Why do some Mexicans with psychosis risk symptoms seek mental health care and others do not?

Help-seeking barriers differ according to the sociocultural context and country-specific mental healthcare system. More research is needed in low-middle-income countries, where early psychosis programs are still scarce, and the mental health care gap is wide. This study aims to explore predisposing, enabling, and need factors associated with mental health service utilization in 481 Mexicans self-reporting psychosis risk symptoms, as well as differences between those who were currently mental health service users (MHSU) and those who were not (non-MHSU). Participants responded to self-reported measures through an online survey. The factors associated with an increased probability of using mental health services were having an occupation, having a medium/high socioeconomic status, an intention to seek help from a mental health professional, fewer help-seeking barriers, moderate/severe anxious symptoms, higher distress associated with psychosis risk symptoms and social functioning impairment. Findings provide relevant information for designing more effective strategies to improve help-seeking, early identification, and timely treatment delivery in Mexico. The need to generate strategies focused on reducing stigma, enhancing psychosis literacy in the community, and increasing the identification of emerging signs of psychosis in primary healthcare professionals is highlighted, mainly when co-occurring with other psychiatric symptoms.

LGBTQIA+ vs the Brazilian Unified Health System: Basic Health Unit Use and Associated Factors.

The Brazilian Unified Health System provides universal health care access without regard to sexual orientation and gender identity. We conducted a nationwide study with a cross-sectional design and intentional sampling methods to investigate factors associated with Basic Health Unit (BHU) use by the LGBTQIA+ community. Data were collected via a questionnaire available through social networks. Statistical analysis included Poisson regression with robust variance. A total of 603 LGBTQIA+ community members participated in the study, of whom 417 (69.2%) had visited a BHU in the last year. The factors "transgender woman" and "self-rated health status as very good/good/fair" increased the probability of BHU use in the last year by 10% (PR: 1.10; 95% CI: 1.00-1.20) and 9% (PR = 1.09; 95% CI: 1.01-1.18), respectively. "Not suffering sexual orientation-related discrimination at a BHU" and "Not suffering discrimination by a receptionist or waiting room worker" increased the probability of use by 28% (PR = 1.28; 95% CI: 1.22-1.34) and 22% (PR = 1.22; 95% CI: 1.14-1.30), respectively. Our study supports evidence that access to primary health care services in Brazil can be influenced by the social determinants gender identity and sexual discrimination.

Examining healthcare needs and decisions to seek health services among Venezuelan migrants living in Trinidad and Tobago using Andersen's Behavioral Model.

Introduction: Beginning in 2016, Trinidad and Tobago experienced increasing flows of migrants and refugees from Venezuela. Through a Government Registration Exercise in 2019, followed by a Re-registration Exercise in 2020, migrants and refugees benefitted from access to publicly available primary care and emergency medical services. By applying Andersen's Behavioral Model for Health Service Use, our study examined the non-communicable disease care needs of migrants, and factors influencing their decision to seek public and private health services. Method: Between September and December 2020, a health questionnaire was administered via telephone to n = 250 migrants from Venezuela. Descriptive statistics summarized the constructs of Andersen's Behavioral Model. The model comprised of predisposing factors including migrants' social characteristics; enabling factors namely monthly earnings, education level and most trusted source of information on medical needs; need for care factors such as migrants self-reported health status, presence of non-communicable health conditions and having visited a doctor in the past 12 months; and the outcome variables which were migrants' decisions to seek public and private health services. Pearson χ2 tests, odds ratios and multivariable logistic regression with backward elimination examined the factors influencing a migrant's decision to seek health services. Results: Overall, 66.8% of migrants reported they would seek public health services, while 22.4% indicated they would seek private health services. Predisposing factors namely length of time residing in Trinidad and Tobago (p = 0.031) and living with family/friends (p = 0.049); the enabling factor of receiving information from publicly available sources (p = 0.037); and the need for care factor of visiting a doctor for a physical health problem (p = 0.010) were significant correlates of their decision to seek care in the public sector. Predisposing factors namely living with family/friends (p = 0.020) and the enabling factor of having difficulty accessing healthcare services (p = 0.045) were significant correlates of their decision to seek care from private providers. Discussion: Our findings demonstrated the positive association between social networks and a migrant's decision to use public and private health services, thus underscoring the importance of family and friends in facilitating health service use, promoting proper health practices and preventing diseases. Overall, the use of Andersen's Behavioral Model aided in identifying the factors associated with the use of health services by Venezuelan migrants in Trinidad and Tobago. However, further studies are needed to better understand their need for ongoing care, to inform policy, and to plan targeted health interventions for addressing the gaps in health service access, barriers and use.

