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O estudo buscou identificar a prevalência de Síndrome de Burnout (SB), bem como verificar se existe uma associação da SB com fatores ocupacionais e a prática de atividade física (AF) em servidores técnico-administrativos (STA) de uma universidade federal do sul do Brasil. A amostra foi composta por 203 STA. Foram coletados dados sociodemográficos, ocupacionais, nutricional, SB e prática de AF. A prevalência de SB entre os STA foi de 50%, sendo que a mesma esteve associada inversamente com a faixa etária (p=0,02) e com as atividades administrativas ou de escritório (p=0,008), ambas com proteção superior a 30%. Conclui-se que a prevalência de SB é elevada entre os STA e que políticas voltadas a redução dos fatores que levam a SB entre STA devem ser criadas e implementadas pela instituição, auxiliando na redução do adoecimento.

The study sought to identify the prevalence of Burnout Syndrome (BS), as well as to verify if there is an association of BS with occupational factors and the practice of physical activity (PA) in technical-administrative servers (TAS) of a federal university in south of Brazil. The sample was composed by 203 STA. Sociodemographic, occupational, nutritional, SB and PA practice data were collected. The prevalence of BS among the TAS was 50%, being that it was inversely associated with age group (p=0.02) and with administrative or desk activities (p=0.008), both with protection greater than 30 %. It was concluded that the prevalence of BS is high among the TAS and policies aimed at reducing two factors that lead to BS among TAS should be created and implemented by the institution helping in the reduction of the treatment.

El estudio buscó identificar la prevalencia del Síndrome de Burnout (SB), así como verificar si existe asociación del SB con factores ocupacionales y la práctica de actividad física (AF) en servidores técnico-administrativos (STA) de una universidad federal en el sur de Brasil. La muestra fue compuesta por 203 STA. Fueron colectados datos sociodemográficos, ocupacionales, nutricional, SB y práctica de AF. La prevalencia de SB entre os STA foi de 50%, siendo que la misma estuvo asociada inversamente com el grupo de edad (p=0,02) y com las actividades administrativas o- de oficina (p=0,008), ambas con protección superior a 30 % Se concluyo que la prevalencia de SB es elevada entre los STA y políticas específicas de disminución de los factores que llevam a SB entre STA deven ser creadas y aplicadas por la institución auxiliando en la disminución de dolencias.

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ABSTRACT BACKGROUND AND OBJECTIVES: Musculoskeletal pain (MSP) in sedentary workers is a cause of absenteeism, high health costs and is relate to their lifestyle and work. Systematic reviews of interventions on the condition of MSP in this population are based on work equipment and do not present consensus on the type of intervention and its effectiveness. Terefore, the objective was to analyze the evidence of intervention studies that included education strategies to change the lifestyle of sedentary workers on the reduction of MSP. CONTENTS: This systematic review follows the recommendations of PRISMA 2020. Searches were conducted until April 2021 in the PubMed, BIREME and Scielo databases, in order to identify randomized or non-randomized clinical trials published between January 1999 and April 2021. Indexed search descriptors were used and eligibility criteria were defined according to the PICOS strategy. The risk of bias was assessed using the PEDro scale. Eight randomized clinical trials published between 2004 and 2020, conducted in Europe, Asia, the United States and Australia involving 1,871 people (35 to 52 years old) were included. Interventions ranged from two weeks to 12 months. Five studies showed a higher number of women. In addition to lifestyle counseling, three studies addressed work characteristics (time in sitting posture, body posture) and three others investigated issues related to pain (symptoms, neck/shoulder anatomy and self-management). Six interventions were effective to reduce the intensity and frequency of MSP in the cervical and lumbar regions of the spine, shoulders and thoracic spine, which used counseling to increase the practice of physical activity, stress control, healthy eating, decreased alcohol consumption and smoking. Six studies presented medium/low bias risk in the following items: occult allocation, baseline comparability, blinding (individuals, therapists and evaluators), adequate follow-up and intention to treat analysis; and two studies presented medium/high risk in the same items, except in baseline comparability. CONCLUSION: Workplace interventions that include education strategies and counseling for lifestyle changes are effective for reducing the intensity and frequency of MSP in sedentary workers. PROSPERO registration: CRD42022342636. HIGHLIGHTS Lifestyle education can reduce musculoskeletal pain in workers. Physical activity and stress control contribute to reducing pain intensity. The workplace is a potent environment for decreasing musculoskeletal pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor musculoesquelética (DME) em trabalhadores sedentários é causa de absenteísmo, custos elevados em saúde e está relacionada ao seu estilo de vida e de trabalho. Revisões sistemáticas de intervenções sobre a condição de DME nesta população baseiam-se nos equipamentos de trabalho e não apresentam consenso quanto ao tipo de intervenção e sua efetividade. Portanto, o objetivo foi analisar as evidências dos estudos de intervenção que incluíram estratégias de educação para mudança do estilo de vida de trabalhadores sedentários para a redução da DME. CONTEÚDO: Esta revisão sistemática segue as recomendações do PRISMA 2020. Foram realizadas buscas até abril de 2021 nas bases de dados Pubmed, BIREME e Scielo, visando identificar estudos clínicos randomizados ou não randomizados publicados entre janeiro de 1999 e abril de 2021. Foram utilizados descritores de busca indexados e definidos critérios de elegibilidade segundo a estratégia PICOS. O risco de viés foi avaliado por meio da escala PEDro. Foram incluídos oito estudos clínicos randomizados publicados entre 2004 e 2020, realizados na Europa, Ásia, Estados Unidos e Austrália, que envolveram 1.871 pessoas (35 a 52 anos). As intervenções variaram de duas semanas a 12 meses. Cinco estudos apresentaram maior número de mulheres. Além dos aconselhamentos para estilo de vida, três estudos abordaram características do trabalho (tempo na postura sentada, postura corporal) e outros três investigaram questões relacionadas à dor (sintomas, anatomia pescoço/ombro e autogerenciamento). Seis intervenções foram efetivas para a redução da intensidade e da frequência de DME nas regiões cervical e lombar da coluna, nos ombros e coluna torácica, as quais utilizaram aconselhamentos para aumento da prática de atividade física, controle do estresse, alimentação saudável, diminuição do consumo de álcool e do tabagismo. Seis estudos apresentaram risco de viés médio/baixo nos itens alocação oculta, comparabilidade da linha de base, cegamento (indivíduos, terapeutas e avaliadores), acompanhamento adequado e análise de intenção de tratar; e dois estudos apresentaram risco médio/alto nos mesmos itens, exceto na comparabilidade da linha de base. CONCLUSÃO: Intervenções realizadas no local de trabalho e que incluam estratégias de educação e aconselhamentos para mudanças no estilo de vida podem ser efetivas para redução da intensidade e da frequência de DME em trabalhadores sedentários. Registro PROSPERO: CRD42022342636. DESTAQUES Educação a respeito de estilo de vida pode reduzir a dor musculoesquelética de trabalhadores. Atividade física e controle do estresse contribuem para redução da intensidade de dor. O local de trabalho é um ambiente potente para melhora na dor musculoesquelética.

