Popular knowledge of stroke in São Paulo: a cross-sectional study within the World Stroke Campaign

ABSTRACT BACKGROUND: Stroke is the second leading cause of death in Brazil and the main cause of disability. Inability to identify alarm signals causes delays in seeking emergency services, thereby leading to a worse prognosis. OBJECTIVES: To assess the population's knowledge of how to recognize and prevent stroke. DESIGN AND SETTING: Prospective cross-sectional study on data derived from a questionnaire that was administered during the 2016 World Stroke Campaign, launched in the city of São Paulo, Brazil. METHODS: Data on 806 interviewees were evaluated using descriptive statistics and univariate and multivariate analyses. RESULTS: Among all the interviewees, 52.1% knew how to conceptualize stroke; 70.07% knew someone who had suffered a stroke; and 29.03% listed three or more risk factors. Only 27.5% mentioned controlling high blood pressure as a preventive measure. In the event of witnessing a stroke, 57.8% would call the emergency service and 2.9% would check the timing. Less educated individuals were 5.6 times more likely (95% confidence interval, CI 3.45-9.02) to have poor knowledge of stroke, compared with the more educated group. Knowing someone who had had a stroke reduced the chances of not knowing the terms relating to the disease (odds ratio, OR = 0.56; 95% CI 0.4-0.78). CONCLUSIONS: Despite the severity and prevalence of stroke, the population still has little information on this disease. In this context, the importance of mounting campaigns to improve prevention and treatment and to contribute to healthcare policies becomes evident.

Popular knowledge of stroke in São Paulo: a cross-sectional study within the World Stroke Campaign.

BACKGROUND: Stroke is the second leading cause of death in Brazil and the main cause of disability. Inability to identify alarm signals causes delays in seeking emergency services, thereby leading to a worse prognosis. OBJECTIVES: To assess the population's knowledge of how to recognize and prevent stroke. DESIGN AND SETTING: Prospective cross-sectional study on data derived from a questionnaire that was administered during the 2016 World Stroke Campaign, launched in the city of São Paulo, Brazil. METHODS: Data on 806 interviewees were evaluated using descriptive statistics and univariate and multivariate analyses. RESULTS: Among all the interviewees, 52.1% knew how to conceptualize stroke; 70.07% knew someone who had suffered a stroke; and 29.03% listed three or more risk factors. Only 27.5% mentioned controlling high blood pressure as a preventive measure. In the event of witnessing a stroke, 57.8% would call the emergency service and 2.9% would check the timing. Less educated individuals were 5.6 times more likely (95% confidence interval, CI 3.45-9.02) to have poor knowledge of stroke, compared with the more educated group. Knowing someone who had had a stroke reduced the chances of not knowing the terms relating to the disease (odds ratio, OR = 0.56; 95% CI 0.4-0.78). CONCLUSIONS: Despite the severity and prevalence of stroke, the population still has little information on this disease. In this context, the importance of mounting campaigns to improve prevention and treatment and to contribute to healthcare policies becomes evident.

Epidemiological profile of tuberculosis in São Paulo municipality from 2006 to 2013. / Perfil epidemiológico da tuberculose no município de São Paulo de 2006 a 2013.

BACKGROUND: Tuberculosis is a serious public health problem that still persists in the world and in Brazil. The municipality of São Paulo, Brazil, is among the prioritized ones in the country for disease control. OBJECTIVE: To describe the epidemiological profile of all new tuberculosis cases in São Paulo municipality reported between the years 2006 and 2013. METHODS: The variables selected for the study were: socioeconomic, demographic and clinical-epidemiologic obtained through the online information system TB-WEB. A descriptive analysis of the data was performed to undertake the comparison among the years. To study the historical series, linear trend analysis was held. RESULTS AND DISCUSSION: There was an increase in the tuberculosis incidence rate in children under 15 years and in homeless people. The cure rate has improved as the proportion of completion of supervised treatment and the proportion of cases diagnosed by primary care clinics. The disease is unevenly distributed within the municipality of São Paulo and there are districts that were not able to improve the tuberculosis control. CONCLUSION: The municipal tuberculosis program control needs to target the vulnerable groups and the regions of the city where the incidence rates are higher.

