na população brasileira: Pesquisa Nacional de Saúde, 2013.

OBJECTIVE: To analyze social inequalities in the prevalence of indicators of active aging in the Brazilian older adult population. METHODS: This is a cross-sectional study with a sample of 11,177 older adults who participated in the Brazilian National Health Survey in 2013. We estimated the prevalence of five domains of active aging (social activities, civic engagement, leisure-time physical activity, paid work, and volunteer work) according to gender, ethnicity, schooling, income, and private health insurance. Prevalence ratios and confidence intervals were calculated using Poisson regression. RESULTS: The percentage of involvement in organized social activities, civic engagement, and physical activity was 25.1, 12.4, and 13.1%, respectively. Regarding work, 20.7% of the sample had a paid job, and 9.7% participated in volunteer work. Women had a higher prevalence of participation in organized social activities and volunteer work; while civic engagement and paid work were more frequent among men. White people were more likely to participate in social activities, volunteer work, and leisure-time physical activity, explained by their schooling. The strata with a higher level of schooling, income, and who had private health insurance showed a greater incidence of participation in all activities studied. CONCLUSION: The five activities analyzed are challenging for the proposed policy of active aging, as they are marked by considerable social inequality.

OBJETIVO: Analisar desigualdades sociais na prevalência de indicadores de envelhecimento ativo na população idosa brasileira. MÉTODOS: Estudo transversal com amostra de 11.177 idosos que participaram da Pesquisa Nacional de Saúde do Brasil em 2013. Estimaram-se as prevalências de cinco domínios do envelhecimento ativo (atividades sociais, participação cívica, atividade física de lazer, trabalho remunerado e trabalho voluntário) segundo sexo, raça/cor, escolaridade, renda e posse de plano privado de saúde. As razões de prevalência e os intervalos de confiança foram calculados pela regressão de Poisson. RESULTADOS: O percentual de envolvimento em atividades sociais organizadas, participação cívica e atividade física foi de 25,1; 12,4 e 13,1%, respectivamente. Em relação ao trabalho, 20,7% exerciam trabalho remunerado e 9,7% participavam de trabalho voluntário. As mulheres apresentaram maiores prevalências de participação em atividades sociais organizadas e em trabalho voluntário; e entre os homens prevaleceu a participação cívica e o trabalho remunerado. Entre os brancos, foram observadas maiores frequências de participação em atividades sociais, trabalho voluntário e atividade física de lazer, explicadas pela escolaridade. E os estratos com maior nível de escolaridade, renda e com posse de plano privado de saúde apresentaram maiores prevalências de participação em todas as atividades consideradas. CONCLUSÃO: As cinco atividades analisadas se apresentam como desafiadoras à proposta política de envelhecimento ativo por serem marcadas por considerável desigualdade social.

Use of antihypertensive and antidiabetic medications in Brazil: an analysis of socioeconomic differences. National Health Survey, 2013. / Utilização de anti-hipertensivos e antidiabéticos no Brasil: análise das diferenças socioeconômicas. Pesquisa Nacional de Saúde 2013.

OBJECTIVES: To analyze the socioeconomic and demographic differences in medication use to control hypertension and diabetes mellitus in Brazil. METHOD: Data from the National Health Survey (Pesquisa Nacional de Saúde - PNS) performed in Brazil in 2013 with a representative sample of the population aged 18years old or older were analyzed. The use of medications for hypertension and diabetes according to income, education, race, possession of a private health insurance plan and region of household were estimated. Theprevalence ratios adjusted for sex and age were also estimated using Poisson regression. RESULTS: 81.4% of the hypertensive population used medication to control the disease. The use was higher among females, white/Caucasian individuals and those with a private health plan. In the case of diabetes mellitus, 80.2% of the population used medication to control the disease and the use was higher in elderly patients, patients with a higher level of education, patients with a private health plan, and patients in the Southeast region. Inequalities according to income and health plan were small even in the strata of sex, age and geographic region analyzed. CONCLUSION: We found a high use of medication to control hypertension and diabetes. Socioeconomic inequalities in use were not expressive, probably due to medication policies that promote greater and equitable access to medicines in Brazil.

OBJETIVOS: Avaliar a magnitude de desigualdades socioeconômicas e demográficas da utilização de medicamentos para controle de hipertensão arterial e diabetes mellitus na população brasileira. MÉTODO: Foram analisados dados da Pesquisa Nacional de Saúde (PNS) conduzida no Brasil em 2013, com amostra representativa da população com idade de 18 anos ou mais. Foi estimada a utilização de medicamentos para hipertensão e diabetes segundo renda, escolaridade, raça, posse de plano de saúde e região de moradia. Também foram estimadas as razões de prevalência ajustadas por sexo e idade, por meio de regressão de Poisson. RESULTADOS: Entre os hipertensos, 81,4% fazem uso de medicamentos para controle da doença, sendo a utilização maior entre as mulheres, os brancos e os que têm plano de saúde. No caso de diabetes mellitus, 80,2% fazem uso de medicamentos para controlar a doença e o uso foi mais elevado entre os pacientes idosos, com maior escolaridade, com plano de saúde e da Região Sudeste. As desigualdades segundo renda e plano de saúde foram de pequena magnitude mesmo nos estratos de sexo, idade e região geográfica analisados. CONCLUSÃO: Foi constatada utilização de medicamentos para controle da hipertensão e diabetes que pode ser considerada elevada, e as desigualdades socioeconômicas e regionais desse uso revelaram-se de magnitude não expressiva, em virtude da implementação de políticas farmacêuticas no Brasil, que visam promover maior e mais equânime acesso da população a medicamentos.