Multimorbidity patterns: obesity as the main modifiable risk factor in adult women in Southern Brazil

Objective

To identify multimorbidity patterns in women in southern Brazil, and its relationship with sociodemographic, lifestyle characteristics, and nutritional status, as well as to explore the main independent risk factor for the identified patterns.

Subjects and methods

This is a cross-sectional, population-based study with 1,128 women (20-69 years), southern Brazil. Chronic conditions were identified using the therapeutic and chemical anatomical classification of continuous use of medications. Multimorbidity was assessed as ≥2 or ≥3 chronic conditions to identify dyads and triads. Poisson regression was used to explore risk factors in the different adjustment models. As independent variables evaluated, in addition to sociodemographic characteristics, lifestyle variables were included: consumption of fruits and vegetables, physical activity, alcohol consumption, smoking and nutritional status.

Results

Eleven dyads (frequencies between 2.0% and 6.4%) and three triads (frequencies between 1.9% and 2.1%) of morbidities were identified in the study. Aging was related to a higher prevalence of all patterns, and obesity was a risk factor for multimorbidity patterns that contained conditions related to the cardiovascular and metabolic system and mental health. After adjustment, obesity increased the probability of "hypertension + common mental disorders (CMD)" (PR 3.63; 95% CI 1.94-6.78) and "dyslipidemia + CMD" (PR 3.69; 95% CI 1.08-12.65) by more than three times.

Conclusion

This study identified common and important diseases in the patterns, associated with a common risk factor, obesity, that must be addressed by public health policies to prevent multimorbidity.

[Low-dose naltrexone (LDN): consumption trend in Brazilian capitals and the Federal District, 2014-2020]

The scope of this paper is an ecological study to determine the consumption of low-dose naltrexone (LDN) in the 26 Brazilian capitals and the Federal District and monitor the trend between the years 2014 to 2020. Data collection on the dispensation of manipulated naltrexone was done through the National Management System of Controlled Products, published in 2020, considering low-dose prescriptions of up to 5 mg. The calculation of the dispensation coefficients used the population estimates of the Brazilian Institute of Geography and Statistics. Descriptive statistical analysis and generalized Prais-Winsten regression analysis were used for the time series analysis. The trends observed were classified as increasing, stable, or decreasing, with a 95% confidence interval and 5% significance level. The results showed higher LDN consumption coefficients in the Mid-West, South and Southeast regions and lower coefficients in the North and Northeast. Increasing dispensation of LDN was observed in 55.6% of the capitals, being stationary in 44.4%, with no decreasing coefficients. Despite the limited evidence regarding LDN pharmacotherapy and its off-label prescription, the data show that prescription, dispensing, and consumption have been on the increase in Brazil, with emphasis on the central-south regions of the country.

Overweight and obesity among Brazilian healthcare university students: prevalence and associated factors

Objective

Obesity is an important factor for cardiovascular and metabolic events. Thus, this study aimed to assess the prevalence of overweight/obesity and the associated factors among healthcare university students.

Materials and methods

A cross-sectional university-based study of 2,245 healthcare university students in the Midwest region of Brazil was conducted in 2018. Overweight and obesity were defined as body mass index (BMI) ≥ 25 kg/m² and BMI ≥ 30 kg/m², respectively. Demographic, socioeconomic, behavioral, family and comorbidities characteristics were investigated. Poisson regression was used for the multivariable analysis. All analysis was stratified by sex.

Results

The mean age of the sample was 22.7 years (standard deviation = 4.1) and 69.5% of the students was female. The prevalence of overweight and obesity were 13.9% (95% confidence interval [CI]: 12.2- 15.6) and 4% (95% CI: 3.0-4.9) for women and 34.5% (95% CI: 30.9-38.1) and 11.3% (95% CI: 8.9-13.6) for men, respectively. After multivariate adjustment, the prevalence of overweight/obesity was at least 70% higher in female students aged 24 years or older (prevalence ratio [PR] = 1.73; 95% CI: 1.24-2.41) and those who smoke (PR = 1.95; 95% CI: 1.66-3.02). Additionally, female students with a family history of obesity (PR = 2.01; 95% CI: 1.46-2.77) or with two or three comorbidities (PR = 2.09; 95% CI: 1.43-3.04) exhibited a significantly higher probability for overweight/obesity. Similar findings were observed in male students, but with smaller effect sizes.

Conclusion

This study revealed a high prevalence of overweight/obesity among healthcare university students, especially in men. It was related to the socio-demographic and family characteristics rather than behavioral factors.

Dietary patterns and prevalence of multimorbidity in women in southern Brazil

OBJECTIVE

This study aimed to investigate the association between dietary patterns and prevalence of multimorbidity in women.

METHODS

This population-based cross-sectional study was conducted in 2015 and included 1,128 women aged 20 to 69 years living in the urban area of São Leopoldo municipality, southern Brazil. Multimorbidity was defined as the presence of two or more chronic conditions, among the 26 identified. Poisson regression with robust variance was used to investigate the association between the three dietary patterns (healthy, risk, and Brazilian), using different models adjusted for sociodemographic, behavioral, and nutritional status variables.

RESULTS

The results showed differences in the prevalence of adherence to different dietary patterns and multimorbidity across age groups, with a prevalence of multimorbidity and a healthy dietary pattern showing a direct linear trend with age, whereas the risk dietary pattern showed an inverse linear trend with age. The prevalence of the Brazilian dietary pattern remained constant despite differences in age. After adjustment, we found that women with greater adherence to the Brazilian dietary pattern showed a 40% reduction in the prevalence of multimorbidity compared with those with less adherence (prevalence ratio, 0.60; 95% confidence interval, 0.40-0.86).

CONCLUSION

The results revealed that the prevalence of multimorbidity was significantly lower in women with greater adherence to the Brazilian dietary pattern and highlight the importance of dietary interventions in early adulthood as a way to prevent multimorbidity in women.

Lifestyle, high Body Mass Index, and markers of socioeconomic conditions associated with multimorbidity in women

OBJECTIVE

This study aimed to identify the prevalence of multimorbidity and its associated factors in women in southern Brazil.