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Counseling by health professionals has promising results in behavior change and is recommended as part of integrated community interventions. However, the knowledge about sedentary behavior (SB) counseling is incipient. The study aimed to identify the prevalence and explore the associated factors with SB counseling received from healthcare professionals by adults in primary health care (PHC) in Brazil. A cross-sectional study was conducted in 2019 that included a representative sample of 779 users in all 15 basic health units (BHU) in São José dos Pinhais, Paraná. We identified those who reported having received SB counseling during a consultation. The association between the sociodemographic factors, chronic diseases, access to health services, physical activity, SB, and counseling were analyzed using Poisson regression in a hierarchical model. The prevalence of counseling was 12.2% (95% CI: 10.1-14.7%); it was higher in women (PR: 1.77; 95% CI: 1.10-2.83), those aged ≥60 yrs (PR: 1.84; 95% CI: 1.14-2.98), BMI ≥ 30 kg/m2 (PR: 2.60; 95% CI: 1.31-5.17), who consume ≥3 medications (PR: 2.21; 95% CI: 1.06-4.59), and those who spend a prolonged period of the day engaged in SB (4th quartile PR: 3.44; 95% CI: 1.88-6.31). The results highlight that SB counseling is underutilized and incipient in PHC. Understanding these results can help managers and healthcare professionals in BHU teams to implement and direct specific actions to reduce SB in adults through counseling.

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ABSTRACT BACKGROUND AND OBJECTIVES: Back pain is one of the main causes of disability worldwide, resulting in higher rates of work absenteeism and years lived with disability. This study aimed to evaluate back pain prevalence and its associated factors in Primary Health Units (PHU) users. METHODS: A community-based cross-sectional study was conducted at PHU located in Pelotas, Brazil. Fifteen individuals of each PHU, aged 18 years or more, were interviewed (n=540). Back pain was defined as pain in one to three back areas (neck, dorsal and lumbar). Demographic, economic, behavioral, nutritional status (body mass index) and health characteristics were assessed as covariates. Poisson regression was used to estimate the prevalence ratio and 95% confidence intervals. RESULTS: Prevalence of back pain in PHU users was 20% (95%CI 16.8 - 23.6). Fair (PR 2.66 95%CI 1.00 - 7.09) and poor (PR 3.65 95%CI 1.31 - 10.16) self-perceived health, musculoskeletal disease (RP 2.71 95%CI 1.84 - 3.98) and current smoking (PR 1.71 95%CI 1.18 - 2.47) were associated with back pain. CONCLUSION: Back pain is a common problem in PHU users in Brazil. Patients with musculoskeletal disease, who are current smokers and have a poor self-perceived health, are more likely to experience back pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor nas costas é uma das principais causas de incapacidade em todo o mundo, resultando em maiores taxas de absenteísmo no trabalho e anos vividos com incapacidade. Este estudo teve como objetivo avaliar a prevalência de dor nas costas e seus fatores associados em usuários de Unidades Básicas de Saúde (UBS). MÉTODOS: Foi realizado um estudo transversal de base comunitária em UBS localizadas em Pelotas, Brasil. Foram entrevistados 15 indivíduos de cada UBS, com idade igual ou superior a 18 anos (n=540). A dor nas costas foi definida como dor em uma a três áreas das costas (pescoço, dorsal e lombar). Características demográficas, econômicas, comportamentais, nutricionais (índice de massa corporal) e de saúde foram avaliadas como covariáveis. A regressão de Poisson foi utilizada para estimar a razão de prevalência e os intervalos de confiança de 95%. RESULTADOS: A prevalência de dor nas costas em usuários de UBS foi de 20% (IC95% 16,8 - 23,6). Autopercepção de saúde regular (RP 2,66 IC95% 1,00 - 7,09) e ruim (RP 3,65 IC95% 1,31 - 10,16), doença musculoesquelética (RP 2,71 IC95% 1,84 - 3,98) e tabagismo atual (RP 1,71 IC95% 1,18 - 2,47) foram associados à dor nas costas. CONCLUSÃO: A dor nas costas é um problema comum em usuários de UBS. Pacientes com doença musculoesquelética, fumantes atuais e com autopercepção de saúde ruim são mais propensos a sentir dor nas costas.

