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Purpose To evaluate time trends in physical activity among adolescents aged 10 to 19 years living in southern Brazil over a 7-year period. Methods Two population-based cross-sectional surveys with similar methodologies were carried out in the city of Pelotas, Brazil, in 2005 and 2012. Leisure-time and transport-related physical activity were measured using a validated questionnaire. A cut-off point of 300 minutes per week was used to classify adolescents as active or not. We also analyzed the two domains of physical activity (leisure time and transportation) separately. Results The prevalence of physical inactivity was 69.6% (95% CI 66.5–73.2) in 2005 and 69.9% (95% CI 66.5–72.7) in 2012. The percentage of active adolescents in leisure time also remained stable in the period (26.3% in 2005 [95% CI 23.3–29.2] vs. 28.1% in 2012 [95% CI 24.9–31.4]). Among boys, we observed an increase in the practice of some leisure-time activities—weight lifting (87%) and running (78%)—and a decline in others—volleyball (61%) and basketball (56%). Among girls, the only significant difference was an increase in the practice of weight lifting (271%). The prevalence of active commuting to and from school declined from 69% (95% CI 65.6–72.4) in 2005 to 56.5% (95% CI 52.5–60.2) in 2012. Conclusions There was a significant decline in active commuting to school among adolescents. Interventions promoting active commuting modes to school are urgently needed in Brazil.

OBJECTIVE To assess factors associated with low adherence to pharmacotherapy in older adults. METHODS Cross-sectional population-based study, with a representative sample of 1,593 individuals aged 60 or older, living in the urban area of Bagé, RS, Southern Brazil, in 2008. A multiple stage sampling model was used. The data were collected through individual household interviews. The analyses of the association between low adherence regarding pharmacotherapy, measured using the Brief Medication Questionnaire (BMQ), and demographic, socioeconomic, behavioral, health, assistance and prescription factors were carried out applying Poisson regression model to assess crude and adjusted prevalence ratios, their respective 95% confidence intervals and p-value (Wald test). RESULTS Around 78.0% of individuals reported have taken at least one medication in the seven days prior to the interview. Of these, approximately one third (28.7%) were considered to have low adherence to the treatment. The factors significantly associated to low adherence to treatment were: age (65 to 74 years old), not having health insurance, having to purchase (totally or partially) their own medicines, having three or more morbidities, having functional disabilities and using three or more medicines. CONCLUSIONS The increased use of medicines by older adults, because of the high prevalence of non-communicable diseases in this group, and the access to the treatment need to be considered by health care professionals regarding fostering adherence to treatment, which increases therapeutic solutions and quality of life among older people.

This retrospective study aimed to analyse demographic data and the severity of traumatic dental injuries (TDIs) to the primary dentition based on children’s dental records at a university clinic. A cross-sectional retrospective study. The records of all patients were analysed according to gender, age, aetiology, teeth involved, number of affected teeth, place of occurrence, witness to the trauma, time elapsed between trauma occurrence and care-seeking, type of trauma and severity of injury. A total of 576 children aged 8–89 months suffered injuries to 1,043 teeth. Severe injuries were the most prevalent (45.5 %). These occurred at all ages, but their frequency was higher in children aged between 13 and 24 months. The prevalence of mild injury was higher when the cause was a fall from one’s own height. No differences were detected in severity according to the place of occurrence and witnesses of the accident. The prevalence of severe injury was higher in cases where three or more teeth were involved. In this specialist treatment centre, severe injuries were the most common TDIs, which occurred in children aged 13–24 months, mainly due to falls and most occurred at home. Professionals must be prepared to deliver the best and most efficient care to this population.

This study aimed to describe the prevalence of access to medicines in the Brazilian Unified National Health System and associated factors among patients that received prescriptions in the public system. The study analyzed data from the National Household Sample Survey (2008). The sample consisted of individuals with prescriptions written in the National Health System in the two weeks prior to the interview (n = 19,427). The dependent variable was access to all the prescribed medicines inside the system itself. Slightly fewer than half of the sample with prescriptions received the medicines in the public health system; the proportions were higher in the South of Brazil, among black patients, those with less schooling and lower income, and those registered in the Family Health Strategy. When analyzing prescriptions written by the private sector, access to all the prescribed drugs was associated with higher income, higher education, and white skin color. The results emphasize the need for policies to decrease inequalities in access to medicines in Brazil.

OBJECTIVE: To identify factors associated to medicine use among children from the 2004 Pelotas Birth Cohort, Brazil. METHODS: Prospective study to evaluate medicine use in children aged 3, 12 and 24 months regardless of the reasons, therapeutic indication or class. The study included 3,985 children followed up at three months of age, 3,907 at 12 months, and 3,868 at the last follow-up time of 24 months. Mothers were interviewed to collect information on medicine use during the recall period of 15 days prior to the interview. The outcome was studied according to sociodemographic and perinatal variables, mother's perception of child's health and breastfeeding status. Crude and adjusted analyses were performed by Poisson regression following a hierarchical model. RESULTS: The prevalence of medicine use ranged from 55% to 65% in the three follow-ups. After controlling for confounders, some variables remained associated to medicine use only at the three-month follow-up with greatest use among children of younger mothers, those children who had intrapartum complications, low birthweight, were never breastfed and were admitted to a hospital. Greatest medicine use was also associated with being a firstborn child at 3 and 12 months; mother's perception of their child health as fair or poor and children whose mothers have private health insurance at 12 and 24 months; highest maternal education level at all follow-up times. CONCLUSIONS: Different variables influence medicine use among children during the first two years of life and they change as the child ages especially maternal factors and those associated to the child's health problems.

