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OBJECTIVE: To describe the indicators of smoking cessation in 2013 and 2019 for Brazil and federative units, according to sociodemographic variables, collected in the National Health Survey (PNS). METHODS: Cross-sectional, population-based and descriptive study with data from the 2013 and 2019 PNS, a household survey collected by trained interviewers. The prevalence of ex-smokers and the proportion of smokers who tried to quit smoking in the 12 months prior to the interview, and respective confidence intervals (95%CI) were calculated, according to sociodemographic variables. Additionally, the percentage variation between the years was calculated. RESULTS: In 2013, the prevalence of ex-smokers was 17.5% (95%CI 16.9;18.0) and, in 2019, 26.6% (95%CI 26.1;27.2). In 2013, 51.1% tried to quit smoking (95%CI 49.3;52.9) and, in 2019, 46.6% (95%CI 45.0;48.3). CONCLUSION: It is important to strengthen and maintain strategies for coping with tobacco use in Brazil, to increase the current smoker's willingness and ability to quit smoking.

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Objetivo: Descrever os indicadores de abandono do uso de tabaco, em 2013 e 2019, para o Brasil e as Unidades da Federação, segundo variáveis sociodemográficas, coletadas na Pesquisa Nacional de Saúde (PNS). Métodos: Estudo transversal, populacional e descritivo realizado com dados da PNS 2013 e 2019, uma pesquisa domiciliar coletada por entrevistadores treinados. Foram calculadas a prevalência de ex-fumantes e a proporção de fumantes que tentaram parar de fumar nos últimos 12 meses imediatamente anteriores à data da entrevista, e os respectivos intervalos de confiança (IC95%), segundo as variáveis sociodemográficas. Ademais, calculou-se a variação percentual entre os anos estudados. Resultados: Em 2013, a prevalência de ex-fumantes foi 17,5% (IC95% 16,9;18,0) e, em 2019, 26,6% (IC95% 26,1;27,2). Tentaram parar de fumar 51,1% (IC95% 49,3;52,9), em 2013, e 46,6% (IC95% 45,0;48,3) em 2019. Conclusão: É importante o fortalecimento e manutenção de estratégias para enfrentamento do uso de tabaco no país, de forma a aumentar a disposição e a capacidade do fumante atual de parar de fumar.

Objetivo: Describir los indicadores de abandono del hábito tabáquico en 2013 y 2019 para Brasil y Unidades Federadas, según variables sociodemográficas, recogidas en la Encuesta Nacional de Salud (PNS). Métodos: Estudio transversal, poblacional y descriptivo con datos de las PNS, 2013 y 2019, una encuesta de hogares recolectada por entrevistadores capacitados. Se calculó la prevalencia de exfumadores y proporción de fumadores que intentaron dejar de fumar en los últimos 12 meses y respectivos intervalos de confianza (IC95%), según variables sociodemográficas. Además, se calculó la variación porcentual entre los años. Resultados: En 2013, la prevalencia de exfumadores fue de 17,5% (IC95% 16,9;18,0), en 2019, 26,6% (IC95% 26,1;27,2). En 2013, el 51,1% intentó dejar de fumar (IC95% 49,3;52,9), y, en 2019, el 46,6% (IC95% 45,0;48,3). Conclusión: Es importante fortalecer y mantener las estrategias de afrontamiento del tabaquismo, para incrementar la disposición y capacidad del fumador actual para dejar de fumar.

Objective: To describe the indicators of smoking cessation in 2013 and 2019 for Brazil and federative units, according to sociodemographic variables, collected in the National Health Survey (PNS). Methods: Cross-sectional, population-based and descriptive study with data from the 2013 and 2019 PNS, a household survey collected by trained interviewers. The prevalence of ex-smokers and the proportion of smokers who tried to quit smoking in the 12 months prior to the interview, and respective confidence intervals (95%CI) were calculated, according to sociodemographic variables. Additionally, the percentage variation between the years was calculated. Results: In 2013, the prevalence of ex-smokers was 17.5% (95%CI 16.9;18.0) and, in 2019, 26.6% (95%CI 26.1;27.2). In 2013, 51.1% tried to quit smoking (95%CI 49.3;52.9) and, in 2019, 46.6% (95%CI 45.0;48.3). Conclusion: It is important to strengthen and maintain strategies for coping with tobacco use in Brazil, to increase the current smoker's willingness and ability to quit smoking.