METHODS

We conducted a cross-sectional, population-based study with a sample of 1,128 women (age 20-69 years), living in São Leopoldo, southern Brazil. Multimorbidity was defined as two or more chronic conditions measured using the therapeutic and chemical anatomical classification of continuous use medications prescribed by a physician. Poisson regression model with robust variance was used to assess the association between sociodemographic and lifestyle variables and multimorbidity.

RESULTS

The prevalence of multimorbidity was 21.7% (95%CI 19.3-24.2), and 26 chronic conditions were identified. A direct linear association was observed with age and income and an inverse association with education. Being unemployed was a risk factor for multimorbidity (PR 1.95; 95%CI 1.51-2.52). Alcohol consumption (moderate or excessive) had a protective effect. Overweight and obese women were 53% (PR 1.53; 95%CI 1.09-2.15) and 76% (PR 1.76; 95%CI 1.27-2.45) more likely to have multimorbidity than eutrophic women.

CONCLUSION

Over 20% of the adult women had multimorbidity, and its occurrence was strongly associated with socioeconomic characteristics, such as fewer years of schooling, higher income, and not having an occupation. The results regarding alcohol consumption are still insufficient to propose a public policy for the prevention of multimorbidity. Excess weight was an independent risk factor and should be addressed in public health policies for the prevention and management of multimorbidity.

Prevalence of Premenstrual Syndrome and Associated Factors Among Academics of a University in Midwest Brazil

OBJECTIVE

 To investigate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in university students, the factors associated with PMS, the most prevalent symptoms, and the interference of symptoms in academic, family, social, and work activities.

METHODS

 This cross-sectional study included 1,115 university students aged ≥ 18 years from the University of Rio Verde, Goiás. Premenstrual syndrome and PMDD were identified using the Premenstrual Symptoms Screening Tool. Associations with sociodemographic, behavioral, reproductive, nutritional, and health factors were investigated using the Poisson regression.

RESULTS

 The prevalence of PMS was 46.9% (95% confidence interval [CI] 44.0-49.8), and of PMDD, 11.1% (95% CI 9.3-13.0). The most prevalent symptoms were physical, such as breast tenderness, bloating, e weight gain (73%); followed by psychological ones such as overeating/food cravings, tearful/more sensitive to rejection (> 60%). More than 30% of the patients reported that the symptoms interfered in a moderate-to-severe way in their social and academic activities. After adjusted analysis, PMS was more prevalent in those who were attending the 1^st/2^nd semester of college (prevalence ratio [PR] 1.44; 95% CI 1.14-1.80), those who consumed alcohol in the last 30 days (PR 1.23; 95% CI 1.04-1.47), and those who had depression (PR 1.49; 95% CI 1.30-1.71).

CONCLUSION

 Almost half of the university students had PMS and ∼ 11%, PMDD. Physical symptoms were the most common and interfered in a moderate-to-severe way in various aspects of life. Attending the first semesters, consuming alcohol, and having depression were risk factors for PMS. The identification of risk factors for PMS is essential to prevent symptoms and reduce the impact of the syndrome.

Factors associated with common mental disorders: a study based on clusters of women

OBJECTIVE

to identify factors associated with common mental disorders (CMD) in a sample of adult women in Southern Brazil.

METHODS

This population-based study, composed of 1,128 women, investigated socioeconomic, behavioral and health/disease explanatory demographic variables. Five response groups were explored: one group with common mental disorders - cut-off point 6/7 in the Self-Reporting Questionnaire 20 (SRQ-20) - and four others corresponding to the different clusters found using the latent class clustering technique, also from the SRQ-20. These four clusters (low, medium-depressive, medium-digestive and high) were named (denominated) based on the mean scores in the SRQ-20 in each group and on the response patterns of the variables and factorial characteristics. The "low" cluster comprised women with lower SRQ-20 scores and, therefore less likely to present CMD. The "high" cluster, with high mean values in the SRQ-20, was related to higher psychiatric morbidity. We used the Poisson regression technique to compare the findings of the different groups.

RESULTS

We identified ten variables as factors associated with CMD. Age, education, smoking, physical activity, perception of health and number of medical appointments were the common variables for the cut-off point and cluster-based analyses. Heavy alcohol use was associated only when the sample was evaluated as a cut-off point. Social class, work situation and existence of chronic diseases were associated only when the sample was analyzed by clusters. There was a significant association in the "high" cluster with lower classes (D or E), smoking, physical inactivity, existence of chronic diseases and negative perception of health.

CONCLUSION

We identified different associated factors according to the response groups considered. New approaches allowing identification of subgroups of individuals with specific characteristics and associated factors may contribute for a more accurate understanding of CMD and provide the basis for health interventions.

Serum 25-hydroxyvitamin D concentration among users of a referral outpatient unit for vascular diseases and associated factors

OBJECTIVE

Assess serum 25-hydroxyvitamin D (25OHD) concentration and associated factors among users of a referral outpatient unit for vascular diseases in Southern Brazil.

DESIGN

Cross-sectional study conducted for almost one year, from March 2016 to January 2017. The serum vitamin D level was determined biochemically and classified as: sufficient (>50 nmol/L), insufficient (30-50 nmol/L) and deficient (<30 nmol/L). Associations were tested through multiple linear regression.

SETTING

At a reference outpatient clinic specialized in vascular diseases located in a southern Brazilian medium-sized city (latitude 29°S).

SUBJECTS

Consecutive sample of 133 individuals of both sexes, aged at least 40 years.

RESULTS

The mean serum 25OHD concentration was 54.9 ± 25.9 nmol/L (57.7 ± 27.9 nmol/L for men; 52.2 ± 24.2 nmol/L for women, p = 0.267). A total of 12.8% of the participants had vitamin D deficiency and 32.3% had insufficiency. Regarding the total sample, variables associated to the serum 25OHD concentration were: age (β = -0.55; CI95% -0.95; -0.17), sun exposure (β = 1.22; CI95% 0.32; 2.10) and vitamin D intake (β = 7.29; CI95% 2.10; 12.48). Among men, a significant association was observed for age (β = -0.82; CI95% -1.47; -0.17, p = 0.015) and borderline for sun exposure (β = 1.22; CI95% 0.32; 2.10, p = 0.053). Among women, only vitamin D intake was significantly associated with serum concentration of this vitamin (β = 8.74; CI95% 1.32; 16.17, p = 0.022).