To assess the affordability by workers of drugs used for treatment of chronic diseases, as well as the availability of the reference, similar, or generic forms of these drugs in the public health care system.We employed the methodology recommended by the World Health Organization (WHO) and Health Action International (HAI) for the standardized collection of information on selling prices in the private sector and availability in the public health care system of drugs in six cities in the state of Rio Grande do Sul, Brazil. Data were collected from November 2008 to January 2009. Affordability was estimated as the number of salary days required for a worker receiving the national minimum wage to buy, in a private pharmacy, the amount of medication required for one month of treatment. Availability was assessed by the presence of these drugs in public health care system facilities.Twenty-two public facilities and 30 private pharmacies were studied. Of 21 drugs used for the treatment of seven chronic disorders, only nine were available free of charge in the six cities. Mean availability ranged from 83.3% (São Leopoldo) to 97.6% (Caxias do Sul). Affordability ranged from 0.4 to 10.5 salary days for reference drugs, 0.2 to 8.4 salary days for similar drugs, and 0.3 to 3.8 salary days for generic drugs.The overall availability of the drugs surveyed was higher than the 80% recommended by WHO. However, some treatments were not available, or had limited availability in the public system. Concerning affordability, the number of salary days required to buy these drugs may affect the continuation of drug treatments for chronic diseases.

To analyze access to and utilization of dental care services in Brazil.We used data from the 2003 and 2008 Brazilian National Household Surveys, which we compared to data from the 1998 survey. We investigated access and utilization variables at ages three, six, nine, 12, 15, and 19 years in the first (Q1) and fifth (Q5) quintiles of per capita family income. All analyses took into account the complex sampling strategy.The proportion of subjects that had never seen a dentist decreased during the period (18.7% in 1998, 15.9% in 2003 and 11.7% in 2008). There was an important reduction in the absolute difference in failure to use dental care services after age nine years between Q1 and Q5 from 1998 to 2008, which decreased to about half its value at 15 (30.3 percentage points - pp to 16.1 pp) and 19 years (20.4 pp to 9.9 pp). Q5/Q1 ratios for recent dental appointments fell across all age groups, especially between zero and six years (Q5/Q1 from 3.2 to 2.6); utilization of the National Health Care System for dental care increased in Q1 and Q5, with a reduction in the Q1/Q5 ratio of approximately 20%. Use of the National Health Care System for dental care increased by approximately 8% in Q1 and 35% in Q5 between 2003 and 2008.There have been considerable advances in terms of reducing inequalities in access to, and increasing the utilization of, dental care services in Brazil between 1998 and 2008. However, inequality between social groups remains substantial.

To review the scientific literature on the tracking of dietary patterns from childhood to adolescence.A search of the MEDLINE/PubMed, Lilacs and SciELO databases was performed, using the following key words: "tracking", "dietary patterns" and "childhood/adolescence" and their respective synonyms. A total of 45 abstracts were found and, after the inclusion criteria were applied, 13 articles were included. The tracking of dietary patterns was assessed by three main statistical analyses: (Pearson or Spearman) correlation coefficients, kappa coefficient and probability analysis.The tracking of dietary patterns ranged from weak to moderate between the childhood-childhood and childhood-adolescence periods. During adolescence, there appears to be no tracking.Dietary patterns in childhood may continue until adolescence, although such patterns may be changed or discontinued throughout adolescence.

To describe socioeconomic inequalities regarding the use, expenditures and the income committed to the purchase of medicines.A cross-sectional population-based study was carried out with 1,720 adults living in the urban area of Florianópolis, Southern Brazil, in 2009. Cluster sampling was adopted and census tracts were the primary sampling units. Use of medicines and the expenditures incurred in their purchase in the past 30 days were investigated through interviews. Use, expenditures and the income committed concerning medicines were analyzed according to per capita family income, self-reported skin color, age and sex, adjusting for the complex sample.The prevalence of medicine use was 76.5% (95%CI: 73.8; 79.3), higher among women and in older individuals. The mean expenditure on medicine was R$ 46.70, with higher values among women, whites, older individuals and among richer people. While 3.1% of the richest committed more than 15% of their income to purchasing medicine, that figure reached 9.6% in the poorest group. The proportion of people that had to buy medicines after an unsuccessful attempt to obtain them in the public health system was higher among the poor (11.0%), women (10.2%) and the elderly (11.1%). A large part of the adults bought medicines contained in the National List of Essential Medicines (19.9%) or in the Municipal List of Essential Medicines (28.6%), with significant differences according to gender, age and income.There is socioeconomic, age and gender inequality in the income committed to the purchase of medicines, with worse conditions for the poor, older individuals and women.

To describe medicine use by children at three, 12 and 24 months of age.Cross-sectional study using data from the 2004 Pelotas Birth Cohort (Southern Brazil), including: 3,985 children at three months, 3,907 children at 12 months, and 3,868 children at 24 months of age. The outcome investigated was use of medicine in the 15 days preceding the interview. Information on independent variables (medicine used, who indicated it, how it was obtained, periodicity of use, and therapeutic group) were collected using a standardized questionnaire administered during a home interview with the child's parents.Prevalence of medicine use at three, 12, and 24 months was 65.0% (95% CI: 63.5;66.5), 64.4% (95% CI: 62.9;65.9), and 54.7% (95% CI: 53.1;56.2), respectively. As age increased, there was a reduction in the total number of medicines used and an increase in self-medicine, which reached 34% at 24 months. Furthermore, frequency of sporadic medicine use increased, while that of continuous use decreased. Medicine was purchased mainly using private resources, with roughly 10% of drugs being purchased through the Brazilian National Health Care System. The profile of medicine types used also changed with age. The type of medicine most frequently used were dermatological products (36%) at three months; respiratory system drugs (24%) at 12 months; and analgesics (26%) at 24 months of age. Compared to three months, medicine use at 24 months was characterized by decreased use of digestive tract and metabolism drugs, drugs for the sensory organs, cardiovascular system drugs, and dermatological products, and an increase in systemic anti-infectious drugs, medicine for the skeletomuscular and respiratory systems, analgesics, insecticides, and repellents.Medicine use in this cohort was high and indicates the need for prioritizing rational use of medicine in early life.