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BACKGROUND: This article presents the recommendations from the Physical Activity Guidelines for the Brazilian Population. METHODS: A steering committee composed of a chair, 6 experts in physical activity, and representatives from the Ministry of Health/Brazil, Pan American Health Organization, Brazilian Society of Physical Activity and Health designed the guidelines, which was implemented by 8 working groups, as follows: (1) understanding physical activity, (2) children up to 5 years old, (3) children and youth from 6 to 17 years old, (4) adults, (5) older adults (60 years and above), (6) physical education at school, (7) pregnant and postpartum women, and (8) people with disabilities. The methodological steps included evidence syntheses, hearings with key stakeholders, and public consultation. RESULTS: Across 8 chapters, the guidelines provide definitions of physical activity and sedentary behavior, informing target groups on types of physical activity, dosage (frequency, intensity, and duration), benefits, and supporting network for physical activity adoption. The guidelines are openly available in Portuguese, Spanish, English, and Braille and in audio versions, with a supplementary guide for health professionals and decision makers, and a report about the preparation and references. CONCLUSIONS: The Physical Activity Guidelines for the Brazilian Population provide evidence-based recommendations, being a public-directed resource to contribute to the physical activity promotion in Brazil.

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BACKGROUND: This article describes the process and methods used in the development of the first ever Physical Activity Guidelines for the Brazilian Population. METHODS: The steering committee established 8 working groups based on other guidelines and the Brazilian agenda for public health and physical activity (PA) promotion: (1) understanding PA; (2) children up to 5 years; (3) children and youth (6-17 y); (4) adults; (5) older adults (60 years and above); (6) physical education at school; (7) pregnant and postpartum women; and (8) people with disabilities. Working groups were formed to (1) synthesize the literature on each topic; (2) conduct workshops with stakeholders, health professionals, researchers, and the public; and (3) prepare a draft chapter for open online consultation. RESULTS: The document provides guidance for the population on the benefits of being active and recommendations regarding the amount (frequency, intensity, and duration) of PA recommended across all chapters. It also includes information on supporting networks for PA. CONCLUSIONS: The PA guidelines are widely accessible in Portuguese, including versions in English, Spanish, audiobook, and Braille, and will assist policy makers and professionals from several sectors to promote PA. The ultimate goal is to increase population levels of PA in Brazil.

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Visando orientar a população dos benefícios da prática de atividade física à saúde, pesquisadores nacionais, em parceria com o Ministério da Saúde, elaboraram o Guia de Atividade Física para a População Brasileira (Guia). O objetivo deste estudo foi apresentar o processo de elaboração das recomendações brasileiras de atividade física para pessoas com deficiência (PCD). O processo de elaboração das recomendações específicas para PCD foi liderado por um grupo de trabalho com nove pesquisadores/profissionais que realizaram reuniões semanais, e que conduziram revisões sistemáti-cas e escutas com PCD, familiares, gestores, profissionais da saúde, professores e pesquisadores. Na revisão sistemática, um total de 83 estudos foram revisados e incluídos. As escutas foram realizadas por meio de formulários eletrônicos enviados por e-mail para profissionais, gestores, professores e pesquisadores que trabalhavam com PCD e de escutas virtuais, as quais foram conduzidas em dois momentos: (a) com PCD, familiares e profissionais; (b) com professores, gestores; e pesquisadores da temática. Baseado nos resultados das revisões sistemáticas e das escutas, as recomendações de atividade física para PCD foram elaboradas considerando o tempo mínimo de atividade física de acordo com faixas etárias, domínios da atividade física e recomendações para redução do comporta-mento sedentário. Portanto, o presente trabalho apresentou as estratégias e as etapas utilizadas para a elaboração do Guia, com recomendações de atividade física para PCD, as quais podem ser aliadas a políticas públicas, ambientes e oportunidades de atividade física, tornando-se estratégia essencial para o engajamento de PCD em atividades físicas