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Resumo O estudo tem como objetivo conhecer as percepções dos gestores acerca dos avanços, barreiras e desafios do processo regionalização. Estudo qualitativo realizado por meio de 40 entrevistas em profundidade com os gestores das regiões de saúde dos estados do Ceará, Mato Grosso do Sul, Paraná, Minas Gerais e Tocantins, analisadas com auxílio do software Iramuteq. O primeiro eixo demonstrou a falta de financiamento, a dificuldade e os esforços para prover as ações e serviços, bem como as iniquidades no acesso. O segundo eixo revelou dinâmica da organização e funcionamento regional, que apresenta avanços, sobretudo no modus operandi da organização regional, que conta com melhorias na organização e no desempenho dos Colegiados Intergestores Regionais. Todavia, demonstrou-se que há que se continuar investindo na construção de coordenação federativa cooperativa para melhor organização e redução das desigualdades regionais.

Abstract The study aims to understand the perceptions of managers about the advances, barriers and challenges of the regionalization process. Qualitative study carried out through 40 in-depth interviews with managers of health regions in the states of Ceará, Mato Grosso do Sul, Paraná, Minas Gerais and Tocantins, analyzed using the Iramuteq software. The first axis demonstrated the lack of funding, the difficulty and efforts to provide actions and services, as well as inequities in access. The second axis revealed the dynamics of the regional organization and functioning, which presents advances, especially in the modus operandi of the regional organization, which includes improvements in the organization and performance of the Regional Inter-Management Collegiate. However, it showed that it is necessary to continue investing in the construction of cooperative federative coordination for better organization and reduction of regional inequalities.

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OBJECTIVE: To describe cases of violence against people with disabilities notified by Brazilian health services between 2011 and 2017. METHODS: This was a descriptive study of secondary data on notifications of violence against people with disabilities recorded on the Notifiable Health Conditions Information System (Sinan). RESULTS: 116,219 cases of violence against people with disabilities were recorded in the period. Most of the victims were female (67%), White (50.7%), between 20 and 59 years old (61.6%) and mentally disabled (58.1%), with multiple disabilities occurring frequently (15.9%), especially mental and intellectual disabilities. Self-inflicted violence accounted for 44.5% of notifications. Physical violence was the most reported (51.6%), and in 36.5% of notifications the probable aggressor was a family member. CONCLUSION: The description of cases of violence against people with disabilities notified by Brazilian health services can contribute to the formulation and improvement of public policies to address this important problem.

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Objetivo: Descrever os casos de violência contra pessoas com deficiência notificados por serviços de saúde brasileiros, em 2011-2017. Métodos: Estudo descritivo de dados secundários das notificações de violência contra pessoas com deficiência no Sistema de Informação de Agravos de Notificação (Sinan). Resultados: Foram registrados 116.219 casos de violência contra pessoas com deficiência no período. A maioria das vítimas era do sexo feminino (67%), branca (50,7%), na idade de 20 a 59 anos (61,6%), com deficiência mental (58,1%), sendo frequente a ocorrência de múltipla deficiência (15,9%), especialmente mental e intelectual. A violência autoprovocada correspondeu a 44,5% das notificações, enquanto a violência física foi a mais notificada (51,6%); em 36,5% das notificações, o provável agressor era um membro da família. Conclusão: A descrição dos casos de violência contra pessoas com deficiência, notificados por serviços de saúde brasileiros, pode contribuir para a formulação e aprimoramento de políticas públicas voltadas a esse importante problema.

