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Ecologia médica: uma reavaliação na realidade brasileira, 2010; The ecology of medical care 2010: in brazilian's scenarios

Roncoloetta, Adriana Fernanda Tamassia
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 21/10/2010 PT
Relevância na Pesquisa
56.03%
Introdução A educação médica sofreu transformações ao longo do século XX. Alguns educadores médicos já reconheceram o problema do modelo centrado na doença e focado em condições não usuais de pacientes hospitalizados e a carência do ensino sobre problemas comuns de saúde. O termo ecologia do cuidado médico é como se conhece a relação entre as pessoas e os cenários de saúde. Esse conceito foi introduzido em 1961 por K. White (e atualizado por Green em 2001), que mostrou graficamente a proporção de pessoas que utilizaram serviços de saúde no período de um mês. Esses resultados influenciaram organizações do sistema de saúde, pesquisa científica e educação médica ao longo dos anos. Objetivos Reavaliar a ecologia médica, agora na população brasileira, identificando, no período de um mês, o número de pessoas que apresentaram sintomas, qual atitude tomaram em relação a eles e comparar as queixas apresentadas com o conteúdo dos livros tradicionais de clínica médica. Métodos Entrevistas telefônicas realizadas por auxiliares de enfermagem a 1.065 participantes consecutivos de uma empresa de convênio médico no período de maio de 2008 a fevereiro de 2009 em São Paulo. Resultados Dos entrevistados...

Medical care and deaths due to coronary artery disease in Brazil, 1980-1999

Lessa,Ines
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2003 EN
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OBJECTIVE: To estimate the frequency of medical care preceding deaths due to coronary artery diseases (CAD) in different Brazilian regions and capitals and to describe trends in medical care from 1980 to 1999. METHODS: Information on medical care preceding deaths due to coronary artery diseases/acute myocardial infarction in adults > 20 years from 1980 to 1999 was collected in the DATASUS, the databank of the Brazilian Health Ministry. Sex, states, and capitals selected for 1999 were analyzed in the study. Medical care was stratified as follows: with, without, and ignored medical care. The descriptive analysis comprised frequencies, ratios of frequency, test for proportions, and increments or reductions in frequencies. RESULTS: Acute myocardial infarction (AMI) represented 75 to 85% of the CAD in the period; the frequency of deaths with medical care ranged from 48.9 to 63%, and that of ignored medical care ranged from 27.2 to 41.5%. The frequency of other CAD with medical care ranged from 56 to 76%. The frequency of deaths preceded by medical care decreased by 17.8%, and that with ignored medical care increased by 36.5% (RF=2). The values for the other CAD were -20.2% and +64.6% (RF=44.4). Deaths preceded by medical care were more frequent in females at all ages and in all Brazilian regions. CONCLUSION: The results show a high frequency of sudden death and suggest errors in diagnosis or codification and overestimation of the statistics about mortality. Validation of the death certificate diagnosis and frequent surveillance are required.

The Quality of Medical Advice in Low-Income Countries

Das, Jishnu; Hammer, Jeffrey; Leonard, Kenneth
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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This paper provides an overview of recent work on quality measurement of medical care and its correlates in four low and middle-income countries-India, Indonesia, Tanzania, and Paraguay. The authors describe two methods-testing doctors and watching doctors-that are relatively easy to implement and yield important insights about the nature of medical care in these countries. The paper discusses the properties of these measures, their correlates, and how they may be used to evaluate policy changes. Finally, the authors outline an agenda for further research and measurement.

Long-Run Effects of Temporary Incentives on Medical Care Productivity

Celhay, Pablo; Gertler, Paul; Giovagnoli, Paula; Vermeersch, Christel
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Trabalho em Andamento
EN_US
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The adoption of new clinical practice patterns by medical care providers is often challenging, even when the patterns are believed to be efficacious and profitable. This paper uses a randomized field experiment to examine the effects of temporary financial incentives paid to medical care clinics for the initiation of prenatal care in the first trimester of pregnancy. The rate of early initiation of prenatal care was 34 percent higher in the treatment group than in the control group while the incentives were being paid, and this effect persisted at least 15 months and likely 24 months or more after the incentives ended. These results are consistent with a model where the incentives enable providers to address the fixed costs of overcoming organizational inertia in innovation, and suggest that temporary incentives may be effective at motivating improvements in long-run provider performance at a substantially lower cost than permanent incentives.