INTRODUÇÃO: A tuberculose é um grave problema de saúde que ainda persiste no mundo e no Brasil. O município de São Paulo é considerado prioritário para o controle da doença. OBJETIVO: Descrever o perfil epidemiológico de todos os casos novos de tuberculose no município de São Paulo notificados entre os anos de 2006 e 2013. MÉTODOS: As variáveis selecionadas para o estudo foram as socioeconômicas, demográficas e as clínico-epidemiológicas obtidas através do sistema de informação online TB-WEB. Foi realizada uma análise descritiva dos dados e feita a comparação entre os anos. Para estudo da série histórica realizou-se análise de tendência linear. Um mapa temático foi confeccionado para visualizar a distribuição da doença no espaço urbano da cidade. RESULTADOS E DISCUSSÃO: Houve um aumento da taxa de incidência-ano da tuberculose em menores de 15 anos e em moradores de rua. A taxa de cura melhorou, bem como a proporção de realização do tratamento supervisionado e a proporção dos diagnósticos feitos pela Atenção Básica. A doença está desigualmente distribuída no espaço do município, sendo que há distritos administrativos que não estão conseguindo progredir com relação ao seu controle. CONCLUSÃO: O programa municipal de controle da tuberculose necessita envidar esforços para os grupos vulneráveis para a tuberculose identificados e para as regiões da cidade com maior taxa de incidência-ano da doença.

Perfil epidemiológico da tuberculose no município de São Paulo de 2006 a 2013 / Epidemiological profile of tuberculosis in São Paulo municipality from 2006 to 2013

RESUMO: Introdução: A tuberculose é um grave problema de saúde que ainda persiste no mundo e no Brasil. O município de São Paulo é considerado prioritário para o controle da doença. Objetivo: Descrever o perfil epidemiológico de todos os casos novos de tuberculose no município de São Paulo notificados entre os anos de 2006 e 2013. Métodos: As variáveis selecionadas para o estudo foram as socioeconômicas, demográficas e as clínico-epidemiológicas obtidas através do sistema de informação online TB-WEB. Foi realizada uma análise descritiva dos dados e feita a comparação entre os anos. Para estudo da série histórica realizou-se análise de tendência linear. Um mapa temático foi confeccionado para visualizar a distribuição da doença no espaço urbano da cidade. Resultados e discussão: Houve um aumento da taxa de incidência-ano da tuberculose em menores de 15 anos e em moradores de rua. A taxa de cura melhorou, bem como a proporção de realização do tratamento supervisionado e a proporção dos diagnósticos feitos pela Atenção Básica. A doença está desigualmente distribuída no espaço do município, sendo que há distritos administrativos que não estão conseguindo progredir com relação ao seu controle. Conclusão: O programa municipal de controle da tuberculose necessita envidar esforços para os grupos vulneráveis para a tuberculose identificados e para as regiões da cidade com maior taxa de incidência-ano da doença.

ABSTRACT: Background: Tuberculosis is a serious public health problem that still persists in the world and in Brazil. The municipality of São Paulo, Brazil, is among the prioritized ones in the country for disease control. Objective: To describe the epidemiological profile of all new tuberculosis cases in São Paulo municipality reported between the years 2006 and 2013. Methods: The variables selected for the study were: socioeconomic, demographic and clinical-epidemiologic obtained through the online information system TB-WEB. A descriptive analysis of the data was performed to undertake the comparison among the years. To study the historical series, linear trend analysis was held. Results and discussion: There was an increase in the tuberculosis incidence rate in children under 15 years and in homeless people. The cure rate has improved as the proportion of completion of supervised treatment and the proportion of cases diagnosed by primary care clinics. The disease is unevenly distributed within the municipality of São Paulo and there are districts that were not able to improve the tuberculosis control. Conclusion: The municipal tuberculosis program control needs to target the vulnerable groups and the regions of the city where the incidence rates are higher.