The objective of this study was to verify the frequency of fiber-rich food intake and evaluate its association with socioeconomic, demographic and behavioral characteristics. A city representative sample was selected and 3,993 subjects (> 10 years) were interviewed. The study used the Block Screening Questionnaire. A majority of subjects - 65.6% (95%CI: 64.2-67.1) - presented an inadequate intake frequency. Adjusted analysis for the overall sample showed an increased risk of inadequate frequency among men, adolescents, people of lower socioeconomic levels, current smokers, those insufficiently active and those having fewer than four daily meals. Age group-stratified analysis showed that among adolescents, living alone was a risk factor; for adults, risk factors were sex (male), current smoker, insufficiently active and fewer than four daily meals and; among the elderly they were male and being a current smoker. A lower socioeconomic level was associated to the outcome in all groups. Although the inadequate frequency of intake is very common in this population, teenagers are at a higher risk, pointing to a need for public health actions targeting this particular age group. Verificar a freqüência do consumo de alimentos fontes de fibras e avaliar sua associação com características sócio-econômicas, demográficas e comportamentais. Foi selecionada amostra representativa da cidade e 3.993 indivíduos (> 10 anos) foram entrevistados. Foi utilizado o instrumento Block Screening. A maioria da amostra, 65,6% (IC95%: 64,2-67,1), mostrou freqüência inadequada de consumo. A análise ajustada para amostra global mostrou risco aumentado de freqüência inadequada entre homens, adolescentes, de menor nível sócio-econômico, fumante atual, insuficientemente ativo e aqueles que faziam menos de 4 refeições/dia. A análise por faixa etária mostrou que entre adolescentes, morar sozinho foi um fator de risco; entre adultos, homens, fumantes, insuficientemente ativos e que realizavam menos de 4 refeições/dia; e, entre idosos, somente homens e fumantes. O menor nível sócio-econômico associou-se ao desfecho em todos os grupos. Ressalta-se que embora a população apresente alto porcentual do desfecho, chama atenção os adolescentes, sugerindo medidas prioritárias nesta faixa etária.

The aim of this study was to describe resting pulse rate and associated factors among adolescents. This was a cross-sectional analysis nested in a prospective cohort study, including 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil in 1993, representing 87.5% of the original cohort. Pulse rate was measured with an electronic device at the beginning and end of the interview, and the mean value was used in the analyses. Mean pulse rate was 78.4bpm (SD = 11.0) in the total sample, 76.5bpm (SD = 10.7) in boys, and 80.2bpm (SD = 10.9; p < 0.001) in girls. Black adolescents showed lower mean pulse rates. There was a direct association between pulse rate and blood pressure. Physical activity was inversely associated with pulse rate in the crude analysis only. Elevated pulse rate is strongly associated with high blood pressure, and both variables are predictors of risk of chronic disease in adulthood. O objetivo do estudo foi descrever a freqüência do pulso de repouso em adolescentes e avaliar variáveis associadas. Trata-se de análise transversal aninhada a um estudo de coorte prospectivo, incluindo 4.452 adolescentes nascidos em Pelotas, Rio Grande do Sul, Brasil, em 1993, os quais representam 87,5% da coorte original. A freqüência do pulso foi mensurada no início e ao final da entrevista com aparelho digital, sendo o valor médio utilizado nas análises. O valor médio da freqüência do pulso foi de 78,4bpm (DP = 11,0), sendo de 76,5bpm (DP = 10,7) nos meninos e 80,2bpm (DP = 10,9; p < 0,001) nas meninas. Os adolescentes com pele preta apresentaram valores mais baixos da freqüência do pulso. Houve uma forte associação positiva entre pressão arterial e freqüência do pulso. O escore de atividade física associou-se inversamente com a freqüência do pulso somente na análise bruta. Valores elevados de freqüência do pulso estão fortemente relacionados com valores elevados de pressão arterial, sendo ambas variáveis preditoras do risco de doenças crônicas na vida adulta.

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.

O artigo descreve o perfil das prescrições de antimicrobianos, suas principais indicações clínicas e aspectos sazonais. Realizou-se um estudo transversal nas unidades de saúde da família do Município de Bagé, Rio Grande do Sul, Brasil, nos meses de julho de 2005 e janeiro de 2006. Foram analisadas todas (n = 2.877) as prescrições médicas, e a prevalência de prescrição de antimicrobianos encontrada nos meses de inverno e verão foi de 30,4% (IC95%: 28,5-32,4) e 21% (IC95%: 19,1-22,9), respectivamente. Os antimicrobianos mais prescritos foram a amoxicilina e a associação de sulfametoxazol/trimetropin. As principais indicações clínicas para sua prescrição foram: infecção das vias aéreas superiores não especificadas (22,5%), amigdalites (20,8%) e infecções do trato urinário (13,3%). Observou-se uma mudança no perfil de prescrição de antimicrobianos para o tratamento das mesmas patologias entre os dois períodos. Os resultados evidenciam a falta de um padrão de prescrição de antimicrobianos na atenção básica à saúde, o que contraria as recomendações da Organização Mundial da Saúde, que sugerem a criação de protocolos de uso de antimicrobianos em todos os níveis de cuidado, como estratégia para a prevenção do uso inadequado dos antimicrobianos disponíveis. This paper describes antimicrobial prescription, clinical indications, and seasonal characteristics in primary health care. We performed a cross-sectional study in family health units in Bagé, Rio Grande do Sul State, Brazil, in July 2005 and January 2006. All medical prescriptions (n = 2,877) were analyzed, and the prevalence rates for antimicrobial prescription in winter and summer were 30.4% (95%CI: 28.5-32.4) and 21% (95%CI: 19.1-22.9), respectively. The most frequently prescribed antimicrobials were amoxicillin and sulfamethoxazole-trimethoprim. The main clinical indications for antimicrobial prescription were non-specific upper respiratory tract infections (22.5%), throat infections (20.8%), urinary tract infections (13.3%), otitis (8.5%), and sinusitis (7.5%). We observed differences between summer and winter in prescriptions for the same diseases. Seasonal differences between treatment profiles for the same diseases show the absence of a consistent antimicrobial prescription pattern in primary health care, contrary to World Health Organization guidelines, which advocate the establishment of protocols for antimicrobial use at all levels of care, as a strategy to prevent inadequate usage and the occurrence of strains that are resistant to available antimicrobials.

