Made available in DSpace on 2014-08-20T13:58:01Z (GMT). No. of bitstreams: 1 RODRIGO_PEREIRA_DUQUIA_tese.pdf: 673344 bytes, checksum: ae25f96b35c9d6357bf3d184433ebb25 (MD5) Previous issue date: 2006-10-26 / Background: Sunscreen use is important for the prevention of skin cancer, but population-based information about the prevalence and its associated factors are scarce in Brazil. Objective: To evaluate the prevalence and associated factors with sunscreen use among Brazilian adults. Methods: We conducted a cross-sectional population-based study with a representative sample of adults aged 20 years or older living in the urban area of the city of Pelotas, Southern Brazil. We evaluated sunscreen use at the beach, at work, and during outdoor sports, for at least 20 minutes between 10 a.m. and 4 p.m., from December 2004 to March 2005. The outcome measure was dichotomized in subjects who never used sunscreen, and those who used sunscreen, regardless of frequency. Results: Prevalence of sunscreen use at the beach, work, and outdoor sports was 60.8% (CI95% 55.6 - 66.0), 13.7% (CI95% 10.7 - 16.6%), and 30.2% (CI95% 24.1 - 36.3), respectively. At work, the median number of days of exposure was 70 days, while at the beach it was 10 and, for sport it was 16. Females, whites, those with higher educational achievement, and with higher income were more likely to use sunscreen. Limitations: No data on adequacy of sunscreen use was gathered Conclusion: Our data show that the subjects most exposed to sunlight are those that use sunscreen the least. Interventions targeting this group are required, since this is also the population with the lowest socioeconomic level. / Diversos estudos já comprovaram que ficar exposto ao sol acarreta prejuízos para a pele. Pessoas que se protegem do sol têm menor chance de desenvolver câncer de pele. Além disso, a proteção contra os raios solares retarda o aparecimento de rugas e manchas, preservando, desta forma, a pele das pessoas. Apesar deste conhecimento, muitas pessoas preferem expor-se ao sol para ficarem bronzeadas ao invés da preservação de uma pele jovem e saudável. Este assunto tem despertado o interesse de diversos pesquisadores na área da saúde. O médico dermatologista Rodrigo Pereira Duquia realizou uma pesquisa com adultos da cidade de Pelotas para avaliar o comportamento da população com relação à utilização de fotoprotetores (creme protetor solar) durante o verão. O trabalho foi realizado durante os meses de outubro a dezembro de 2005, sendo entrevistadas 3136 pessoas com 20 anos ou mais de idade. Entre os achados mais importantes do estudo destaca-se que 23% dos entrevistados trabalhavam em média 65 dias no verão expostos ao sol, no período das 10:00 às 16:00h, considerado o de maior risco para o desenvolvimento do câncer de pele. Mais preocupante ainda foi o achado de que apenas cerca de 14% dessas pessoas utilizavam fotoprotetor. O estudo também demonstrou que a freqüência do uso do protetor solar foi muito maior na praia. Mais campanhas são necessárias para que a população saiba os malefícios da exposição ao sol e utilize medidas preventivas, como o uso do fotoprotetor, com o objetivo de 106 diminuir as taxas de câncer de pele e retardar o envelhecimento da pele. Atenção especial deve ser dirigida aos trabalhadores expostos ao sol, já que este é o grupo que menos usa o fotoprotetor solar e que permanece maior número de dias exposto ao sol.

