Access to mental health care in El Salvador: a case study of progress toward decentralization / Acceso a la atención de salud mental en El Salvador: un estudio de caso de progreso hacia la descentralización / Acesso à saúde mental em El Salvador: um estudo de caso sobre o progresso em direção à descentralização

ABSTRACT Objective To assess the need for decentralization of psychiatric services in El Salvador, based on country-specific evidence, and to generate baseline measures the government and researchers could use to monitor and measure future progress toward decentralization. Methods Observations were made and psychiatric outpatients and their families/caregivers (n = 453) surveyed with a cross-sectional instrument at the National Psychiatric Hospital (Hospital Nacional General y de Psiquiatría "Dr. José Molina Martínez") in the capital city of San Salvador. Findings were compared with national census data to determine barriers to psychiatric care in a largely centralized system. The following data were collected: department of origin, travel time to hospital, time in hospital, costs, and qualitative comments about accessing services. Descriptive statistics and regression were used to assess the data. Government reports on all psychiatric outpatient consultations provided nationwide in 2015 (n = 61 010) at 10 regional hospitals were also reviewed and compared to population data to determine the proportion of the population of each hospital service area (department or group of departments) that received a psychiatric outpatient consultation. Results Households from the half of the country (7 out of 14 departments) farthest away from the National Psychiatric Hospital (42% of the general population) spent twice as much time and three times as much money to access the hospital's psychiatric outpatient services, resulting in severe hardship on both patients and families/caregivers. Conclusions This report estimates that 45% of those with mental health needs in the seven departments farthest away from the National Psychiatric Hospital departments are still not accessing services compared to the seven departments nearest the hospital. The results of this study support the World Health Organization's call for governments to fully implement community-based mental health systems. This is the first study to assess progress toward decentralization of psychiatric services in El Salvador.

RESUMEN Objetivo Evaluar la necesidad de la descentralización de los servicios psiquiátricos en El Salvador con base en la evidencia específica del país y generar medidas de referencia que podrían ser utilizadas por el gobierno y los investigadores para monitorear y medir el progreso futuro hacia la descentralización. Métodos Se realizaron observaciones, y se encuestaron pacientes psiquiátricos ambulatorios y sus familiares/cuidadores (n = 453) con un instrumento de corte transversal en el Hospital Nacional Psiquiátrico (Hospital Nacional General y de Psiquiatría "Dr. José Molina Martínez") en la capital, San Salvador. Los hallazgos se compararon con los datos del censo nacional para determinar las barreras en el acceso a la atención psiquiátrica en un sistema en gran medida centralizado. Se recopilaron los siguientes datos: departamento de origen, tiempo de viaje al hospital, tiempo en el hospital, costos y comentarios cualitativos sobre el acceso a los servicios. Se usaron estadísticas descriptivas y regresión para evaluar los datos. También se revisaron informes gubernamentales sobre todas las consultas psiquiátricas ambulatorias proporcionados a nivel nacional en 2015 (n = 61 010) en 10 hospitales regionales, y estos se compararon con datos poblacionales para determinar la proporción de la población de cada área de servicio hospitalario (departamento o grupo de departamentos) que efectuó una consulta psiquiátrica ambulatoria. Resultados Los hogares de la mitad del país (7 de los 14 departamentos) más alejados del Hospital Psiquiátrico Nacional (42% de la población general) gastaron el doble de tiempo y tres veces más dinero para acceder a los servicios psiquiátricos ambulatorios del hospital, lo que resultó en dificultades económicas severas tanto para los pacientes como para sus familias/cuidadores. Conclusiones Este informe estimó que el 45% de las personas con necesidades de salud mental en los 7 departamentos más alejados del Hospital Nacional Psiquiátrico aún no tienen acceso a los servicios en comparación con los 7 departamentos más cercanos al hospital. Los resultados de este estudio respaldan el llamado de la Organización Mundial de la Salud para que los gobiernos implementen por completo sistemas de salud mental basados en la comunidad. Este es el primer estudio en evaluar el progreso hacia la descentralización de los servicios psiquiátricos en El Salvador.

RESUMO Objetivo Avaliar a necessidade de descentralização dos serviços psiquiátricos em El Salvador com base em provas específicas do país e gerar medições de referência que poderiam ser usados pelo governo e pesquisadores para monitorar e medir o progresso futuro no sentido da descentralização. Métodos Observações foram feitas, e foram pesquisados pacientes psiquiátricos ambulatoriais e suas famílias/cuidadores (n = 453) com uma ferramentas de seção transversal no Hospital Psiquiátrico Nacional (National Hospital Geral e Psiquiatria "Dr. Jose Molina Martinez") na capital, São Salvador. Os resultados foram comparados com dados do censo nacional para determinar as barreiras ao acesso à assistência psiquiátrica em um sistema amplamente centralizado. Os seguintes dados foram coletados: departamento de origem, tempo de deslocamento para o hospital, tempo no hospital, custos e comentários qualitativos sobre o acesso aos serviços. Para avaliar os dados foram utilizadas estatística descritiva e regressão. Também foram analisados relatórios do governo sobre todas as consultas psiquiátricas ambulatoriais a nível nacional em 2015 (n = 61 010) em 10 hospitais regionais, e comparados com os dados da população para determinar a proporção da população de cada área de serviço hospitalar (departamento ou grupo de departamentos) que recebeu uma consulta psiquiátrica para pacientes ambulatoriais. Resultados As pessoas da metade do país (7 dos 14 departamentos) mais afastada do Hospital Psiquiátrico Nacional (42% da população geral) gastaram o dobro do tempo e três vezes mais dinheiro para acessar os serviços psiquiátricos ambulatoriais do hospital, o que resultou em privação severa para pacientes e familiares/cuidadores. Conclusões Este relatório estimou que 45% das pessoas com necessidades de saúde mental nos 7 departamentos mais distantes do Hospital Psiquiátrico Nacional ainda não têm acesso aos serviços em comparação com os 7 departamentos mais próximos do hospital. Os resultados deste estudo apoiam o apelo da Organização Mundial de Saúde para que os governos implementem totalmente os sistemas de saúde mental baseados na comunidade. Este é o primeiro estudo a avaliar o progresso em direção à descentralização dos serviços psiquiátricos em El Salvador.