The antimicrobials are one of the groups of the most prescribed drugs in hospitals and which cause a great concern for the suitability of their use. The profile of the antimicrobials utilized in a private hospital in the countryside of Rio Grande do Sul State was described and the quantity of each antimicrobial consumed was analyzed. All the prescriptions of patients who utilized antimicrobials while they were hospitalized in the period from March to June 2006 were analyzed. The antimicrobial consumption was expressed in Defined Daily Dose (DDD) in 100 day-beds. The antimicrobial utilization analysis were done generally speaking and divided by age groups and by medical clinics. During the studying period the antimicrobial use prevalence was of 52.4 % (IC 95 % 49.2 - 55.7). The cephalosporins were the most utilized (43.4 %), followed by the penicillins (16.3 %), fluoroquinolones (13.0 %) and aminoglycosides (9.7 %). The high consumption of antimicrobials during the studying period is the result of the absence of a policy for controlling the drugs prescribed in hospital and the lack of protocols of antimicrobial use. In order to exist a control of antimicrobial consumption the hospitals must assume a surveillance policy on the prescriptions of this drug group.

Background In a country where comprehensive free health care is provided via a public health system (SUS), an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure. Methods All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery. Results The majority of the deliveries (81%) were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment. Conclusion The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense.

Physical activity in adolescence is associated with several health benefits, including a direct influence on adolescent morbidity and an indirect effect on adult health mediated by physical activity levels in adulthood. This study assessed the prevalence of sedentary lifestyle and associated variables in 4,452 adolescents aged 10-12 years, belonging to the 1993 Pelotas Birth Cohort Study, representing 87.5% of the original cohort. Sedentary lifestyle, defined as300 minutes per week of physical activity, was reported by 58.2% (95%CI: 56.7-59.7) of the cohort. In the multivariate analysis, sedentary lifestyle was positively associated with female gender, socioeconomic status, maternal physical inactivity, and television viewing, but inversely correlated with time spent playing videogames. Adolescents with low socioeconomic status were more likely to walk or bicycle to and from school. Effective strategies against sedentary lifestyle in adolescence are needed because of its high prevalence and association with physical inactivity in adulthood.

Background Few studies have investigated the association between physical activity practice and medicine use; data from these studies are inconsistent. The aim of this study was to evaluate the association between level of physical activity and medicine use in adults aged 20 years or more. Methods A population-based cross-sectional study was carried out in the first semester of 2002 in the urban area of Pelotas; a medium-sized Southern Brazilian city. Physical activity was assessed with the short version of the International Physical Activity Questionnaire. A physical activity score was created as the weekly time spent in moderate-intensity activities plus twice the weekly time spent in vigorous-intensity activities. Medicine use in the 15 days prior to the interview was also assessed. Adjusted analyses taking into account the sampling design was carried out using Poisson regression. Wald tests for heterogeneity and linear trend were used to calculate significance. Results Out of the 3,182 individuals interviewed, 41% were not sufficiently active according to current physical activity guidelines. Only 34% of the subjects did not use medicines in the previous 15 days, and 18% used three or more drugs in the same period. Level of physical activity was inversely associated with the number of medicines used both in the crude and in the adjusted analyses. Conclusion There are well-documented benefits of physical activity for several chronic diseases in the literature. Data from the present study suggest that medicine use is also positively affected by physical activity behavior.

This study aimed to evaluate the prevalence of access to continuous-use medicines for treatment of systemic arterial hypertension, diabetes mellitus, and/or mental health problems, and the associated factors. A cross-sectional study was developed under the Project for the Expansion and Consolidation of the Family Health Program in 41 cities in South and Northeast Brazil. The sample included 4,060 adults and 4,003 elderly living in the coverage areas for primary health care clinics. Prevalence of access to continuous-use medicines was 81% in non-elderly adults and 87% in the elderly. Greater access was associated with the following factors: adults in South Brazil - older age, higher socioeconomic status, type of chronic disease, and participation in support groups in the primary health clinic area; adults in the Northeast - systemic arterial hypertension with or without diabetes mellitus; elderly in the South - more schooling; and elderly in the Northeast - older age, more schooling, non-smoking, enrollment in the primary health care clinic coverage area, and the family health care model. The results show important inequity in health, reinforcing the need for policies to expand access, mainly for lower-income population groups.

This study evaluated knowledge and use of generic drugs in a population-based sample of adults from a southern Brazilian city. The outcomes were: the proportion of generics in total medicines used; theoretical and practical knowledge about generics; and strategies used to buy medicines on medical prescriptions. The recall period for drug utilization was 15 days. The proportion of generics in total medicines was 3.9%. While 86.0% knew that generics cost less and 70.0% that the quality is similar to brand name medicines, only 57.0% knew any packaging characteristics that distinguish generics from other medicines. The highest proportion of generic drug utilization was in the antimicrobial pharmacological group. A brand name medicine (with a brand similar to the generic name) was mistakenly classified as a generic through photos by 48.0% of the interviewees. Among subjects who bought medicines in the 15-day period, 18.9% reported buying a generic, but this result should be interpreted with caution, because the population frequently fails to differentiate between generics and other medicines.

Lack of comparability has been a major limitation in studies on physical activity, due to the utilization of different methodological instruments and inconsistent cut-off points. This study aims to compare the levels of physical activity in adults from two Brazilian areas: (a) São Paulo, the richest State in the country; (b) Pelotas, a medium-sized southern Brazilian city. Both sites used cross-sectional population-based designs, with multiple-stage sampling strategies. Level of physical activity was assessed with the short version of the International Physical Activity Questionnaire. Prevalence of sedentary lifestyle was three times higher in Pelotas than in São Paulo. On the other hand, the proportion of very active subjects was significantly higher in Pelotas. The proportion of insufficiently active individuals (sedentary + irregularly active) was almost identical between the sites. Socioeconomic status was inversely related to level of physical activity in both sites. Among the insufficiently active subjects, those living in São Paulo are at least engaged in a limited amount of activity. On the other hand, among sufficiently active people, those living in Pelotas are more active. A incomparabilidade sempre foi uma limitação entre os estudos sobre atividade física, em função da utilização de vários instrumentos e pontos de corte inconsistentes. Comparou-se o nível de atividade física de adultos do Estado de São Paulo e da cidade de Pelotas, Rio Grande do Sul, no Brasil. Ambos os centros usaram delineamento transversal de base populacional, com amostragem em múltiplos estágios. A prática de atividade física foi avaliada com a versão curta do Questionário Internacional de Atividade Física. A prevalência de sedentarismo foi três vezes maior em Pelotas do que em São Paulo. Já a proporção de pessoas muito ativas foi significativamente maior em Pelotas. A prevalência de atividade física insuficiente (sedentários + irregularmente ativos) foi similar em ambos os centros. O nível sócio-econômico associou-se inversamente com o nível de atividade física nos dois centros. Entre as pessoas insuficientemente ativas, as de São Paulo estão ao menos praticando uma pequena quantidade de atividade física. Já entre os suficientemente ativos, as pessoas de Pelotas têm maior nível de atividade física.