Abstract The primary aim of this study was to survey attention and behavioural problems among Finnish adolescents living in different family environments. The second aim was to study the psychosocial well-being of these adolescents. The third aim was to study the psychiatric comorbidity of ADHD (attention deficit hyperactivity disorder) in association with the family environment. The fourth aim was to study the persistence of ADHD from childhood to adolescence. In the first phase, 15-year-old adolescents and their parents from the Northern Finland 1986 Birth Cohort (N = 9432) completed questionnaires on attention and behavioural problems, family characteristics and the life situation of the adolescents. In the second phase, 457 adolescents aged from 16 to 18 years were drawn from the cohort. After assessment with a clinical semi-structured interview, logistic regression models were used to study ADHD and the persistence of the diagnosis and comorbid psychopathology in association with family characteristics. Girls reported more commonly than boys attention and behavioural problems, while their parents reported more attention problems in their sons than daughters. Living in other than intact families was related to attention and behavioural problems in both genders. Adolescents with ADHD symptoms considered their physical health and psychosocial well-being poor more often than their controls. Psychosocial problems accumulated for those with many ADHD symptoms. Adolescents with ADHD had more commonly than others comorbid behavioural disorder, alcohol abuse and depression. Those with ADHD and comorbidity lived more commonly than others in non-intact families, in low-income families, with mothers who were dissatisfied with life and with parents who showed little interest in their adolescent's activities. Persistence of ADHD into adolescence occurred in about two thirds of cases. Those who persisted with the diagnosis compared to those who remitted it had more dreamy-like inattentive symptoms, and had more often early-onset comorbid depression or oppositional defiant disorder and had more often fathers with attention problems. These results indicate that attention and behavioural problems are common among adolescents in Finland, especially among those living in disrupted families. Being a persistent disorder, ADHD warrants more concern in primary health care and the educational system in order to prevent the concurrent development of other psychiatric and psychosocial problems. In primary health care, family intervention is essential. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli ensiksi selvittää suomalaisten nuorten tarkkaavuuden ja käyttäytymisen ongelmia suhteessa nuoren perherakenteeseen. Toiseksi tutkittiin näiden nuorten psykososiaalista hyvinvointia. Kolmanneksi tavoitteena oli tutkia ADHD:n (tarkkaavuushäiriö) psykiatrisia liitännäissairauksia suhteessa perheympäristöön. Neljäntenä tavoitteena oli tutkia ADHD:n pysyvyyttä lapsuudesta nuoruuteen. Tutkimuksen ensimmäisessä vaiheessa Pohjois-Suomen vuoden 1986 syntymäkohorttiin kuuluvat 15-vuotiaat nuoret (N = 9 432), ja heidän vanhempansa täyttivät kyselylomakkeet. Kysymykset koskivat nuoren tarkkaavuuden ja käyttäytymisen ongelmia, perheympäristöä ja nuoren elämäntilannetta. Toisessa vaiheessa tutkittiin 457 16–18-vuotiasta kohorttiin kuuluvaa nuorta. Nuoret arvioitiin käyttäen puolistrukturoitua kliinistä haastattelua. Logistisia regressiomalleja käytettiin kuvaamaan ADHD-diagnoosia ja sen pysyvyyttä sekä psykiatrisia liitännäissairauksia suhteessa perheympäristöön. Tytöt raportoivat poikia useammin tarkkaavuuden ja käyttäytymisen ongelmista, kun taas vanhemmat raportoivat tarkkaavuuden ongelmia olevan useammin pojilla kuin tytöillä. Perhetaustaltaan muu kuin ydinperhe oli yhteydessä tarkkaavuuden ja käyttäytymisen ongelmiin sekä tytöillä että pojilla. Nuoret, joilla oli ADHD-oireita, pitivät terveyttään ja psykososiaalista hyvinvointiaan huonona useammin kuin nuoret, joilla näitä oireita ei ollut. Psykososiaaliset ongelmat kasaantuivat niillä nuorilla, joilla oli paljon ADHD-oireita. Myös käyttäytymishäiriöistä, alkoholin väärinkäytöstä ja masennuksesta kärsivät muita useammin nuoret, joilla havaittiin ADHD. Nuoret, joilla oli ADHD ja edellä mainittu liitännäissairaus, asuivat muita useammin muussa kuin ydinperheessä, alemman tulotason perheessä, äidin kanssa, joka oli tyytymätön elämäänsä tai vanhempien kanssa, jotka eivät olleet kiinnostuneet nuorensa asioista. ADHD-diagnoosi pysyi nuoruuteen noin kahdella kolmasosalla niistä, joilla se oli lapsuudessa. Niillä nuorilla, joilla diagnoosi pysyi, oli muita useammin unelmoivasta hajamielisyydestä kertovia tarkkaamattomuusoireita, varhain alkanut masennus- tai käyttäytymishäiriö tai isä, jolla oli itsellään ADHD-oireita. Nämä tulokset osoittavat, että tarkkaavuuden ja käyttäytymisen ongelmat ovat yleisiä suomalaisilla nuorilla, ja erityisesti niillä, jotka asuvat muussa kuin ydinperheessä. Koska ADHD on pysyvä häiriö, se tulee ottaa paremmin huomioon perusterveydenhuollossa ja koulumaailmassa, jotta voitaisiin ehkäistä muita psykiatrisia ja psykososiaalisia ongelmia. Perusterveydenhuollossa erityisesti perheinterventiot ovat tärkeitä.

