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RESUMO: Objetivo: Descrever a prevalência do autorrelato de diagnóstico médico prévio de depressão na população adulta brasileira (18 anos ou mais) segundo fatores sociodemográficos. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde 2013, inquérito de base populacional. Foi investigado o autorrelato do diagnóstico médico prévio de depressão, recebido em algum momento da vida. Foram calculadas as prevalências e seus respectivos intervalos de confiança de 95% (IC95%), estratificados por sexo, faixa etária, escolaridade, raça/cor da pele, para Brasil, local de residência, grandes regiões, unidades federativas e capitais. Resultados: A prevalência de autorrelato de diagnóstico de depressão em adultos no Brasil foi de 7,6% (IC95% 7,2 - 8,1), sendo maior em mulheres (10,9%; IC95% 10,3 - 11,6) e em pessoas entre 60 e 64 anos (11,1%; IC95% 9,1 - 13,1). Ainda, as maiores prevalências foram em indivíduos sem instrução ou com fundamental incompleto, 8,6% (IC95% 7,9 - 9,3), para aqueles com ensino superior completo, 8,7% (IC95% 7,5 - 9,9); e para aqueles que se autodeclararam brancos (9,0%; IC95% 8,3 - 9,6). Por local de residência, esse autorrelato foi maior em indivíduos residentes na região urbana (8,0%; IC95% 7,5 - 8,4) e na região Sul (12,6%; IC95% 11,2 - 13,9). Conclusão: A análise deste estudo revela a importância de conhecer o acesso ao diagnóstico de depressão no Brasil. É necessário aprimorar o acesso aos serviços de saúde com qualidade em todo o território nacional para abranger as populações mais desfavorecidas. Reduzir as disparidades no acesso aos serviços de saúde é fundamental para garantir que direitos sociais sejam equânimes e universais.

OBJECTIVE: To perform a systematic review regarding studies that investigated the association between contextual socioeconomic factors and tooth loss.METHODS: MEDLINE, Embase, and LILACS databases were searched and no language or date restrictions were applied for this research. The search was also carried out at the Brazilian Library of Theses and Dissertations (BDTD), with the objective of seeking unpublished studies. We evaluated the bibliographical and methodological characteristics of the studies, as well as the findings.RESULTS: We found 348 articles, out of which only 6 were included in this study after revision by 2 independent researchers. We also identified an unpublished thesis. In general, these results show that the socioeconomic context interferes in tooth loss. We found an association between the highest number of missing teeth with less favorable contextual variables, despite the weak evidence, due to the fact that all selected studies had a cross-sectional design.CONCLUSION: We suggest the standardization of outcome formats and exposures in order to favor the comparison between studies and their quantitative analysis.

Este artigo resume a avaliação de três programas de saúde pública em relação à sua eficácia e impacto sobre as desigualdades sociais na saúde. Foram examinadas a fluoração da água de abastecimento público no contexto brasileiro, a provisão de terapêutica antirretroviral para pacientes com Aids e a vacinação de idosos contra a gripe na cidade de São Paulo. As três intervenções foram consideradas efetivas, na medida em que propiciaram uma redução na carga de doença na população. No entanto, elas tiveram resultados conflitantes quanto ao impacto sobre as desigualdades em saúde. Concluiu-se, por fim, que os programas de saúde pública devem ser implementados com um alcance imediata e efetivamente universal, direcionando recursos adicionais aos grupos com mais necessidades de saúde. Essa estratégia reduziria, ao mesmo tempo, o nível geral de doença na população e as desigualdades na experiência de doenças entre os estratos sociais.