CONCLUSION

Although the mean 25OHD concentration was greater than 50 nmol/L, about 45% of this consecutive sample presented poor vitamin D nutritional status. Unadjusted for seasonality, factors associated with serum 25OHD concentration were age and sun exposure among men and vitamin D intake among women.

Vitamin D serum levels and peripheral arterial disease among southern Brazilian adults

OBJECTIVE

To investigate the association between low serum vitamin D levels and peripheral arterial disease (PAD).

METHODS

A cross-sectional study with a consecutive sample of 133 individuals from Caxias do Sul, Brasil. We considered PAD patients those with an ankle-brachial index (ABI) ≤ 0.90 or with arterial revascularization. Vitamin D serum level was categorized as sufficient (≥30 ng/mL), insufficient (>20 to 29 ng/mL), and deficient (<20 ng/mL). Prevalence ratios (RP) were calculated through Poisson regression.

RESULTS

The prevalence of PAD was 50.7% (95% CI 42-59). After adjustment for potential PAD risk factors, RP were 1.08 (95% CI 0.66-1.76) for insufficient serum level and 1.57 (95% CI 0.96-2.57) for deficient vitamin D serum level; (p for trend = 0.020).

CONCLUSION

Vitamin D serum levels showed an inverse and significant dose-response relationship with PAD.

Prevalence of self-reported diabetes mellitus in women and associated factors: a population-based study in São Leopoldo, Rio Grande do Sul, Brazil, 2015

Objective to analyze the prevalence of Diabetes Mellitus (DM) and associated factors in women aged 20 to 69 years in São Leopoldo, RS, Brazil. Method this was a population-based cross-sectional study, the outcome of which was self-reported medical diagnosis of DM. Poisson regression was used. Results 1,128 women took part, 8.16% (95%CI2.56;13.74) reported DM diagnosis; in the adjusted analysis association was found between the outcome and the 50-59 years age group (PR=15.73 - 95%CI4.84;71.00) and the over 60s (PR=8.95 - 95%CI1.98;40.49), economic classes D/E (PR=2.37 - 95%CI1.17;4.83), obesity (PR=1.41 - 95%CI0.85;2.32), arterial hypertension (PR=2.78 - 95%CI1.73;4.46), common mental disorders (PR=1.47 - 95%CI1.04;2.05), dyslipidemia (PR=2.16 - 95%CI1.45;3.23), regular/poor self-perception of health (PR=2.80 - 95%CI1.20;6.56), and not working (PR=1.98 - 95%CI1.11;3.53). Conclusion DM was associated with situations of economic and social vulnerability, such as poverty and being outside the labor market, as well as with the presence of other diseases.

Pain and Inflammation Management in Older Adults: A Brazilian Consensus of Potentially Inappropriate Medication and Their Alternative Therapies

Purpose: The aim of the present study was to develop and validate a Potentially Inappropriate Medications (PIM) list and alternative therapies for treatment of pain and inflammation in older people adapted to the Brazilian context.

Methods: A preliminary PIM list suitable for the Brazilian market was developed on the basis of three published international PIM lists [Beers 2015, Screening Tool of Older People’s Potentially Inappropriate Prescriptions - 2015, European Union (7) PIM list]. We used the modified Delphi technique (two-round) to validate concerns of use and alternative therapies related to PIM for treatment of pain and inflammation in older adults ≥65 years in Brazil. The panel involved nine Brazilian experts in geriatric pharmacotherapy. All items with mean Likert scale score ≥4.0 (agree) and the lower limit of 95% confidence interval ≥4.0 were considered validated in this study.

Results: At the end of the consensus process, 94 (65.3%) items of 144 were validated. In total, consensus was reached for 33/35 (94.3%) concerns about drugs that should be avoided in older patients regardless of diagnosis, for 22/23 (95.7%) concerns about drugs that should be avoided in older patients with specific conditions or diseases, for 11/23 (47.8%) with special considerations of use, and for 28/63 (44.4%) of therapeutic alternatives.

Conclusion: Although these criteria are not designed to replace clinical judgement, PIM and alternative therapies lists can be useful to inform prescribers, pharmacists, and health care planners and may serve as a starting point for safe and effective use of medications in older people.

Obesidade abdominal e padrões alimentares em mulheres trabalhadoras de turnos

Resumo Objetivou-se identificar os padrões alimentares e a associação destes com a obesidade abdominal em mulheres trabalhadoras de turnos no sul do Brasil. Para isso, realizou-se um estudo de caso-controle não pareado, incluindo um total de 541 mulheres de 18 a 53 anos de idade (215 casos; 326 controles). A presença de obesidade abdominal foi verificada pela aferição da circunferência da cintura ≥ 88 centímetros e os padrões alimentares foram obtidos por meio da análise de componentes principais de 53 itens. Os padrões foram classificados com base nos alimentos de maior carga fatorial e características nutricionais. A associação entre obesidade abdominal e os padrões foi verificada por meio de regressão logística não condicional. Três padrões alimentares foram identificados: “gordura animal/calorias”, “lanches/fast-food” e “frutas/verduras”. Após análise ajustada, os casos apresentaram uma maior chance de adesão ao padrão “frutas/verduras” (OR = 2,26; IC95%:1,30-3,93) e uma menor chance de adesão ao padrão “lanches/fast-food” (OR = 0,60; IC95%:0,36-1,01). Assim, identificou-se três padrões alimentares entre as trabalhadoras de turnos e verificou-se uma melhora na alimentação naquelas com obesidade abdominal, representando uma possível alteração de hábitos alimentares após sua ocorrência.

Pharmacotherapeutic profile of users and expenditure on high-cost drugs in São Leopoldo, Rio Grande do Sul State, Brazil, 2014

OBJECTIVE

to describe the pharmacotherapeutic profile of users of the Specialized Program for Pharmaceutical Assistance, and to measure the expenditure on the most prevalent and the most expensive medications.

METHODS

descriptive study conducted in São Leopoldo-RS, Brazil, with secondary data regarding information about requests accepted in 2014, through administrative proceedings; delivery notes of the State Health Department/RS were used to assess the costs.

