OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex.METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex.RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%.CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors. The review included 31 articles published in the last 12 years. Prevalence of inappropriate ED use varied from 20 to 40% and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician also showed more inappropriate ED use, with the relative risk varying from 1.12 to 2.42. Difficulties in accessing primary health care (difficulties in setting appointments, longer waiting periods, and short business hours at the primary health care service) were also associated with inappropriate ED use. Thus, primary care requires fully qualified patient reception and efficient triage to promptly attend cases that cannot wait. It is also necessary to orient the population on situations in which they should go to the ED and on the disadvantages of consulting the ED when the case is not really urgent.

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.

To identify the prevalence of chronic low back pain (CLBP) and examine factors associated with this condition in a Southern Brazilian adult population, a population-based cross-sectional study was conducted, including 3,182 subjects of both sexes, aged 20 years or over, living in the urban area of Pelotas, Rio Grande do Sul State. The questionnaire included socio-demographic, behavioral, and nutritional variables, as well as characterization of exposure to ergonomic factors in daily activities. CLBP prevalence was 4.2%. The variables sex, age, marital status, schooling, smoking, body mass index, working in a lying position, heavy physical work, and repetitive movements were associated with CLBP. Prevalence of CLBP is important as it limits normal activities and increases the use of health care services. There may be differences in the ergonomic risk factors for CLBP and low back pain in general.

Background: The inappropriate use of emergency room (ER) service by patients with non-urgent health problems is a worldwide problem. Inappropriate ER use makes it difficult to guarantee access for real emergency cases, decreases readiness for care, produces negative spillover effects on the quality of emergency services, and raises overall costs.

IntroduçãoO acesso a medicamentos é um indicador da qualidade e resolutividade do sistema de saúde 1 e um determinante importante do cumprimento do tratamento prescrito. A literatura indica que a falta de acesso é uma causa freqüente de retorno de pacientes aos serviços de saúde 2 .Os medicamentos de uso contínuo assumem grande importância no tratamento de doenças crônico-degenerativas, como a hipertensão arterial sistêmica e o diabetes mellitus, bem como de problemas de saúde mental, morbidades estas que apresentam prevalências crescentes no Brasil em decorrência do envelhecimento populacional 3 . A falta de acesso a medicamentos para tratamento dessas enfermidades pode levar ao agravamento do quadro e aumentar os gastos com a atenção secundária e terciária 2 . Considerando-se que a maioria da população atendida no serviço público de saúde é de baixa renda, a obtenção gratuita é, freqüentemente, a única alternativa de acesso ao medicamento. Nesse contexto, o sistema público de saúde, e em particular o Programa Saúde da Família (PSF), desenvolve ações que visam a acompanhar de forma sistemática os indivíduos com essas morbidades e promover o cuidado integral, incluindo o acesso a medicamentos essenciais 4 .No Brasil, dados populacionais sobre o acesso a medicamentos são raros. A maioria dos estudos avalia o acesso com base na proporção de me-ARTIGO ARTICLE

BackgroundChronic low back pain (CLBP) is a highly disabling morbidity with high social, economic and individual effects. Demographic, occupational and behavioral changes that took place in Brazil over the last decade are related with an increasing burden of chronic conditions. Despite these changes, comparison studies on CLBP prevalence and associated factors, over time are scarce in the literature in general, and unknown in Brazil. The present study compared the CLBP prevalence in a medium sized city in Brazil between the years 2002 and 2010 and examined factors associated with prevalence in 2010.MethodsTwo cross-sectional studies with similar methodology were conducted in a medium-sized city in southern Brazil, in 2002 and 2010. 3182 individuals were interviewed in the first study and 2732 in the second one, all adults aged twenty years or more. Those who reported pain for seven weeks or more in the last three months in the lumbar region where considered cases of CLBP.ResultsThe CLBP prevalence increased from 4.2% to 9.6% in 8 years. In most of the studied subgroups the CLBP prevalence has at least doubled and the increase was even larger among younger individuals with more years of education and higher economic status.ConclusionsIncrease in CLBP prevalence is worrisome because it is a condition responsible for substantial social impact, besides being an important source of demand for health services.

The study reinforces the evidence of the association between pesticide poisoning and mental health disorders. It also points to increased risk of MPD from low socioeconomic status, dermal pesticide exposure as well as from exposure to organophosphates. Furthermore, the study reveals intense nicotine exposure as a risk for tobacco farmers' mental health.