Objetivo: Describir los casos de violencia contra personas con discapacidad notificados por servicios de salud brasileños en el período 2011 - 2017. Métodos: Estudio descriptivo de datos secundarios de notificaciones de violencia contra personas con discapacidad registradas en el Sistema de Información de Agravamiento de Notificación (Sinan). Resultados: En el período se registraron 116.219 casos de violencia contra personas con discapacidad. La mayoría de las víctimas eran mujeres (67%), blancas (50,7%), entre 20 y 59 años (61,6%) con discapacitad mental (58,1%), y con discapacidades múltiples, que ocurren con frecuencia (15,9%), especialmente mental e intelectual. La violencia autoinfligida representó el 44,5% de las notificaciones. La violencia física fue la más denunciada (51,6%) y en el 36,5% de las notificaciones, el probable agresor fue un miembro de la familia. Conclusión: La descripción de casos de violencia contra personas con discapacidad notificados por los servicios de salud puede contribuir a la formulación y mejora de las políticas públicas para enfrentar este importante problema.

Objective: To describe cases of violence against people with disabilities notified by Brazilian health services between 2011 and 2017. Methods: This was a descriptive study of secondary data on notifications of violence against people with disabilities recorded on the Notifiable Health Conditions Information System (Sinan). Results: 116,219 cases of violence against people with disabilities were recorded in the period. Most of the victims were female (67%), White (50.7%), between 20 and 59 years old (61.6%) and mentally disabled (58.1%), with multiple disabilities occurring frequently (15.9%), especially mental and intellectual disabilities. Self-inflicted violence accounted for 44.5% of notifications. Physical violence was the most reported (51.6%), and in 36.5% of notifications the probable aggressor was a family member. Conclusion: The description of cases of violence against people with disabilities notified by Brazilian health services can contribute to the formulation and improvement of public policies to address this important problem.

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BACKGROUND: Measuring the Global Burden of Disease (GBD) has been the key to verifying the evolution of health indicators worldwide. We analyse subnational GBD data for Brazil in order to monitor the performance of the Brazilian states in the last 28 years on their progress towards meeting the health-related SDGs. METHODS: As part of the GBD study, we assessed the 41 health-related indicators from the SDGs in Brazil at the subnational level for all the 26 Brazilian states and the Federal District from 1990 to 2017. The GBD group has rescaled all worldwide indicators from 0 to 100, assuming that for each one of them, the worst value among all countries and overtime is 0, and the best is 100. They also estimate the overall health-related SDG index as a function of all previously estimated health indicators and the SDI index (Socio-Demographic Index) as a function of per capita income, average schooling in the population aged 15 years or over, and total fertility rate under the age of 25 (TFU25). RESULTS: From 1990 to 2017, most subnational health-related SDGs, the SDG and SDI indexes improved considerable in most Brazilian states. The observed differences in SDG indicators within Brazilian states, including HIV incidence and health worker density, increased over time. In 2017, health-related indicators that achieved good results globally included the prevalence of child wasting, NTD, household air pollution, conflict mortality, skilled birth attendance, use of modern contraceptive methods, vaccine coverage, and health worker density, but poor results were observed for child overweight and homicide rates. The high rates of overweight, alcohol consumption, and smoking prevalence found in the historically richest regions (i.e., the South and Southeast), contrast with the high rates of tuberculosis, maternal, neonatal, and under-5 mortality and WASH-related mortality found in the poorer regions (i.e., the North and Northeast). CONCLUSIONS: The majority of Brazil's health-related SDG indicators have substantially improved over the past 28 years. However, inequalities in health among the Brazilian states and regions remain noticeable negatively affecting the Brazilian population, which can contribute to Brazil not achieving the SDG 2030 targets.

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OBJECTIVE: To analyze notifications of intimate partner violence (IPV) against women. METHODS: Cross-sectional study on IPV against women (≥ 15 years old) registered in Brazilian Notification Disease Information System (Sinan) from 2011 to 2017, analyzed using the chi-square test (χ2) and Poisson regression with robust variance to estimate proportion ratios (PR) and their respective 95% confidence intervals (95%CI). RESULTS: A total 454,984 cases of violence perpetrated by men against women were reported, of which 62.4% were IPV. The most reported types of violence were physical (86.6%), psychological (53.1%) and sexual (4.8%) abuse. IPV was positively associated with women aged 20-39 years (PR = 1.70; 95%CI 1.68; 1.71), pregnant women (PR = 1.07; 95%CI 1.06; 1.08), marital partnership (PR = 1.55; 95%CI 1.54; 1.56), occurrence at home (PR = 1.80; 95%CI 1.79; 1.81), recurrence of violence (PR = 1.77; 95%CI 1.76; 1.78) and alcohol intake by the aggressor (PR = 1.12; 95%CI 1.12; 1.13). Physical violence was associated with the 20-39 age group (PR = 1.03; 95%CI 1.02; 1.03). Psychological violence predominated among women ≥ 40 years old (PR = 1.33; 95%CI 1.31; 1.35). Sexual violence was reported in greater proportion among pregnant women (PR = 2.71; 95%CI 2.59; 2.83) and women with disabilities or disorder (PR = 2.30; 95%CI 2.17; 2.44). CONCLUSION: Most reports of violence against women recorded in health services were perpetrated by an intimate partner, especially physical, psychological and sexual violence. It was possible to identify factors associated with IPV such as age, education, pregnancy, occurrence at home, recurrence and alcohol consumption by the aggressor.