INTRODUÇÃO: Sequelas de queimaduras na morfologia e mobilidade das estruturas motoras orais e nas funções orofaciais como mastigação, deglutição e fala não são incomuns em pacientes que sofreram queimaduras graves na região de cabeça e pescoço. O objetivo deste estudo foi analisar as características dos movimentos motores orais e da mímica facial em pacientes com queimaduras de cabeça e pescoço. MÉTODOS: Estudo transversal descritivo observacional, realizado com pacientes que sofreram queimaduras na cabeça e pescoço e que foram encaminhados para a Divisão de Funções da Face - Queimados de um hospital público brasileiro, entre janeiro de 2013 e dezembro de 2013, para avaliação e reabilitação. Somente pacientes com queimaduras de segundo grau (superficial e profunda) e queimaduras de terceiro grau em face e pescoço foram incluídos no estudo. Os pacientes foram submetidos à avaliação clínica, que incluiu: avaliação motora oral (postura, posição e mobilidade dos órgãos motoras orais e desempenho durante a mastigação e deglutição); avaliação da amplitude mandibular; avaliação da mímica facial. Para fins de caracterização, os pacientes foram divididos em dois grupos: G1 - pacientes com queimaduras de segundo grau superficial; G2 - pacientes com queimaduras de segundo grau profunda e terceiro grau. RESULTADOS: A amostra final do estudo foi composta por 40 pacientes: G1 com 19 indivíduos e G2 com 21 indivíduos. A análise estatística indicou que as contraturas e cicatrizes hipertróficas tem impacto negativo sobre o sistema miofuncional orofacial. A pontuação global obtida para avaliação clínica dos órgãos motores orofaciais indicou que tanto os pacientes de segundo grau como de terceiro grau apresentaram déficits relacionados à postura, posição e mobilidade dos órgãos motores orofaciais. Considerando a mímica facial, os grupos diferiram significativamente ao realizar movimentos faciais voluntários. Os pacientes também apresentaram limitação na medida de abertura oral máxima. Os déficits foram maiores para os indivíduos do G2 em todas as avaliações. CONCLUSÃO: Pacientes com queimaduras de cabeça e pescoço apresentam déficits significativos relacionados à postura, posição e mobilidade das estruturas miofuncionais orais, incluindo os movimentos da mímica facial. Estes pacientes devem ser considerados de risco para o desenvolvimento de futuras desordens temporomandibulares / INTRODUCTION: Burn sequelae on oral motor structures morphology, mobility and functions such as mastication, swallowing and speech are not uncommon in patients who suffered severe burns to the head and neck. The purpose of this study was to analyze the characteristics of the oral-motor movements and facial mimic in patients with head and neck burns. METHODS: An observational descriptive cross-sectional study was conducted with patients who suffered burns to the head and neck and who were referred to the Division of Orofacial Myology of a Brazilian public hospital, between January 2013 and December 2013, for assessment and rehabilitation. Only patients presenting second (i.e. superficial and deep) and third degree burns to areas of the face and neck were included in the study. Patients underwent clinical assessment that included: an oral motor evaluation (i.e. posture, position and mobility of the oral motor organs and performance during mastication and swallowing); assessment of the mandibular range of movement; assessment of the facial mimic. For characterization purposes, patients were divided into two groups: G1 - patients with superficial second degree burns; G2 - patients with deep second and third degree burns. RESULTS: Our final study sample was composed by 40 patients: G1 with 19 individuals and G2 with 21 individuals. Statistical analyzes indicated that contractures and hypertrophic scars have a negative impact on the oral myofunctional system. The overall scores obtained in the clinical assessment of the oral motor organs indicated that both second and third degree patients presented deficits related to posture, position and mobility of the oral motor organs. Considering facial mimic, groups differed significantly when performing voluntary facial movements. Patients also presented limited maximal incisor opening. Deficits were greater for individuals in G2 in all assessments. CONCLUSION: Patients with head and neck burns present significant deficits related to posture, position and mobility of the oral myofunctional structures, including facial movements. These patients should be considered at risk for developing future temporomandibular disorders