RESULTS

1,528 users were included in the study, mostly women (56.7%), and the average age was 52 years (standard deviation=17.9); the most frequent diagnoses were allergic asthma (17.1%), chronic kidney disease (11.5%) and rheumatoid arthritis (8.4%); the most prevalent drug was budesonide+formoterol fumarate (18.3%); among the most prevalent drugs, the highest total monthly expense was with epoetin alfa (BRL37,922.34) and among the most expensive drugs, infliximab (BRL72,503.28).

CONCLUSION

the data show the importance of the Specialized Program for Pharmaceutical Assistance in the high-cost treatment of highly prevalent.

Basal cortisol levels and metabolic syndrome: A systematic review and meta-analysis of observational studies

OBJECTIVE

To perform a qualitative synthesis (systematic review) and quantitative analysis (meta-analysis) to summarize the evidence regarding the relationship between basal cortisol levels and metabolic syndrome (MetS) in adults.

METHODS

A systematic search was performed in the PubMed, Embase, and PsycINFO databases for observational studies on the association between basal cortisol levels and MetS. The quality of individual studies was assessed by the Newcastle-Ottawa score. A random effects model was used to report pooled quantitative results and the I2 statistic was used to assess heterogeneity. Egger's and Begg's tests were used to evaluate publication bias.

RESULTS

Twenty-six studies (19 cross-sectional and seven case-control) met the inclusion criteria for the systematic review. The majority was classified as having a low risk of bias and used established criteria for the diagnosis of MetS. Twenty-one studies provided data on basal cortisol levels as continuous values and were included in the meta-analysis; they comprised 35 analyses and 11,808 subjects. Pooled results showed no significant difference in basal cortisol levels between subjects with and without MetS (standardized mean difference [SMD] = 0.02, 95% confidence interval [CI]=-0.11 to 0.14). There was high heterogeneity between the studies when all comparisons were considered (I2 = 83.1%;p < 0.001). Paradoxically, meta-analysis of studies evaluating saliva samples showed no significantly lower basal cortisol levels among subjects with MetS (SMD=-0.18, 95% CI=-0.37 to 0.01), whereas those studies that evaluated serum samples (SMD = 0.11, 95% CI=-0.02 to 0.24) and urine samples (SMD = 0.73, 95% CI=-0.40 to 1.86) showed no significantly higher basal cortisol levels among subjects with MetS. In the subgroup and meta-regression analyses, a significant difference in basal cortisol levels was observed according to study design, population base, age, gender, cortisol level assessment method, and study quality.

CONCLUSION

This systematic review and meta-analysis does not reveal any association between basal cortisol levels and MetS based on results of observational studies. The results of a random-effect meta-analysis showed no significant difference in basal cortisol levels between subjects with and without MetS. The present findings should be considered in order to help future studies.

Work-related musculoskeletal pain and its association with common mental disorders among employees of a poultry producing company in Southern Brazil

Background

Musculoskeletal pain is one of the most common occupational problems in the industrial society and its prevalence is potentially associated with mental disorders.

Objective

To estimate the prevalence of work-related musculoskeletal pain and its association with occurrence of common mental disorders among employees of a poultry processing company in Southern Brazil.

Methods

Cross-sectional study conducted in 2010 with 1,103 employees aged 18 to 52 years old. Musculoskeletal pain was investigated based on a human figure adapted from the Standardized Nordic Questionnaire. We considered reported work-related pain in any part of the body in the past 12 months. Occurrence of common mental disorders was assessed- by the Self-Reporting Questionnaire (SRQ-20). Crude and adjusted prevalence ratios (PR) and corresponding 95% confidence interval (95%CI) were obtained by Poisson regression with robust variance.

Results

The prevalence of work-related musculoskeletal pain was 40.3% (95%CI 37.4-43.2) for the total sample, 46.8% (95%CI 43.2-50.5) for women and 27.8% (95%CI 23.2-32.3) for men. The prevalence of musculoskeletal pain was twice higher for the participants with common mental disorders compared to those without this condition (PR=2.27; 95%CI 1.99-2.58). This effect remained significant after adjustment for sociodemographic, behavioral, health-related and occupational variables.

Conclusion

The results of the present study point to the relevance of preventive measures to promote the mental and physical health of workers in order to reduce or minimize the occurrence of pain.

Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria

PURPOSE

Potentially inappropriate medication (PIM) use causes preventable adverse drug reactions in older patients. Several assessment tools have been published to identify and avoid PIM use. In this systematic literature review, we aim to provide summaries and comparisons of validated PIMs lists published between 1991 and 2017 internationally.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA), we performed a systematic review of articles describing the development and validation of criteria for identification of PIMs among older people published between January 1991 and April 2017. The searches were conducted on PUBMED, AgeLine, Academic Search, Academic Search Premier, and CINAHL. We identified the most common medications/classes described as PIM. We also identified the drug-disease interactions and drug-drug interactions reported among criteria.

RESULTS

From 2933 articles screened, 36 met our inclusion criteria. The majority used the Delphi method to validate their criteria. We identified 907 different medications/classes, 536 different drug disease interactions involving 84 diseases/conditions, and 159 drug-drug interactions. Benzodiazepines and nonsteroidal anti-inflammatory drugs were the medications most commonly reported as potentially inappropriate for older people.

CONCLUSION

Although approaches aimed at detecting inappropriate prescribing have intensified in recent years, we observed limited overlap between different PIM lists. Additionally, some PIM lists did not provide special considerations of use and alternative therapies to avoid PIMs. These facts may compromise the use of PIM lists in clinical practice. Future PIM lists should integrate information about alternative therapies and special considerations of use in order to help clinicians in the drug prescription.

Effect of characteristics of pharmacotherapy on non-adherence in chronic cardiovascular disease: A systematic review and meta-analysis of observational studies

INTRODUCTION

Cardiovascular medications are effective in prevention of cardiovascular diseases (CVD); however, medication non-adherence contributes to morbidity and mortality.

OBJECTIVE

This systematic review and meta-analysis aims to summarise the evidence regarding the relationship between characteristics of drug therapy (pharmacotherapy) and medication non-adherence in the CVD population.