Coinsurance rate elasticity of demand for medical care in a stochastic optimization model

Sidorenko, Alexandra
Fonte: Universidade Nacional da Austrália Publicador: Universidade Nacional da Austrália
Tipo: Working/Technical Paper Formato: 1254968 bytes; application/pdf
EN_AU
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This paper proposes a model of demand for medical care under uncertainty and incorporates an insurance contract with a constant coinsurance rate. Health capital and wealth are modelled as Wiener processes. A theoretical relationship between the coinsurance rate elasticity of the demand for medical care and the coinsurance elasticities of health and wealth is established. Direction and magnitude of change in demand for medical care are shown to depend on the degree of the relative risk aversion with respect to health. Coinsurance rate elasticities of consumption and leisure have also been obtained.; no

Health System Impact Assessment and the High Level Group on Health Services and Medical Care

Albuquerque, José Maria; Miguel, José Pereira
Fonte: Instituto Nacional de Saúde Doutor Ricardo Jorge Publicador: Instituto Nacional de Saúde Doutor Ricardo Jorge
Tipo: Conferência ou Objeto de Conferência
Publicado em 18/12/2007 ENG
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Agenda EU Ministerial Conference (draft) disponível em: http://www.salute.gov.it/imgs/C_17_primopianoNuovo_18_documenti_itemDocumenti_1_fileDocumento.pdf; The High Level Group on Health Services and Medical Care was established by lhe European Commission in 2004 to endorse and implement the recommendations issued from lhe Patient Mobility reflection process. Amongsl lhese, arose lhe need lo develop and explore an assessment on social grounds (along lhe economic and lhe environmental) were lhe impact of non-health EU policies on health systems effectiveness should be delailed. In this paper we review the mandate and role of lhe High Levei Group in putting forward a mechanism specifically addressing Heallh Systems (HS), within the integrated impact assessment current methodology. The proposed model (and assessment tool) is presented and discussed along the key function elements, priorities and objectives of HS in formulating and implemenling EU legislative initiatives and policies.; European Commission/ D.G. SANCO; WHO /Regional Office for Europe

Diabetes Self-management Behaviors, Medical Care, Glycemic Control, and Self-rated Health in US Men by Race/Ethnicity

Vaccaro, Joan A.; Anderson, Kelitha; Huffman, Fatma G.
Fonte: FIU Digital Commons Publicador: FIU Digital Commons
Tipo: Artigo de Revista Científica Formato: application/pdf
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Men, particularly minorities, have higher rates of diabetes as compared with their counterparts. Ongoing diabetes self-management education and support by specialists are essential components to prevent the risk of complications such as kidney disease, cardiovascular diseases, and neurological impairments. Diabetes self-management behaviors, in particular, as diet and physical activity, have been associated with glycemic control in the literature. Recommended medical care for diabetes may differ by race/ethnicity. This study examined data from the National Health and Nutrition Examination Surveys, 2007 to 2010 for men with diabetes (N = 646) from four racial/ethnic groups: Mexican Americans, other Hispanics, non-Hispanic Blacks, and non-Hispanic Whites. Men with adequate dietary fiber intake had higher odds of glycemic control (odds ratio = 4.31, confidence interval [1.82, 10.20]), independent of race/ethnicity. There were racial/ethnic differences in reporting seeing a diabetes specialist. Non-Hispanic Blacks had the highest odds of reporting ever seeing a diabetes specialist (84.9%) followed by White non-Hispanics (74.7%), whereas Hispanics reported the lowest proportions (55.2% Mexican Americans and 62.1% other Hispanics). Men seeing a diabetes specialist had the lowest odds of glycemic control (odds ratio = 0.54...

Diabetes Self-management Behaviors, Medical Care, Glycemic Control, and Self-rated Health in US Men by Race/Ethnicity

Vaccaro, Joan A.; Anderson, Kelitha; Huffman, Fatma G.
Fonte: SelectedWorks Publicador: SelectedWorks
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
65.92%
Men, particularly minorities, have higher rates of diabetes as compared with their counterparts. Ongoing diabetes self-management education and support by specialists are essential components to prevent the risk of complications such as kidney disease, cardiovascular diseases, and neurological impairments. Diabetes self-management behaviors, in particular, as diet and physical activity, have been associated with glycemic control in the literature. Recommended medical care for diabetes may differ by race/ethnicity. This study examined data from the National Health and Nutrition Examination Surveys, 2007 to 2010 for men with diabetes (N = 646) from four racial/ethnic groups: Mexican Americans, other Hispanics, non-Hispanic Blacks, and non-Hispanic Whites. Men with adequate dietary fiber intake had higher odds of glycemic control (odds ratio = 4.31, confidence interval [1.82, 10.20]), independent of race/ethnicity. There were racial/ethnic differences in reporting seeing a diabetes specialist. Non-Hispanic Blacks had the highest odds of reporting ever seeing a diabetes specialist (84.9%) followed by White non-Hispanics (74.7%), whereas Hispanics reported the lowest proportions (55.2% Mexican Americans and 62.1% other Hispanics). Men seeing a diabetes specialist had the lowest odds of glycemic control (odds ratio = 0.54...