Barriers and Facilitators to Mental Health Help-Seeking and Experiences with Service Use among LGBT+ University Students in Chile.

Barriers limiting access to mental health care for lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) university students have not yet been explored in depth. The aim of this study was to explore the barriers and facilitators to mental health help seeking and experiences with service use among LGBT+ university students. Participants were 24 LGBT+ students between 18 and 23 years of age from a university in Chile. Individual semi-structured interviews were conducted and analysed using thematic content analysis. Multiple barriers and facilitators influence mental health help-seeking of LGBT+ students, with some of these barriers being explicitly related to LGBT+ issues (e.g., fear of discrimination or accessing specialised services). Perceived effectiveness of services was closely related to access safe/affirming care. Trans students reported more barriers to help-seeking and negative experiences with professionals than their cisgender peers. Perceptions of university mental health services as safe spaces for LGBT+ students were related to a positive perception of the university regarding LGBT+ issues. Knowing the factors that either hinder or facilitate help-seeking and characterising service use experiences in this population is useful for improving access to mental health services and for the development of policies that promote affirmative care for LGBT+ people.

Challenges and Insights From Treating Psychotic Disorders During COVID-19 Pandemic in Brazil.

The COVID-19 pandemic mainly affected the most vulnerable individuals. Among those, patients with schizophrenia especially suffered from unexpected changes in their routines, barriers to treatment, and distress-related events. We conducted a narrative review using all available sources of information to describe the challenges faced by schizophrenia patients and their families in Brazil, including the strategies that have been adopted to tackle them. In addition, we analyzed public data on antipsychotic prescriptions and hospitalizations. It was found that digital prescriptions with extended expiration dates implemented during the pandemic in Brazil allowed patients to maintain their access to antipsychotics. Hospitalizations among patients with schizophrenia, schizotypal, and schizoaffective disorders decreased at the beginning of the pandemic. Nevertheless, in the following months, the admissions returned to a trend similar to the prepandemic period. The systematization of online resources will be one of the main legacies to mental health care, including schizophrenia. We believe one of the main limitations of the policies adopted was the decision to not prioritize COVID-19 vaccination in patients with severe psychiatric disorders, despite preliminary evidence of a higher risk of complications in this group. The coronavirus pandemic is still ongoing and a longer time will be required to have a better perspective of its effects, but we expect this record of challenges and insights about the lessons learned during the pandemic can help healthcare professionals to face similar situations in the future.

The influence of caregiver attitudes and socioeconomic group on formal and informal mental health service use among youth.

BACKGROUND: Young people can receive mental health care from many sources, from formal and informal sectors. Caregiver characteristics/experiences/beliefs may influence whether young people get help and the type of care or support used by their child. We investigate facilitators/barriers to receiving formal and/or informal care, particularly those related to the caregiver's profile. METHODS: We interviewed 1,400 Brazilian primary caregivers of young people (aged 10-19), participants of a high-risk cohort. Caregivers reported on young people's formal/informal mental health care utilization, and associated barriers and facilitators to care. Data were also collected on youth mental health and its impact on everyday life; and caregiver characteristics-education, socioeconomics, ethnicity, mental health, and stigma. Logistic regression models were used to examine the relationship between caregiver and young people characteristics with formal/informal care utilization. RESULTS: Persistence and greater impact of youth mental health conditions were associated with a higher likelihood of care, more clearly for formal care. Caregiver characteristics, however, also played a key role in whether young people received any care: lower parental stigma was associated with greater formal service use, and lower socioeconomic class showed higher odds of informal care (mainly from religious leaders). CONCLUSIONS: This study highlights the key role of the caregivers as gatekeepers to child treatment access, particularly parental stigma influencing whether young people received any mental health care, even in a low resource setting. These results help to map barriers for treatment access and delivery for young people, aiming to improve intervention efforts and mental health support.