Characteristics of women who do not consult a doctor: a population-based study / Características das mulheres que não consultam com médico: estudo de base populacional

ABSTRACT OBJECTIVE To analyze the prevalence of not consulting a doctor within a year. METHODS Cross-sectional population-based study, including women aged 20-60 years, living in the urban area of São Leopoldo, state of Rio Grande do Sul, in 2015. The association between variables and outcome was assessed using prevalence ratios and 95% confidence intervals (95%CI). The adjusted analysis was performed using Poisson regression with robust variance. RESULTS Among the 1,127 women participating in the study, 954 (84.6%, 95%CI 82.5-86.7) reported having consulted a physician in the year prior to the interview, 173 (15.4%, 95%CI 13.2-17.5) did not. Women belonging to lower income classes D and E, younger, and smokers had higher prevalences of no medical visits. The participants with hypertension had a higher prevalence of consultations. CONCLUSIONS There was no expected evolution in the local health system, despite the emergence of the policies implemented in this period. It is necessary to provide care for those in less favored socioeconomic conditions and for younger women.

RESUMO OBJETIVO Analisar a prevalência de não consultar com médico no período de um ano. MÉTODOS Estudo transversal de base populacional, incluindo mulheres de 20 a 60 anos, residentes na zona urbana de São Leopoldo, RS, em 2015. A associação entre as variáveis e o desfecho foi avaliada por meio das razões de prevalência e dos intervalos de 95% de confiança (IC95%). A análise ajustada foi realizada por meio da regressão de Poisson com variância robusta. RESULTADOS Entre as 1.127 mulheres participantes do estudo, 954 (84,6%; IC95% 82,5-86,7) referiram consultar com médico no ano anterior à entrevista, 173 (15,4%; IC95% 13,2-17,5) não consultaram. As mulheres inseridas nas classes econômicas D e E, com menor idade, e fumantes apresentaram maiores prevalências de não consulta médica. As participantes com hipertensão arterial tiveram maior prevalência de consultas. CONCLUSÕES Não houve a esperada evolução no sistema local de saúde, apesar do surgimento das políticas implantadas nesse período. É necessário provimento da atenção para os indivíduos em condições socioeconômicas menos favorecidas e para as mulheres mais jovens.

Utilization of basic health units of FHS according to private health insurance / Utilização das unidades básicas de saúde da ESF conforme a cobertura por plano de saúde

ABSTRACT OBJECTIVE To describe the utilization of basic health units according to coverage by discount card or private health insurance. METHODS Household survey in the area covered by Family Health Strategy in Pelotas, state of Rio Grande do Sul, Brazil, from December 2007 to February 2008, with persons of all age groups. The frequency of (medical or non-medical) healthcare seeking at the basic health units in the last six months and the prevalence of basic health unit utilization for the last medical consultation (in case it had been performed up to six months before, for a non-routine reason) were analyzed by Poisson regression adjusted for the sampling design. RESULTS Of the 1,423 persons, 75.6% had no discount card or private health insurance. The average frequency of (medical or non-medical) healthcare seeking was 1.6 times in six months (95%CI 1.3-2.0); this frequency was 55.8% lower (p < 0.001) among privately insured persons compared to those with no discount card or private health insurance. Among the last medical consultations, 35.8% (95%CI 25.4-47.7) had been performed at the basic health units; this prevalence was 36.4% lower (p = 0.003) among persons covered by discount card and 87.7% lower (p = 0.007) among privately insured persons compared to those without both coverages. CONCLUSIONS Private health insurance and, to a lesser degree, discount card coverage, are related to lower utilization of basic health units. This can be used to size the population under the accountability of each Family Health Strategy team, to the extent that community health workers are able to differentiate discount card from PHI during family registration.

RESUMO OBJETIVO Descrever a utilização de unidades básicas de saúde conforme a cobertura por cartão de desconto e plano de saúde. MÉTODOS Inquérito domiciliar na área de abrangência da Estratégia Saúde da Família de Pelotas, RS, entre dezembro de 2007 e fevereiro de 2008, incluindo pessoas de todas as faixas etárias. A frequência de busca por atendimento (médico ou não) nas unidades básicas de saúde nos últimos seis meses e a prevalência do uso das unidades básicas de saúde para a última consulta médica (caso esta tivesse sido realizada até seis meses atrás, e tivesse tido um motivo que não rotina) foram analisadas por regressão de Poisson ajustada para o delineamento amostral. RESULTADOS Das 1.423 pessoas, 75,6% não estavam cobertas por cartão de desconto ou plano de saúde. A frequência média da busca por atendimento (médico ou não) foi de 1,6 vezes em seis meses (IC95% 1,3-2,0); essa frequência foi 55,8% menor (p < 0,001) entre as pessoas cobertas por plano de saúde em comparação às pessoas sem cartão de desconto ou plano de saúde. Dentre as últimas consultas médicas, 35,8% (IC95% 25,4-47,7) tinham sido realizadas nas unidades básicas de saúde; essa prevalência foi 36,4% menor (p = 0,003) entre as pessoas cobertas por cartão de desconto e 87,7% menor (p = 0,007) entre as pessoas cobertas por plano de saúde em comparação às pessoas com ambas as coberturas. CONCLUSÕES A cobertura por plano de saúde e, em menor grau, a cobertura por cartão de desconto associam-se a uma menor utilização das unidades básicas de saúde. Isso pode ser utilizado para dimensionar a população sob a responsabilidade de cada equipe de Estratégia Saúde da Família, na medida em que os agentes comunitários de saúde sejam capazes de diferenciar cartão de desconto e plano de saúde durante o cadastramento das famílias.

Influencing factors of basic public health service utilization of the migrant elderly / 中国卫生政策研究

Objective:The aim of this study is to explore the utilization of basic public health services by elder-ly migrants and its influencing factors, and to provide data support for the equalization of public health services. Methods:The framework of the Behavioral Model of Health Services Utilization elaborated by Anderson was used as the theoretical basis. Basing on the data of 2015 National Dynamic Monitoring of Mobile Population,the multivariate logistic regression model was used to analyze the materials coming from in-depth interviews. Results: The utilization rate of basic public health services by the elderly migrant was low and there are differences as compared to other groups. The type of household registration,living duration and the scope of mobility were the main factors influencing the utilization of health services by the elderly migrants. The allocation of funds to primary health care services is in-consistent with the workload,and other difficulties for the community service agencies. Conclusions:The accessibility of basic public health services for the elderly migrants is poor,the health consciousness is weak,and health education should be strengthened. The elderly migrants coming from rural areas,having long-term residence and migrating long distance should be paid more attention too. The administrative departments should strengthen the statistics on elderly migrants,ensure a fair allocation of funds for the basic public health service,and optimize the top-level design of in-formation technology to improve the use of the basic public health services for elderly migrants.