Health social inequality of the homeless in the city of São Paulo / Desigualdade social em saúde na população em situação de rua na cidade de São Paulo

To describe the sociodemographic characteristics, health status and access to services of the population living on the streets in a sample obtained from three homeless shelters in the downtown area of Sao Paulo. The sample included 251 subjects: 171 males, 78 females and 2 people who reported themselves as transgender. A structured questionnaire was applied about: sociodemographic characteristics, time on the street, physical activity, discrimination, social network and support, health status, alcohol or drug use, violence and access to health services. The subjects were adults, non-white, low education level, and with a monthly income lower than half the minimum wage. A third of the respondents had already been in this situation for more than 5 years. The health status for 45% of the respondents was considered good or very good health. The majority preferred to use primary care centers when needed and the precarious financial conditions and lack of family added to physical violence situations. Discrimination, poor hygiene and physical or mental disabilities are common in their lives. The challenge of formulating health policy is to incorporate the representations and care practices of these individuals, but also the services, as a starting point for organizing care.

Descrever as características sociodemográficas, o estado de saúde e o acesso a serviços na população em situação de rua em uma amostra em três albergues do centro da cidade de São Paulo. Amostra de 251 indivíduos: 171 do sexo masculino, 78 do sexo feminino e duas pessoas que se autodenominaram transexuais. Foi aplicado um questionário estruturado contendo dados sociodemográficos, trajetória e tempo de vida na rua, atividade física, discriminação, rede e suporte social, estado de saúde, consumo de álcool ou drogas, violência e acesso a serviços de saúde. Verificou-se o predomínio de adultos do sexo masculino, não brancos, com baixo nível de escolaridade, e com renda mensal menor que 1/2 (meio) salário mínimo. Um terço dos entrevistados já se encontrava nessa situação há mais de cinco anos. 45% dos entrevistados consideraram sua saúde boa ou muito boa. A maioria prefere utilizar as unidades básicas de saúde quando tem necessidade. As precárias condições financeiras e ausência de família somam-se às situações de violência física sofrida. Discriminação, péssimas condições de higiene e incapacidade física ou mental são comuns em suas vidas. O desafio que se coloca para a formulação da política de saúde é incorporar as representações e as práticas de cuidados desses sujeitos, como também dos serviços, como ponto de partida para a organização da assistência.

Fatores que influenciam o aluno na escolha da especialidade médica / Factors that influence the student's choice of medical specialty

A escolha da especialidade define a carreira profissional de um médico. Pesquisas que visem analisar os fatores que impulsionam os alunos nessa decisão são importantes para entendermos os anseios dos estudantes e planejar estratégias educacionais correspondentes à necessidade do sistema de saúde brasileiro. O presente estudo analisou os fatores que influenciam a escolha da especialidade, correlacionando-os ao ano letivo e com aspectos socioeconômicos dos estudantes de Medicina da Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP) . Trata-se de um estudo transversal, realizado com 456 alunos do primeiro ao sexto ano da FCMSCSP que responderam a um questionário, divididos em três grupos: primeiro ciclo (primeiro e segundo anos) , segundo ciclo (terceiro e quarto anos) e terceiro ciclo (quinto e sexto anos) . Os fatores estatisticamente significantes na comparação entre os ciclos foram: horas de trabalho, qualidade de vida, tempo livre para lazer, enriquecimento precoce, recompensa financeira, relação médico-paciente, conteúdo cognitivo da especialidade, conselhos de amigos e de parentes. Qualidade de vida, retorno financeiro e influências de terceiros foram os mais importantes para a escolha das especialidades.

The choice of specialty defines the career of a doctor. Studies to analyze the factors that contribute to the student's decision are important to reveal the students' expectations and to plan strategies relevant to the needs of the Brazilian health system. The present study analyzed the factors that influence the choice of specialty correlating them to the academic year and socioeconomic aspects of medical students of the Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP) . This is a cross-sectional study with 456 first to sixth year students at FCMSCSP who answered a questionnaire and were divided into 3 groups: First cycle (first and second years) , second cycle (third and fourth years) and third (fifth and sixth years) . Statistically significant factors in comparisons between the cycles were: hours of work, quality of life, free time for leisure activities, early enrichment, financial reward, doctor-patient relationship, the cognitive content of the specialty, advice from friends and relatives. Quality of life, financial return and third-party influences were shown to be the most important factors in the choice of specialties.