Background To evaluate medicine prices, availability and affordability in Brazil, considering the differences across three types of medicines (originator brands, generics and similar medicines) and different types of facilities (private pharmacies, public sector pharmacies and “popular pharmacies”). Methods Data on prices and availability of 50 medicines were collected in 56 pharmacies across six cities in Southern Brazil using the World Health Organization / Health Action International methodology. Median prices obtained were divided by international reference prices to derive the median price ratio (MPR). Results In the private sector, prices were 8.6 MPR for similar medicines, 11.3 MRP for generics and 18.7 MRP for originator brands, respectively. Mean availability was 65%, 74% and 48% for originator brands, generics and similar medicines, respectively. In the public sector, mean availability of similar medicines was 2–7 times higher than that of generics. Mean overall availability in the public sector ranged from 68.8% to 81.7%. In “popular pharmacies”, mean availability was greater than 90% in all cities. Conclusions Availability of medicines in the public sector does not meet the challenge of supplying essential medicines to the entire population, as stated in the Brazilian constitution. This has unavoidable repercussions for affordability, particularly amongst the lower socio-economic strata.

Background Studies carried out in the community enable researchers to understand access to medicines, affordability, and barriers to use from the consumer's point of view, and may stimulate the development of adequate medicines policies. The aim of the present article was to describe methodological and analytical aspects of quantitative studies on medicine utilization carried out at the household level. Methods Systematic review of original papers with data collected in studies in which the household was a sampling unit, published between 1995 and 2008. The electronic review was carried out in Medline/Pubmed, Scielo and Lilacs. The reference lists of the papers identified were examined, as well as other publications by their authors. Studies on the utilization of specific pharmacological groups, or those including only respondents with a given disease were excluded. Results Out of 4852 papers initially identified in the literature search, 61 fulfilled our inclusion criteria. Most studies were carried out in Europe and North America and used a cross-sectional approach. More than 80% used face-to-face interviews for data collection, and the most frequently used recall period for assessing medicine utilization was 14–15 days. In 59% of the studies, interviewers were trained to request the packaging of the medicines reported by the subjects; medical prescriptions were requested less frequently (15% of the studies). Conclusion These data will be useful for updating researchers on what methods their peers are currently using. Such information may help overcome challenges in the planning and analyses of future studies. Moreover, this publication may contribute to the improvement of the quality of medicine use data obtained in household surveys.

OBJETIVO: Analisar o acesso e utilização de serviços odontológicos no Brasil. MÉTODOS: Foram utilizados os dados da Pesquisa Nacional por Amostra de Domicílios de 2003 e 2008, comparando-os com os de 1998. Investigaram-se as variáveis de acesso e uso de serviços odontológicos nas idades de três, seis, nove, 12, 15 e 19 anos e no primeiro (Q1) e no quinto (Q5) quintis de renda familiar per capita. As análises consideraram o desenho amostral complexo. RESULTADOS: A proporção de pessoas que nunca consultaram o dentista diminuiu (18,7% em 1998, 15,9% em 2003 e 11,7% em 2008). Houve importante redução na diferença absoluta de não utilização do serviço odontológico a partir dos nove anos entre Q1 e Q5 de 1998 a 2008, diminuindo para cerca de metade aos 15 (30,3 pontos percentuais - pp para 16,1 pp) e aos 19 anos (20,4 pp para 9,9 pp). As razões entre Q1 e Q5 para consulta recente ao dentista diminuíram em todas as idades, principalmente entre zero e seis anos (Q5/Q1 de 3,2 para 2,6); a utilização do Sistema Único de Saúde para atendimento odontológico aumentou nos Q1 e Q5, com redução na razão entre os grupos Q1/Q5 de cerca de 20%. A utilização do Sistema Único de Saúde para atendimento odontológico aumentou cerca de 8% no Q1 e 35% no Q5 entre 2003 e 2008. CONCLUSÕES: Houve avanço considerável na redução das desigualdades no acesso e aumento na utilização de serviços odontológicos no Brasil entre 1998 e 2008. Entretanto, as iniquidades entre os grupos sociais ainda é expressiva. OBJECTIVE: To analyze access to and utilization of dental care services in Brazil. METHODS: We used data from the 2003 and 2008 Brazilian National Household Surveys, which we compared to data from the 1998 survey. We investigated access and utilization variables at ages three, six, nine, 12, 15, and 19 years in the first (Q1) and fifth (Q5) quintiles of per capita family income. All analyses took into account the complex sampling strategy. RESULTS: The proportion of subjects that had never seen a dentist decreased during the period (18.7% in 1998, 15.9% in 2003 and 11.7% in 2008). There was an important reduction in the absolute difference in failure to use dental care services after age nine years between Q1 and Q5 from 1998 to 2008, which decreased to about half its value at 15 (30.3 percentage points - pp to 16.1 pp) and 19 years (20.4 pp to 9.9 pp). Q5/Q1 ratios for recent dental appointments fell across all age groups, especially between zero and six years (Q5/Q1 from 3.2 to 2.6); utilization of the National Health Care System for dental care increased in Q1 and Q5, with a reduction in the Q1/Q5 ratio of approximately 20%. Use of the National Health Care System for dental care increased by approximately 8% in Q1 and 35% in Q5 between 2003 and 2008. CONCLUSIONS: There have been considerable advances in terms of reducing inequalities in access to, and increasing the utilization of, dental care services in Brazil between 1998 and 2008. However, inequality between social groups remains substantial. OBJETIVO: Analizar el acceso y utilización de servicios odontológicos en Brasil. MÉTODOS: Se utilizaron los datos de la Investigación Nacional por Muestra de Domicilios de 2003 y 2008, comparándolos con los de 1998. Se investigaron las variables de acceso y uso de servicios odontológicos en las edades de tres, seis, nueve, 12, 15 y 19 años y en el primer (Q1) y en el quinto (Q5) quintil de renta familiar per capita. Los análisis consideraron el diseño muestral complejo. RESULTADOS: La proporción de personas que nunca consultó el dentista disminuyó (18,7% en 1998, 15,9% en 2003 y 11,7% en 2008). Hubo importante reducción en la diferencia absoluta de no utilización de servicio odontológico a partir de los nueve años entre Q1 y Q5 de 1998 a 2008, disminuyendo para cerca de la mitad a los 15 (30,3 puntos porcentuales - pp para 16,1 pp) y a los 19 años (20,4 pp para 9,9 pp). Los cocientes entre Q1 y Q5 para consulta reciente al dentista disminuyeron en todas las edades, principalmente entre cero y seis años (Q5/Q1 de 3,2 a 2,6); la utilización del Sistema Único de Salud para atención odontológica aumentó en los Q1 y Q5, con reducción en el cociente entre los grupos Q1/Q5 de cerca de 20%. La utilización del Sistema Único de Salud para atención odontológica aumentó cerca de 8% en el Q1 y 35% entre 2003 y 2008. CONCLUSIONES: Hubo avance considerable en la reducción en las desigualdades en el acceso y aumento en la utilización de servicios odontológicos en Brasil entre 1998 y 2008. Mientras que, las inequidades entre los grupos sociales aún es expresiva.