Salud bucodental y utilización de servicios Odontológicos / Oral health and dental health service use

En el Paraguay, los datos epidemiológicos sobre la salud bucodental y la utilización de los servicios en adultos son limitados, de ahí, la urgente necesidad de generar información para diseñar y establecer programas de salud pública acordes a las necesidades de dicha población. El objetivo de este estudio transversal retrospectivo fue determinar la situación de salud bucodental y el patrón de utilización de los servicios odontológicos de los pacientes atendidos en las cátedras de Operatoria Dental II y III de la carrera de Odontología de la Universidad Católica-Campus de Itapúa. La muestra incluyó 411 historias clínicas odontológicas de pacientes atendidos entre 2014 y 2017. La edad promedio de los pacientes fue de 28 años. La prevalencia de caries fue del 94,6%. El Índice de dientes cariados, perdidos y obturados promedio fue de 13,2 (DE± 6,9), siendo el mayor componente el de dientes cariados (7,0±4,5), seguido por el de dientes perdidos (4,4±5,7). Un alto porcentaje (77%) de los pacientes no tenía seguro médico al momento de consultar. El motivo de consulta actual del 42% fue la estética y el 64% sólo consulta al dentista cuando necesita. El valor promedio del índice de dientes cariados, perdidos y obturados (13,2) es catalogado como grave. El predominio de los componentes dientes cariados y perdidos es indicativo de un limitado acceso a los servicios odontológicos y tratamientos restauradores. Se requiere la instauración de estrategias de promoción de la salud y prevención de las afecciones bucodentales enmarcadas dentro de programas desde el primer nivel de atención.

In Paraguay, epidemiological data on the oral health situation and the use of dental care services by adult are limited, hence the urgent need to generate relevant information to design and establish public health programs in accordance with the needs of the population. The objective of this cross-sectional retrospective study was to determine the oral health situation and the pattern of utilization of the dental services of the patients treated in the Dental Operatory Chairs II and III of the Odontology program at the Catholic University-Campus of Itapúa. The sample consisted of 411 clinical records of patients treated between 2014 and 2017. The average age of patients was 28 years. The prevalence of caries was 94.6%. The index of decayed, missing and filled teeth was 13.2 (±6.9). The largest component was decayed teeth (7.0±4.5), followed by teeth lost (4.4±5.7). A high percentage (77%) of patients did not have health insurance at the time of consultation. The main reason for current consultation was aesthetics (42%) and 64% of participants only attends dentist when needed. The average index of decayed, missing and filled teeth (13.2) is classified as severe. The predominance of decayed and missing teeth components is indicative of limited access to the use of dental services and restorative treatments. It is necessary to establish strategies for health promotion and prevention of oral diseases as part of the programs from the first care level.

Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil / Doenças crônicas não transmissíveis e a utilização de serviços de saúde: análise da Pesquisa Nacional de Saúde no Brasil

ABSTRACT OBJECTIVE To assess whether sex, education level, and health insurance affect the use of health services among the adult Brazilian population with chronic noncommunicable diseases (NCD). METHODS Data from a cross-sectional survey were analyzed, the National Health Survey (PNS). Frequency of use of services in the population that referred at least one NCD were compared with the frequency from a population that did not report NCD, according to sex, education level, health insurance, and NCD number (1, 2, 3, 4, or more). The prevalence and prevalence ratios were calculated crude and adjusted for sex, age, region, and 95% confidence intervals. RESULTS The presence of a noncommunicable disease was associated with increase in hospitalizations in the last 12 months, in 1.7 times (95%CI 1.53–1.9). Failing to perform usual activities in the last two weeks for health reasons was 3.1 times higher in NCD carriers (95%CI 2.78–3.46); while the prevalence of medical consultation in the last 12 months was 1.26 times higher (95%CI 1.24–1.28). NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. CONCLUSIONS NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level.

RESUMO OBJETIVO Analisar se sexo, escolaridade e posse de plano de saúde influenciam a utilização de serviços de saúde entre a população adulta brasileira portadora de doenças crônicas não transmissíveis (DCNT). MÉTODOS Foram analisados dados de inquérito transversal, a Pesquisa Nacional de Saúde (PNS). Foram comparadas as frequências de uso de serviços na população que referiu pelo menos uma DCNT, com aquelas que não relatam DCNT, segundo sexo, escolaridade, posse de plano de saúde e número de DCNT (1, 2, 3, 4 ou mais). Foram calculadas as prevalências e razões de prevalência (RP) brutas e ajustadas por sexo, idade e região e respectivos intervalos de confiança de 95%. RESULTADOS A presença de doença crônica associou-se ao aumento de internação nos últimos 12 meses, em 1,7 vezes (IC95% 1,53–1,9). Deixar de realizar atividades habituais nas duas últimas semanas por motivo de saúde foi 3,1 vezes maior em portadores de DCNT (IC95% 2,78–3,46), e a prevalência de consulta médica nos últimos 12 meses foi 1,26 vezes maior (IC95% 1,24–1,28). Portadores de DCNT utilizam mais os serviços de saúde, assim como as mulheres, pessoas com maior número de DCNT, com planos de saúde e elevada escolaridade. CONCLUSÕES Portadores de DCNT têm maior utilização de serviços de saúde, assim como as mulheres, pessoas com maior número de comorbidades, com planos de saúde e elevada escolaridade.