Improving Health and Health Care in Belarus : Belarus Health Policy Note

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Pre-2003 Economic or Sector Report; Economic & Sector Work
ENGLISH; EN_US
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The document reviews the health system in Belarus, inherited from the Soviet era, where health care services includes good health indicators relative to its average income levels, a strong commitment to providing equitable access to health care, and well trained medical doctors. However, there is an overall dissatisfaction with the health system's performance, namely a deteriorated health status, declining birth rates, and increased death rates. There is inadequate prevention, and treatment of cardiovascular disease, including that for renewed epidemics of communicable diseases, i.e., tuberculosis, HIV/AIDS, and sexually transmitted infections, and, further concerns include the inappropriate allocation of the percentage of GDP to health care. Such performance arise from the absence of clinical protocols, and treatment methods which do not reflect effective approaches to medical care and disease prevention; from an unbalanced health care delivery; inadequate health facilities, and management systems; and, the inefficient allocation of health resources. A sustained...

Strained Mercy: The Quality of Medical Care in Delhi

Das, Jishnu; Hammer, Jeffrey S.
Fonte: World Bank, Washington, D.C. Publicador: World Bank, Washington, D.C.
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
ENGLISH; EN_US
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The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. The authors address this gap through a survey in Delhi with two related components. They evaluate "competence" (what providers know) through vignettes and practice (what providers do) through direct clinical observation. Overall quality as measured by the competence necessary to recognize and handle common and dangerous conditions is quite low, albeit with tremendous variation. While there is some correlation with simple observed characteristics, there is still an enormous amount of variation within such categories. Further, even when providers know what to do they often do not do it in practice. This appears to be true in both the public and private sectors though for very different...

Building on Values: Report of the Commission on the Future of Health Care in Canada [Reports]

Commission on the Future of Health Care in Canada; Romanow, Roy
Fonte: Saskatoon: Commission on the Future of Health Care in Canada Publicador: Saskatoon: Commission on the Future of Health Care in Canada
EN
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65.84%
In April 2001, the Prime Minister established the Commission on the Future of Health Care in Canada. The mandate of the Commission was to review medicare, engage Canadians in a national dialogue on its future, and make recommendations to enhance the system's quality and sustainability.; Paper copy - CA1 Z1 2001F0 Stauffer Library - Documents

Building on Values: Report of the Commission on the Future of Health Care in Canada [Discussion Papers]

Commission on the Future of Health Care in Canada; Romanow, Roy
Fonte: Saskatoon: Commission on the Future of Health Care in Canada Publicador: Saskatoon: Commission on the Future of Health Care in Canada
EN
Relevância na Pesquisa
65.84%
In April 2001, the Prime Minister established the Commission on the Future of Health Care in Canada. The mandate of the Commission was to review medicare, engage Canadians in a national dialogue on its future, and make recommendations to enhance the system's quality and sustainability.; Paper copy - CA1 Z1 2001F0 Stauffer Library - Documents

Estudio de la cultura organizacional dentro de Fresenius Medical Care en la ciudad de Bogotá

González Muñoz, Giovanna Marcela; Forero Triviño, Diego Fernando; Ricardo Bray, Rafael Guillermo, dir.
Fonte: Universidade La Sabana Publicador: Universidade La Sabana
Tipo: Tese de Doutorado
ES
Relevância na Pesquisa
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Este proyecto analiza cada una de las variables pertinentes a la cultura organizacional dentro de Fresenius Medical Care en la ciudad de Bogotá, basándose en el modelo Deninson Organizational Culture Survey (DOCS), como herramienta de recolección y análisis con el fin de generar con cada una de las variables del modelo un rasgo crítico de la cultura que conllevaron a realizar propuestas de mejoramiento del desempeño dentro de la organización. La medición de los doce índices evaluó el comportamiento específico, una vez los datos fueron recolectados y se obtuvieron los promedios por características culturales, índices e indicadores de desempeño en las áreas de finanzas, ventas, participación de mercado, innovación calidad de productos, servicios y satisfacción de empleados.