Tendências na prevalência de hipertensão arterial sistêmica e na utilização de serviços de saúde no Brasil ao longo de uma década (2008-2019) / Trends in the prevalence of systemic arterial hypertension and health care service use in Brazil over a decade (2008-2019)

Resumo A carga global e a prevalência de hipertensão arterial sistêmica (HAS) têm crescido nas últimas duas décadas, especialmente em países de baixa e média renda, representando uma preocupação para as autoridades em saúde. Este estudo analisou a prevalência de HAS entre adultos brasileiros em 2008, 2013 e 2019 e o controle da doença pelos indivíduos em 2013 e 2019. Utilizou-se dados da Pesquisa Nacional por Amostra de Domicílio (2008) e da Pesquisa Nacional de Saúde (2013-2019). Foram calculadas razões de prevalência da doença pelo método de Poisson, ajustado para caraterísticas sociodemográficas. Para os indicadores de cuidados em saúde e organização da atenção primária calculamos proporções estratificadas por sexo, faixa etária, raça e região. Os resultados indicam que as desigualdades regionais persistem, com menores prevalências no Norte e Nordeste e maiores no Sudeste e Sul. Embora os indicadores de acesso e utilização dos serviços de saúde sejam considerados bons, refletindo as melhorias na atenção primária nos últimos anos, ressaltamos a importância da adoção de estratégias multifacetadas para a prevenção e controle da HAS no país.

Abstract The global burden and the prevalence of systemic arterial hypertension (SAH) have increased over the last two decades, especially in low- and middle-income countries, and are a concern to health authorities. This study analyzed the prevalence of SAH reported by Brazilian adults in 2008, 2013, and 2019, and individual disease control in 2013 and 2019. Data from the National Household Sample Survey (2008) and National Health Survey (2013-2019) were employed. We calculated the disease's prevalence ratios using Poisson regression, adjusted for sociodemographic characteristics. Regarding health care and PHC organization indicators, we calculated proportions by gender, age group, ethnicity, and region. The results reveal persistent regional inequalities, with lower prevalence in the North and Northeast and higher prevalence in the Southeast and South. While the health care access and use indicators are positive, reflecting PHC improvements in recent years, we highlight the importance of adopting multifaceted SAH prevention and control strategies in the country.

Mudanças no padrão de utilização de serviços de saúde no Brasil entre 2013 e 2019 / Changes in the pattern of health services use in Brazil between 2013 and 2019

Resumo Este estudo teve o objetivo de comparar os padrões de utilização de serviços de saúde, a partir das informações das edições da Pesquisa Nacional de Saúde (PNS), 2013 e 2019. Os dois desfechos "Procura de atendimento relacionado à saúde nas últimas duas semanas" e "Consulta médica nos últimos doze meses" foram analisados segundo fatores socioeconômicos, geográficos, e condições de saúde. Foram usados modelos multivariados de regressão de Poisson para investigar os fatores associados à procura de atendimento de acordo com o motivo (problema de saúde ou prevenção). Entre 2013 e 2019, a prevalência de doenças crônicas aumentou de 15,0% a 22,5%. A proporção de busca de atendimento cresceu de 15,3 a 18,6%, e de uso de médico, de 71,2% a 76,2%, com amplitudes de variação de 61,4-75,8% e 68,0-80,6% entre as regiões Norte e Sudeste. Para atendimento por problema de saúde, não houve associação significativa com rendimento per capita, após o controle das demais covariáveis. Conclui-se que apesar da expansão da cobertura de utilização de serviços de saúde, as persistentes desigualdades regionais indicam necessidades de saúde não atendidas entre os residentes das regiões menos desenvolvidas. Modelos de atenção focados na prevenção e promoção da saúde são necessários.

Abstract This study aimed to investigate changes in the health service use pattern based on information from the 2013 and 2019 National Health Surveys (PNS). The two outcomes, "Seeking health-related care in the past two weeks" and "Medical visit in the last twelve months", were analyzed according to socioeconomic, geographic and health conditions characteristics. Multivariate Poisson regression models were used to investigate the factors associated with seeking care due to a health problem or prevention. The prevalence of chronic diseases increased from 15.0% to 22.5% between 2013 and 2019. The proportion of seeking care increased from 15.3 to 18.6%, and medical visits from 71.2% to 76.2%, ranging from 61.4 to 75.8% and 68.0 to 80.6% between the North and Southeast regions. There was no significant association of seeking care due to a health problem with per capita income, after controlling for the other covariates. We conclude by saying that, despite the expanded coverage of health service use, the persistent regional inequalities indicate unmet health needs among residents of the less developed regions. Health care models focused on prevention and health promotion are required.