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo / Determinantes do uso de serviços de saúde: análise multinível da Região Metropolitana de São Paulo

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

OBJETIVO Analisar os determinantes individuais e contextuais do uso de serviços de saúde na Região Metropolitana de São Paulo. MÉTODOS Foram utilizados os dados do estudo São Paulo Megacity, a versão brasileira da pesquisa multicêntrica World Mental Health Survey. Foram analisados 3.588 indivíduos adultos residentes em 69 áreas da Região Metropolitana de São Paulo, SP (38 municípios adjacentes e 31 subprefeituras do município de São Paulo), selecionados por meio de amostragem multiestratificada da população não institucionalizada. Foram ajustados modelos multinível logísticos Bayesianos para identificar os determinantes individuais e contextuais do uso de serviços de saúde nos últimos 12 meses e a presença de médico de referência para cuidados de rotina. RESULTADOS As características contextuais do local de residência (desigualdade de renda, violência e renda mediana) não apresentaram associação significativa (p > 0,05) com o uso de serviços ou com a presença de médico de referência para cuidados de rotina. A única exceção foi a associação negativa entre residir em uma área com alta desigualdade de renda e a presença de médico de referência (OR 0,77; IC95% 0,60;0,99) após controle das características individuais. O estudo apontou uma forte e consistente associação entre algumas características individuais (principalmente escolaridade e presença de plano de saúde) com o uso de serviços de saúde e ter médico de referência. A presença de doenças crônicas e mentais associou-se fortemente com o uso de serviços no último ano (independentemente de características individuais), mas não com a presença de médico de referência. CONCLUSÕES Características individuais como maior escolaridade e ter plano de saúde foram determinantes importantes do uso de serviços de saúde na Região Metropolitana de São Paulo. A melhor compreensão desses determinantes é necessária para o desenvolvimento de políticas públicas que permitam o uso equitativo dos serviços ...

STUDY ON COMMUNITY HEALTH SERVICE UTILIZATION IN LIWAN DUOBAO DISTRICT CITIZENS OF GUANGZHOU / 现代医院

Objective To research and analyze health status, health service utilization of the community residents, and find the influencing factors of residents health status, health service utilization.Methods The study was made through questionnaires and medical examination.Data were analyzed by SPSS13.0 software packet, and using χ2 inspection and logistic regression.Results The two-week prevalence of the residents was 264.4‰, and the CHS utilization rate was 54.94%.The main influence factors to CHS utilization were sex, age, marital status and chronic disease.Conclusion Residents of the community health service needs and utilization characteristics: There was great health service need, and CHS utilization rate was low.We should make use of community health service in City Community Public Health Service and essential medical service.

Impact of choice of living standard indicators on the equality index of health and health service utilization / 中国卫生政策研究

Objective:To evaluate outcomes and differences of the equality indexes of health and health service utilization in different living standard indicators. Methods: Using multi-phase stratified random sampling to select samples of rural families in Ningxia region and collect data about sample families' income, consumption, wealth and some relevant data on family members' health status and health services utilization. Using concentration index to measure the equality of health and health services utilization with income, consumption or wealth index as living standard indicators respectively and discuss the differences of the outcomes. Results:For different living standard in-dicators, the correlation between each other was weak. The differences of concentration indexes with different living standard indicators between 0. 01 to 0. 21 , and most of whichweresignificant on the level of 0. 05. Conclusion: The impact of choice of living standard indicators on the equality index of health and health service utilization was signifi-cant. In a limited area, living standards measured by wealth index could be more accurate and objective than by in-come or consumption, but the condition of this method wasmore strict.

Supply and usage of hemodynamic services in the state of Rio de Janeiro, Brazil / Oferta e utilização de serviços de hemodinâmica no estado do Rio de Janeiro, Brasil

Objective: The paper analyzes the supply and the utilization of hemodynamic services in Rio de Janeiro, Brazil. Methods: It's an exploratory study that uses data obtained from Brazilian official databases. The period of supply analysis was from 1999 to 2009, and of utilization was from 2008 to October 2012. Results: Since 1999 there is a growth of hemodynamic equipment purchase. The private sector concentrates most of the supply, but it has been reducing its availability to SUS. The rate between population and equipment in Brazil exceeds the ones of some rich countries. In the sense of supply, there are in 2009, a supply rate of 1,4 equipments for 1 million inhabitants in RJ state, larger than brazilian rate, of 3,4 but the rates are similar for public customers. Conclusion: Interventional cardiology procedures have improved in the state, but in a different way. And this is because the public hospitals at Rio de Janeiro have mostly reduced their production, while the private ones have increased their production. The observed result is the SUS users performing their procedures at great distances. .

Objetivo: analisar a oferta dos equipamentos e a utilização dos procedimentos inerentes aos serviços públicos de hemodinâmica no estado do Rio de Janeiro, Brasil. Métodos: Estudo exploratório, a partir de bancos de dados oficiais: pesquisa AMS do IBGE, CNES, AIH e APAC, e da ANS. O período de análise da oferta foi de 1999 a 2009 e o da utilização, de 2008 a outubro de 2012. Resultados: Desde 1999 há crescimento na aquisição dos equipamentos de hemodinâmica. O setor privado concentra grande parte da oferta, mas vem reduzindo sua disponibilidade ao Sistema Único de Saúde (SUS). A taxa de equipamentos pela população supera a de alguns países ricos. Quanto à oferta, havia, no Rio de Janeiro, em 2009, uma taxa de 4,1 aparelhos por milhão de habitantes maior do que no Brasil, de 3,4, mas considerando apenas a oferta para o SUS, os valores são semelhantes, de 1,6 e 1,5. Conclusão: Os procedimentos de cardiologia intervencionista cresceram entre 2008 e 2011 no RJ mas os hospitais públicos na sua maioria têm reduzido a produção e os privados aumentado, resultando no encaminhamento dos usuários do SUS para realizar os procedimentos a grandes distâncias. .

Utilización correcta de las técnicas de detección de cáncer de mama en mujeres mexicanas / Correct utilization of breast cancer detection techniques in Mexican women

Objetivo. Identificar las características asociadas con la prevalencia de utilización correcta de la autoexploración manual (AE), el examen clínico (EC) y la mamografía (MA) para la detección de cáncer mamario (CaMa). Material y métodos. Se entrevistó a 1 030 mujeres mexicanas, sanas, de entre 20 y 88 años sobre su historia reproductiva y sociodemográfica. Con base en la forma y frecuencia de realización de estas técnicas de detección, se construyó un índice de utilización correcta. Resultados. La prevalencia de utilización correcta de la AE fue de 11% y del EC de 5.4%. El 7.6% de las mujeres entre 40 y 49 años y 31.6% de las mujeres con 50 años o más se realizaron una MA de acuerdo con la norma vigente al momento del estudio. El aseguramiento por parte del Instituto Mexicano del Seguro Social, del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado o del Seguro Popular fue el principal determinante de la utilización de la MA. Conclusiones. Se evidencia la necesidad de incrementar la correcta utilización de la AE, el EC y la MA.