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OBJECTIVE: To describe the notifications of interpersonal and self-inflicted firearm violence in adolescents and to identify the factors associated with the notification of this event. METHODOLOGY: Cross-sectional study analyzing data from Sinan from 2011 to 2017, in adolescents aged 10-19 years, injured by firearms. The χ2 test was used to verify the gender ratio difference. Correlation analysis and multiple linear regression were performed between the logarithm of the firearm notification rate and each independent variable, in a sample of large municipalities. RESULTS: There were 30,103 reports of firearm violence in adolescents, of which (74.7%) were males aged 15-19 years (83.8%). Among girls, violence is more common at home, with a known perpetrator, and with physical and sexual violence combined. The death rate by firearms was higher in Fortaleza, Maceió, João Pessoa, Salvador and Natal, ranging from 105.88 to 71.73 per 100 thousand. Higher notification rates of firearm violence were associated with higher firearm death rates and greater coverage of health facilities. CONCLUSION: Firearm violence is a major public health problem in adolescents. Attacks on the disarmament statute and the loosening of gun possession and ownership directly confront the present and future of children and adolescents.

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INTRODUCTION: Violence experienced in adolescence results in serious damage and suffering to society. This study aims to characterize the profile of violence victims and likely perpetrators of violence against adolescents, as well as to describe the percentage of notifying municipalities according to the federation unit. METHODS: Cross-sectional study conducted with data on notification of violence against adolescents from the Information System for Notifiable Diseases, from 2011 to 2017. The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders. Proportion ratios for the most frequent types of violence were estimated according to selected variables. RESULTS: The notifications came from 75.4% of all the Brazilian municipalities. Physical violence predominated among males, aged 15-19 years. Psychological violence was predominant among females, between 10 and 14 years old, when perpetrated repeatedly at home by family aggressors. Sexual violence prevailed among females, aged 10 to 14 years old, in the indigenous, black and yellow races/colors, when perpetrated repeatedly at home. Negligence was more common among males, between 10 and 14 years old, when perpetrated repeatedly by family aggressors. CONCLUSIONS: Sexual violence occurred predominantly against females and generated significant negative impacts on mental, physical, sexual and reproductive health. Community violence, perpetrated with sharp objects and firearms, were prominent among males and are important risk factors for male over-mortality. Because the problems are complex, addressing them requires intersectoral actions.

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Resumo Este estudo tem como objetivo analisar a percepção de representantes de Comissões Intergestores Regionais (CIRs) sobre o processo de regionalização em saúde no Estado de Minas Gerais. Foram realizadas entrevistas com representantes de dez regiões de saúde do estado. Os dados, analisados por meio do software IRAMUTEQ, geraram um dendograma com dois eixos temáticos. O primeiro eixo, denominado "O papel das CIRs e dos principais atores no processo de governança regional", subdividiu-se nas classes 4, 3 e 2, que abordaram, respectivamente, o protagonismo dos apoiadores do Conselho de Secretarias Municipais de Saúde (COSEMS) nas CIRs; a CIR como espaço de pactuação das ações regionais; atores envolvidos na governança da região de saúde. O segundo, denominado "Organização da assistência nas redes de atenção", subdividiu-se nas classes 5, 1 e 6, que descreveram, respectivamente, vazios assistenciais nas regiões de saúde; fragilidades e potencialidades do processo de regionalização; dificuldades de provisão de serviços de média e alta complexidade. A regionalização em saúde em Minas Gerais, apesar de estratégias bem-sucedidas, apresenta grandes desafios. O financiamento insuficiente do SUS, em um cenário de disputas políticas, e fragmentação de recursos prejudica a provisão da atenção nas regiões de saúde. Trata-se, portanto, de um processo em construção.