Resumo Objetivos: identificar fatores associados ao pré-natal inadequado, com destaque para cor da pele, em usuárias do SUS do Estado do Rio de Janeiro (RJ), no último trimestre de 2011. Métodos: estudo de corte seccional em duas maternidades públicas no RJ. Foram entrevistadas 1790 parturientes, arroladas sequencialmente. Número de consultas e início do acompanhamento foram coletados dos cartões de pré-natal. O desfecho foi adequação do pré-natal, classificada pelo Índice de Adequação de Utilização do Pré-natal. A exposição principal foi cor da pele, além de covariáveis sociodemográficas e reprodutivas. A regressão logística multivariada usou níveis hierárquicos: variáveis predisponentes e capacitantes da utilização do pré-natal no primeiro e segundo nível, respectivamente. Resultados: a cor da pele preta manteve-se associada ao pré-natal inadequado, mesmo após ajuste para covariáveis (OR=1,37; IC95%:1,02-1,83). Gravidez adolescente (OR=1,85; IC95%:1,43-2,41); ausência de companheiro (OR=1,75; IC95%:1,38- 2,20) e multiparidade (OR=2,40; IC95%:1,49-3,85) também se associaram positivamente ao desfecho. O atendimento ao pré-natal em serviços públicos (OR=0,67; IC95%: 0,49-0,91) e primiparidade (OR=0,41; IC95%: 0,32 e 0,52) tiveram efeito protetor. Conclusões: gestantes de cor preta tiveram maior chance de realizar pré-natal inadequado no RJ. São necessárias políticas para reduzir iniquidades de raça/cor na assistência pré-natal desta população.

Socioeconomic inequality, or the socioeconomic status (SES) gradient, is arguably one of the most-studied phenomena in health. The gradient in health is apparent in objective and subjective measures, across virtually all countries, and is evident at individual and population levels. There is no longer much debate over the relationship between SES and health. However, exact causal pathways remain elusive. Advocating for strong policy to reduce or eliminate the SES-health gradient necessitates understanding the causal pathways, from intervention to outcome. While economists are not convinced that there is a clear enough understanding of the causal pathways of the SEShealth gradient, they have produced a substantial body of work from which to move forward. The article briefly discusses the theoretical underpinnings used by economists as a basis for the study of the causal pathways for the health gradient. That presentation is followed by a concise overview of some of the evidence that economists have produced. The paper concludes with a discussion of how current economic evidence may be used to help policymakers advocate for interventions to limit the SES gradient in noncommunicable diseases. [ABSTRACT FROM AUTHOR]

Introduction - Health inequalities are recognized as a public health problem. The relationship between social determinants and health inequalities is a robust finding. While in adulthood, these socioeconomic inequalities become manifest in terms of general health status, the situation is less clear in childhood and adolescence in a hospital setting. It was then undertaken a systematic in order to contribute towards a better knowledge of the subject. Methods - Based on the PRISMA guidelines, the following MeSH terms were used: 'social class', 'pediatric', 'hospital', 'emergency treatment', 'socioeconomic factor', and 'healthcare disparities'. The search was performed on articles published between 1 January 2000 and 31 August 2016, on PubMed, MEDLINE, and on the database from Cochrane. Review and opinion articles were excluded, as well as articles dealing with issues of access to healthcare. It was performed a qualitative and quantitative description of the results. Results - Seventeen publications were selected all reporting observational analyses, most of the using retrospective data. These publications showed strong evidence for health inequalities, as a length of stay or severity of illness upon admission to the intensive care unit, and the social determinants of health in the pediatric age in a hospital setting. Conclusions - Although the same relationship has already been demonstrated in a community setting, it is necessary to elaborate more studies that relate socioeconomic status and health inequalities in a hospital context. It is important to deepen the studies in these areas, in order to identify the most significant social determinants and vulnerable populations, to better plan the health care and to tackle the health inequalities. [ABSTRACT FROM AUTHOR]

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The objective of this study was to verify the oral hygiene and prevalence of dental caries and malocclusion index of children in a charitable association as well as the parents' perception of the impact of oral diseases on children's quality of life and family routine. Oral hygiene was assessed through the Simplified Oral Hygiene Index (OHI-S). An epidemiological survey of dental caries and malocclusion were carried out through the Dental caries and treatment needs and Malocclusion indexes. The Parental-Caregiver Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) were applied to assess the perception of parents about the impact of oral diseases in children and the family routine, respectively. Among the evaluated people, 62.2% of the respondents had regular IHOS, 46.7% had mild malocclusion, 55.1% and 45.6% had permanent and deciduous teeth attacked by cavities, respectively. Regarding the P-CPQ questionnaire, 41.1% of the parents answered that the general well-being of the child was affected as "not at all" or "only a little" due to the condition of oral health. As for FIS, the subscale that most interfered in the family routine was "Parent / family activity". The children studied were deficient in hygiene and oral diseases. Parents have a low perception of the impact of oral diseases on children's quality of life, and higher on the family routine. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Atencao Primaria a Saude is the property of Revista de Atencao Primaria a Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is enough evidence to show the importance of the first 1000 days of life for child survival and development, and the next 8000 days for a child to reach adulthood. Yet discrimination, place of residence, socio-economic status, and inequalities within and between countries contribute to earlier mortality and significant morbidities for mothers and their children, particularly in settings with limited resources. Therefore, many children and adolescents and their families were left behind. JHGD has been raising public health issues related to inequalities and right to health. In this issue, articles generate debate around human dignity and health disparities. Several articles discuss a verity of health issues particularly in Amazon and Northeast region. School health was also discussed in this issue. Three studies were conducted in schools in Rio Grande do Sul, Brazil. Research indicate that many children and adolescents are left behind. We are missing many opportunities to bridge the gap of inequality. Actions need to be taken now to make sure no one is left behind. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