METHODS

Systematic searches in PubMed, LILACS, Academic Search and CINAHL databases for observational studies that enrolled adults with CVD were performed, from January 1960 to December 2015. The meta-analysis tested the association between characteristics of pharmacotherapy and self-reported medication non-adherence outcome, using a random effects model. To investigate heterogeneity, we performed subgroup analysis and sensitivity analysis.

RESULTS

Twenty-four cross-sectional studies and 7 cohort studies were included in this review. Based on 31 studies including 27 441 participants, we performed meta-analyses for all the characteristics of drug therapy that at least 2 studies evaluated, with a total of fourteen meta-analyses. The pooled results showed that studies which evaluate whether participants have insurance or another program that assists with medication costs, but not full coverage (OR = 0.63; 95% CI: 0.53-0.74; P < .001; I²  = 0%, P = .938), and a dosing frequency of twice or more daily (OR = 1.38; 95% CI: 1.13-1.69; P < .001) were associated with non-adherence.

CONCLUSIONS AND RELEVANCE

The results of this review suggest that access to insurance or another program that assists with medication costs was a protection factor for non-adherence. On the other hand, a high frequency of dosing was a risk factor for non-adherence. Therefore, these characteristics of pharmacotherapy must be considered to improve medication adherence among CVD patients.

Regular access and adherence to medications of the specialized component of pharmaceutical services

OBJECTIVE

To investigate the prevalence of the adherence to the medications of the Specialized Component of Pharmaceutical Services and its association with regular access in users of these medications in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil.

METHODS

This is a cross-sectional study with adults aged 20 years and over, who are users of medications of the Specialized Component of Pharmaceutical Services. Sampling was carried out consecutively for users who accessed the service of the Specialized Component of Pharmaceutical Services during the period from December 2014 to March 2015. Adherence was measured by the Brief Medication Questionnaire, and adherents were defined as those who did not present barriers to adherence in the three domains. Regular access was defined as getting all medications in the last three months, regardless of how it was obtained (paying or for free). Data analysis was performed using Poisson regression with robust variance.

RESULTS

We interviewed 414 subjects, being them mostly women (60.9%), with mean age of 55 years (SD = 13), and using a single medication of the Specialized Component of Pharmaceutical Services (68.1%). The prevalence of adherence to the medications used in the last seven days was 28.3% and the prevalence of free regular access was 46.1%, and 25.7% did not have access to all treatment. After adjusting for the number of medications in the Specialized Component of Pharmaceutical Services and the number of medications of continuous use, users who had free regular access in the last three months were 60% more likely to show adherence. For individuals with paid regular access, no association was found between access and adherence.

CONCLUSIONS

The regularity in the free access to the medications of the Specialized Component of Pharmaceutical Services has an impact on the behavior of users, contributing to their commitment to treatment and self-care. The Specialized Component of Pharmaceutical Services needs programming in order to avoid irregular access, which suggests a significant limitation of the drug policies in Brazil.

Sleep-related problems and minor psychiatric disorders among Brazilian shift workers

The aim of this study was to explore the association between sleep-related problems with the occurrence of minor psychiatric disorders in shift workers of southern Brazil. A cross-sectional study with 1202 workers (785 females) aged 18-50 years was carried out. Minor psychiatric disorders were assessed using the Self-Reporting Questionnaire (SRQ-20), and four sleep problems were collected and analyzed: sleep deprivation (≤ 5h), difficulty falling asleep, waking up during sleep, and sleep medication use. Results show that the overall prevalence of minor psychiatric disorders was 26.8%, but it was more prevalent among females than males (30.2% vs. 20.4%). Nightshift work was significantly associated with the occurrence of sleep-related problems. After adjusting for confounding factors, the number of sleep-related problems showed a positive linear trend with psychiatric disorders in both sexes. Having two or more sleep-related problems was associated with increased probability of psychiatric disorders approximately three-fold among males and two-fold among females, when compared with those without sleep problems. In conclusion, this study demonstrated that sleep-related problems have a strong and independent association with psychiatric disorders among shift workers. Furthermore, the prevalence of both conditions was higher among females than males; however, the strength of these associations was higher in males.

Workplace social capital, mental health and health behaviors among Brazilian female workers

OBJECTIVE

Previous studies have investigated the relationship between workplace social capital and mental health, yet few have sought to examine the mediating mechanisms. We sought to explore the role of workplace social capital on health related behaviors and on mental health among female employees in Brazil.

METHODS

A cross-sectional study was undertaken with 553 women aged 28-50 years working in the production line of a poultry processing plant. We assessed workplace social capital, common mental disorders, stress (Perceived Stress Scale) and health related behaviors (physical activity, healthy eating habits and co-occurrence of risk behaviors). We used structural equation modeling to clarify relationships between exposures, outcomes, and mediating variables.

RESULTS

Our model demonstrated a direct effect of social capital on the outcomes studied. Higher workplace social capital was associated with lower stress and common mental disorders as well as more favorable health-related behaviors. Our model also showed an indirect effect of social capital on mental health and on behaviors that was mediated by lower levels of perceived stress.

CONCLUSION

Workplace social cohesion may play an important role in the promotion of mental health and healthy behaviors among women employees.

[Access to medicines prescribed for acute health conditions in adults in South and Northeast Brazil]

This was a cross-sectional study within Brazil's Project for the Expansion and Consolidation of Family Health, 2005, with the objective of universal and free access to the medication prescribed in the last medical appointment for acute health problems and to estimate the degree to which access may have improved with inclusion of the medicines in prevailing policies and programs. The sample included 4,060 adults living in the area of primary health care units in 41 municipalities in South and Northeast Brazil. Access was greater in the South (83.2%) than in the Northeast (71%), and free access was similar (37%), with a greater share by the Family Health Program (FHP) when compared to the traditional model, especially in the Northeast. Some 60% of prescribed medicines and 50% of those on the National List of Essential Medicines (RENAME) were paid for. No variation was observed in the proportion of medicines present on the prevailing RENAME list and access. However, 40% of the medicines that were paid for can currently be obtained through the Popular Pharmacy Program. The latter program appears to emerge as a new way to guarantee access to medicines prescribed in the health system.

Use of medicines recommended for secondary prevention of acute coronary syndrome

OBJECTIVE

: To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome.

METHODS

: In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression.