Aiming to guide the population of the physical activity benefits to health, national researchers, in partnership with the Health Ministry, have elaborated the Physical Activity Guide for the Brazilian population. The aim of this study is to present the process of elaborating Brazilian physical activity recommendations for people with disabilities (PWD). The process of elaborating specific recommendations for PWD has included the participation of nine researchers/professionals who held weekly meetings, systematic reviews, and focus groups with PWD, caregivers, healthcare managers, professionals, and researchers. In the systematic review, a total of 83 studies were included and reviewed. The focus groups were performed using an electronic form sent by e-mail to health professionals, managers, and researchers who worked with PWD and virtual focus groups, which were conducted in two moments: (a) with PWD, caregivers, and professionals; (b) with pro-fessors and researchers on the theme. Based on the results of systematic reviews and focus groups, the physical activity recommendations for PWD were developed considering the minimum physical activity time accord-ing to age group, types of physical activity, and recommendations for reducing sedentary behavior. Therefore, the present work presented recommendations for physical activity for PWD, which can be combined with public policies, environments, and opportunities for physical activity, becoming an essential strategy for the engagement of PWD in physical activities

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Introdução: O absenteísmo às consultas médicas previamente marcadas é um problema que interfere com a efetividade dos serviços de saúde. Neste contexto, a reorganização da agenda dos profissionais é central no sentido de garantir o acolhimento e a continuidade do cuidado. Objetivo: Descrever a prevalência de absenteísmo a partir da agenda de atendimento médico de um serviço de Atenção Primária à Saúde (APS) de ensino de graduação e pós-graduação do município de Pelotas, no estado do Rio Grande do Sul. Métodos: Foi realizado um estudo transversal com a totalidade dos agendamentos de um mês de atendimento de cada estação do ano, entre julho de 2016 e abril de 2017. Os dados foram coletados da agenda física local, digitados e analisados em planilha Excel®. Resultados: De 3.131 consultas médicas agendadas, foram computadas 598 faltas, resultando em uma prevalência de absenteísmo de 19,2% (IC95% 17,7-20,8). Dos 153 turnos de atendimento, em apenas 2% não ocorreram ausências e, entre os demais, a prevalência variou de 4,2% a 45%. Na distribuição do absenteísmo entre os sete grupos de consultas pesquisados destacaram-se os 62,3% de absenteísmo para os atendimentos de clínica geral e os 12,2% para a realização de exame citopatológico de colo uterino. Conclusão: Os resultados mostram uma elevada prevalência de absenteísmo, especialmente nas consultas de clínica médica, o que pode acarretar problemas tanto para a continuidade do cuidado, especialmente aos usuários da clínica geral, quanto para o ensino médico na APS. Este achado é superior ao encontrado por Tristão et al. em um estudo brasileiro em serviços de saúde ambulatoriais, e inferior ao resultado descrito por Izecksohn e Ferreira em um Centro de Saúde Escola. Os autores sugerem a necessidade de mudanças organizacionais na oferta de consultas objetivando ampliar o acesso e facilitar a adesão às consultas agendadas, de forma a garantir a longitudinalidade do cuidado.

Introduction: The absenteeism at scheduled medical appointments is a problem that interferes with the effectiveness of health services. In this context, the reorganization of the professionals schedule is central in ensuring the reception and continuity of care. Objective: To describe the prevalence of absenteeism from the health care agenda of a primary health care service (APS) for undergraduate and postgraduate education in the municipality of Pelotas, state of Rio Grande do Sul. Methods: A cross-sectional study was carried out with all the schedules of one month of medical appointments in each season between July 2016 and April 2017. The data were collected from the local appointment system, typed and analyzed in an Excel® worksheet. Results: Of the 3,131 scheduled medical appointments, 598 absences were recorded, resulting in a prevalence of absenteeism of 19.2% (95% CI, 17.7-20.8). Of the 153 care shifts in only 2%, there were no absences and, among others, the prevalence ranged from 4.2% to 45%. In the distribution of absenteeism among the seven groups of consultations surveyed, 62.3% of absenteeism was observed for general practitioner and 12.2% for the accomplishment of cytopathological exam of the uterine cervix. Conclusion: The results show a high prevalence of absenteeism, especially in medical clinic visits, which can lead to problems both for continuity of care, especially for general practitioners, and for medical teaching in APS. This finding is superior to that found by Tristão et al. in a Brazilian study on outpatient health services, and lower than the result described by Izecksohn and Ferreira in a School Health Center. The authors suggest the need for organizational changes aiming at increasing access and facilitating adherence to scheduled appointments, in order to guarantee the longitudinality of care.