RESUMO O objetivo deste estudo foi analisar a relação entre os indicadores epidemiológicos da hanseníase, a cobertura da Estratégia da Saúde da Família (ESF) e o Índice de Desenvolvimento Humano Municipal (IDHM) em Minas Gerais - Brasil, no período de 1998 a 2013. Trata-se de um estudo ecológico. A forma de mensurar as condições de vida foi a partir do IDHM. Foram realizadas duas análises: uma considerando a média de cada indicador no período de 1998 a 2005, e outra de 2006 a 2013. Foi feita análise descritiva da situação epidemiológica da hanseníase, da cobertura da ESF e do IDHM em Minas Gerais. Em seguida, foi estabelecida uma relação geral entre as taxas de detecções, em menores de 15 anos e com grau 2 de incapacidade e a cobertura da ESF e o IDHM, utilizando os testes de Poisson com inflação de zeros e de Deviance. As análises foram realizadas no programa estatístico SPSS versão 19.0 e Stata versão 10.0. Os resultados sugerem redução da endemia no estado, identificado pela queda dos indicadores da doença. O aumento da cobertura da ESF contribuiu para o aumento da detecção de casos da doença, redução de casos em menores de 15 anos e com grau 2 de incapacidade. Além disso, o aumento do IDHM contribuiu para a redução de casos da doença e de incapacidade grau 2. Apesar das políticas de melhoria do acesso aos serviços de saúde e das condições de vida da população, observa-se a persistência de municípios hiperendêmicos no estado.

Objetivo: Relacionar a implantação da Estratégia de Saúde da Família (ESF) entre 2001 e 2010 com as variáveis do Índice de Desenvolvimento Humano Municipal (IDH-M) e indicadores socioeconômicos. Métodos: Estudo ecológico coletou informações sobre o IDH-M, indicadores socioeconômicos e da ESF referentes ao número de Agentes Comunitários de Saúde (ACS), Equipes de Saúde da Família (ESF), Equipes de Saúde Bucal (ESB), cobertura populacional e relativa (%) em 645 municípios do estado de São Paulo no período de 2001 a 2010. A análise descritiva foi conduzida por meio de frequências absoluta e relativa para avaliação de cada indicador. Utilizaram-se testes não paramétricos: coeficientes de correlação de Spearman para as variáveis da ESF e os indicadores socioeconômicos, e Wilcoxon Test (p

O objetivo deste estudo foi identificar fatores associados à utilização dos serviços odontológicos, públicos (básicos e especializados) e privados. Foi realizado inquérito populacional de base domiciliar em dois municípios da Bahia, Brasil. Informantes-chave forneceram dados socioeconômicos e de utilização dos serviços odontológicos (desfecho). A organização do serviço público odontológico local foi classificada em pior/melhor. Realizou-se regressão logística politômica uni e múltipla. Do total de 1.290 indivíduos, 38,76% usaram o serviço privado, 33,80% atenção básica e 17,29% atenção básica e o Centro de Especialidades Odontológicas (CEO). Um perfil de vulnerabilidade social foi associado ao uso do serviço público, quando comparado ao privado. Menor escolaridade (OR = 1,47; IC95%: 1,03-2,10) e pior organização do serviço (OR = 1,74; IC95%: 1,22-2,48) foram associados ao menor uso da rede de serviços atenção básica e CEO em comparação ao uso exclusivo da atenção básica. A desigualdade na utilização dos serviços odontológicos foi observada mesmo quando comparados grupos mais homogêneos, como os usuários dos serviços públicos.