Disability, Hospital Care, and Cost: Utilization of Emergency and Inpatient Care by a Cohort of Children with Intellectual and Developmental Disabilities.

OBJECTIVE: To use medical claims data to determine patterns of healthcare utilization in children with intellectual and developmental disabilities, including frequency of service utilization, conditions that require hospital care, and costs. STUDY DESIGN: Medicaid administrative claims from 4 states (Iowa, Massachusetts, New York, and South Carolina) from years 2008-2013 were analyzed, including 108 789 children (75 417 male; 33 372 female) under age 18 years with intellectual and developmental disabilities. Diagnoses included cerebral palsy, autism, fetal alcohol syndrome, Down syndrome/trisomy/autosomal deletions, other genetic conditions, and intellectual disability. Utilization of emergency department (ED) and inpatient hospital services were analyzed for 2012. RESULTS: Children with intellectual and developmental disabilities used both inpatient and ED care at 1.8 times that of the general population. Epilepsy/convulsions was the most frequent reason for hospitalization at 20 times the relative risk of the general population. Other frequent diagnoses requiring hospitalization were mood disorders, pneumonia, paralysis, and asthma. Annual per capita expenses for hospitalization and ED care were 100% higher for children with intellectual and developmental disabilities, compared with the general population ($153 348 562 and $76 654 361, respectively). CONCLUSIONS: Children with intellectual and developmental disabilities utilize significantly more ED and inpatient care than other children, which results in higher annual costs. Recognizing chronic conditions that increase risk for hospital care can provide guidance for developing outpatient care strategies that anticipate common clinical problems in intellectual and developmental disabilities and ensure responsive management before hospital care is needed.

Does childhood mental health service use predict subsequent mental health service use during Latino youth transition to young adulthood? Evidence from the Boricua Youth Study.

PURPOSE: Studies document the substantial underutilization of mental health services by US Latinos in young adulthood. Rates of service use are higher in childhood, raising questions about whether mental health service use during childhood may facilitate access to services later in life. This article examines the extent to which utilization of mental health services in childhood is predictive of utilization in young adulthood among US Latinos. METHODS: Data come from the Boricua Youth Study, a longitudinal study of Puerto Rican youth at two sites (South Bronx, New York, and the standard metropolitan area of San Juan, Puerto Rico). Data were collected in three waves during childhood (ages 5-13; surveyed 1 year apart), with an approximately 11-year follow-up in young adulthood (ages 16-29). In childhood, parents reported on youth mental health service use (Waves 1-3). In Wave 4, as youth transitioned to young adults (N = 2004), they reported on their past year mental health service use. RESULTS: Whereas 30.2% of parents reported their child received mental health services, only 3.5% of young adults reported mental health service use in the past year. After controlling for young adult disorders and their severity, childhood disorders were associated with increased likelihood of mental health service use in young adulthood. Childhood mental health service use was also associated with young adult service use; however, this association attenuated when controlling for childhood disorders. CONCLUSION: Findings suggest the importance of specifically considering childhood disorders in understanding mechanisms for improving access to mental health services among Latino young adults.

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys.

AIMS: To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. METHODS: Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. RESULTS: Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. CONCLUSIONS: These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Use of health services among international migrant children - a systematic review.

BACKGROUND: Migrant children have specific health needs, and may face difficulties in accessing health care, but not enough is known about their health service use. This study aims to describe patterns of use of health services of international migrant children and differences to respective native populations. METHODS: Electronic databases PubMed and Web of Science, references of identified publications, and websites of relevant international agencies were searched. We included observational studies published between 2006 and 2016 that reported use of formal health services by migrant children (0-18 years), including first and second generation migrants. Data on study characteristics, study theme, main outcome and study quality were extracted. RESULTS: One hundred seven full texts were included in the review. Of the studies that reported comparable outcomes, half (50%) indicated less use of healthcare by migrants compared with non-migrants; 25% reported no difference, 18% reported greater use, and 7% did not report this outcome. There was variation by theme, so that the proportion of conclusions "less use" was most common in the categories "general access to care", "primary care" and "oral health", whereas in the use of emergency rooms or hospitalisations, the most common conclusion was "greater use". CONCLUSIONS: Migrant children appear to use different types of healthcare services less than native populations, with the exception of emergency and hospital services. SYSTEMATIC REVIEW REGISTRATION: PROSPERO systematic review registration number: CRD42016039876 .

Twelve-month prevalence rates of mental disorders and service use in the Argentinean Study of Mental Health Epidemiology.