Introducción: El absentismo a las consultas previamente marcadas es un problema que interfiere con la efectividad de los servicios de salud. En este contexto, la reorganización de la agenda de los profesionales es central en el sentido de garantizar la acogida y la continuidad del cuidado. Objetivo: Describir la prevalencia de absentismo a partir de la agenda de atención médica de un servicio de Atención Primaria a la Salud (APS) de enseñanza de graduación y postgrado del municipio de Pelotas, en el estado de Rio Grande do Sul (RS). Métodos: Se realizó un estudio transversal con la totalidad de la planificación de un mes de atención de cada estación del año, entre julio de 2016 y abril de 2017. Los datos fueron recolectados de la agenda física local, digitados y analizados en hoja de cálculo Excel®. Resultados: De 3.131 consultas médicas programadas fueron computadas 598 faltas, resultando en una prevalencia de absentismo del 19,2% (IC95% 17,7-20,8). De los 153 turnos de atención en apenas 2% no ocurrieron ausencias y, entre los demás, la prevalencia varió del 4,2% al 45%. En la distribución del absentismo entre los siete grupos de consultas encuestadas se destacaron el 62,3% de absentismo para las atenciones de clínica general y el 12,2% para la realización de examen citopatológico del cuello del útero. Conclusión: Los resultados muestran una elevada prevalencia de absentismo, especialmente en las consultas de clínica médica, lo que puede acarrear problemas tanto para la continuidad del cuidado, especialmente a los usuarios de la clínica general, como a la enseñanza médica en la APS. Este hallazgo es superior al encontrado por Tristão et al. en un estudio brasileño en servicios de salud de ambulatorios, e inferior al resultado descrito por Izecksohn y Ferreira en un Centro de Salud Escuela. Los autores sugieren la necesidad de cambios organizacionales en la oferta de consultas con el objetivo de ampliar el acceso y facilitar la adhesión a las consultas programadas, para garantizar la longitudinalidad del cuidado.

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OBJETIVO: to investigate the provision of health education and promotion actions in primary care, and their association with demographic characteristics and Family Health Strategy (FHS) coverage in Rio Grande do Sul state, Brazil. METHODS: this is a cross-sectional study conducted with 816 teams that adhered to the 2012 Primary Care Access and Quality Improvement Program. RESULTS: the most frequent actions were directed towards people with diabetes (91.2%), hypertension (90.8%) as well as antenatal and postnatal care (84.6%). The least frequent were directed to wards crack, alcohol and other drug users (32.4%), anxiolytic/benzodiazepine users (20.3%), people with tuberculosis (31.4%) and leprosy (21.0%). The greatest provision of health promotion and education actions occurred in smaller municipalities and with greater Family Health coverage. CONCLUSION: actions aimed at the reproductive period and chronic morbidities were the focus of primary care. FHS implementation strengthens health promotion.

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Objetivo: investigar a oferta de ações educativas e de promoção da saúde na atenção básica e sua associação com fatores demográficos e cobertura da Estratégia Saúde da Família (ESF), no estado do Rio Grande do Sul, Brasil. Métodos: estudo transversal realizado com 816 equipes que aderiram ao Programa de Melhoria do Acesso e da Qualidade da Atenção Básica, 2012. Resultados: as ações mais frequentes eram direcionadas aos diabéticos (91,2%), hipertensos (90,8%) e ao pré-natal e puerpério (84,6%). As menos frequentes, aos dependentes de crack, álcool e outras drogas (32,4%), ansiolíticos e benzodiazepínicos (20,3%), assim como aos portadores de tuberculose (31,4%) e hanseníase (21,0%). As maiores ofertas de ações educativas e de promoção da saúde ocorreram nos municípios de menor porte e com maior cobertura de saúde da família. Conclusão: ações voltadas ao período reprodutivo e a morbidades crônicas eram o foco da atenção básica. A implementação da ESF fortalece a promoção da saúde.

Objetivo: investigar la oferta de acciones educativas y promoción de la salud en la atención básica y su asociación con factores demográficos y la cobertura de la estrategia de salud de la familia, en Rio Grande do Sul, Brasil. Métodos: estudio transversal con 816 equipos que adhirieron al Programa de Mejora del Acceso y Calidad en la atención básica, 2012. Resultados: las acciones más frecuentes eran dirigidas a diabéticos (91,2%), hipertensos (90,8%), prenatal y puerperio (84,6%). Las menos frecuentes, dependientes de crack, alcohol, otras drogas (32,4%), ansiolíticos/benzodiazepinas (20,3%), portadores de tuberculosis (31,4%) y lepra (21,0%). La mayor oferta de acciones educativas y de promoción ocurrió en municipios de menor porte y con mayor cobertura de salud de la familia. Conclusión: acciones dirigidas al período reproductivo y morbilidades crónicas eran el foco de la atención básica. La implementación de la estrategia de salud de la familia fortalece la promoción de la salud.

Objetivo: to investigate the provision of health education and promotion actions in primary care, and their association with demographic characteristics and Family Health Strategy (FHS) coverage in Rio Grande do Sul state, Brazil. Methods: this is a cross-sectional study conducted with 816 teams that adhered to the 2012 Primary Care Access and Quality Improvement Program. Results: the most frequent actions were directed towards people with diabetes (91.2%), hypertension (90.8%) as well as antenatal and postnatal care (84.6%). The least frequent were directed to wards crack, alcohol and other drug users (32.4%), anxiolytic/benzodiazepine users (20.3%), people with tuberculosis (31.4%) and leprosy (21.0%). The greatest provision of health promotion and education actions occurred in smaller municipalities and with greater Family Health coverage. Conclusion: actions aimed at the reproductive period and chronic morbidities were the focus of primary care. FHS implementation strengthens health promotion.

