OBJECTIVE:To identify individual characteristics associated with a higher likelihood of consulting a physician and excess physician appointments. METHODS:We carried out a population-based study including 3,100 adults (≥20 years) living in the city of Pelotas, Southern Brazil between October and December 2003, using a multi-stage cluster sampling strategy. Subjects were interviewed to obtain socioeconomic, demographic, and health-related data, as well as information on the number of medical appointments in the past three months. Overusage was defined as ≥4 appointments. Multivariate analysis was carried out using Poisson regression based on a conceptual model, and results are presented as prevalence ratios and their respective 95% confidence intervals. RESULTS:The prevalence of medical appointments was 55.1%. Higher likelihood of consulting a physician was associated with female sex, hospital admission in the past year, former smoking, diabetes, and arterial hypertension. We found an increasing trend in the number of appointments with increasing age (p<0.001) and decreasing self-perceived health status (p<0.001). Prevalence of over utilization was 9%, and showed positive association with increased body mass index, (p=0.01), increasing age (p=0.006), and decreasing self-perceived health status (p<0.001). CONCLUSIONS:Presence and over utilization of physician appointments were associated with female sex, hypertension, and hospital admission in past year, as well as with increasing age and decreasing self-perceived health status.

Autopercepção de saúde em adolescentes, adultos e idososSelf-reported health status in adolescents, adults and the elderlyResumo O objetivo deste estudo foi verificar a prevalência e os fatores associados a autopercepção de saúde regular/ruim em adolescentes, adultos e idosos. O estudo foi transversal, de base populacional, realizado em Pelotas. A amostra compreendeu 820 adolescentes, 2715 adultos e 385 idosos. Autopercepção de saúde foi investigada pela pergunta: "Como o Sr(a) considera sua saúde?" Características demográficas, socioeconômicas, comportamentais e de saúde foram coletadas. Razões de prevalência ajustada foram estimadas pela Regressão de Poisson. A prevalência de autopercepção regular ou ruim de saúde foi de 12,1%, 22,3% e 49,4% entre adolescentes, adultos e idosos, respectivamente. Adolescentes com menor nível econômico e com escolaridade não adequada relataram pior autopercepção de saúde. Entre os adultos e idosos, relataram pior autopercepção de saúde: as mulheres, aqueles com maior faixa etária, menor nível econômico e os que possuíam alguma morbidade. Conclui-se que a população percebe saúde não apenas como ausência de doença, mas também como um constructo relacionado com aspectos sociais e demográficos, e em menor magnitude, com aspectos comportamentais. Abordagens em saúde devem superar o modelo simplista onde saúde é dicotomizada em doente e não-doente. Palavras-chaves Autopercepção de saúde, Prevalência, Fatores associados, Fatores de risco, Epidemiologia Abstract The scope of this study was to verify the prevalence and associated factors of self-reported health status as regular/bad. A cross-sectional, population-based study was conducted in Pelotas. The sample size comprised 820 adolescents, 2715 adults and 385 elderly. Self-reported health status was investigated via the question: "How do you rate your health?" Data on demographics, socioeconomic, behavioral, and health-related characteristics of individuals were gathered. Adjusted prevalence ratios were estimated through the Poisson regression. Prevalence of reporting health status as regular or bad was 12.1%, 22.3% and 49.4% in adolescents, adults and the elderly, respectively. Adolescents with lower economic status and schooling had higher prevalence of regular/bad selfreported health. Among adults and the elderly, women and older men with lower economic status and some morbidity presented a higher proportion of regular/bad self-reported health. In conclusion, individuals perceive health not only as the absence of a disease, but also as a construct related to social, demographic and, to a lesser extent, behavioral aspects. Health approaches must recognize this fact and transcend the simplistic model where health is dichotomized into the sick and the non-sick.

BackgroundExcessive crying in early infancy has been associated with behavioural problems among preschool children from high income countries but studies in low income and middle income countries are scarce.MethodsThe 2004 Pelotas Birth Cohort is a population-based study planned to enrol all live births occurring in Pelotas that year and comprises 4231 children who so far have been followed up at 3, 12, 24, 48 and 72 months of age. Several familial, maternal and child characteristics were gathered in every follow-up. At the 3-month follow-up, infants whose mothers perceived them as crying more than others of the same age were classified as ‘crying babies’. Child behavioural problems were assessed through the Child Behavior Checklist (CBCL) applied to the mother at the 48-month follow-up. Crude and adjusted ORs with 95% CIs were calculated by logistic regression.ResultsPrevalence of excessive crying at 3 months was 11.9% (10.9% to 13.0%). Among children with excessive crying at 3 months the proportion in the clinical range for CBCL total, internalising and externalising problems at 4 years of age was 31.2%, 12.9% and 37.5%, respectively, against 20.6%, 6.8% and 29.6%, respectively, among non-crying babies. After controlling for confounders crying babies presented increased risk of being in clinical range of CBCL total (OR=1.34; 1.03 to 1.74), internalising (OR=1.55; 1.09 to 2.21) and externalising problems (OR=1.29; 1.01 to 1.64) than infants without excessive crying.ConclusionsExcessive crying in early infancy may represent one important risk factor for developing behavioural problems in later phases of early childhood.