OBJETIVO: Analisar as desigualdades socioeconômicas na utilização de consultas médicas (CM) no último ano no Brasil. MÉTODOS: Dados da Pesquisa Nacional por Amostra de Domicílios (≥ 20 anos de idade) das Regiões Nordeste (2003, n = 75.652 e 2008, n = 79.779) e Sudeste (2003, n = 76.029 e 2008, n = 79.356) foram analisados segundo CM. Compararam-se as prevalências de CM segundo as variáveis exploratórias demográficas e de saúde no primeiro (D1) e último (D10) decil de renda familiar per capita. As análises consideraram o desenho amostral complexo. RESULTADOS: A proporção de pessoas com CM aumentou no período na Região Nordeste (61,2 para 66,9%) e Sudeste (67,9 para 73,5%). A diferença absoluta de CM, segundo D1 e D10 no período, foi de 6,4 pontos percentuais (pp) no Nordeste e 4,2 pp no Sudeste. Houve importante redução das desigualdades entre os homens; naqueles sem doenças crônicas; naqueles que tinham uma percepção positiva da sua saúde e naqueles sem plano de saúde com direito a CM. A Região Sudeste ainda apresentou redução entre aqueles com apenas uma morbidade autorreferida (8 pp) e com percepção negativa da saúde (6 pp). CONCLUSÃO: Houve aumento de CM no Brasil. Observa-se ainda persistente desigualdade entre os mais pobres e os mais ricos, maior no Nordeste do que no Sudeste. Políticas para a redução da desigualdade em saúde mais eficazes e equânimes devem ser adotadas no Brasil.

Objetivos: descrever o perfil de utilização de serviços de saúde em crianças brasileiras menores de cinco anos. Métodos: estudo seccional de base populacional realizado em 2009, com crianças residentes em 100 municípios de cinco regiões brasileiras. Investigou-se o uso dos seguintes tipos de atendimento de saúde: domiciliar e médico ambulatorial - últimos três meses - e de urgência e internação hospitalar - últimos doze meses. As variáveis independentes foram: sexo, idade, classificação econômica familiar, escolaridade materna, família beneficiada pelo Programa Bolsa Família, ter apresentado problema agudo de saúde, estado nutricional, porte do município e região. Análises brutas e ajustadas para associação entre a utilização de serviços de saúde e classe econômica foram realizadas por meio de regressão de Poisson com ajuste robusto da variância. Resultados: das 6360 crianças, 3422 (54%) foram atendidas por médico, 506 (8%) receberam atendimento domiciliar, 2144 (34%) foram atendidas em serviços de urgência/emergência e 681 (11%) foram hospitalizadas. Crianças das classes A/B consultaram mais com o médico, tiveram menos atendimento domiciliar, usaram mais serviços de urgência do que crianças das classes C e D/E. Não houve diferença na hospitalização segundo classe econômica. Conclusões: os achados destacam importantes desigualdades no uso de serviços de saúde por crianças brasileiras.

OBJECTIVE To analyze if the nutritional status of children aged less than five years is related to the biological conditions of their mothers, environmental and socioeconomic factors, and access to health services and social programs.METHODS This cross-sectional population-based study analyzed 664 mothers and 790 children using canonical correlation analysis. Dependent variables were characteristics of the children (weight/age, height/age, BMI/age, hemoglobin, and retinol serum levels). Independent variables were those related to the mothers’ nutritional status (BMI, hemoglobin, and retinol serum levels), age, environmental and socioeconomic factors and access to health service and social programs. A < 0.05 significance level was adopted to select the interpreted canonical functions (CF) and ± 0.40 as canonical load value of the analyzed variables.RESULTS Three canonical functions were selected, concentrating 89.9% of the variability of the relationship among the groups. In the first canonical function, weight/age (-0.73) and height/age (-0.99) of the children were directly related to the mother’s height (-0.82), prenatal appointments (-0.43), geographical area of the residence (-0.41), and household incomeper capita (-0.42). Inverse relationship between the variables related to the children and people/room (0.44) showed that the larger the number of people/room, the poorer their nutritional status. Rural residents were found to have the worse nutritional conditions. In the second canonical function, the BMI of the mother (-0.48) was related to BMI/age and retinol of the children, indicating that as women gained weight so did their children. Underweight women tended to have children with vitamin A deficiency. In the third canonical function, hemoglobin (-0.72) and retinol serum levels (-0.40) of the children were directly related to the mother’s hemoglobin levels (-0.43).CONCLUSIONS Mothers and children were associated concerning anemia, vitamin A deficiency and anthropometric markers. Living in rural areas is a determining factor for the families health status.

OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo. METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care. RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician. CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.

OBJECTIVE To analyze oral health behaviors changes over time in Brazilian adolescents concerning maternal educational inequalities.METHODS Data from the Pesquisa Nacional de Saúde do Escolar(Brazilian National School Health Survey) were analyzed. The sample was composed of 60,973 and 61,145 students from 26 Brazilian state capitals and the Federal District in 2009 and 2012, respectively. The analyzed factors were oral health behaviors (toothbrushing frequency, sweets consumption, soft drink consumption, and cigarette experimentation) and sociodemographics (age, sex, race, type of school and maternal schooling). Oral health behaviors and sociodemographic factors in the two years were compared (Rao-Scott test) and relative and absolute measures of socioeconomic inequalities in health were estimated (slope index of inequality and relative concentration index), using maternal education as a socioeconomic indicator, expressed in number of years of study (> 11; 9-11; ≤ 8).RESULTS Results from 2012, when compared with those from 2009, for all maternal education categories, showed that the proportion of people with low toothbrushing frequency increased, and that consumption of sweets and soft drinks and cigarette experimentation decreased. In private schools, positive slope index of inequality and relative concentration index indicated higher soft drink consumption in 2012 and higher cigarette experimentation in both years among students who reported greater maternal schooling, with no significant change in inequalities. In public schools, negative slope index of inequality and relative concentration index indicated higher soft drink consumption among students who reported lower maternal schooling in both years, with no significant change overtime. The positive relative concentration index indicated inequality in 2009 for cigarette experimentation, with a higher prevalence among students who reported greater maternal schooling. There were no inequalities for toothbrushing frequency or sweets consumption.CONCLUSIONS There were changes in the prevalences of oral health behaviors during the analyzed period; however, these changes were not related to maternal education inequalities.

OBJECTIVE To describe the lack of access and continuity of health care in adults. METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided by a doctor, by other health professional or home care in the last three months). Based on the results obtained by the description of the sample, a projection is provided for adults living in Brazilian urban areas. RESULTS The highest prevalence of lack of access to health services and to provision of care by health professionals was for hospitalization (3.0%), whilst the lowest prevalence was for care provided by a doctor (1.1%). The lack of access to care provided by other health professionals was 2.0%; to accident and emergency services, 2.1%; and to home care, 2.9%. As for prevalences, the greatest absolute lack of access occurred in emergency care (more than 360,000 adults). The main reasons were structural and organizational problems, such as unavailability of hospital beds, of health professionals, of appointments for the type of care needed and charges made for care. CONCLUSIONS The universal right to health care in Brazil has not yet been achieved. These projections can help health care management in scaling the efforts needed to overcome this problem, such as expanding the infrastructure of health services and the workforce.

OBJECTIVE The objective of this study was to analyze whether socioeconomic conditions and the period of availability of fluoridated water are associated with the number of teeth present. METHODS This cross-sectional study analyzed data from 1,720 adults between 20 and 59 years of age who resided in Florianópolis, SC, Southern Brazil, in 2009. The outcome investigated was the self-reported number of teeth present. The individual independent variables included gender, age range, skin color, number of years of schooling, and per capita household income. The duration of residence was used as a control variable. The contextual exposures included the period of availability of fluoridated water to the households and the socioeconomic variable for the census tracts, which was created from factor analysis of the tract’s mean income, education level, and percentage of households with treated water. Multilevel logistic regression was performed and inter-level interactions were tested. RESULTS Residents in intermediate and poorer areas and those with fluoridated water available for less time exhibited the presence of fewer teeth compared with those in better socioeconomic conditions and who had fluoridated water available for a longer period (OR = 1.02; 95%CI 1.01;1.02). There was an association between the period of availability of fluoridated water, per capita household income and number of years of education. The proportion of individuals in the poorer and less-educated stratum, which had fewer teeth present, was higher in regions where fluoridated water had been available for less time. CONCLUSIONS Poor socioeconomic conditions and a shorter period of availability of fluoridated water were associated with the probability of having fewer teeth in adulthood. Public policies aimed at reducing socioeconomic inequalities and increasing access to health services such as fluoridation of the water supply may help to reduce tooth loss in the future.

OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting. METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student’s t-test. RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions. CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue.