PURPOSE: Community surveys of mental disorders and service use are important for public health policy and planning. There is a dearth of information for Latin America. This is the first representative community survey in the Argentinean population. The purpose is to estimate the 12-month prevalence and severity of mental disorders, socio-demographic correlates and service use in a general population survey of adults from urban areas of Argentina. METHODS: The World Mental Health Composite International Diagnostic Interview was administered to 3927 individuals aged 18 years and older participating in a multistage clustered area probability household survey. The response rate was 77%. RESULTS: The 12-month prevalence of any disorder was 14.8%, and a quarter of those disorders were classified as severe. Younger participants and those with lower education had greater odds of any disorder and most classes of disorder. 11.6% of the total population received treatment in the prior 12 months and only 30.2% of those with a severe disorder. Women and those never married were more likely to receive or seek treatment, whereas those with low and low-average education were less likely. CONCLUSION: Most individuals with a mental disorder in the past year, even those with a severe disorder, have not received treatment. Because low education is a barrier to treatment, initiatives aimed at mental health education might help timely detection and treatment of these disorders in Argentina.

Association of comorbidity and health service usage among patients with dementia in the UK: a population-based study.

BACKGROUND: The majority of people with dementia have other long-term diseases, the presence of which may affect the progression and management of dementia. This study aimed to identify subgroups with higher healthcare needs, by analysing how primary care consultations, number of prescriptions and hospital admissions by people with dementia varies with having additional long-term diseases (comorbidity). METHODS: A retrospective cohort study based on health data from the Clinical Practice Research Datalink (CPRD) was conducted. Incident cases of dementia diagnosed in the year starting 1/3/2008 were selected and followed for up to 5 years. The number of comorbidities was obtained from a set of 34 chronic health conditions. Service usage (primary care consultations, hospitalisations and prescriptions) and time-to-death were determined during follow-up. Multilevel negative binomial regression and Cox regression, adjusted for age and gender, were used to model differences in service usage and death between differing numbers of comorbidities. RESULTS: Data from 4999 people (14 866 person-years of follow-up) were analysed. Overall, 91.7% of people had 1 or more additional comorbidities. Compared with those with 2 or 3 comorbidities, people with ≥6 comorbidities had higher rates of primary care consultations (rate ratio (RR) 1.31, 95% CI 1.25 to 1.36), prescriptions (RR 1.68, 95% CI 1.57 to 1.81), and hospitalisation (RR 1.62, 95% CI 1.44 to 1.83), and higher risk of death (HR 1.56, 95% CI 1.37 to 1.78). DISCUSSION: In the UK, people with dementia with higher numbers of comorbidities die earlier and have considerably higher health service usage in terms of primary care consultations, hospital admissions and prescribing. This study provides strong evidence that comorbidity is a key factor that should be considered when allocating resources and planning care for people with dementia.

Posição social e julgamento dos serviços de saúde pelos usuários / Social position and judgment of health care services by users

Com o objetivo de investigar as relações entre o julgamento dos serviços de saúde pelos usuários e a sua posição no espaço social, foi realizado um estudo apoiado na sociologia de Bourdieu envolvendo dois grupos. Foram realizadas 22 entrevistas em profundidade com professores universitários e usuários de unidades de saúde. A posição no espaço social desses agentes foi caracterizada por meio da análise dos seus capitais e trajetória social. Identificou-se que a escolha dos médicos entre os agentes de maior capital global vinculava-se a critérios técnicos e simbólicos. Em contrapartida, entre agentes de classes populares, o acesso foi o principal critério. Analisou-se que a tomada de posição em relação ao serviço corresponde a um ajuste inconsciente das necessidades às possibilidades dos usuários. Discutem-se as implicações da distância social existente entre médicos e pacientes na escolha e julgamento dos serviços de saúde.

To investigate the relationship between the judgment of health care services by users and their position in the social space, we performed a study supported by the sociology of Bourdieu involving two groups. Twenty-two in-depth interviews were conducted with university professors and users of the health care system. The social position of these agents was characterized by analyzing their available capital and their social trajectory. We found that the choice of physicians by those users with greater global capital was linked to technical and symbolic criteria. In contrast, among agents of the popular classes, access was the main criterion. We analyzed that the stance taken regarding the service corresponds to an unconscious adjustment between needs and the possibilities available to users. We discussed the implications of a social distance between physicians and their patients in choosing and judging health care services.