Objective. Identify the characteristics associated with correct utilization of self examination (SE), clinical exam (CE) and mammography (MA) for breast cancer (BC) early detection. Materials and methods. Interviews were undertaken with 1 030 Mexican women (n=1 030), 20 to 88 years of age, regarding their reproductive and sociodemographic characteristics. An index of correct utilization was constructed based on the form and frequency practice of those techniques. Results. The prevalence of correct utilization of SE was 11% and 5.4% for CE. Further, 7.6% of women 40-49 years of age with 2 or more BC risk factors had MA during the two years prior to the interview, and for 31.6% among women ≥50 years of age the MA was annually. The main determinant of MA utilization was having financial protection from either IMSS, ISSSTE or Seguro Popular. Conclusions. It is necessary to improve the correct utilization of BC detection techniques in Mexico.

Study of rural health centre services utilization by adolescents in district Muzaffarnagar (Uttar Pradesh-India).

Background: Currently adolescents mortality and morbidity in rural areas is featured by many causes such as communicable as well as non-communicable diseases apart from accidents, suicides etc which lead to illness or premature death later in their life and their usage of rural health centre services is also emerging to be a new issue. That’s why it is important to study this area critically. Aims & Objective: To study the rural health centre services utilization by adolescents. Materials and Methods: This was prospective study carried out from 1st January 2013 to 31st December 2013. The study was carried out at the rural health and training center (RHTC), Bilaspur of Muzaffarnagar Medical College, Muzaffarnagar (UP) which covers 6 villages. All adolescents attending OPD in year 2013 according to the WHO defined criteria of adolescents (10-19 years) and who gave consent were included and enrolled in this study. Adolescents who did not attend OPD and those who did not give consent for participation in study at RHTC Bilaspur were excluded. Results: The study found that the majority of female patients utilized OPD services of RHTC (53.3%) but main health care service utilized among adolescents was Medical Problem (20.5%) whereas Obstetrical & Gynaecology problems were least (13.8%). Among the other services; most common utilized were dressing for injuries (11.3%) and least utilized were, immunization services (0.8%). Conclusion: The usage of health services utilization of RHTC suggests that there are emerging problems in different health specialties among adolescents, so this area needs further research in future studies.

Impact of primary care oriented outpatient benefit package design in new rural cooperative medical system on hypertension outpatient services utilization / 北京大学学报(医学版)

Objective:To study the impact of primary care oriented outpatient benefits package design of outpatient services coverage and ladder reimbursement of county , town and village levels in the new ru-ral cooperative medical system ( NRCMs) on hypertension outpatient services utilization .Methods:The panel data of treatment and control groups in 2009 and 2011 before and after the policy reform were drawn from the household survey data of the innovative payment system project .The difference in difference ( DID) method was used for data analysis .The outcome indicators included the utilization of outpatient services of patients with self-reported hypertension and their main treatment locations .Results:The pri-mary care oriented outpatient benefit package design in the NRCMs reduced the probability of no treat-ment in the latest three months of hypertension by 10.2 percent points.Meanwhile, it increased the prob-ability of choosing village clinic as the preferred location by 15 .7 percent points .Conclusion: Primary care oriented outpatient benefits package design lead patients with hypertension to use the nearest outpa -tient services at low risk of disease .

Fatores associados a utilizacao dos servicos odontologicos por idosos brasileiros / Factores asociados a la utilizacion de los servicios odontologicos por ancianos brasilenos / Factors associated with the use of dental services by elderly Brazilians

OBJETIVO: Avaliar a associação entre a utilização recente de serviços odontológicos, fatores socioeconômicos e condições de saúde bucal entre idosos no Brasil. MÉTODOS: A amostra foi composta pelos indivíduos de 65-74 anos (n = 6.702) que participaram da Pesquisa Nacional de Saúde Bucal em 2010 (SBBrasil 2010). A variável dependente foi a utilização recente de serviços odontológicos (última consulta há dois anos ou menos). As variáveis independentes foram: fatores sociodemográficos, medidas clínicas de saúde bucal e medida subjetiva de saúde bucal. A análise estatística foi feita por meio da descrição das medidas de frequência, análise bivariada e múltipla utilizando-se regressão de Poisson. RESULTADOS: Observou-se que 46,5% dos idosos foram ao dentista há dois anos ou menos. A partir da análise múltipla observou-se que a escolaridade, a renda e a macrorregião foram independentemente associadas ao desfecho. Indivíduos com zero a 20 dentes e necessidade de prótese apresentaram menor prevalência de consulta odontológica recente. Maiores prevalências de consulta recente foram observadas entre os indivíduos com necessidade de tratamento odontológico e usuários de prótese. CONCLUSÕES: A utilização recente de serviços odontológicos foi associada a fatores socioeconômicos (escolaridade, renda e macrorregião do País) e a medidas clínicas de saúde bucal (número de dentes, uso e necessidade de prótese e necessidade de tratamento). .

OBJETIVO: Evaluar la asociación entre la utilización reciente de servicios odontológicos, factores socioeconómicos y condiciones de salud bucal entre ancianos en Brasil. MÉTODOS: La muestra estuvo compuesta por individuos de 65-74 años (n= 6.702) que participaron de la Investigación Nacional de Salud Bucal en 2010 (SBBrasil 2010). La variable dependiente fue la utilización reciente de servicios odontológicos (última consulta hace dos años o menos). Las variables independientes fueron: factores sociodemográficos, medidas clínicas de salud bucal y medida subjetiva de salud bucal. El análisis estadístico fue realizado a través de la descripción de las medidas de frecuencia, análisis bivariado y múltiple utilizando la regresión de Poisson. RESULTADOS: Se observó que 46,5% de los ancianos fueron al dentista hace dos años o menos. A partir del análisis múltiple se observó que la escolaridad, la renta y la macro región fueron independientemente asociadas al resultado. Individuos con cero a 20 dientes y necesidad de prótesis presentaron menor prevalencia de consulta odontológica reciente. Mayores prevalencias de consulta reciente fueron observadas entre los individuos con necesidad de tratamiento odontológico y usuarios de prótesis. CONCLUSIONES: La utilización reciente de servicios odontológicos fue asociada a factores socioeconómicos (escolaridad, renta y macro región del País) y a medidas clínicas de salud bucal (número de dientes, uso y necesidad de prótesis y necesidad de tratamiento). .