Social class: concepts and operationalization models in health research.

This article discusses the use of the concept of class in health research, different sociological approaches to social stratification and class structure, and the explanatory potential of the class concept in studies on social determinants and health inequalities. It also elaborates on the operationalization models that have been developed for use in sociological, demographic, or health research, as well as the limitations and scope of these models. Four main operationalization models were highlighted: the model developed by Singer for studies on income distribution in Brazil and adapted by Barros for use in epidemiological research, the model of Bronfman and Tuirán to study the Mexican demographics census and adapted by Lombardi for epidemiological research, the model proposed by Goldthorpe for socioeconomic studies in the UK and adapted by the Spanish Society of Epidemiology, and the model proposed by Wright for research in sociology and political science, which has also been used in population surveys in health. In conclusion, each of the models presented is consistent with their underlying theoretical concept, precluding the selection of one model over the others.

Living conditions and access to health services by Bolivian immigrants in the city of São Paulo, Brazil.

Bolivian immigrants in Brazil experience serious social problems: precarious work conditions, lack of documents and insufficient access to health services. The study aimed to investigate inequalities in living conditions and access to health services among Bolivian immigrants living in the central area of São Paulo, Brazil, using a cross-sectional design and semi-structured interviews with 183 adults. According to the data, the immigrants tend to remain in Brazil, thus resulting in an aging process in the group. Per capita income increases the longer the immigrants stay in the country. The majority have secondary schooling. Work status does not vary according to time since arrival in Brazil. The immigrants work and live in garment sweatshops and speak their original languages. Social networks are based on ties with family and friends. Access to health services shows increasing inclusion in primary care. The authors conclude that the immigrants' social exclusion is decreasing due to greater access to documentation, work (although precarious), and the supply of health services from the public primary care system.

Living conditions and access to health services by Bolivian immigrants in the city of São Paulo, Brazil / Condições de vida e acesso a serviços de saúde de imigrantes bolivianos no centro da cidade de São Paulo, Brasil / Condiciones de vida y acceso a servicios de salud por los inmigrantes bolivianos en el centro de la ciudad de São Paulo, Brasil

Bolivian immigrants in Brazil experience serious social problems: precarious work conditions, lack of documents and insufficient access to health services. The study aimed to investigate inequalities in living conditions and access to health services among Bolivian immigrants living in the central area of São Paulo, Brazil, using a cross-sectional design and semi-structured interviews with 183 adults. According to the data, the immigrants tend to remain in Brazil, thus resulting in an aging process in the group. Per capita income increases the longer the immigrants stay in the country. The majority have secondary schooling. Work status does not vary according to time since arrival in Brazil. The immigrants work and live in garment sweatshops and speak their original languages. Social networks are based on ties with family and friends. Access to health services shows increasing inclusion in primary care. The authors conclude that the immigrants' social exclusion is decreasing due to greater access to documentation, work (although precarious), and the supply of health services from the public primary care system.

Os bolivianos no Brasil têm problemas sociais evidentes: inserção precária no trabalho, falta de documentos e necessidades em saúde. O estudo teve por objetivo conhecer as desigualdades geradas pelas condições de vida e de acesso aos serviços de saúde entre os imigrantes bolivianos na cidade de São Paulo, Brasil. Foi feito um estudo transversal com 183 adultos, subdivididos pelo tempo de residência no país, com aplicação de questionário semiestruturado. Os dados evidenciaram a permanência e o envelhecimento desses imigrantes. A renda per capita é ascendente conforme o tempo no país; na formação escolar predomina o nível médio; o tempo de permanência no Brasil não altera a situação de trabalho; trabalham e vivem nas confecções e falam suas línguas de origem. Predominam as redes sociais familiares e de amigos. O acesso aos serviços de saúde ocorre com progressiva inclusão em ações de atenção primária. Concluímos que há um processo de exclusão decrescente, que acontece pelo acesso à documentação, ao trabalho, ainda que precário, e pela oferta de serviços da rede pública de atenção primária em saúde.