Prevalência e fatores associados à consulta médica entre adultos de uma comunidade de baixa renda do Sul do Brasil / Prevalence of medical appointments and associated factors among adults in a low-income community in southern Brazil

Objetivo: estimar a prevalência de consultas médicas, nos três meses que antecederam à entrevista, em adultos de 20 anos ou mais, de uma comunidade de baixa renda, do Sul do Brasil, em 2O09. Métodos: foi realizado estudo transversal, com análise ajustada por meio de Regressão de Poisson. Resultados: a prevalência de consulta médica nos 3.391 entrevistados foi 76,2 por cento (Intervalo de Confiança de 95 por cento (IC95 por cento) 74,8; 77,6 por cento) no último ano e 64,8 por cento (IC95 por cento 63,0; 66,7 por cento) nos últimos três meses, maior entre as mulheres (67,8 por cento) do que entre os homens (60,2 por cento) (p<0,001). Na análise ajustada, para homens, o desfecho associou-se mais fortemente: ao aumento de idade (p=0,001) e autopercepção de saúde ruim/ muito ruim (p<0,001). Entre mulheres, ao aumento da idade (p=0,001), possuir médico de referência (p=0,001), local usual de atendimento (p<0,001) e morbidades (p= 0,001). Conclusões: a diferença na utilização de consultas deve ser considerada no planejamento e organização do acesso

Objective: to estimate medical appointment prevalence during the three months prior to interview, in adults aged ≥20 from a low-income community in Southern Brazil in 2009. Methods: cross-sectional study with analysis adjusted using Poisson regression. Results: 3391 people were interviewed. Medical appointment prevalence was 76.2 percent (95 percent CI 74.8, 77.6) in the last year and 64.8 percent (95 percent CI 63.0, 66.7) in the last three months: 67.8 percent in females (95 percent CI 65.5, 70.1) (p<0.001); 60.2 percent in males (95 percent CI57.1, 63.2). Adjusted analysis outcome in males was more strongly associated with increasing age (p 0.001) and poor/very poor self-rated health (p<0.001). In females association was with increasing age (p 0.001), seeing the same physician (p 0.001), usual place of care (p<0.001) and morbidities (p 0.001). Conclusions: differences in appointment use should be considered when planning and organizing access

Objetivo: estimar la prevalencia de consultas médicas, en los tres meses que antecedieron a la entrevista, en adultos de 20 años o más, de una comunidad de renta baja, del Sur de Brasil, en 2009.Método: se realizó un estudio transversal, con análisis ajustado por la Regresión de Poisson.Resultados: la prevalencia de consulta médica en los 3.391 entrevistados fue de 76,2% (Intervalo de Confianza de 95% (IC95%) 74,8; 77,6%) el último año y de 64,8% (IC95% 63,0; 66,7%) los últimos tres meses, mayor entre las mujeres (67,8%) que entre los hombres (60,2%) (p<0,001). En el análisis ajustado, para hombres, el desenlace está asociado más intensamente: al aumento de edad (p=0,001) y a la auto percepción de salud mala/muy mala (p<0,001). Entre las mujeres al aumento de la edad (p=0,001), tener un médico de referencia (p=0,001), local usual de atención (p<0,001) y a morbilidades (p= 0,001). Conclusiones: la diferencia en la utilización de consultas debe ser llevada en cuenta en la planificación y la organización del acceso.

Factores asociados al uso de servicios de atención primaria por adultos mayores de Cartagena, Colombia / Factors associated with senior citizens using primary healthcare services in Cartagena, Colombia

RESUMEN Objetivo Establecer los factores asociados al uso de los servicios de salud por los adultos mayores de Cartagena-Colombia. Métodos Estudio transversal. Con una población de 66 795 adultos mayores, se estimó una muestra de 656. Muestreo estratificado. Se aplicó el cuestionario "uso de los servicios de salud". Se utilizó estadística descriptiva y regresión logística para modelar la probabilidad de ser usuario del servicio. Resultados Participaron del estudio 656 adultos mayores, con un promedio de edad de 67,9 años. Consultaron por enfermedad, en el último mes, 407 participantes (62,0 %) de los cuales 376 (92,4 %) consultó 1 o 2 veces. Residir en estrato socio-económico 4, 5 y 6) (chi² 4,14 p=0,043), tener una enfermedad diagnosticada (chi² 3,82 p=0,051), enfermedad crónica (chi² 7,0 p=0,008) o esperar 30 minutos o menos para ser atendidos (chi² 3,17 p=0,075), son factores asociados al uso de los servicios de atención primaria en salud por parte de los adultos mayores en Cartagena. En el modelo de regresión las variables tener enfermedad diagnosticada (chi²3, 59 p=0,0581) y esperar 30 minutos o menos para ser atendido (chi² 3,02 p=0,0818), fueron variables explicativas del uso de los servicios. Conclusión El uso de los servicios de atención primaria por parte de los adultos mayores en Cartagena está influido por múltiples dimensiones como residir en estrato socio-económico medio, tener enfermedad diagnosticada, padecer enfermedad crónica y esperar 30 minutos o menos para ser atendidos.