Realizamos este estudo com o objetivo de analisar as principais variáveis clínicas dos pacientes que sofreram parada cardiorrespiratória e detectar fatores prognósticos de sobrevivência a curto e longo prazos, tentando oferecer subsídios aos profissionais de saúde que estão envolvidos com reanimação. Analisamos prospectivamente 452 pacientes que receberam reanimação em hospitais gerais de Salvador. Utilizou-se análise bivariada e estratificada nas associações entre as variáveis e a curva de sobrevida para análise de nove anos de evolução. Observamos 24% de sobrevida imediata e 5% de sobrevida à alta hospitalar. Os fatores prognósticos de sobrevida imediata foram: ter doença de base, a enfermidade cardiovascular, diagnosticar o ritmo cardíaco , ritmo de fibrilação ou taquicardia ventricular, tempo estimado pré-reanimação menor ou igual a cinco minutos; tempo de reanimação menor ou igual a 15 minutos. As variáveis prognósticas sobrevida a longo prazo foram: não usar adrenalina; ser reanimado em hospital privado;tempo de reanimação menor ou igual a 15 minutos / The objectives of this study are to analyze the main clinical and demographic characteristics of patients who suffer cardiac arrest and identify variables involved in survival outcomes. The study enrolled 452 patients, which received cardiopulmonary resuscitation in general hospitals. We prospectively analyzed the main variables associated with ROSC and survival to hospital discharge utilizing bivariate and stratified. The Kaplan-Meier technique was used to analyze the survival curves after nine years. Of the 452 resuscitation attempts, 107 (24%) patients had ROSC and only 22 (5%) were discharge from hospital. The variables with greatest prognostic value for immediate survival were: having a co-morbid condition, cardiovascular disease as the etiology, determination of cardiac rhythm, ventricular arrhythmia as rhythm of arrest, estimated pre-resuscitation time less than or equal to 5 minutes and the resuscitation effort duration less than or equal to 15 minutes. The variables associated with better long term survival were: not using adrenaline, being resuscitated in a private hospital and resuscitation efforts lasting less than or equal to 15 minutes

We sought to examine the concordance of two suicidal ideation items from the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS), to evaluate the prevalence of suicidal ideation among pregnant women, and to assess the co-occurrence of suicidal ideation with antepartum depressive symptoms. A cross-sectional study was conducted among 1,517 pregnant women attending prenatal care clinics in Lima, Peru. Item 9 of the PHQ-9 assesses suicidal ideation over the last 14 days while item 10 of the EPDS assesses suicidal ideation in the past 7 days. The two suicidal ideation items have a high concordance rate (84.2 %) but a moderate agreement (the Cohen's kappa = 0.42). Based on the PHQ-9 and the EPDS, 15.8 and 8.8 % of participants screened positive for suicidal ideation, respectively. Assessed by the PHQ-9, 51 % of participants with suicidal ideation had probable depression. In prenatal care clinics, screening for suicidal ideation is needed for women with and without depressive symptoms. Future studies are needed to identify additional predictors of antepartum suicidality, determine the appropriate duration of reporting period for suicidal ideation screening, and assess the percentage of individuals with positive responses to the two suicidal ideation items at high risk of planning and attempting suicide. / This research was supported by an award from the National Institutes of Health (NIH), the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835). The NIH had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The authors wish to thank the dedicated staff members of Asociacion Civil Proyectos en Salud (PROESA), Peru and Instituto Especializado Materno Perinatal, Peru for their expert technical assistance with this research. The authors would like to thank Kathy Brenner for her help with revising this manuscript. / Revisión por pares