Acute medical assessment units: an efficient alternative to in-hospital acute medical care

Watts, M; Powys, L; O'Hora, C; Kinsella, Stephen; Saunders, Jean; Reid, Louise; Finucane, Paul
Fonte: Irish Medical Organization Publicador: Irish Medical Organization
Tipo: info:eu-repo/semantics/article; all_ul_research; ul_published_reviewed
ENG
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peer-reviewed; Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs) for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the â coal faceâ of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.; PUBLISHED; peer-reviewed

Optimal Regulation of Specialized Medical Care in a Mixed System

Porteiro, Nicolás
Fonte: Conselho Superior de Investigações Científicas Publicador: Conselho Superior de Investigações Científicas
Tipo: Documento de trabajo
ENG
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We study the optimal public intervention in setting minimum standards of formation for specialized medical care. The abilities the physicians obtain by means of their training allow them to improve their performance as providers of cure and earn some monopoly rents.. Our aim is to characterize the most efficient regulation in this field taking into account different regulatory frameworks. We find that the existing situation in some countries, in which the amount of specialization is controlled, and the costs of this process of specialization are publicly financed, can be supported as the best possible intervention.; Financial support from the Generalitat de Catalunya (grant 1998FI 00020) and from the Spanish Ministry of Education (project DGES PB 97-0181) is gratefully acknowledged.

Medical-care costs associated with posttraumatic stress disorder in Vietnam veterans

Marshall, R; Jorm, Anthony F; Grayson, David A; O'Toole, B
Fonte: SAGE Publications Publicador: SAGE Publications
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
66.03%
Objective. This study examined the relationship between medical-care costs of Vietnam veterans and predictor factors, including posttraumatic stress disorder (PTSD). Method. We merged medical-care cost data from the Department of Veterans' Affairs and the Health Insurance Commission with data from an epidemiological study of 641 Australian Vietnam veterans. Posttraumatic stress disorder and other factors were examined as predictors of medical-care cost using regression analysis. Results. We found that a diagnosis of PTSD was associated with medical costs 60% higher than average. Those costs appeared to be partly associated with higher treatment costs for physical conditions in those with PTSD and also related mental health comorbidities. Major predictors of medical-care cost were age ($137 per year for each 5-year increase in age) and number of diagnoses reported ($81 to $112 per year for each diagnosis). Mental health factors such as depression ($14 per year for each symptom reported) and anxiety ($27 per year for each symptom reported) were also important predictors. Conclusions. The findings indicate that, however they are incurred, high health-care and, presumably, also economic and personal costs are associated with PTSD. There is an important social obligation as well as substantial economic reasons to deal with these problems. From both perspectives...

Situação da rêde pública de assistência médico-sanitária na área metropolitana da Grande São Paulo; Situation of the public health medical care at the "Great São Paulo" metropolitan area, Brazil

Yunes, João; Bromberg, Rosa
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Artigo Avaliado pelos Pares Formato: application/pdf
Publicado em 01/12/1971 POR
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65.92%
A situação da rêde pública de Assistência Médico-Sanitária é analisada para a área metropolitana da Grande São Paulo, constituída por 37 municípios, com uma população de 8 milhões de habitantes. Existe para a área uma unidade sanitária do tipo Centro ou Sub-Centro de Saúde para cada 101.025 habitantes. Não há uma proporção homogênea entre o tamanho da população e o número de unidades sanitárias, pois existem sub-regiões que apresentam desde 22.000 até 136.142 habitantes por Pôsto de Saúde. O número de postos de assistência materno-infantil é de 232, havendo uma unidade para cada 34.400 habitantes, variando esta proporção por sub-região desde 2.444 até 73.500 habitantes por Pôsto. Há um dispensário de tuberculose para cada 380.048 habitantes. A sub-região Norte, com 67.000 habitantes, não conta com nenhum dispensário de tuberculose. Quanto ao Dispensário de Dermatologia Sanitária a proporção de habitantes por unidade é de 570.071. As sub-regiões Norte e Sudoeste, com 155.000 habitantes, não possuem nenhum dispensário de dermatologia sanitária. Observa-se a inexistência de critérios locacionais para as Unidades Sanitárias, a par do déficit quantitativo e qualitativo do atendimento. Foram apontados...