Abstract This study aims to analyze the perception of representatives of Regional Inter-managerial Commissions on the process of health regionalization in the State of Minas Gerais. Interviews were conducted with representatives of 10 state health regions. The data, analyzed through IRAMUTEQ software, generated a dendogram with two thematic axes. The first axis, called "The role of CIR and key actors in the regional governance process", was subdivided into classes 4, 3 and 2, which addressed, respectively, the role of the Council of Municipal Health Secretaries supporters in the Commissions; the Commissions as a space for agreement on regional actions; the actors involved in the governance of the health region. The second, called "Organization of assistance in the care networks" was subdivided into classes 5, 1 and 6, which described, respectively, care gaps in the health regions; weaknesses and potentialities of the regionalization process; difficulties in providing medium and high complexity services. Health regionalization in Minas Gerais, despite successful strategies, brings great challenges. Insufficient financing of the SUS in a scenario of political disputes and resource fragmentation undermines the provision of care in health regions. It is a process still under construction.

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RESUMO: Introdução: A violência sofrida na adolescência resulta em sérios prejuízos e sofrimento para a sociedade. Este estudo objetivou caracterizar o perfil das violências, das vítimas e dos prováveis autores das violências perpetradas contra adolescentes, bem como descrever o percentual de municípios notificantes por unidade da Federação. Métodos: Estudo transversal, realizado com dados de notificação de violência contra adolescentes do Sistema de Informação de Agravos de Notificação referentes ao período de 2011 a 2017. A significância estatística das diferenças entre as proporções na comparação entre sexos foi testada com o qui-quadrado. Estimaram-se razões de proporção para os tipos de violência mais frequentes segundo variáveis selecionadas. Resultados: As notificações foram procedentes de 75,4% dos municípios brasileiros. A violência física predominou no sexo masculino, na idade de 15 a 19 anos. A violência psicológica predominou no sexo feminino, entre 10 e 14 anos, quando praticada de forma repetitiva, no domicílio, por agressores familiares. A violência sexual prevaleceu no sexo feminino, entre 10 e 14 anos, nas raças/cores indígena, negra e amarela, quando perpetrada de forma repetitiva, no domicílio. A negligência predominou no sexo masculino, entre 10 e 14 anos, quando praticada de forma repetitiva, por agressores familiares. Conclusões: Violências sexuais ocorreram preponderantemente no sexo feminino e geram consideráveis impactos negativos à saúde mental, física, sexual e reprodutiva. Violências comunitárias perpetradas com objetos perfurocortantes e arma de fogo tiveram destaque no sexo masculino e são fatores de risco significativos para a sobremortalidade masculina. Como os problemas são complexos, demandam atuação intersetorial para seu enfrentamento.

ABSTRACT: Introduction: Violence experienced in adolescence results in serious damage and suffering to society. This study aims to characterize the profile of violence victims and likely perpetrators of violence against adolescents, as well as to describe the percentage of notifying municipalities according to the federation unit. Methods: Cross-sectional study conducted with data on notification of violence against adolescents from the Information System for Notifiable Diseases, from 2011 to 2017. The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders. Proportion ratios for the most frequent types of violence were estimated according to selected variables. Results: The notifications came from 75.4% of all the Brazilian municipalities. Physical violence predominated among males, aged 15-19 years. Psychological violence was predominant among females, between 10 and 14 years old, when perpetrated repeatedly at home by family aggressors. Sexual violence prevailed among females, aged 10 to 14 years old, in the indigenous, black and yellow races/colors, when perpetrated repeatedly at home. Negligence was more common among males, between 10 and 14 years old, when perpetrated repeatedly by family aggressors. Conclusions: Sexual violence occurred predominantly against females and generated significant negative impacts on mental, physical, sexual and reproductive health. Community violence, perpetrated with sharp objects and firearms, were prominent among males and are important risk factors for male over-mortality. Because the problems are complex, addressing them requires intersectoral actions.