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OBJETIVO: estimar a prevalência de incapacidade funcional para atividades básicas e instrumentais diárias e os fatores associados em idosos residentes na área urbana de Bagé-RS, Brasil. MÉTODOS: foi realizado estudo transversal de base populacional em 2008; a incapacidade funcional foi definida por meio das atividades básicas e instrumentais da vida diária, operacionalizadas pelo índice de Katz e pela escala de Lawton e Brody; para análise bruta e ajustada, utilizou-se a regressão de Poisson. RESULTADOS: foram investigados 1.593 idosos; a prevalência de incapacidade para atividades básicas foi de 10,6% (IC95%: 9,1;12,1), e para atividades instrumentais, de 34,2% (IC95%: 31,9;36,6); ambas incapacidades foram estatisticamente associadas ao incremento da idade, baixa escolaridade, consumo de bebida alcoólica, história de acidente vascular encefálico, deficit cognitivo, hospitalização e atendimento domiciliar. CONCLUSÃO: expressiva proporção de idosos apresentou incapacidade funcional; os desfechos foram associados a variáveis demográficas, socioeconômicas, comportamentais, situação de saúde e uso de serviços.

OBJETIVO: estimar la prevalencia de incapacidad para actividades básicas e instrumentales diarias y factores associados en sujetos mayores de 60 años. MÉTODOS: estúdio poblacional transversal con 1.593 ancianos residentes en el área urbana de Bagé-RS, Brasil; incapacidad funcional se define por necesidad de ayuda parcial o total de al menos una actividad básica o instrumental. RESULTADOS: la prevalencia de incapacidade en actividades básicas fue 10,6% (IC95%: 9,1;12,1) y 34,2% (IC95%:: 31,9;36,6) para instrumentales; se asoció com el aumento de la edad, el bajo nivel educativo, consumo de alcohol, antecedentes de accidente cerebrovascular, deterioro cognitivo, hospitalizados en el año anterior a la entrevista y el cuidado em el hogar en los últimos tres meses. CONCLUSIÓN: características sociodemográficas, del comportamiento y uso de servicio se asociaron com incapacidad poniendo de relieve la complejidad de llevar a cabo acciones para matener y desarrollar la autonomía de los ancianos.

OBJECTIVE: to estimate the prevalence of functional disability in basic and instrumental daily activities and associated factors in elderly who live in the urban area of Bagé-RS, Brazil. METHODS: this is a population-based cross-sectional study, conducted in 2008; functional disability was defined by basic and instrumental daily activities, using Katz index and Lawton and Brody scale; Poisson regression was used for crude and adjusted analyses. RESULTS: 1,593 elderly individuals were investigated; the prevalence of disability for basic activities was of 10.6% (95%CI: 9.1;12.1) and of 34.2% (95%CI: 31.9;36.6) for instrumental activities; both disabilities were statistically associated to the increment of age, low education level, alcohol consumption, history of cerebrovascular diseases, cognitive impairment, hospitalization and home care. CONCLUSION: a high proportion of elderly presented functional disability; the outcomes were associated to the following variables: demographic, socioeconomic, behavioral, health status and use of health services.

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OBJECTIVE: to estimate the prevalence of functional disability in basic and instrumental daily activities and associated factors in elderly who live in the urban area of Bagé-RS, Brazil. METHODS: this is a population-based cross-sectional study, conducted in 2008; functional disability was defined by basic and instrumental daily activities, using Katz index and Lawton and Brody scale; Poisson regression was used for crude and adjusted analyses. RESULTS: 1,593 elderly individuals were investigated; the prevalence of disability for basic activities was of 10.6% (95%CI: 9.1;12.1) and of 34.2% (95%CI: 31.9;36.6) for instrumental activities; both disabilities were statistically associated to the increment of age, low education level, alcohol consumption, history of cerebrovascular diseases, cognitive impairment, hospitalization and home care. CONCLUSION: a high proportion of elderly presented functional disability; the outcomes were associated to the following variables: demographic, socioeconomic, behavioral, health status and use of health services.

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The aim of this study was to describe quality indicators for prenatal care in Brazil as part of the Program for the Improvement of Access and Quality (PMAQ-AB). The study analyzed number of prenatal visits, vaccination status, prescription of ferrous sulfate, physical examination, orientation, and laboratory tests, based on which a summary quality indicator was constructed. Data were collected in 2012-2013 during interviews conducted by External Evaluators of the PMAQ-AB, with 6,125 users who had done their last prenatal follow-up in Family Health units. During prenatal follow-up, 89% reported six or more visits, more than 95% received a tetanus booster and prescription of ferrous sulfate, 24% reported having received all the procedures in the physical examination, 60% received all the orientation, and 69% had all the recommended laboratory tests. Only 15% of interviewees had received adequate prenatal care, including all the recommended measures, and there was a significantly higher proportion of "complete" care in pregnant women that were older, with higher income, in the Southeast region of Brazil, in municipalities with more than 300,000 inhabitants, and in those with (HDI) in the upper quartile. There are persist social and individual inequalities that can be targeted by measures to upgrade the teams' work processes.