O presente artigo versa sobre a questão das desigualdades de saúde nos países do Sul da Europa, mais especificamente Espanha, Grécia, Itália e Portugal. O estudo resultou de uma revisão não sistemática da literatura, baseando-se na proposta da scoping review. Inicialmente, é apresentada uma breve contextualização dos estados de bem-estar social desses países do Sul da Europa, destacando as principais especificidades e diferenças em relação a outros regimes europeus de bem-estar social. Em seguida, são descritos os sistemas de saúde dos quatro países, ressaltando os respectivos processos de reforma e as principais desigualdades de saúde que os tem caracterizado, antes e durante a crise econômica. A crise e as políticas de austeridade aumentaram muito a insatisfação com a prestação de cuidados de saúde, nesses países, particularmente na Grécia e em Portugal. Nesse sentido, são discutidas, comparativamente, as desigualdades de saúde, evidenciando as tendências comuns, assim como as diversidades. Nos quatro países em análise, o gradiente social (em particular educação, rendimento e condição laboral) representa o principal fator determinante das desigualdades de saúde, sem subestimar, contudo, as desigualdades geográficas no acesso aos serviços de saúde, como resultado dos diferentes níveis de desenvolvimento econômico das diversas regiões. Finalmente, é discutido o recente debate, presente na literatura internacional, sobre a relação entre diferentes regimes de estado de bem-estar e desigualdades de saúde e, precisamente, sobre a crítica ao uso de tipologias de estado de bem-estar como determinante de saúde e de desigualdades de saúde.

OBJECTIVE To analyze vaccination coverage and factors associated with a complete immunization scheme in children < 5 years old. METHODS This cross-sectional household census survey evaluated 1,209 children < 5 years old living in Bom Jesus, Angola, in 2010. Data were obtained from interviews, questionnaires, child immunization histories, and maternal health histories. The statistical analysis used generalized linear models, in which the dependent variable followed a binary distribution (vaccinated, unvaccinated) and the association function was logarithmic and had the children’s individual, familial, and socioeconomic factors as independent variables. RESULTS Vaccination coverage was 37.0%, higher in children < 1 year (55.0%) and heterogeneous across neighborhoods; 52.0% of children of both sexes had no immunization records. The prevalence rate of vaccination significantly varied according to child age, mother’s level of education, family size, ownership of household appliances, and destination of domestic waste. CONCLUSIONS Vulnerable groups with vaccination coverage below recommended levels continue to be present. Some factors indicate inequalities that represent barriers to full immunization, indicating the need to implement more equitable policies. The knowledge of these factors contributes to planning immunization promotion measures that focus on the most vulnerable groups.

OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

Este artigo problematiza a visão sobre o “social” que subjaz a noção de determinantes sociais da saúde. Para isso, realizou-se um estudo exploratório, a partir de pesquisa bibliográfica em referenciais produzidos pelas ciências humanas, por meio de autores da sociologia contemporânea que refletem de forma crítica sobre como a ciência atual considera o “social”. O artigo inicia-se com uma caracterização geral do campo dos determinantes sociais da saúde, especialmente do ponto de vista político-científico. Logo em seguida, apresentam-se os elementos críticos, caracterizando caminhos sobre o pensamento dos autores supracitados. O estudo procurou destacar os reducionismos cada vez mais presentes na abordagem ao social no campo dos determinantes sociais da saúde. Tais reducionismos acabam por limitar uma leitura mais aprofundada sobre a complexidade da vida em sociedade e reforçam a mercantilização e banalização da vida. Santos (1988) observa que, frente a esses reducionismos, a ciência não pode ser somente a produção de um paradigma cientifico, mas um paradigma social - o paradigma de uma vida decente. O pensamento de Latour (2012) trouxe argumentos para repensar o “social” para além de um domínio específico e limitado da realidade, como algo sempre externo ao sujeito e à sua própria saúde. A visão fragmentada do campo dos determinantes sociais da saúde é o que colocamos em análise e produzimos questionamentos como forma de suscitar futuros debates sobre o tema em questão.