OBJETIVO: Revisar a literatura científica sobre a continuidade dos padrões alimentares da infância à adolescência. MÉTODOS: Foram realizadas buscas nas bases de dados MEDLINE/PubMed, Lilacs e SciELO utilizando os seguintes termos: "tracking", "dietary patterns" e "childhood/adolescence" e sinônimos. Foram encontrados 45 resumos e, após aplicação dos critérios de inclusão, 13 artigos foram incluídos. A continuidade do padrão foi avaliada por três principais análises estatísticas: coeficientes de correlação (Pearson ou Spearman), coeficiente kappa e análise de probabilidades. RESULTADOS: A continuidade do padrão alimentar foi de fraca a moderada entre os períodos infância-infância e infância-adolescência. Parece não haver continuidade na adolescência. CONCLUSÕES: Os padrões alimentares da infância podem persistir até a adolescência, embora no transcorrer da adolescência possam ser alterados ou descontinuados. OBJECTIVE: To review the scientific literature on the tracking of dietary patterns from childhood to adolescence. METHODS: A search of the MEDLINE/PubMed, Lilacs and SciELO databases was performed, using the following key words: "tracking", "dietary patterns" and "childhood/adolescence" and their respective synonyms. A total of 45 abstracts were found and, after the inclusion criteria were applied, 13 articles were included. The tracking of dietary patterns was assessed by three main statistical analyses: (Pearson or Spearman) correlation coefficients, kappa coefficient and probability analysis. RESULTS: The tracking of dietary patterns ranged from weak to moderate between the childhood-childhood and childhood-adolescence periods. During adolescence, there appears to be no tracking. CONCLUSIONS: Dietary patterns in childhood may continue until adolescence, although such patterns may be changed or discontinued throughout adolescence. OBJETIVO: Revisar la literatura científica sobre la continuidad de los patrones alimenticios de la infancia a la adolescencia. MÉTODOS: Se realizaron búsquedas en las bases de datos MEDLINE/PubMed, Lilacs y SciELO utilizando los siguientes términos: "tracking", "dietary patterns" y "childhood/adolescente" y sinónimos. Se encontraron 45 resúmenes y posterior a la aplicación de los criterios de inclusión, 13 artículos fueron adjuntados. La continuidad del patrón fue evaluada por tres principales análisis estadísticos: coeficientes de correlación (Pearson o Spearman), coeficiente kappa y análisis de probabilidades. RESULTADOS: La continuidad del patrón alimenticio fue débil a moderada entre los períodos infancia-infancia e infancia-adolescencia. Parece no haber continuidad en la adolescencia. CONCLUSIONES: Los patrones alimenticios de la infancia pueden persistir hasta la adolescencia, a pesar de no transcurrir de la adolescencia pueden ser alterados o descontinuados.

Para avaliar a situação de utilização e acesso aos serviços de odontologia no Brasil e estudar diferenciais entre os estratos socioeconômicos, utilizaram-se dados da Pesquisa Nacional por Amostragem de Domicílios (PNAD) de 1998, realizada pelo IBGE. A análise, que levou em conta o desenho amostral, indicou um nível baixo de utilização de serviços odontológicos. Setenta e sete por cento das crianças de 0-6 anos e 4% dos adultos de 20-49 anos nunca haviam consultado um dentista. Entre estes adultos, comparando-se os 20% mais pobres com os 20% mais ricos, observou-se que o número de desassistidos era 16 vezes maior entre os primeiros. No grupo de 0-6 anos, as crianças ricas consultaram o dentista cinco vezes mais do que as pobres no ano anterior à entrevista. Cerca de 4% dos que procuraram atendimento odontológico não o obtiveram, 8% dos quais entre os mais pobres e 1% entre os mais ricos. A maioria (68%) dos atendimentos do grupo mais pobre foi financiada pelo SUS, enquanto 63% deles foram pagos pelos mais ricos. As maiores desigualdades no acesso e na utilização de serviços odontológicos foram encontradas, exatamente, nos grupos de menor acesso ou utilização. A participação do SUS nos atendimentos odontológicos é muito mais baixa do que na atenção médica.