Bakgrund: Icke-heterosexuella ungdomar har ökad risk att drabbas av psykisk ohälsa. Forskning om icke-heterosexuella ungdomars psykiska hälsa i svensk kontext är dock begränsad. Syftet med denna studie var att undersöka sambandet mellan sexuell läggning och psykisk ohälsa respektive psykiskt välbefinnande bland ungdomar på Gotland.  Metod: Tvärsnittsstudiedesign med befolkningsenkäten Liv och Hälsa Ung i Region Gotland användes. Psykisk ohälsa mättes med Strenghts and Difficulties Questionnaire (SDQ). Psykiskt välbefinnande mättes med Mental Health Continuum Short Form (MHC-SF). Chi2-tester, t-tester och logistiska regressioner användes för att analysera data.  Resultat: Jämfört med heterosexuella ungdomar hade icke-heterosexuella ungdomar signifikant högre odds för både psykisk ohälsa och nedsatt psykiskt välbefinnande i ojusterade regressioner. Dessa samband var dock inte signifikanta i justerade regressioner. Däremot påvisades högre odds för psykisk ohälsa respektive nedsatt psykiskt välbefinnande bland tjejer, ungdomar med hög stressnivå, ungdomar som kände sig ensamma eller som inte hade någon att prata med. Risken för nedsatt psykiskt välbefinnande minskade även med bättre upplevd familjeekonomi och ökad social status i skolan.  Slutsats: De justerade resultaten påvisade inga signifikanta samband mellan sexuell läggning och psykisk ohälsa respektive psykiskt välbefinnande bland ungdomar på Gotland. Sexuell läggning kunde därmed inte direkt associeras med en ökad risk för psykisk ohälsa respektive nedsatt psykiskt välbefinnande. Signifikanta samband påvisades mellan stress, ensamhet och att inte ha någon att prata med och psykisk ohälsa samt nedsatt psykiskt välbefinnande. Inkluderingsinsatser och riktade stödjande insatser kan möjligen minska upplevelsen av stress, ensamhet och utanförskap. Studien visade också hög förekomst av nedsatt psykiskt välbefinnande i hela studiepopulationen. Breda åtgärder för att stärka ungdomars psykiska välbefinnande, såsom insatser i skolan, skulle kunna förbättra hälsan för många ungdomar, inklusive de med icke-heterosexuell läggning. / Background: Non-heterosexual adolescents are at higher risk of mental health problems than heterosexual adolescents. Research on the mental health among non-heterosexual adolescents in the Swedish context is limited. The purpose of this study was to investigate the relationship between sexual orientation and mental health problems and mental well-being in adolescents on Gotland.  Method: A cross-sectional design including the population survey Life and Health Youth in Region Gotland was utilized. The survey included the Strengths and Difficulties Questionnaire (SDQ) for assessing mental health problems, and the Mental Health Continuum Short Form (MHC-SF) for assessing mental well-being. Chi2 tests, t-tests and logistic regressions were used to analyze the data.  Results: In unadjusted regressions, non-heterosexual adolescents had significantly higher odds for both mental health problems and decreased mental well-being compared to heterosexual adolescents. These associations were no longer significant in adjusted regressions. Significantly higher odds for mental health problems and decreased mental well-being was demonstrated in girls, adolescents with high levels of stress, and adolescents who felt lonely or who had no one to talk to. The risk of decreased mental well-being was also reduced with better perceived family finances and increased social status at school.  Conclusion: Adjusted regressions showed no significant associations between sexual orientation and mental health problems or mental well-being among adolescents on Gotland. Therefore, sexual orientation could not be directly associated with an increased risk of mental health problems or decreased mental well-being. The results showed significant associations between stress, loneliness and not having anyone to talk to and mental health problems and decreased mental well-being. Inclusive interventions and targeted support efforts could possibly reduce the experience of stress, loneliness and exclusion. The study also showed a high prevalence of decreased mental well-being in the entire study population. Interventions to strengthen adolescents’ well-being, e.g. school-based interventions, could improve the health of adolescents, including those with a non-heterosexual orientation.