OBJECTIVE: To assess the association between recent use of dental services, socioeconomic factors and oral health measures among elderly Brazilians. METHODS: The sample consisted of elderly individuals aged 65 to 74, who participated in the Brazilian Oral Health Survey in 2010 (Brazil SB-2010). The dependent variable was “recent use of dental services” (last dental visit ≤ 2 years). The independent variables were: 1) sociodemographic factors, clinical oral health measures, and subjective measure of oral health. Statistical analysis included descriptive analyses of frequency, bivariate and multiple analyses using Poisson regression. RESULTS: About 46.5% of the elderly individuals had had a dental appointment in the last two years. In the multiple Poisson regression model, education, income and region were independently associated with the outcome. Individuals with 0-20 teeth and need for prosthesis had a lower prevalence of recent dental visit. A higher prevalence of recent dental visit was observed among individuals in need of dental treatment and among those with dental prosthesis. CONCLUSIONS: Recent use of dental services was associated with socioeconomic factors (education, income, and region) and clinical oral health measures (number of teeth, use and need for dental prosthesis and need for dental treatment). .

Associacao de dor cronica com uso de servicos de saude em idosos residentes em Sao Paulo / Asociacion de dolor cronico con uso de servicios de salud en ancianos residentes en Sao Paulo, Brasil. / Association of chronic pain with the use of health care services by older adults in Sao Paulo

OBJETIVO Analisar a associação entre a utilização de serviço de saúde por idosos com dor crônica e variáveis sociodemográficas e de saúde. MÉTODOS Estudo transversal com amostra populacional realizado por meio de inquérito domiciliar em São Paulo, SP, em 2006, com 1.271 idosos de 60 anos ou mais, sem déficit cognitivo, que relataram dor crônica. Dor crônica foi definida como aquela com duração ≥ 6 meses. O critério para uso do serviço de saúde foi ter feito mais de quatro consultas ou uma internação no último ano. Para os idosos com dor há pelo menos um ano, testou-se a existência de associação entre uso do serviço de saúde com as variáveis independentes (características da dor, sociodemográficas e doenças autorreferidas), por meio de análises univariadas (teste de Rao & Scott) e múltiplas (Regressão Múltipla de Cox com variância robusta). Utilizou-se o programa Stata 11.0 e adotou-se como valor de significância p < 0,05. RESULTADOS A prevalência de utilização do serviço de saúde nos idosos com dor foi 48,0% (IC95% 35,1;52,8) e não diferiu dos idosos sem dor (50,5%; IC95% 45,1;55,9). A chance de utilização do serviço de saúde foi 33,0% menor nos idosos com dor há mais de dois anos do que naqueles com dor entre um e dois anos (p = 0,002); 55,0% maior nos idosos com dor intensa (p = 0,003) e 45,0% maior entre os que relataram interferência moderada da dor no trabalho (p = 0,015) na análise múltipla. CONCLUSÕES A dor crônica foi frequente e esteve associada a maiores prejuízos na independência e mobilidade. A dor crônica mais intensa, a mais recente e a com impacto no trabalho resultaram em maior uso dos serviços de saúde. .

OBJETIVO Analizar la asociación entre la utilización de servicio de salud por ancianos con dolor crónico y variables sociodemográficas y de salud. MÉTODOS Estudio transversal con muestra poblacional realizado por medio de pesquisa domiciliar en Sao Paulo, SP-Brasil, en 2006, con 1.271 ancianos de 60 años o más, sin déficit cognitivo, que manifestaron dolor crónico. Dolor crónico fue definido como aquel con duración ≥ 6 meses. El criterio para uso del servicio de salud fue haber tenido más de cuatro consultas o una internación en el último año. Para los ancianos con dolor por al menos un año, se evaluó existencia de asociación entre uso del servicio de salud con las variables independientes (características del dolor, sociodemográficas y enfermedades auto-referidas), por medio de análisis univariados (prueba de Rao & Scott ) y múltiples (Regresión Múltiple de Cox con varianza robusta). Se utilizó el programa Stata 11.0 y se adoptó como valor de significancia p<0,05. RESULTADOS La prevalencia de utilización del servicio de salud en los ancianos con dolor fue 48,0% (IC 95% 35,1;52,8), y no difirió de los ancianos sin dolor (50,5%; IC95% 45,1;55,9). El porcentaje de utilización del servicio de salud fue 33,0% menor en los ancianos con dolor por más de dos años que en aquellos con dolor entre uno y dos años (p=0,002); 55,0% mayor en los ancianos con dolor intenso (p=0,003) y 45% mayor entre los que manifestaron interferencia moderada del dolor (p=0,015) en el análisis múltiple. CONCLUSIONES El dolor crónico fue frecuente y estuvo asociado a mayores perjuicios en la independencia y movilidad. El dolor crónico más intenso, el más reciente y con impacto en el trabajo resultaron en mayor uso de los servicios de salud. .

OBJECTIVE Evaluate the association between use of health care services by older adults with chronic pain and sociodemographic and health variables. METHODS Cross-sectional study whose population sample of 1,271 older adults with chronic pain and with no cognitive deficit was obtained through home surveys in Sao Paulo, SP, Southeastern Brazil,, in 2006. The study considered pain lasting for six or more months as chronic. The criterion for health care service use was more than four doctor appointments or having been admitted to a hospital during the past year. For those in chronic pain for at least one year, the existence of an association between the use of health care services and independent variables (pain and socio-demographical characteristics and self-reported morbidities) was tested using univariate (RaoScott test of association) and multivariate analysis (Cox Multiple Regression with robust variance). Stata 11.0 was used for the statistical analysis, and the significance level adopted was p < 0.05. RESULTS The prevalence of health care service use among older people with pain was 48,0% (95%CI 35.1;52.8) and did not differ from older adults without chronic pain (50.5%, 95%CI 45.1;55.9). The multivariate analysis showed that the chance of using health care services was 33,0% lower for older adults with pain for more than two years than those with pain between one and two years (p = 0.002). The chance was 55,0% higher for those with intense pain (p = 0.003) and 45,0% higher for those with moderate pain interference in the work (p = 0.015). CONCLUSIONS Chronic pain was found to be common and was associated with negative effects on independence and mobility. More intense and recent chronic pain that affected work resulted in greater use of health care services. .