Los bolivianos en Brasil tienen evidentes problemas sociales: inserción precaria en el trabajo, falta de documentos y necesidades de salud. El estudio tiene como objetivo identificar las desigualdades generadas por las condiciones de vida y el acceso a los servicios de salud entre los inmigrantes bolivianos en São Paulo, Brasil. Se realizó un estudio transversal con 183 adultos, dividido por el tiempo de residencia en el país, con la aplicación de un cuestionario semi-estructurado. Los datos mostraron la permanencia de estos inmigrantes y el envejecimiento. El ingreso per cápita aumenta con el tiempo que están en el país, la formación educacional domina la enseñanza secundaria, la duración del tiempo en el país no cambia la situación laboral, trabajan y viven en los talleres textiles y hablan sus lenguas nativas. Predominan las redes sociales de familiares y amigos. El acceso a los servicios de salud ocurre vía la inclusión progresiva en acciones de atención primaria. Llegamos a la conclusión de que existe un proceso de exclusión decreciente, derivado del acceso a la documentación, al trabajo, aunque precario, y la prestación de servicios en la atención primaria de la salud pública.

Classe social: conceitos e esquemas operacionais em pesquisa em saude / Clase social: conceptos y esquemas operativos en investigacion en salud / Social class: concepts and operationalization models in health research

Discute-se a utilização do conceito de classe em pesquisas em saúde, as diferentes abordagens sociológicas de estratificação social e de estrutura de classes, o potencial explicativo do conceito em estudos de determinação social e desigualdades em saúde, os modelos de operacionalização elaborados para uso em pesquisas sociológicas, demográficas ou de saúde e os limites e possibilidades desses modelos. Foram destacados quatro modelos de operacionalização: de Singer para estudo da distribuição de renda no Brasil, adaptado por Barros para uso em pesquisas epidemiológicas; de Bronfman & Tuirán para o censo demográfico mexicano, adaptado por Lombardi et al para pesquisas epidemiológicas; de Goldthorpe para estudos socioeconômicos ingleses, adaptado pela Sociedade Espanhola de Epidemiologia; e o modelo de Wright para pesquisa em sociologia e ciência política, também usado em inquéritos populacionais em saúde. Em conclusão, conceitualmente cada um dos modelos apresentados é coerente com a concepção teórica que os embasam, mas não há como optar por qualquer deles, descartando os demais.

Se discute la utilización del concepto de clase en investigaciones en salud, los diferentes abordajes sociológicos de estratificación social y de estructura de clases, el potencial explicativo del concepto en estudios de determinación social y desigualdades en salud, los modelos de operatividad elaborados para uso en investigaciones sociológicas, demográficas o de salud y los límites y posibilidades de tales modelos. Se destacaron cuatro modelos de operatividad: el de Singer para estudio de la distribución de renta en Brasil, adaptado por Barros para uso en investigaciones epidemiológicas; el de Bronfman & Tuirán para el censo demográfico mexicano, adaptado por Lombardi et al para investigaciones epidemiológicas; de Goldthorpe para estudios socioeconómicos ingleses, adaptado por la Sociedad Española de Epidemiología; y el modelo de Wright para investigación en sociología y ciencia política, también usado en pesquisas poblacionales en salud. En conclusión, conceptualmente cada uno de los modelos presentados es coherente con la concepción teórica que los fundamentan, pero no hay como optar por cualquiera de ellos, descartando al resto.

This article discusses the use of the concept of class in health research, different sociological approaches to social stratification and class structure, and the explanatory potential of the class concept in studies on social determinants and health inequalities. It also elaborates on the operationalization models that have been developed for use in sociological, demographic, or health research, as well as the limitations and scope of these models. Four main operationalization models were highlighted: the model developed by Singer for studies on income distribution in Brazil and adapted by Barros for use in epidemiological research, the model of Bronfman and Tuirán to study the Mexican demographics census and adapted by Lombardi for epidemiological research, the model proposed by Goldthorpe for socioeconomic studies in the UK and adapted by the Spanish Society of Epidemiology, and the model proposed by Wright for research in sociology and political science, which has also been used in population surveys in health. In conclusion, each of the models presented is consistent with their underlying theoretical concept, precluding the selection of one model over the others.