Although the problem of patients with dual diagnoses is not new, it has only been in the last few years that their unique and complex problems have begun to be addressed. This recognition coincides with society's concern regarding the magnitude of substance abuse problems in general. Currently, treatment consists of integrating concepts from substance abuse and mental health fields. This integration may improve the therapeutic outcome for these patients. As more experience is gained in this specialty, it is hoped that new treatment concepts will evolve that will more powerfully address the interactive aspect of substance abuse and psychiatric disorders.

No / PURPOSE: To examine foveal structure in amblyopia using spectral-domain optical coherence tomography (SD-OCT). DESIGN: Prospective, cross-sectional study. PARTICIPANTS AND CONTROLS: Two subject groups were recruited to the study: 85 amblyopes (34 adults, 51 children) and 110 visually normal controls (44 adults, 66 children). METHODS: A detailed eye examination, including an SD-OCT scan, was performed in all participants. A total of 390 eyes of 195 subjects were imaged using a 3-dimensional (3D) macula scan covering a nominal 6 x 6-mm area with a resolution of 256 x 256 (65,536 axial scans). Data from the B-scans bisecting the fovea both horizontally and vertically were fitted with a mathematical model of the fovea to determine a range of foveal parameters. MAIN OUTCOME MEASURES: Foveal thickness, foveal pit depth, and foveal pit slope. RESULTS: Bilateral differences between the eyes of amblyopes compared with visually normal controls were found. The difference between foveal structure in amblyopic participants relative to structure in subjects with normal vision persisted even when variables such as age, ethnicity, axial length, and sex were taken into account. Amblyopes showed increased foveal thickness (+8.31 mum; P = 0.006) and a reduction in pit depth in the horizontal meridian (-10.06 mum; P = 0.005) but not in the vertical meridian (P = 0.082) when compared with subjects with normal vision. Foveal pit slopes were found to be approximately 1 degree flatter in the nasal (P = 0.033) and temporal (P = 0.014) meridians in amblyopes, but differences between amblyopes and controls in the superior (P = 0.061) and inferior (P = 0.087) meridians did not reach statistical significance. No statistically significant interocular differences were found in the foveal structure between amblyopic and fellow eyes. CONCLUSIONS: Differences were found in the foveal structure in both eyes of amblyopes compared with subjects with normal vision. These differences consisted of increased foveal thickness, reduced pit depth when measured along the horizontal meridian, and flattening of the nasal and temporal sides of the foveal pit.