RESUMO: Objetivo: Descrever as pessoas com diabetes no Brasil e comparar suas características sociodemográficas, o acesso e a adesão autorreferida aos medicamentos prescritos. Métodos: Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos, um inquérito domiciliar, com plano amostral por conglomerados, segundo domínios de sexo e idade e representatividade nacional e macrorregional. Os adultos (≥ 20 anos) que referiram ter diabetes constituíram a amostra. Analisaram-se as frequências ponderadas das variáveis na amostra e aplicou-se o teste do χ2 de Pearson para avaliar a significância estatística das diferenças entre os estratos para os dados de acesso, forma de financiamento e adesão aos medicamentos, considerando o nível de significância de 5%. Resultados: Encontrou-se uma maior proporção de mulheres, de maiores de 60 anos e da classe econômica C. A maioria referiu ter duas ou mais comorbidades além do diabetes e tomar cinco ou mais medicamentos. Quanto ao acesso, 97,8% dizem ter acesso aos medicamentos prescritos para diabetes e 70,7%, que os obtêm de forma totalmente gratuita. Verificou-se baixa adesão ao tratamento farmacológico, com diferenças macrorregionais significativas (p = 0,001) e maior vulnerabilidade nas regiões sul e nordeste. Conclusão: Demonstrou-se melhor acesso aos medicamentos para diabetes no país. Entretanto, para melhorar a eficiência dos gastos públicos, ficou demonstrada a necessidade de melhorar a adesão ao tratamento medicamentoso. ABSTRACT: Objective: To describe people with diabetes in Brazil and to compare their sociodemographic characteristics, access and self-reported adherence to diabetes prescribed drugs. Methods: Data analysis from the National Survey on Access, Use and Promotion of the Rational Use of Medicines, a household survey, with sampling by clusters, according to sex and age domains and national and macro-regional representativeness. Adults (≥ 20 years old) who reported having diabetes constituted the sample. The weighted frequencies of the variables in the sample were analyzed and the Pearson χ2 test was applied to evaluate the statistical significance of the differences between the strata for the data of access, form of financing and adherence to the drugs, considering the level of significance of 5%. Results: We found a higher proportion of women, people over 60 years and economy class C. Most participants reported having two or more comorbidities, in addition to diabetes, and taking five or more drugs. Regarding access, 97.8% say they have access to prescription drugs for diabetes and 70.7% say they get them totally free of charge. There was low adherence to anti-diabetic treatment, with significant macro-regional differences (p = 0,001), and greater vulnerability in the South and Northeast regions. Conclusion: Better access to diabetes medicines in the country has been demonstrated. However, to improve the efficiency of health public spending, it is necessary to achieve higher rates of adherence to treatment.

Background The present study aimed to examine the impact of socioeconomic, demographic, and health status-related factors on out-of-pocket expenditure on health care for children. Methods Data were obtained from a birth cohort study conducted in the city of Pelotas, state of Rio Grande do Sul (RS), southern Brazil, in 2004. The final sample is a result of adjusts made in order to keep in the analysis only those that attended to 3 follow-ups (at 12, 24 and 48 months of age). Estimates were carried out using the Panel Data Tobit Model with random effects. Results The study showed that expenditure on medicines was 20 % less likely in those considered healthy children by their mothers and, if there was any expenditure with healthy children, the expected expenditure was reduced by 58 %. A 1 % increase in household income increased the expected expenditure on medicines by 16 %, and by 23 % in children with private health insurance coverage. Conclusions All types of health care expenditures examined were higher for children covered by private health insurance. Although total health care expenditure was higher for children of better-off families, it represented a lower share of these families’ income evidencing income inequality in health care expenditures. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0180-0) contains supplementary material, which is available to authorized users.

OBJECTIVE To analyze the prevalence of current use of oral and injectable contraceptives by Brazilian women, according to demographic and socioeconomic variables and issues related to access to those medicines. METHODS A cross-sectional, population-based analytical study with probability sampling based on data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), carried out between September 2013 and February 2014 in 20,404 Brazilian urban households. Prevalence was calculated based on reports from non-pregnant women aged 15-49 on the use of oral or injectable contraceptives. The independent variables were gender, age, level of education, socioeconomic class, Brazilian region and marital status. Also analyzed were access, means of payment, sources, and reported medicines. Statistical analyses considered 95% confidence intervals (95%CI) and Pearson Chi-square test to evaluate the statistical significance of differences between groups, considering a 5% significance level. RESULTS Prevalence of use was 28.2% for oral contraceptives (OC) and 4.5% for injectable contraceptives (IC). The highest prevalence of oral contraceptives was in the South region (37.5%) and the lowest in the North region (15.7%). For injectable contraceptives there was no difference between regions. Access was higher for oral contraceptive users (90.7%) than injectable contraceptives users (81.2%), as was direct payment (OC 78.1%, IC 58.0%). Users who paid for contraceptives acquired them at retail pharmacies (OC 95.0% and IC 86.6%) and at Farmácia Popular (Popular Pharmacy Program) (OC 4.8% and IC 12.7%). Free of charge contraceptives were mostly obtained from the Brazilian Unified Health System – SUS (OC 86.7%; IC 96.0%). Free samples were reported by 10.4% of users who did not pay for oral contraceptives. Most of paying users did not try to obtain contraceptives from SUS. Monophasic combined oral contraceptives were the most frequently reported (71.6%) and low-level levonorgestrel + ethinylestradiol combination accounted for 38.7% of them. The most frequently reported medicines are included in the Relação Nacional de Medicamentos Essenciais (RENAME – National List of Essential Medicines. CONCLUSIONS Most women aged 15 to 49 who reported using contraceptives had access to the medicine and use monophasic combined oral contraceptives of appropriate efficiency and safety purchased by direct payment, mainly from retail pharmacies. RESUMO OBJETIVO Analisar a prevalência do uso atual de contraceptivos orais e injetáveis por mulheres brasileiras, segundo variáveis demográficas, socioeconômicas e aspectos relacionados ao acesso a esses medicamentos. MÉTODOS Estudo transversal, analítico, baseado nos dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), de base populacional e amostra probabilística, realizada entre setembro/2013 e fevereiro/2014, em 20.404 domicílios urbanos brasileiros. A prevalência foi calculada a partir do relato das mulheres de 15 a 49 anos, não grávidas, sobre o uso de contraceptivos orais ou contraceptivos injetáveis. As variáveis independentes foram sexo, idade, escolaridade, nível socioeconômico, região geográfica e situação conjugal. Também foram analisados acesso, fontes de financiamento, fontes de obtenção e medicamentos citados. As análises estatísticas consideraram intervalos de confiança de 95% (IC95%) e teste Qui-quadrado de Pearson para avaliação da significância estatística das diferenças entre os grupos, considerando o nível de significância de 5%. RESULTADOS A prevalência de uso de contraceptivos orais (CO) foi 28,2% e de contraceptivos injetáveis (CI), 4,5%. A prevalência de contraceptivos orais foi maior no Sul (37,5%) e menor no Norte (15,7%). Para contraceptivos injetáveis não houve diferença entre as regiões. O acesso foi maior para as usuárias de contraceptivos orais (90,7%) do que de contraceptivos injetáveis (81,2%), assim como o pagamento por desembolso direto (CO 78,1%; CI 58,0%). As usuárias que pagaram pelo contraceptivo compraram na farmácia comercial (CO 95,0% e CI 86,6%) e na Farmácia Popular (CO 4,8% e CI 12,7%). A principal fonte de obtenção gratuita foi o SUS (CO 86,7%; CI 96,0%). Amostra grátis foi citada por 10,4% das usuárias que não pagaram pelos contraceptivos orais. A maioria das usuárias que pagaram, não tentou obter no SUS. Contraceptivos orais combinados monofásico foram os mais citados (71,6%) e a combinação levonorgestrel+etinilestradiol de baixa concentração representou 38,7% destes. Os medicamentos mais citados constam na Relação Nacional de medicamentos Essenciais. CONCLUSÕES A maioria das mulheres entre 15 e 49 anos que referiram usar contraceptivos obteve acesso ao medicamento, usa contraceptivos orais combinados monofásico, de eficácia e segurança adequada, obtido com pagamento do próprio bolso, principalmente, nas farmácias comerciais.