Objective Establishing the factors associated with using healthcare services for the aged in Cartagena, Colombia. Methods This was a cross-sectional study. A 656 sample-size was estimated for a population of 66,795 senior citizens; stratified sampling was used. A questionnaire entitled "Using healthcare services" (Uso de los servicios de salud) was used; descriptive statistics and logistical regression were then used for modeling the probability of being a healthcare service user. Results 656 senior citizens participated in the study; average age was 67.9 years old. 407 of the participants had consulted for disease during the last month (62.0 %); 376 of them (92.4 %) had consulted once or twice. Living in socio-economicstrata4, 5 and/or 6 (Chi² 4.14; p=0.043), having a diagnosed disease (Chi² 3.82 p=0,051), suffering from a chronic disease (Chi² 7.0; p=0.008) or waiting for 30 minutes or less to be seen (Chi² 3.17; p=0.075) were factors associated with using primary healthcare services by senior citizens in Cartagena. Having a diagnosed disease (Chi² 3.59; p=0.0581) and waiting for 30 minutes or less to be seen (Chi² 3.02; p=0.0818) were the regression model variables explaining healthcare service use. Conclusion A senior citizen using primary healthcare services in Cartagena was influenced by variables such as residing in mid-level socio-economic strata, having a diagnosed disease, suffering from a chronic disease and waiting for 30 minutes or less to be seen.

Características associadas ao uso de serviços odontológicos públicos pela população adulta brasileira / Characteristics associated with the use of dental services by the adult Brazilian population

O objetivo deste estudo foi investigar os fatores associados ao uso de serviços odontológicos públicos pela população adulta brasileira. Foram utilizados dados coletados junto a 13.356 adultos (35-44 anos), em um inquérito epidemiológico de saúde bucal, de abrangência nacional (Projeto SB-Brasil 2003). A análise dos dados baseou-se na regressão de Poisson, que produziu estimativas de Razões de Prevalências como medida de associação. A análise dos dados mostrou que o uso de serviços odontológicos públicos por adultos esteve associada com: sexo feminino, baixa escolaridade e renda, residência nas regiões Nordeste e Sul e em municípios de menor porte, queixas de dor de dente ou gengival, necessidades de prótese parcial e total, maior quantidade de dentes permanentes demandando tratamento, procura por serviço motivada por algum problema bucal e avaliação do tratamento recebido como regular. Esses resultados mostraram que a população atendida pelo serviço público era menos favorecida socioeconomicamente e apresentava maiores necessidades de tratamento. A grande necessidade acumulada reflete o histórico apartamento desse segmento populacional da atenção à saúde bucal em nosso país e coloca um grande desafio ao SUS, considerando o seu papel na redução das desigualdades e de provimento de acesso universal ao cuidado integral.

The scope of this study was to investigate the factors related to the use of dental services by Brazilian adults. Data were collected from 13,356 adults (35 to 44 years of age), participating in a nationwide epidemiological survey of oral health (SB-BRASIL 2003 Project). Data analysis was based on Poisson regression, which produced estimates of Prevalence Ratios as a measure of association. Data analysis showed that the use of dental services by adults was associated with: female gender, low education and income, living in the Northeastern and Southern regions and in small cities, complaints of toothache or gum pain, need for partial/total prosthesis, a greater amount of permanent teeth requiring treatment, demand for service due to some dental problems and evaluation of dental care received on a regular basis. These results showed that the population attended by the public service was socio-economically less privileged and had greater need for treatment. This situation reflects an historical abandonment of the adult population by the dental healthcare system in Brazil and poses a major challenge to the Unified Health Service, in light of its intended role to reduce inequalities and provide universal access to comprehensive care.