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This article describes the primary health care offered to 8118 service users with diabetes in Brazil based on data from the PMAQ (Program to Improve Primary Care Access and Quality) first survey. Structure, access, service organization and management, and clinical care quality were analyzed. Prevalence of self-reported receipt of appropriate treatment was 14.3% (95% confidence interval [CI]: 13.4-15.2). Following adjustment, it was 26% higher (prevalence ratio [PR] = 1.26; 95% CI: 1.04-1.54) when primary health care centers had all the structure items investigated, it was 13% higher (PR = 1.13; 95% CI: 1.00-1.29) when the teams' work process for service organization and management was adequate and it was 14% higher (PR = 1.14; 95% CI: 1.00-1.30) when the teams' clinical practice was adequate.

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O objetivo foi descrever indicadores de qualidade da atenção pré-natal no Brasil no âmbito do Programa de Melhoria do Acesso e da Qualidade (PMAQ-AB). Foram analisados número de consultas, situação vacinal, prescrição de sulfato ferroso, exame físico, orientações e exames complementares, com base no que se construiu como um indicador sintético de qualidade. Os dados foram coletados em 2012/2013 por meio de entrevistas realizadas por Avaliadores Externos do PMAQ-AB às 6.125 usuárias que fizeram seu último pré-natal nas unidades de saúde da família. Durante o pré-natal, 89% fizeram seis ou mais consultas, mais de 95% atualizaram a vacina antitetânica e receberam prescrição de sulfato ferroso, 24% referiram ter recebido todos os procedimentos de exame físico, 60% receberam todas as orientações e 69% realizaram todos os exames complementares. Apenas 15% das entrevistadas receberam atenção pré-natal adequada, considerando-se todas as ações preconizadas, sendo significativamente maior a proporção de completude da atenção em gestantes com mais idade, de maior renda, na Região Sudeste, nos municípios com mais de 300 mil habitantes e com IDH no quartil superior. Persistem desigualdades sociais e individuais que podem ser objeto de ações de qualificação dos processos de trabalho das equipes.

The aim of this study was to describe quality indicators for prenatal care in Brazil as part of the Program for the Improvement of Access and Quality (PMAQ-AB). The study analyzed number of prenatal visits, vaccination status, prescription of ferrous sulfate, physical examination, orientation, and laboratory tests, based on which a summary quality indicator was constructed. Data were collected in 2012-2013 during interviews conducted by External Evaluators of the PMAQ-AB, with 6,125 users who had done their last prenatal follow-up in Family Health units. During prenatal follow-up, 89% reported six or more visits, more than 95% received a tetanus booster and prescription of ferrous sulfate, 24% reported having received all the procedures in the physical examination, 60% received all the orientation, and 69% had all the recommended laboratory tests. Only 15% of interviewees had received adequate prenatal care, including all the recommended measures, and there was a significantly higher proportion of "complete" care in pregnant women that were older, with higher income, in the Southeast region of Brazil, in municipalities with more than 300,000 inhabitants, and in those with (HDI) in the upper quartile. There are persist social and individual inequalities that can be targeted by measures to upgrade the teams' work processes.

El objetivo fue describir indicadores de calidad de la atención prenatal en Brasil en el ámbito del Programa de Mejoría del Acceso y de la Calidad (PMAQ-AB). Se analizaron el número de consultas, situación de vacunación, prescripción de sulfato ferroso, examen físico, orientaciones y exámenes complementarios, en base a lo que se construyó como un indicador sintético de calidad. Los datos fueron recogidos en 2012/2013, mediante entrevistas realizadas por evaluadores externos del PMAQ-AB, entre 6.125 usuarias que realizaron su último examen prenatal en las unidades de Salud de la Familia. Durante el periodo prenatal, un 89% realizaron seis o más consultas, más de un 95% actualizaron la vacuna antitetánica y obtuvieron recetas de sulfato ferroso, un 24% informaron haber recibido todos los procedimientos de examen físico, un 60% recibieron todas las orientaciones y un 69% realizaron todos los exámenes complementarios. Solamente un 15% de las entrevistadas recibieron atención prenatal adecuada, considerándose todas las acciones preconizadas, siendo significativamente mayor la proporción "de en su totalidad" en la atención en gestantes con más edad, de mayor renta, en la Región Sudeste, en los municipios con más de 300 mil habitantes y con IDH en el cuartil superior. Persisten desigualdades sociales e individuales que pueden ser objeto de acciones de cualificación de los procesos de trabajo de equipos de salud.

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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.

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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.