Background Medicine access is an important goal of medicine policy; however the evaluation of medicine access is a subject under conceptual and methodological development. The aim of this study was to describe quantitative methodologies to measure medicine access on household level, access expressed as paid or unpaid medicine acquisition. Methods Searches were carried out in electronic databases and health institutional sites; within references from retrieved papers and by contacting authors. Results Nine papers were located. The methodologies of the studies presented differences in the recall period, recruitment of subjects and medicine access characterization. Conclusions The standardization of medicine access indicators and the definition of appropriate recall periods are required to evaluate different medicines and access dimensions, improving studies comparison. Besides, specific keywords must be established to allow future literature reviews about this topic.

OBJECTIVE The objective of this study is to identify factors associated with the preference for purchasing generic drugs in a medium-sized municipality in Southern Brazil. METHODS We have analyzed data from a population-based cross-sectional study conducted in 2012 with a sample of 2,856 adults (≥ 20 years old). The preference for purchasing generic drugs was the main outcome. The explanatory variables were the demographic and socioeconomic variables. Statistical analyses included Poisson regressions. RESULTS The preference for purchasing generic drugs was 63.2% (95%CI 61.4–64.9). The variables correlated with this preference in the fully adjusted models were: male (prevalence ratio [PR] = 1.08; 95%CI 1.03–1.14), age of 20–39 years (PR = 1.10; 95%CI 1.02–1.20), low socioeconomic status (PR = 1.15; 95%CI 1.03–1.28), and good knowledge about generic drugs (PR= 4.66; 95%CI 2.89–7.52). Among those who preferred to purchase generic drugs, 55.1% have reported accepting to replace the prescribed drug (if not a generic) with the equivalent generic drug. Another correlate of the preference for purchasing generic drugs was because individuals consider their quality equivalent to reference medicines (PR = 2.15; 95%CI 1.93–2.41). CONCLUSIONS Knowledge about generic drugs was the main correlate of the preference for purchasing generic drugs. The greater the knowledge or positive perception about generic drugs, the greater is the preference to purchase them. Therefore, educational campaigns for healthcare professionals and consumers appear to be the best strategy for expanding the use of generic drugs in Brazil.

OBJECTIVE To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid. METHODS Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson’s Chi-squared test to assess the differences between the groups, considering a 5% significance level. RESULTS About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1–50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1–54.8), age group of 40-59 years (51.1%; 95%CI 48.1–54.2), and in the poorest social classes (53.9%; 95%CI 50.2–57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2–80.5), beta-blockers (C07) (62.7%; 95%CI 59.4–65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8–75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7–66.9) were mostly paid with own resources. CONCLUSIONS Free access to medicines for treatment of chronic diseases occurs to a considerable portion of the Brazilian population, especially for the poorest ones, indicating decreased socioeconomic inequalities, but with differences between regions and between some classes of medicines. RESUMO OBJETIVO Analisar o acesso gratuito ao tratamento medicamentoso para doenças crônicas na população brasileira, segundo fatores socioeconômicos e demográficos. Analisaram-se também os grupos farmacológicos mais utilizados, segundo fonte de financiamento: gratuito ou pago do próprio bolso. MÉTODOS Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. O desfecho analisado foi a prevalência de acesso gratuito (sem pagamento) a todos os medicamentos para tratamento das doenças crônicas referidas, nos últimos 30 dias. As variáveis independentes investigadas foram: sexo, faixa etária, escolaridade em anos completos de estudo, classe econômica, plano de saúde e região geográfica de residência. Foram estimadas as prevalências e calculados intervalos de 95% de confiança (IC95%) e aplicado o teste Qui-quadrado de Pearson para avaliação das diferenças entre os grupos, considerando nível de significância de 5%. RESULTADOS Cerca de metade dos adultos e idosos que tiveram acesso total ao tratamento de doenças crônicas no Brasil obtiveram todos os medicamentos que necessitavam gratuitamente (47,5%; IC95% 45,1–50,0). As prevalências de acesso gratuito foram maiores entre os homens (51,4%; IC95% 48,1–54,8), na faixa etária de 40-59 anos (51,1%; IC95% 48,1–54,2) e nas classes sociais mais pobres (53,9%; IC95% 50,2–57,7). Grande parte dos medicamentos que atuam no sistema cardiovascular, como os diuréticos (C03) (78,0%; IC95% 75,2–80,5), betabloqueadores (C07) (62,7%; IC95% 59,4–65,8) e os agentes que atuam no sistema renina-angiotensina (C09) (73,4%; IC95% 70,8–75,8) foram obtidos de forma gratuita. Os medicamentos que atuam no sistema respiratório como os agentes contra doenças obstrutivas das vias aéreas (R03) (60,0%; IC95% 52,7–66,9) foram na sua maioria pagos do próprio bolso. CONCLUSÕES O acesso gratuito aos medicamentos para tratamento das doenças crônicas ocorre para uma considerável parcela da população brasileira, principalmente para os mais pobres, indicando diminuição das desigualdades socioeconômicas, mas com diferenças regionais e entre algumas classes de medicamentos.