Cardiovascular risk in individuals with depression / Risco cardiovascular em indivíduos com depressão

Depression and cardiovascular diseases (CVD) are both common illnesses. Several studies demonstrated that depressed individuals have higher mortality compared to age-and gender-matched population, with an excess of cardiovascular deaths. There is a bidirectional association between depression and CVD. Several factors can interact and influence this relationship: poverty and social inequality, reduced accessibility to health care, biological alterations (as reduced heart rate variability, endothelial dysfunction, increased inflammation and platelet function, and hyperactivity of hypothalamic-pituitary-adrenal axis), side effects of psychiatric medication, lower adherence to medical treatments, and higher frequency of cardiovascular risk factors (higher tobacco use, physical inactivity, obesity, diabetes mellitus). This article aims to update the current evidence of the possible mechanisms involved in the association between depression and CVD.

A depressão e as doenças cardiovasculares (DCV) são patologias frequentes. Estudos demon stram que indivíduos deprimidos têm maior mortalidade quando comparados a indivíduos do mesmo sexo e faixa etária, com um excesso de mortes por doenças cardiovasculares. Há uma associação bidirecional entre depressão e doenças cardiovasculares. Vários fatores podem interagir e influenciar esta relação: a pobreza e a desigualdade social, dificuldade de acesso a cuidados de saúde, alterações biológicas (menor variabilidade da frequência cardíaca, disfunção endotelial, atividade inflamatória e função plaquetária aumentadas, hiperatividade do eixo hipotálamo-hipófise-adrenal), efeitos colaterais de medicações psiquiátricas, menor adesão aos tratamentos e maior frequência de fatores de risco cardiovasculares (pior estilo de vida, maior frequência de tabagismo e inatividade física e maior prevalência de obesidade e diabetes mellitus). O objetivo deste artigo é revisar as evidências sobre a associação entre depressão e doenças cardiovasculares.

Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007-2008.

BACKGROUND: Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract. METHODS: The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination. RESULTS: Among 17,295 children with immunisation cards, 14,538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%-86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant. CONCLUSIONS: Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas.

[Socio-demographic profile and utilization patterns of the public healthcare system (SUS), 2003-2008]. / Perfil sociodemográfico e padrão de utilização dos serviços de saúde do Sistema Único de Saúde (SUS), 2003-2008.

PNAD data was employed to analyze the utilization profile of health services, and this was measured by the proportion of individuals seeking and reporting use of health services in the prior two weeks and those who reported hospitalization in the preceding 12 months. Private health plans covered 25.9% of the Brazilian population. Comparing data from 2003 and 2008 surveys, there was no change in the proportion of individuals seeking health services, as well as the proportion of those attended by these services (96%). The Unified Health System (SUS) was responsible for 56,7% of all healthcare, providing the bulk of medical visits, vaccine activities and hospital admissions, but accounted for only 1/3 of dental care. There was a reduction in SUS health services utilization with the increase of education and income level, in the two surveys. There was also a decrease in utilization of services due to prevention and an increase in dental problems, accidents, injuries and rehabilitation. The pattern of SUS services utilization per region was inversely related to the proportion of individuals with private health insurance coverage.

Perfil sociodemográfico e padrão de utilização dos serviços de saúde do Sistema Único de Saúde (SUS), 2003- 2008 / Socio-demographic profile and utilization patterns of the public healthcare system (SUS), 2003- 2008

O objetivo foi analisar a evolução do perfil de utilização de serviços de saúde, entre 2003 e 2008, no Brasil e nas suas macrorregiões. Foram utilizados dados da PNAD. A utilização de serviços de saúde foi medida pela proporção de pessoas que procuraram e foram atendidas nas 2 semanas anteriores e pelos que relataram internação nos últimos 12 meses, segundo SUS e não SUS. Foram analisadas as características socioeconômicas dos usuários, o tipo de atendimento e de serviço e os motivos da procura. A proporção de indivíduos que procuraram serviços de saúde não se alterou, assim como a parcela dos que conseguiram atendimento (96 por cento), entre 2003 e 2008. O SUS respondeu por 56,7 por cento dos atendimentos, realizando a maior parte das internações, vacinação e consultas e somente 1/3 das consultas odontológicas. Em 2008, manteve-se o gradiente de redução de utilização de serviços de saúde SUS conforme o aumento de renda e escolaridade. Houve decréscimo da proporção dos que procuraram serviços de saúde para ações de prevenção e aumento de procura para problemas odontológicos, acidentes e lesões e reabilitação. O padrão de utilização do SUS por região esteve inversamente relacionado à proporção de indivíduos com posse de planos privados de saúde.