Realizou-se um estudo transversal para avaliar o conhecimento e desempenho quanto à prevenção de fatores de risco para doenças crônicas não transmissíveis (DCNT) em adultos, dos médicos de Atenção Primária da rede urbana de Pelotas, Rio Grande do Sul, Brasil. Foram observadas 422 consultas realizadas por 61 médicos. Em 58,8% das consultas por pacientes com DCNT e 25,3% das por outros motivos, não foram feitas quaisquer recomendações preventivas nem foram aferidos peso, altura ou pressão arterial. Para os portadores de DCNT, as recomendações mais frequentes foram para perda de peso, promoção da atividade física e redução do consumo de gorduras e sal. Entre os não portadores de DCNT, somente 39,1% receberam recomendações de prevenção primária. O desempenho quanto à prevenção de DCNT foi ruim, contemplando mais a prevenção terciária (aconselhando os já portadores de DCNT) do que a primária (prevenindo a incidência de DCNT).

Houve profundas mudanças ocorridas no sistema de saúde brasileiro nas últimas décadas. Dados de dois estudos transversais de base populacional, realizados em 1992 (n = 1657) e 2007 (n = 2706), entre indivíduos de 20-69 anos, foram comparados objetivando descrever mudanças na utilização dos serviços de saúde nos últimos quinze anos, em Pelotas, RS. Calcularam-se as frequências percentuais de consulta médicas no ano e nos últimos três meses, estratificadas por sexo. A última consulta foi analisada conforme local e motivo. A utilização no último ano aumentou de 69,8% para 76,2% (p < 0,001) e nos três meses, de 39,5% para 60,6% (p < 0,001). Quanto ao local, houve aumento do uso de planos de saúde, exceto para pretos/pardos, que continuaram usando os serviços públicos (69%, em 1992 e 61,8%, em 2007). Entre homens, as consultas preventivas aumentaram mais de dez vezes. Nos últimos quinze anos, os planos de saúde absorveram grande parte da demanda pública. Essa absorção não foi uniforme, com os pretos/pardos permanecendo no setor público. O maior aumento de consultas preventivas pelo sexo masculino ocorreu na faixa etária de menor risco (20-39 anos).

The CARMEN Initiative is a strategy of the Pan American Health Organization and the World Health Organization that proposes population-based interventions to reduce risk factors for chronic non-communicable diseases (CNCD) by approaching them simultaneously. The present study aims to provide a baseline for further interventions by the CARMEN Initiative based on a cross-sectional population-based study of 3,100 adults (>20 years old) in Pelotas, a city in the South of Brazil. Prevalence of smoking, physical inactivity, diabetes mellitus, hypertension, and excess weight were studied and presented separately and aggregated in various combinations. The most frequent risk factor was physical inactivity (73.2%), followed by excess weight (48.1%). Women were less active and thinner than men. More than half of the sample showed two or three risk factors (53.4%). The combination of physical inactivity and excess weight was observed in 34.7% of the sample, while 10.8% presented physical inactivity, excess weight, and hypertension concurrently. The accumulation of risk factors for CNCD is frequent in the study population and the identification of the most common combinations is essential for planning future interventions.

OBJECTIVE:To identify type of service, frequency, and individual patient determinants associated with diagnostic test ordering in medical appointments. METHODS:A population-based study included 3,100 adults aged 20 years or older, living in the city of Pelotas, Southern Brazil. Sampling was carried out in multiple stages. Information were collected by means of a questionnaire, administered between October and December 2003. Multivariate analyses were carried out using Poisson Regression, based on a conceptual model. A sub-study was also conducted based on the test requests received during one workday in all laboratories in the city processing requests from both the public and private sectors. RESULTS:Fifty-five percent of subjects reported having had medical appointments during the three-month period investigated. Of these, 60% reported more than one appointment, generating a total of 4,167 appointments, most of which were paid for by health plans (38%). Diagnostic test were requested in 55% of appointments. Women and diabetic patients were more likely to have tests ordered. The greater the age (p<0.001) the higher the socioeconomic level (p=0.04), and the number of medical appointments (p<0.001), the greater the proportion of appointments leading to test requests. Mean waiting time between test request and sample collection was six days for the private sector and 21 days for the public sector (p<0.001). The mean number of tests per request was 4.4. CONCLUSIONS:The proportion of appointments leading to the request for some type of diagnostic test was in accordance with Brazilian recommendations. The waiting time before sample collection indicates an excessive number of tests per request and/ or insufficient financial resources to fulfill the demand for tests.

RESUMO:Introdução: O câncer de colo uterino é causado pela infecção persistente por algumas cepas oncogênicas do Papiloma Vírus Humano. Ele acontece devido ao crescimento anormal de células que possuem a capacidade de invadir localmente e metastatizar à distância. O câncer cervical é o terceiro tumor mais frequente entre as mulheres e a quarta maior causa de morte por câncer nesta população. Por isso, o exame citopatológico de colo de útero mostra-se fundamental no rastreamento e diagnóstico precoce desta patologia, evitando, assim, que essa assuma um papel metastático.