Remeasurement, Evaluation And Comparison The Health Services Utilization Among Women Staff At Universiti Kebangsaaan Malaysia After Eleven Years Period

A cross-sectional study was carried out in July-October 2012 in UKM to remeasure, evaluate and compare the changes in health services utilization level among women staff in UKM with a previous study done in 2001 and its influencing factors. The services studied were blood pressure (BP) measurement and Pap smear test. A total of 234 respondents aged between 18 and 55 were selected using stratified random sampling from Bangi, Kuala Lumpur and UKMMC, Malaysia. Data was collected via self-administered questionnaire and was analyzed by using SPSS version 17.0. Majority 85.9% of the respondents were found to have utilized at least one BP measurement which is higher compared to previous study. The Pap smear test, 64.5% of women have had a Pap smear test done also higher compared to previous study. Multivariate analysis shows the factors associated with BP measurement are age (OR 2.7, CI 95% 1.2, 6.3), family history of general health problems (OR 3.4, CI 95% 1.5, 7.6), and health staff influence (OR 5.2, CI 95% 1.1, 25.5). The factors associated with Pap smear test are marital status (OR 62.8, CI 95% 7.2, 546.4), general health problems (OR 2.3, CI 95% 1.2, 4.5), family planning (OR 6.9, CI 95% 3.0, 16.5) and self-interest (OR 3.3, CI 95%, 1.3, 8.6). The level of health services utilization on BP measurement and Pap smear test in 2012 is higher than 2001. For both BP measurement and Pap smear test the determinant factors are differed in the aforesaid years.

Uso de serviços de saúde segundo posição socioeconômica em trabalhadores de uma universidade pública / Social determinants of the use of health services among a public university workers / Uso de servicios de salud según posición socioeconómica en trabajadores de una universidad pública

OBJETIVO: Analisar o uso de serviços de saúde segundo posição socioeconômica em trabalhadores de uma universidade pública. MÉTODOS: Estudo transversal com 759 funcionários de uma universidade pública brasileira que referiram restrição das atividades habituais por motivo de saúde nos últimos 14 dias. Foram utilizados dados de 2001 provenientes da coorte "Estudo Pró-Saúde", realizado no Rio de Janeiro, RJ. O uso de serviços de saúde foi avaliado pela proxy busca por assistência de saúde e tipo de serviço. A presença de variações adicionais na morbidade foi verificada pelo tempo de restrição. Foram analisados os marcadores de escolaridade, renda e ocupação e calculadas razões de proporções brutas e ajustadas do uso e por tipo de serviço. RESULTADOS: Nível ocupacional foi o indicador de maior desigualdade no uso de serviços de saúde. Após o ajuste por sexo, idade e demais marcadores de posição socioeconômica, a razão de proporção de uso de assistência de saúde entre trabalhadores de rotina manual foi 1,31 (IC95 por cento 1,11;1,55) e entre trabalhadores de rotina não-manual foi 1,21 (IC95 por cento 1,06;1,37), comparados aos profissionais, considerada a categoria de referência. CONCLUSÕES: Padrão de desigualdade social foi observado no uso de serviços de saúde em favor dos indivíduos de menor posição socioeconômica, mesmo após o controle por necessidade, com destaque para o marcador de ocupação. As diferenças remanescentes na morbidade dos indivíduos parecem não ser suficientes para explicar o achado e fatores ocupacionais podem exercer maior influência no uso de serviços de saúde dessa população.

OBJECTIVE: To analyze the use of health services and socioeconomic status among a public university workers. METHODS: A cross-sectional study with 759 workers at a Brazilian public university who reported health-related restrictions of their usual activities in the previous 14 days, was carried out. Data were supplied by the 2001 cohort of the "Pró-Saúde Study" in Rio de Janeiro, Southeastern Brazil. Health services use was assessed with a proxy for "seeking health care" and according to the type of service. The presence of additional variation in morbidity was verified by time restriction. Schooling, income and occupation markers were analyzed, and crude and adjusted proportion ratios of use and types of service were calculated. RESULTS: The occupation level was the indicator of the greatest inequality in health services use. After adjustments for gender, age and the other socioeconomic status markers, the ratio of the proportion of health care use was 1.31 for manual workers (95 percentCI: 1.11;1.55) and 1.21 for non-manual workers (95 percentCI: 1.06;1.37) compared to the reference category of professionals. CONCLUSIONS: A pattern of social inequality was identified in health services use. Even after an adjustment for health need, the pattern favored individuals with lower socioeconomic status, particularly for the occupation marker. Remaining differences in individual morbidities do not explain this finding. Rather, occupational factors may exert a greater influence on health services use in this population.

OBJETIVO: Analizar el uso de servicios de salud según posición socioeconómica en trabajadores de una universidad pública. MÉTODOS: Estudio transversal con 759 funcionarios de una universidad pública brasileña que refirieron restricción de las actividades habituales por motivo de salud en los últimos 14 días. Se utilizaron datos de 2001 provenientes de la cohorte "Estudio Pro-Salud", realizado en Rio de Janeiro, Sureste de Brasil. El uso de servicios de salud fue evaluado por la proxy "búsqueda por asistencia de salud" y "tipo de servicio". La presencia de variaciones adicionales en la morbilidad fue verificada por el tiempo de restricción. Se analizaron los marcadores de escolaridad, renta y ocupación y calculadas tasas de proporciones brutas y ajustadas del uso y por tipo de servicio. RESULTADOS: El nivel ocupacional fue el indicador de mayor desigualdad en el uso de servicios de salud. Posterior al ajuste por sexo, edad y demás marcadores de posición socioeconómica, la tasa de proporción de uso de asistencia de salud entre trabajadores de rutina manual fue 1,31 (IC95 por ciento 1,11;1,55) y entre trabajadores de rutina no manual fue 1,21 (IC95 por ciento 1,06;1,37), comparados con los profesionales considerados en la categoría de referencia. CONCLUSIONES: El patrón de desigualdad social fue observado en el uso de servicios de salud a favor de los individuos de menor posición socioeconómica, aún después del control por necesidad, resultando el marcador ocupacional. Las diferencias remanentes en la morbilidad de los individuos parecen no ser suficientes para explicar el resultado y factores ocupacionales pueden ejercer mayor influencia en el uso de servicios de salud de esta población.