OBJETIVO Descrever a falta de acesso e de continuidade da atenção à saúde de adultos.MÉTODOS Estudo transversal de base populacional com 12.402 adultos entre 20 e 59 anos, residentes em áreas urbanas de 100 municípios de 23 estados brasileiros, nas cinco regiões geopolíticas. Investigaram-se as barreiras no acesso e na continuidade da atenção a partir do recebimento, necessidade e busca de algum atendimento de saúde (internação hospitalar e pronto-socorro nos 12 meses prévios ao estudo; atendimento médico, de outro profissional de saúde e domiciliar nos três meses prévios). A partir dos resultados obtidos na descrição da amostra, apresenta-se uma projeção para os adultos residentes em áreas urbanas no território nacional.RESULTADOS A prevalência de falta de acesso aos serviços e aos atendimentos com profissionais de saúde mais expressiva foi de 3,0%, para internação hospitalar, enquanto a menor prevalência foi para atendimento médico (1,1%). A falta de acesso para o atendimento com outro profissional de saúde foi de 2,0%; em pronto-socorro, 2,1%; e domiciliar, 2,9%. Quanto às prevalências, o maior número absoluto de falta de acesso foi para atendimentos de urgência (mais de 360.000 adultos). Os principais motivos foram problemas estruturais e organizacionais, como falta de leito, de profissionais, de ficha/vaga do tipo de atendimento necessário e cobrança pelo atendimento.CONCLUSÕES O direito universal à saúde no Brasil ainda não foi alcançado. As projeções podem apoiar a gestão no dimensionamento de esforços dirigidos ao seu enfrentamento, como a ampliação da estrutura física dos serviços e da força de trabalho.

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Indicadores de oferta, acesso e utilização são úteis para caracterizar os serviços, planejar ações e organizar a demanda. Este estudo descreve padrões de utilização de atendimento médico-ambulatorial e associação com variáveis sociodemográficas, de morbidade, porte do município e região, de acordo com a natureza jurídica do serviço. Trata-se de um estudo transversal de base populacional com 12.402 adultos brasileiros entre 20 e 59 anos, residentes nas áreas urbanas de 100 municípios nas cinco regiões brasileiras. A prevalência de atendimento médico-ambulatorial nos três meses anteriores à entrevista foi de 34,6%. O Sistema Único de Saúde foi responsável por mais da metade (53,6%) dos atendimentos, algum convênio de saúde foi utilizado por 34% da amostra e os serviços privados por 12,4%, independentemente da região, do porte populacional e da morbidade referida. Os padrões de utilização de serviços de saúde continuam socialmente determinados, resultando da oferta, das características sociodemográficas e do perfil de saúde dos usuários.

Indicators of supply, access, and use of healthcare are helpful for characterizing services, planning activities, and organizing demand. This study describes patterns of use of outpatient care and the associations with demographic and socioeconomic factors, morbidity, population size of the municipality and region, and administrative and financial classification of the provider. This was a population-based cross-sectional study with a sample of 12,402 Brazilian adults from 20 to 59 years of age living in urban areas of 100 municipalities from five regions. Prevalence of outpatient care in the three months prior to the interview was 34.6%. The Brazilian Unified National Health System (SUS) accounted for more than half (53.6%) of the cases, health insurance was used by 34% of the sample, and out-of-pocket services 12.4%, regardless of region, population size, and morbidity profile. Patterns of use of health services remain socially determined, resulting from the supply, demographic and socioeconomic characteristics, and health profile of users.

Indicadores de la oferta, acceso y uso son útiles para caracterizar los servicios, las actividades de planificación y organización de la demanda. El estudio describe los patrones de uso de tratamiento ambulatorio y su asociación con variables sociodemográficas, morbilidad, tamaño del municipio y de la región, de acuerdo con la naturaleza jurídica del servicio. Se trata de una base poblacional transversal 12.402 adultos brasileños, entre 20 y 59 años, que viven en zonas urbanas de 100 municipios en cinco regiones. La prevalencia de tratamiento ambulatorio en los tres meses anteriores a la entrevista fue del 34,6%. El Sistema Único de Salud fue responsable de más de la mitad (53,6%) de los casos, un plan de salud fue utilizado por el 34% de la muestra y los servicios privados representaron el 12,4%, con independencia de la región, el tamaño de la población y la morbilidad anteriormente. Los patrones de uso de los servicios de salud siguen siendo socialmente determinados, lo que resulta en la oferta, el perfil sociodemográfico y la salud de los usuarios.

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Indicators of supply, access, and use of healthcare are helpful for characterizing services, planning activities, and organizing demand. This study describes patterns of use of outpatient care and the associations with demographic and socioeconomic factors, morbidity, population size of the municipality and region, and administrative and financial classification of the provider. This was a population-based cross-sectional study with a sample of 12,402 Brazilian adults from 20 to 59 years of age living in urban areas of 100 municipalities from five regions. Prevalence of outpatient care in the three months prior to the interview was 34.6%. The Brazilian Unified National Health System (SUS) accounted for more than half (53.6%) of the cases, health insurance was used by 34% of the sample, and out-of-pocket services 12.4%, regardless of region, population size, and morbidity profile. Patterns of use of health services remain socially determined, resulting from the supply, demographic and socioeconomic characteristics, and health profile of users.

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