Situação da rêde pública de assistência médico-sanitária na área metropolitana da Grande São Paulo; Situation of the public health medical care at the "Great São Paulo" metropolitan area, Brazil

Yunes, João; Bromberg, Rosa
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/02/2006 POR
Relevância na Pesquisa
65.92%
A situação da rêde pública de Assistência Médico-Sanitária é analisada para a área metropolitana da Grande São Paulo, constituída por 37 municípios, com uma população de 8 milhões de habitantes. Existe para a área uma unidade sanitária do tipo Centro ou Sub-Centro de Saúde para cada 101.025 habitantes. Não há uma proporção homogênea entre o tamanho da população e o número de unidades sanitárias, pois existem sub-regiões que apresentam desde 22.000 até 136.142 habitantes por Pôsto de Saúde. O número de postos de assistência materno-infantil é de 232, havendo uma unidade para cada 34.400 habitantes, variando esta proporção por sub-região desde 2.444 até 73.500 habitantes por Pôsto. Há um dispensário de tuberculose para cada 380.048 habitantes. A sub-região Norte, com 67.000 habitantes, não conta com nenhum dispensário de tuberculose. Quanto ao Dispensário de Dermatologia Sanitária a proporção de habitantes por unidade é de 570.071. As sub-regiões Norte e Sudoeste, com 155.000 habitantes, não possuem nenhum dispensário de dermatologia sanitária. Observa-se a inexistência de critérios locacionais para as Unidades Sanitárias, a par do déficit quantitativo e qualitativo do atendimento. Foram apontados...

Situação da assistência médico-sanitária e hospitalar no Estado do Ceará, Brasil; Medical care situation in the State of Ceara, Brazil

Yunes, João
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Artigo Avaliado pelos Pares Formato: application/pdf
Publicado em 01/06/1973 POR
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Foi examinada a situação da assistência médico-sanitária e hospitalar no Estado do Ceará (Brasil), através da análise da oferta dos serviços oficiais de saúde pública, da assistência hospitalar e para-hospitalar, bem como dos recursos humanos existentes. Este Estado conta com 141 municípios e com uma população aproximada de 4.000.000 de habitantes. Os serviços oficiais de Saúde Pública são de responsabilidade do poder público Estadual em 59,6% das unidades sanitárias, o poder público Federal participa em 26,9% e o Municipal em 13,5%. O padrão quantitativo observado foi considerado satisfatório, pois encontrou-se em média uma unidade sanitária para cada 23.002 habitantes, aproximando-se do recomendado de um para cada 50.000 habitantes. A avaliação qualitativa, medida indiretamente através dos recursos laboratoriais e humanos existentes, apresentou-se deficitária uma vez que somente 16,7% das unidades sanitárias contam com laboratório e 12,3% não possuem médico, sendo que 21,7% (39) dos centros de saúde encontram-se fechados por carência deste tipo de profissional. Dos 141 municípios que compõem o Estado, 31 (22,4%) não possuem unidade sanitária e 25 (17,71%) não contam com nenhum recurso de saúde. No primeiro caso a população teoricamente descoberta de assistência médica é de 378.449 habitantes e no segundo é de 232.900 habitantes. Dos 103 hospitais existentes no Estado 77...

Procura de serviço médico por mulheres climatéricas brasileiras; Climacteric women seeking medical care, Brazil

Pedro, Adriana Orcesi; Pinto-Neto, Aarão Mendes; Costa-Paiva, Lúcia; Osis, Maria José; Hardy, Ellen
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/.pdf
Publicado em 01/08/2002 POR
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OBJETIVO: Identificar as causas e os fatores relacionados à procura de serviço médico por mulheres climatéricas. MÉTODOS: Realizou-se estudo descritivo e exploratório de corte transversal, de base populacional. Selecionaram-se, por meio de amostragem por conglomerado, 456 mulheres residentes no município de Campinas, SP, na faixa etária entre 45 e 60 anos de idade. Os dados sobre os motivos de procura dos serviços médicos foram coletados por meio de entrevistas domiciliares, com questionário estruturado e pré-testado. A análise dos dados foi realizada pelo teste qui-quadrado, pelo coeficiente de Cramer e pela análise de regressão linear múltipla. RESULTADOS: Aproximadamente 80% das mulheres climatéricas procuraram atenção médica por causa da irregularidade menstrual e dos sintomas climatéricos. Mulheres com companheiro, em terapia de reposição hormonal e com maior intensidade dos sintomas psicológicos foram as que mais procuraram atenção médica. A principal razão para a não-procura foi a mulher considerar que a queixa não merecia atenção médica. CONCLUSÕES: A procura de serviço médico por queixas relacionadas ao climatério foi alta, porém um porcentual significativo de mulheres não procurou atenção médica por considerar a sintomatologia natural.; OBJECTIVE: To study the causes and factors associated with climacteric women seeking medical care. METHODS: A descriptive exploratory cross-sectional population-based study was carried out. Subjects were 456 women aged 45 to 60 years resident in a metropolitan area of Southeastern...