O estudo descreveu a situação de vida e saúde dos residentes de municípios do Estado do Maranhão nos primeiros anos do século XXI. Trata-se de um estudo ecológico com dados secundários disponíveis nos sites do Programa das Nações Unidas para o Desenvolvimento, do Instituto Brasileiro de Geografia e Estatística e nos Cadernos de Informações em Saúde do Ministério da Saúde. As unidades de análise selecionadas foram às cidades sede de macrorregional de saúde do Maranhão (São Luís, Imperatriz e Caxias) e que desempenham papel essencial nas redes de atenção à saúde intraestadual. Comparam-se indicadores socioeconômicos, demográficos e de saúde. Observou-se nas três cidades elevada incidência de pobreza (>50%), concentração de renda e Índices de Desenvolvimento Humano em nível médio. Verificou-se padrão desigual de locação de serviços públicos de saúde. São Luís teve a maior proporção de serviços privados de saúde, o maior o número de leitos/1000 habitantes e o dobro do número de médicos presentes nas outras cidades. O número de enfermeiros nas três cidades foi muito abaixo dos parâmetros recomendados (2,0/1000 hab.). Os resultados indicam grande desigualdade socioeconômica e em saúde. Apontam precárias condições gerais de vida e insuficiente oferta de serviços e de profissionais de saúde no Maranhão. Descritores: Desigualdades em saúde. Municípios. Avaliação da situação de saúde. Condições de vida, Indicadores de serviços.

OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.

OBJECTIVE To analyze the association between negative self-rated health and indicators of health, wellbeing and sociodemographic variables in older adults. METHODS Cross-sectional study that used data from a population-based health survey with a probability cluster sample that was carried out in Campinas, SP, Southeastern Brazil,, in 2008 and 2009. The participants were older adults (≥ 60 years) and the dependent variable was self-rated health, categorized as: excellent, very good, good, bad and very bad. The adjusted prevalence ratios were estimated by means of Poisson multiple regression. RESULTS The highest prevalences of bad/very bad self-rated health were observed in the individuals who never attended school, in those with lower level of schooling, with monthly per capita family income lower than one minimum salary. Individuals who scored five or more in the physical health indicator also had bad self-rated health, as well as those who scored five or more in the Self-Reporting Questionnaire 20 and those who did not refer feeling happiness all the time. CONCLUSIONS The independent effects of material life conditions, physical and mental health and subjective wellbeing, observed in self-rated health, suggest that older adults can benefit by health policies supported by a global and integrative view of old age.

OBJECTIVE To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. METHODS Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households) and 2008-2009 (n = 55,970 households) with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. RESULTS After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8%) and 2.3 percentage points (11.6%), respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9%) and 1.3 (17.3%) percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. CONCLUSIONS Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged.

Objective: In order to identify intraurban differentials, the prevalence of major protection and risk factors for non communicable chronic diseases were analyzed in nine health districts of Belo Horizonte, Minas Gerais, Brazil. Methods: Analysis of data from a telephone survey conducted with 2,000 adults in Belo Horizonte, in 2010, using the average linkage method for cluster analysis among the health districts, using sociodemographic variables (education, race and marital status). The study compared the prevalence of risk factors for non communicable diseases among the health districts. Results: Four clusters were identified. The best socio-demographic indicators were found in cluster 4 (South Central health district), which also showed a higher prevalence of protective factors such as higher consumption of fruits and vegetables, higher frequency of physical activity practice in the free time, use of ultraviolet protection, higher proportion of ex-smokers, and lower prevalence of whole milk and high-fat meat consumption. As a risk factor, cluster 4 showed a higher proportion of alcohol abuse. Cluster 1, with the worst socio-demographic indicators, concentrated more risk factors such as consumption of whole milk, low regular consumption of fruit and vegetables, and lower practice of physical activity in the free time. The most frequent protective indicators in cluster 1 were the regular consumption of beans, having breakfast at home, and lower alcohol abuse. Conclusion: Intra-urban differences were found in the distribution of risk and protection factors or non transmissible diseases, these differences can support planning aimed at actions for greater equity in health.

OBJECTIVE To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families. METHODS Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family’s capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index. RESULTS The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated. CONCLUSIONS There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.