RESULTS

: More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods.

CONCLUSIONS

: The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

The Impact of Diabetes on Mortality Among Elderly Patients Admitted for Treatment at a Hospital for Cardiovascular Disease in Southern Brazil

BACKGROUND

Diabetes has been shown to be associated with increased mortality and morbidity worldwide. This study explored whether diabetes significantly impacts on outcomes among elderly adults with cardiovascular disease (CVD) admitted to a specialist hospital in Southern Brazil.

DESIGN

A prospective cohort study of 411 patients admitted to hospital after a cardiac event between 2008 and 2010.

METHODS

The primary end point was death by all causes during the follow up period of 6 months from admission. All hospital death reports matched those reported by the Brazilian Public Health Death Records. Cumulative probability of survival by Kaplan-Meier plot and log rank tests compared hospital admissions with or without diabetes. Adjusted and unadjusted hazard ratios (HR) for overall mortality were calculated.

RESULTS AND CONCLUSIONS

The mean ± SD age of the subjects was 69.8 years ± 14 and 50% were men. Overall study mortality was 8.7%. Half of the deaths occurred in patients &amp;#8805;80 years (p=0.001). Diabetes was associated with 53% of the overall mortality (p&lt;0.01) and 79% of the CVD-related deaths (p&lt;0.03). The adjusted HR was 2.88 (95% CI 1.42-5.84) for diabetic patients aged &amp;#8805;80 years. In conclusion, the results suggest that elderly patients of European origin with diabetes residing in Southern Brazil admitted to hospital for specialist CVD treatment have poorer survival and higher risk of further CVD events 6 months after hospital discharge compared with those without. We recommend that better strategies for managing CVD risk factors among elderly diabetic patients from similar patient cohorts in Brazil are necessary.

Job characteristics and musculoskeletal pain among shift workers of a poultry processing plant in Southern Brazil

OBJECTIVES

The purpose of this study was to evaluate the association between job characteristics and musculoskeletal pain among shift workers employed at a 24-hour poultry processing plant in Southern Brazil.

METHODS

This was a cross-sectional study of 1,103 production line workers aged 18-52 years. The job characteristics of interest were shift (day/night), shift duration, and plant sector ambient temperature. Musculoskeletal pain was defined as self-reported occupational-related pain in the upper or lower extremities and trunk, occurring often or always, during the last 12 months.

RESULTS

The mean (SD) participant age was 30.8 (8.5) years, and 65.7% of participants were women. The prevalence of musculoskeletal pain was greater among female participants than male participants. After adjustment for job characteristics and potential confounders, the prevalence ratios (PR) of lower extremity musculoskeletal pain among female workers employed in extreme-temperature conditions those working the night shift, and those who had been working longer on the same shift were 1.75 (95% CI 1.12, 2.71), 1.69 (95% CI 1.05, 2.70), and 1.64 (95% CI 1.03, 2.62), respectively. In male workers, only extreme-temperature conditions showed a significant association with lower extremity musculoskeletal pain (PR=2.17; 95% CI 1.12, 4.22) after adjustment analysis.

CONCLUSIONS

These findings suggest a need for implementation of measures to mitigate the damage caused by nighttime work and by working under extreme temperature conditions, especially among female shift workers, such as changing positions frequently during work and implementation of rest breaks and a workplace exercise program, so as to improve worker quality of life.

[Evaluation of knowledge on blood pressure levels and chronicity of hypertension among users of a public pharmacy in Southern Brazil]

The aim of this study was to evaluate patients' knowledge on hypertension and associated factors through a cross-sectional study of adults using antihypertensive medication dispensed by the São Francisco de Paula Public Pharmacy in Rio Grande do Sul State, Brazil. The study evaluated knowledge on the normal limits for systolic and diastolic blood pressure and chronicity of hypertension. Multinomial regression was used to measure knowledge (satisfactory/moderate/unsatisfactory); satisfactory was defined as correct knowledge on two or more items. Of the 635 users with hypertension, 27.7% showed satisfactory knowledge, while 47.2% were only aware of the chronic nature of hypertension. After adjustment, female gender, more education, not living alone, healthy lifestyle, and greater time since diagnosis were associated with satisfactory knowledge on hypertension. Considering the importance of patient autonomy in monitoring blood pressure and continuous treatment to control hypertension, the study showed a low prevalence of satisfactory knowledge.

[Food insecurity and overweight in first grade students in the municipal school system in São Leopoldo, Rio Grande do Sul State, Brazil]

This cross-sectional school-based study in São Leopoldo, Rio Grande do Sul State, Brazil, evaluated the association between food insecurity and overweight in first grade students in the municipal elementary school system. A total of 2,369 students were invited to participate, of whom 847 were examined, and of these, 782 had data available on weight and height. Dietary data were obtained from a parent or guardian. Food insecurity was measured by the Brazilian Food Insecurity Scale (EBIA). Data on weight and height were provided by the Nutrition Service of the Municipal Department of Education. Prevalence rates for overweight and food insecurity were 38.1% and 45.1%, respectively. After controlling for potential confounders, children with food insecurity had 22% lower odds of overweight. Notwithstanding the inverse association between the exposure and outcome, this sample showed high rates of food insecurity and overweight, revealing a complex relationship and indicating that further research is needed to understand it. Robust public policies are critical for addressing these conditions.

Adesão aos "10 passos da alimentação saudável para crianças" e fatores associados em escolares

OBJETIVO: Avaliar a frequência de adesão aos "10 Passos da Alimentação Saudável para Crianças" e fatores associados em escolares. MÉTODOS: Estudo transversal com 813 escolares do 1º ano das Escolas Municipais de Ensino Fundamental de São Leopoldo (RS). Os dados foram obtidos das mães/responsáveis por meio de um questionário com questões sobre alimen-tação, atividade física, tempo de tela e características sociodemográficas. O critério de adesão a cada passo foi definido pelos pesquisadores. As associações foram analisadas por meio do teste Qui-quadrado de Pearson e de tendência linear. RESULTADOS: O número médio de passos atingido foi 3,9, e nenhum escolar aderiu a todos os passos. O Passo 4 (consumir feijão com arroz no mínimo cinco vezes/semana) apresentou maior frequência de adesão (99,8%), e aqueles que envolvem medidas restritivas, como evitar alimentos gordurosos/frituras (Passo 6) e guloseimas (Passo 7), foram os menos frequentemente atingidos, respectivamente, 2,1 e 0,0%. O Passo 10 (ser ativo e ter tempo de tela <2 horas/dia) também apresentou baixa adesão (14,5%). Maior escolaridade materna e melhor nível econômico associou-se positivamente com o Passo 5 (consumo diário de grupo do leite e das carnes), o contrário sendo observado para o Passo 2 (incluir diariamente cereais, tubérculos e raízes nas refeições) e para o Passo 10. CONCLUSÃO: O estudo revelou um cenário desfavorável, que indica a necessidade de ações de diferentes atores (governo, produtores, escola e família) para aumentar a frequência de adesão aos 10 Passos pelos escolares.