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RESUMO Estado, políticas de equidade e participação social: experiência de gestão participativa na construção e na implementação de políticas públicas. Pode a saúde tornar-se um espaço de construção de cidadania que contribua com a redução das desigualdades sociais? Os limites do Estado brasileiro podem ser impeditivos para o desenvolvimento de uma gestão participativa, na qual os movimentos sociais deveriam estar aptos, de fato, a opinar e participar sem perder sua autonomia? O presente ensaio traz elementos para essas reflexões e cita possíveis avanços em tais questões, a partir da implantação de políticas de equidade na saúde, apontando, ainda, potencialidades de articulação entre as esferas da gestão do Sistema Único de Saúde, como espaço, também, de gestão participativa.

ABSTRACT State, equity policies and social participation: participatory management experience in the construction and implementation of public policies. Can health become a space for construction of citizenship that contributes to the reduction of social inequalities? Can the limits of the Brazilian state be prohibitive for the development of a participative management, in which social movements should be able to, in fact, speak about and participate without losing their autonomy? This essay brings elements to this reflection and cites possible advances in such issues, from the implementation of equity policies in health, pointing out, also, potentialities of articulation between the Unified Health System management spheres, as a space, also, of participatory management.

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This article analyzes the use of medicines by individuals with hypertension and/or diabetes mellitus who received their medication through a public network of pharmacies, with a particular emphasis on gender differences. During the first two months of 2010, individuals with hypertension and/or diabetes were interviewed in half of the 64 municipalities (counties) participating in the Minas Gerais Pharmacy Network. Mean age of the 4,777 interviewees was 60.9 years, which may have contributed to the high mean number of medicines used (4.0 among women and 3.5 among men). The most frequently used drugs were those acting on the cardiovascular system (56.3%), alimentary tract and metabolism (14.9%), and nervous system (13.8%), consistent with the sample's epidemiological profile. Women and more elderly individuals tended to use more medicines. The findings show high expenditures on medicines by the interviewees and suggest the design of educational activities targeting rational use of medication.

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Este trabalho descreve o perfil de utilização de medicamentos de indivíduos com hipertensão e/ou diabetes, que adquirem esses produtos por meio de uma rede pública de farmácias, com ênfase nas diferenças entre sexos. No primeiro bimestre de 2010 foram entrevistados indivíduos hipertensos e/ou diabéticos, em metade dos 64 municípios então participantes da Rede Farmácia de Minas. Os 4.777 entrevistados tinham em média 60,9 anos, fato que pode ter contribuído para a elevada média de medicamentos utilizados (4,0 entre as mulheres e 3,5 entre os homens). Os medicamentos mais frequentes foram os que atuam no sistema cardiovascular (56,3%), trato alimentar e metabólico (14,9%), sistema nervoso (13,8%) e estão de acordo com o perfil epidemiológico dos entrevistados. As mulheres, juntamente com os mais idosos destacaram-se no que diz respeito à utilização de um maior número de medicamentos. Os resultados deste estudo mostraram elevados gastos com medicamentos pelos entrevistados e sugerem o delineamento de ações educativas voltadas para o uso racional de medicamentos, entre esses indivíduos.

This article analyzes the use of medicines by individuals with hypertension and/or diabetes mellitus who received their medication through a public network of pharmacies, with a particular emphasis on gender differences. During the first two months of 2010, individuals with hypertension and/or diabetes were interviewed in half of the 64 municipalities (counties) participating in the Minas Gerais Pharmacy Network. Mean age of the 4,777 interviewees was 60.9 years, which may have contributed to the high mean number of medicines used (4.0 among women and 3.5 among men). The most frequently used drugs were those acting on the cardiovascular system (56.3%), alimentary tract and metabolism (14.9%), and nervous system (13.8%), consistent with the sample's epidemiological profile. Women and more elderly individuals tended to use more medicines. The findings show high expenditures on medicines by the interviewees and suggest the design of educational activities targeting rational use of medication.

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