PNAD data was employed to analyze the utilization profile of health services, and this was measured by the proportion of individuals seeking and reporting use of health services in the prior two weeks and those who reported hospitalization in the preceding 12 months. Private health plans covered 25.9 percent of the Brazilian population. Comparing data from 2003 and 2008 surveys, there was no change in the proportion of individuals seeking health services, as well as the proportion of those attended by these services (96 percent). The Unified Health System (SUS) was responsible for 56,7 percent of all healthcare, providing the bulk of medical visits, vaccine activities and hospital admissions, but accounted for only 1/3 of dental care. There was a reduction in SUS health services utilization with the increase of education and income level, in the two surveys. There was also a decrease in utilization of services due to prevention and an increase in dental problems, accidents, injuries and rehabilitation. The pattern of SUS services utilization per region was inversely related to the proportion of individuals with private health insurance coverage.

Social vulnerability and health status: a household survey in the central area of a Brazilian metropolis.

The self-rated health in a sample of adults living in the central area of São Paulo, Brazil, was studied by comparing a group of residents in census tracts without social vulnerability, identified using an indicator developed by the SEADE Foundation, and a group of residents in census tracts with middle, high or very high social vulnerability. Subject age and sex were used as control variables while family income, education level, degree of happiness, adequacy of income, satisfaction with the neighborhood and sense of discrimination were the intervening variables selected. After adjustment in the hierarchical model the self-rated health status was inversely associated with social vulnerability, age and sense of discrimination, and directly related to income, education level and degree of happiness. Satisfaction with the neighborhood and adequacy of income lose significance after adjustment. The degree of happiness is the variable with the greatest strength of association with health status even after controlling for other variables.

Social vulnerability and health status: a household survey in the central area of a Brazilian metropolis / Vulnerabilidade social e estado de saúde: inquérito domiciliar em uma metrópole brasileira

The self-rated health in a sample of adults living in the central area of São Paulo, Brazil, was studied by comparing a group of residents in census tracts without social vulnerability, identified using an indicator developed by the SEADE Foundation, and a group of residents in census tracts with middle, high or very high social vulnerability. Subject age and sex were used as control variables while family income, education level, degree of happiness, adequacy of income, satisfaction with the neighborhood and sense of discrimination were the intervening variables selected. After adjustment in the hierarchical model the self-rated health status was inversely associated with social vulnerability, age and sense of discrimination, and directly related to income, education level and degree of happiness. Satisfaction with the neighborhood and adequacy of income lose significance after adjustment. The degree of happiness is the variable with the greatest strength of association with health status even after controlling for other variables.

O estado de saúde autorreferido de uma amostra de adultos residentes na área central do Município de São Paulo, Brasil, foi estudado comparando-se um grupo de residentes em setores censitários sem vulnerabilidade social, segundo o indicador elaborado pela Fundação SEADE, e um grupo de residentes em setores censitários com média, alta ou muito alta vulnerabilidade social. A idade e o sexo foram utilizados como variáveis de controle, enquanto a renda familiar, o grau de escolaridade, o grau de felicidade, a adequação do nível de renda, a satisfação com a vizinhança e a sensação de discriminação foram as variáveis intervenientes selecionadas. Após o ajuste no modelo hierárquico, o estado de saúde autorreferido mostrou associação inversa com a vulnerabilidade social, idade e sensação de discriminação e relação direta com a renda, a escolaridade, o grau de felicidade. A satisfação com a vizinhança e a adequação do nível de renda perdem significância após o ajuste. O grau de felicidade é a variável com maior força de associação com o estado de saúde mesmo após o controle pelas demais variáveis.