Association between work shift and the practice of physical activity among workers of a poultry processing plant in Southern Brazil

INTRODUCTION

The regular practice of physical activity (PA) has been associated with better health. In addition, job characteristics may determine the PA behaviours of employees, including the work shift. However, relatively few studies have examined the PA behaviour among shift workers.

OBJECTIVE

This study aimed to investigate the association between work shift and the practice of PA among workers of a poultry processing plant in Southern Brazil.

METHODS

A cross-sectional study was conducted with 1206 workers (786 females), ages 18 to 50, working in shifts on a production line that operates 24 hours/day. Workers who engaged in more than 150 minutes/week of PA were considered active. Multivariate analyses were conducted using Poisson regression and all analyses were stratified by gender.

RESULTS

Of the total participants studied, 36% (95%CI: 33-39) were considered active and the sociodemographic characteristics associated with PA differed among males and females. Regarding work shift, night shift workers had higher prevalence of PA. However, increased PA was significantly associated with work shift particularly among females. After controlling for potential confounders, women who worked during the night shift were approximately 30% more active than those who worked during the day (PR[prevalence ratio]= 1.32;95%CI: 1.07-1.62;p=0.010).

CONCLUSIONS

This study found a low prevalence of PA among the workers and indicated a significantly association between work shift and PA. Working at night was positively associated with regular PA, particularly among females. These results contribute for initiatives that aim to increase PA among the workers, take into account the job characteristics and gender differences.

[Knowledge about pharmacotherapy among hypertensive patients]

The scope of this study was to evaluate the knowledge of pharmacotherapy among users of arterial hypertension medication. A quantitative cross-sectional study was conducted with adults aged 20 years or older, who were users of antihypertensive drugs dispensed by the Public Pharmacy of São Francisco de Paula in the State of Rio Grande do Sul. The study evaluated the knowledge of patients about the drug name, therapeutic indication, dose, administration routine, and duration of treatment, attributing a score (0-5). Multiple linear regression was used to investigate the relationship between the patients' knowledge and characteristics and 678 medication users were interviewed. The mean knowledge score was 3.27 (SD = 1.16). Lower age, higher schooling, Caucasian, better self-reported health and lower number of prescribed drugs were associated with higher knowledge scores. It was observed that the patients' knowledge of all the aspects evaluated is limited, a result that could compromise the correct and safe use of the drugs, and suggesting the need for better counseling and follow-up of users, to control this morbidity.

[The prevalence of morbidity and symptoms among the elderly: a comparative study between rural and urban areas]

A cross-sectional study was conducted with the elderly population in rural and urban areas characterized by the prevalence of morbidity and symptoms, and 229 elderly people were interviewed. The average age was 72.3, of which 57.2% lived in the rural zone and 56.3% were female. The morbidities most reported were insomnia (37.7%), anxiety (32.1%), depression (26.7%), and in the rural zone it was diabetes (13.3%). In this zone, Alzheimer's disease was more prevalent among the elderly who handled pesticides (21.7%). The most prevalent symptoms among urban zone residents were: cough/runny nose and sight alterations (41.2%), allergy/itching (11.4%). In the rural zone, dry mouth (25.4%), sight alterations (35.6%) and leg pain (66.1%) were also more prevalent among those who used pesticides. The inadequate use of Individual Protection Equipment was 85.4%, and 45.1% also disposed of pesticide packaging inappropriately. The setting up of public health programs is necessary to promote health among the elderly and the potential exposure to pesticides for this population should be seen as a health risk determinant.

[Characteristics of the emergency health service demand in Southern Brazil]

This study evaluated the demand of emergency health service. It was performed a descriptive analyses of 1647 adults that consulted at emergency public service of Pelotas, Brazil. Older subjects, non white skin color, lower schooling, without partner, and smokers presented higher prevalence of consultations at this service when compared with the general population. Individuals waited, on average, 15 minutes to have their consultations, exams were requested in more than 40% of the visits, and intravenous medication were administered in one third of the visits. Elderly waited longer before searching the service, but they had lowest awaiting time after arriving at emergency service and had higher percentage of regular doctor and social support. Elderly had more diagnosis related to circulatory system, while among the youngest, external causes were the most frequent. The low waiting average for consultation suggest this service provide an immediate care while the great number of ill-defined signs or symptoms indicate that the provided care is provisional. It is necessary to train emergency professionals to reduce the number of tests requested and to assure that either professional as the population is conscious about the importance of a continuity of care.

Free access to hypertension and diabetes medicines among the elderly: a reality yet to be constructed

The study evaluated free access to hypertension and diabetes medicines and the reasons reported for lack of access. The sample included 4,003 elderly people living in Primary Care Unit coverage areas from 41 Southern and Northeastern Brazilian cities. Free access was higher in the Northeast (62.4%). The strategy of the Family Health Program (Programa Saúde da Família - PSF) was more effective in providing access than the traditional model, with higher results in the Northeast (61.2%) than in the South (39.6%). Around 20% of medicines included in the Hypertension and Diabetes Program and 26% of those included in the National Essential Medicines List (RENAME) were paid out of pocket. In the Northeast, 25% of insulin and 32% of oral antidiabetics were paid out of pocket. Unavailability in the public sector and a lack of money determined the lack of access. Although the PSF, Hypertension and Diabetes Program and RENAME expanded free access, supplies were insufficient. A greater connection between programs and a clear definition of responsibilities can improve medicine acquisition process, increasing the effectiveness of pharmaceutical assistance.