Objetivo: Descrever a metodologia e desafios de estudos de saúde bucal, inseridos em uma coorte prospectiva de adultos. Métodos: Foi obtida uma amostra de 2.016 adultos residentes em Florianópolis em 2009. Visitas domiciliares foram realizadas para a aplicação de um questionário sobre condições socioeconômicas e demográficas, de saúde geral, uso de serviços e de medicamentos, doação de sangue, violência doméstica e uma seção relativa à saúde da mulher. Informações sobre saúde bucal incluíram autoavaliação de seu estado, número de dentes, uso de serviços, percepção de necessidade de tratamento, ocorrência, intensidade e impacto nas atividades diárias da dor dentária, sintomas de xerostomia e dificuldade de alimentação em virtude de problemas bucais. Adicionalmente, aferiram-se a pressão arterial e medidas antropométricas. Em 2012, ocorreu a segunda onda do estudo, na qual foi aplicado um questionário sobre questões socioeconômicas, qualidade de vida, experiências discriminatórias, recordatório alimentar de 24 horas e de saúde bucal. Além disso, foi aferida a pressão arterial, medidas antropométricas, e foram realizados exames bucais (cárie, perdas dentárias e condições periodontais). Resultados: A taxa de participação foi de 85,3% (n = 1.720) em 2009 e, destes, 1.222 (71,1%) foram investigados em 2012. Conclusões: A continuidade do estudo poderá contribuir para a elucidação da causalidade de associações entre condições de saude bucal e agravos e doencas cronicas.

OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required.

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: investigate the scientific production on the social determination of HIV/aids published between 2009 and 2015. Method: integrative review in the databases SciELO and Medline via PubMed, using the descriptors "Síndrome da Imunodeficiência Adquirida" (Acquired Immunodeficiency Syndrome); "HIV" (VHI); "Determinantes Sociais da Saúde" (Social Determinants of Health); "Desigualdades em saúde" (Health Inequalities). Results: the sample consisted of 22 manuscripts, revealing five thematic categories based on Whitehead and Dahlgren's social determination model: Individual determinants of HIV/aids, Behavioral determinants of HIV/aids, Influence of social networks on HIV/aids, Intermediary determinants of HIV/aids and Distal determinants of HIV/aids. Conclusion: the study permitted understanding the extensive causal chain involved in HIV/aids infection, which overarches the merely biological aspect. Knowledge on the social determinants of the disease can support articulated interventions in the different sectors of society, beyond the health sector. [ABSTRACT FROM AUTHOR]

Copyright of Saúde e Sociedade is the property of Universidade de Sao Paulo, Faculdade de Saude Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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OBJECTIVE: To review epidemiological studies conducted in Brazil that investigated the distribution of dental caries according to socioeconomic status and demographic characteristics. METHODS: The systematic review included articles published between 1999 and 2010 available in six bibliographic sources, without any other restriction. We analyzed the bibliometric and methodological characteristics of the studies, and the direction and statistical significance of associations tested. RESULTS: Of the 1,128 references identified, 67 were incorporated into this study. There was a higher percentage of publications in the last two years and most of the studies were conducted in the South and Southeast of the country with a young population. The cross-sectional design, using a complex sampling procedure, was the most commonly adopted. The DMFT and dmft indexes were the most commonly used to measure dental caries, while sex/gender, income, education, race/skin color and type of school were the most common socioeconomic exposures. CONCLUSIONS: Most studies identified a high rates of dental caries among the poorest, least educated, black and brown and female individuals. A more detailed methodological and theoretically sound study of the relationship between dental caries and socioeconomic conditions is needed.

Objective. Describe health inequalities with regard to coverage indicators stratified by socioeconomic factors and place of residence. Methods. An ecological study was conducted with data from the 2003 and 2008 Demographic and Health Surveys and the 2012 National Health and Nutrition Survey, with analysis of 15 variables for socioeconomic and place-of-residence stratifiers. Results. Calculation of the composite coverage index showed that the poorest groups have moved closer to the richest groups, bridging the inequality gap; change in the richest quintiles has not been as rapid as in the poorest quintiles. Several of the indicators have seen more rapid progress in the poorest group, such as that for deliveries attended by health personnel; other indicators showed reduced growth in reduction of inequality. Chronic malnutrition in children under 5 has decreased; however, anemia in this age group has increased. Conclusions. The indicators showed advances in reduction of inequality and reduction in the gap between the poorest and richest groups. Expected growth in the use of family planning methods may not have been reached because of the existence of conditional cash transfers. Strategies should be evaluated, such as iron supplementation in children under 5, where provision of the supplement has increased, but it has not had an impact on anemia reduction. [ABSTRACT FROM AUTHOR]

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Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos Saúde Coletiva is the property of Instituto de Estudos em Saude Colectiva (IESC) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)