Os Suplementos Saúde na Pesquisa Nacional por Amostra de Domicílios (PNAD) no Brasil / Health supplements in the Brazilian National Household Survey - PNAD

As mudanças socioeconômicas, demográficas e tecnológicas e suas implicações nas políticas públicas demandam dos órgãos governamentais a produção de informações. As informações atualizadas de base populacional e de âmbito nacional são essenciais ao processo de planejamento e ao acompanhamento pela sociedade do cumprimento dos princípios constitucionais da saúde, como direito ao acesso igualitário aos serviços de saúde. A Pesquisa Nacional por Amostra de Domicílios (PNAD) é uma fonte de dados importante para o conhecimento e monitoramento de aspectos relevantes da situação de saúde da população brasileira e do acesso, utilização e financiamento de serviços de saúde. Neste artigo, faz-se um breve histórico da evolução dos objetivos, da periodicidade e da abrangência geográfica ao longo de quatro décadas da PNAD no Brasil, enfatizando-se os principais aspectos incluídos nos suplementos de saúde em 1981, 1986, 1998 e 2003. A produção de textos técnicos e acadêmicos, gerados a partir desses suplementos, tem permitido conhecer aspectos importantes da saúde da população brasileira e monitorar, em diferentes recortes geográficos e socioeconômicos, as políticas voltadas para o acesso e uso de serviços de saúde. Argumenta-se sobre a necessidade de iniciar uma discussão mais profunda sobre a continuidade da série histórica iniciada em 1998, frente à implantação, em futuro próximo, do Sistema Integrado de Pesquisas Domiciliares (SIPD) pelo IBGE.

¿Cuándo utilizan servicios de salud las mujeres que viven en condiciones de violencia de pareja?

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Abstract: Introduction Violence is recognized as a Public Health problem around the world. In the specific case of Intímate Partner Abuse, which occurs at home, women are particularly vulnerable to be abused by their partners. In Mexico, as in other countries in Latin America, the systematic study of violence towards women is incipient. However, it is a highly predominant problem, which has a big impact on women's health, and represents a significant challenge to the Health System demanding health care due to intentional injuries. This paper analyzed information generated by the first National Survey of violence against women in 2003 (ENVIM, by his name in Spanish). Objective The main objective is to identify the factors associated with the health services utilization by women, because of partner abuse. Methodology A cross-sectional design was used, including women users of health care services on public institutions all over the country in 2003. Intimate partner abuse was defined as "the repetitive event of abuse from the male partner side towards the woman, that is characterized by coercive conducts that could include physical, emotional or sexual violence". It was measure in a scale of 27 items, using the Index of Spouse Abuse (ISA) and the Severity of Violence against Women Scale (SVAWS). Both indexes were vali-dated previously in Mexican population. A factorial analysis was used and the factors that explain the variability were obtained. The selection of women to be interviewed was done using a probabilistic stratify biethapic sample. For the first one, medical unites were selected, and for the second, women over 14 years old who went to those medical unities to demand any kind of health care services. The ethic considerations were resolved using the next procedures: participants received information about the research objectives and signed an informant consent letter endorsed by the ethical committee of the Institution. They also received a brochure with information about the local institutions where they can go in case of abuse. Interviewers trained in technical areas as well as abuse management using a questionnaire on private spaces did the data collection. The answer rate was of 98%. The analyzed variables were Socio demographic, search of support on the health staff or reasons for not doing this. An index of socio-economic level categorized as very low, medium and high. Type of institution and services used. The dependent variable was utilization of the health services to attend the injuries due to a partner abuse event, during the last 12 months. The analysis used was simple and bivariate using chi square, and binary logistic regression model. The final model included the variables that in the binary showed a value of p<0.25. We ad-justed the model using the Goodness of Fit Test of Pearson. Results From 24,958 women that utilized public health services 21% reported to have had a partner abuse event in the last year. From these, only 7.3% utilized health services. The more important variables were: age between 25 to 34 years old, elementary schooling and women having a job. Of the sample 94% belong to the very low and medium socio-economic levels; almost half of them (47%) do not have health insurance. More than 80% have a partner at present; 7.6% reported severe violence. From those who had injuries, 72% declared to have had just one minor injury (bruises, body aches), 25.5% reported more than one type of injuries, from which 10.8% were severe and required surgery or hospitalization. The type of injuries that demand more utilization of health services were those subsequent to sexual abuse as genital infection and genital bleeding. Only 45% of the women users' report to have medical insurance. Less than 6% of abused women talked with the health staff about their abuse situation and the main reason was the lack of trust. The factors associated to the utilization of health services were ages over 24 years(ORA 1.57, CI 95% 1.9 - 2.06) alcohol intake by the women (ORA =1.66 CI 95% 1.57-1.75) High Socio economic status (ORA =1.29 CI95% 1.07-1.54). The model was adjusted by severity index and to having medical insurance. There were not significative interactions (p>0.15) and the global adjusted model was p= 0.23. Discussion and conclusions There is a low percentage of abused women injured that utilize formal medical care. This is a very important result for the identification of prevention and control strategies of the partner abuse problem in the health services. The study shows the existence of different types of injuries or medical problems such as genital infections and bleedings, fainting spells, body aches that provoked on one hand that women did not seek medical attention immediately and on the other that the health staff could not identify this kind of health problems with intimate partner abuse. There is a group of more vulnerable women who do not use health services to take care of the consequences of abuse, because they are uninsured. This inequality reveals that it is urgent to provide support services to poor women in the country. The finding about the difficulty for battered women to report their injuries to the health staff because of their lack of trust, agrees with different studies that report the different obstacles found by abused women in facing the health services. The last situation reveals the obstacles to be solved for the NOM implementation too. It is important to mention the study limitations related with the design utilized, and the selection bias due to the inclusion only of users of services. This situation leaves at one side women with less resources, who confront big obstacles for the utilization of health services, and at the other, women from high socio-economic levels, who utilize private health services; therefore there is no accuracy the point out differences. The way in which the question about the utilization of health services was made, makes it difficult to know the number of times these were used. This variable must be explored in future studies. The information generated by the ENVIM allows the Health Sector to define identification-attention strategies of battered women and provides information about the importance of training the health staff to generate trust among in partner-abused women.