[Use of outpatient services by the elderly in the South and Northeast of Brazil]

This study evaluated the use of outpatient services by senior citizens (N = 4,003) drawing on data from the baseline study that evaluated the Project for Expansion and Consolidation of the Family Health Strategy (PROESF) in 41 cities in South and Northeast Brazil. Use of outpatient services was greater and more appropriate to the needs of the elderly in the South than in the Northeast. Primary care facilities in both regions met the demand by lower-income elderly, but those requiring more care were treated at other levels. The results highlight the need to increase the supply of outpatient services and ensure access by the elderly, particularly for individuals with functional impairments in the Northeast. In addition to promoting equity, primary care in both regions should adopt targeted approaches for the health needs of senior citizens.

Use of primary care services by elderly people with chronic conditions, Brazil

OBJECTIVE

To assess the use of healthcare services by elderly individuals suffering from chronic diseases.

METHODS

Cross-sectional study carried out with 2,889 individuals aged 65 years or more with chronic conditions - arterial hypertension, diabetes mellitus and mental illness -, living in catchment areas of primary care units in 41 cities of the South and Northeast regions of Brazil in 2005. The analyzed data were obtained in the baseline study of Programa de Expansão e Consolidação da Saúde da Família (Program for the Expansion and Consolidation of Family Health). The studied variables were sex, age, skin color, marital status, level of schooling, family income, smoking, functional disability, and care model of the primary care unit. The adjusted analysis of outcomes was performed by means of Poisson regression.

RESULTS

The prevalence of medical visit in the last six months was 45% in the South region and 46% in the Northeast region. The prevalence of participation in groups of educational activities in the last year was 16% in the South and 22% in the Northeast. In both regions, use of services was higher for elderly people under the age of 80 years, with low level of schooling and living in catchment areas of primary care units with Programa Saúde da Família (Family Health Program). Only in the South region did the elderly with functional disability have higher prevalence of medical visits.

CONCLUSIONS

The prevalence of medical visit and participation in groups of educational activities was low when compared to previous studies conducted with elderly individuals in Brazil. The results indicate that, although the Family Health Program promotes greater use of services at primary care units by elderly people with chronic conditions, it is necessary to expand the access of those aged over 80 and of individuals with functional disability.

Fatores associados à continuidade interpessoal na atenção à saúde: estudo de base populacional

Estudar a prevalência de continuidade interpessoal na atenção à saúde e seus determinantes. Foi realizado um estudo transversal de base populacional com 3.133 indivíduos com 20 anos ou mais da zona urbana de Pelotas, Rio Grande do Sul, Brasil. A análise multivariável foi realizada através de regressão de Poisson, tendo no primeiro nível variáveis sócio-econômicas e demográficas e no nível proximal, variáveis assistenciais e de necessidades em saúde. A prevalência de continuidade interpessoal na atenção à saúde foi de 43,7% (IC95%: 42,0-45,5). Sexo feminino, idades avançadas, maior renda, consulta no último ano, relato de doença crônica e não consultarem no sistema público de saúde apresentaram maior continuidade interpessoal na atenção à saúde. Entre os que consultam em unidades básicas de saúde, sexo feminino, aumento da idade e o Programa Saúde da Família estiveram associadas com continuidade interpessoal na atenção à saúde. Alguns grupos vulneráveis, como aqueles de baixa renda e usuários do sistema público de saúde, apresentaram menores prevalências do desfecho.

Acesso a medicamentos de uso contínuo em adultos e idosos nas regiões Sul e Nordeste do Brasil

O objetivo deste estudo foi avaliar a prevalência de acesso a medicamentos de uso contínuo para tratar hipertensão arterial sistêmica, diabetes mellitus e/ou problemas de saúde mental e fatores associados. Foi desenvolvido estudo transversal no âmbito do Projeto de Expansão e Consolidação Saúde da Família (PROESF) em 41 municípios do Sul e Nordeste do Brasil. A amostra incluiu 4.060 adultos e 4.003 idosos residentes na área das unidades básicas de saúde (UBS). A prevalência de acesso a medicamentos de uso contínuo em adultos foi de 81% e em idosos, 87%. O maior acesso entre os adultos da Região Sul esteve associado com maior idade, melhor nível econômico, tipo de morbidade crônica e participação em grupos na UBS; entre os adultos do Nordeste, com hipertensão arterial sistêmica exclusiva ou combinada com diabetes mellitus; entre os idosos do Sul, com maior escolaridade; entre os idosos do Nordeste, com maior idade, maior escolaridade, não fumantes, vínculo com a UBS e modelo de atenção Programa Saúde da Família (PSF). Os resultados revelam importante iniqüidade em saúde, reforçando a necessidade de políticas para ampliar o acesso principalmente para populações de menor poder aquisitivo.

Conhecimento sobre anticoncepcionais em uma população de 15 anos ou mais de uma cidade do Sul do Brasil

A prevalência de uso de anticoncepcional no Brasil é alta; porém, é freqüente seu uso incorreto e inadequado, sugerindo escasso conhecimento sobre os métodos. Assim, avaliou-se o conhecimento sobre métodos anticoncepcionais mais utilizados por meio de um escore (0-10) e fatores associados a este conhecimento. Foi realizado um estudo transversal de base populacional, com 3.542 indivíduos de 15 anos ou mais, residentes na zona urbana de Pelotas, Rio Grande do Sul. A média de escore de conhecimento foi de 4,65 (dp = 2,07), sendo 5,02 (dp = 2,10) para as mulheres e 4,18 (dp = 1,92) para os homens. Menor idade, maior escolaridade, relato de gravidez indesejada e uso de método anticoncepcional exclusivo ou combinado ao longo da vida mostraram-se associados a um maior escore de conhecimento entre os homens, enquanto, para as mulheres, os determinantes de maior conhecimento foram maior idade, viver com companheiro, maior escolaridade, melhor nível econômico, não ter religião e uso de método anticoncepcional exclusivo ou combinado ao longo da vida. Apesar da alta prevalência de uso de anticoncepcional (75,3%), é limitado o conhecimento sobre os métodos mais utilizados, ciclo menstrual e período fértil.