In der Behandlung der zervikalen Dystonie wird die Therapie mit Botulinumtoxin (BTX) erfolgreich angewendet. Neben dieser Therapie werden von Patienten oft alternative Therapien (CAM [Complementary and Alternative Medicine]) angesprochen und ausprobiert. Diese Studie geht der Frage nach, wie häufig CAM-Therapien genutzt werden, wie deren Wirkung bewertet wird und ob es Prädiktoren für die Therapiewahl gibt. Zur Datenerhebung wurden 265 Fragebögen von zwei Patientengruppen ausgewertet. Gruppe 1 (n=101) bestand aus Patienten der Botulinumtoxinsprechstunde des Universitätsklinikums Leipzig und der Paracelsus Klinik Zwickau. Gruppe 2 (n=165) wurde aus Mitgliedern des Selbsthilfeverbandes Bundesverband-Torticollis e.V. rekrutiert. Bei 86% der Patienten wurde die Therapie mit BTX angewendet. Von den Therapiemöglichkeiten der CAM wurden am häufigsten physikalische Therapien (Massagen n=171) genannt. Am besten bewertet wurden jedoch, neben der BTX-Therapie, spezielle physiotherapeutische sowie psychotherapeutische Verfahren. Die CAM-Therapien wurden häufig in Kombination mit der BTX-Therapie angewendet und von Patienten, deren Erkrankung einen langen chronischen Verlauf vorwies (>10 Jahre). Als Prädiktoren für die Wahl einer CAM-Therapie zeigten sich eine Zugehörigkeit zur Gruppe 2, aufgetretene Nebenwirkungen im Rahmen der BTX-Therapie, männliches Geschlecht und erhöhter Stress bei den Erkrankten. Außerdem fand sich ein signifikanter Unterschied zu einem höheren Bildungsabschnitt und Arbeit in gehobeneren Berufsgruppen bei Patienten, die vermehrt CAM Therapie anwenden. Zusammenfassend wurden CAM-Therapien, neben der Behandlung mit BTX, häufig von den Befragten angewendet. Hohe Zufriedenheitswerte erzielte eine Kombination mit physiotherapeutischen Verfahren oder Psychotherapie. Die Wahl von CAM-Therapien ist von der Erkrankungsdauer, Bildungslage und finanziellen Ressourcen abhängig.

Introdução: A adesão à terapia antirretroviral (TARV) é essencial para o sucesso do tratamento do HIV/aids. Apesar das recomendações fornecidas para a promoção da adesão nos serviços de assistência ambulatorial ao HIV/aids do Sistema Único de Saúde (SUS), não há medidas padronizadas para o monitoramento da adesão nos serviços e há pouca informação disponível sobre as atividades de adesão efetivamente realizadas. Este estudo teve como objetivos: descrever medidas nacionais de adesão à TARV e atividades de adesão conduzidas nos serviços de HIV/aids do SUS; investigar relações entre adesão e características dos serviços. Métodos: Entre 2009 e 2011, conduziu-se um estudo transversal da adesão à TARV em amostra nacional de pacientes em tratamento em serviços do SUS. Foram sorteados para participar do estudo: 1) serviços de diferentes níveis de qualidade (segundo avaliação nacional prévia da organização da assistência ao HIV/aids), localizados nas diferentes regiões do país; 2) pacientes sob TARV em acompanhamento nos serviços selecionados, maiores de 18 anos, não gestantes. Para medir a adesão à TARV, utilizou-se o Questionário WebAd-Q, instrumento de autorrelato em linguagem \"Web\", previamente validado, que aborda três dimensões da adesão: medicamentos, dose (número de comprimidos) e horários de tomada. As respostas foram ponderadas de acordo com a probabilidade de seleção amostral dos pacientes. Características dos serviços foram obtidas com base em dois instrumentos autorrespondidos pelos gerentes e equipes de saúde: 1) o Questionário Qualiaids, voltado para a avaliação geral da qualidade organizacional da assistência ao HIV/aids; 2) o Questionário de Atividades de Adesão, que enfoca aspectos especificamente voltados para a promoção da adesão. Outras características dos serviços analisadas foram: região geográfica, porte do serviço (número de pacientes em TARV) e porte do município (número de habitantes). O desempenho dos serviços em relação às atividades de adesão realizadas foi avaliado segundo cinco domínios: monitoramento; investigação da adesão; cuidado multidisciplinar; atividades de grupo e para populações específicas; capacitação e atualização dos profissionais. Associações entre medidas de adesão e características dos serviços foram testadas em modelos de regressão logística (IC 95%, p < 0,05). Associações entre atividades de adesão e demais características dos serviços também foram investigadas. Resultados: De um total de 2.424 participantes, acompanhados em 55 serviços, 61,1% (IC 95% 58,5-63,7) reportaram não adesão a uma ou mais das dimensões analisadas. A dimensão com maior proporção de não adesão foi o horário (50,9%). Os serviços apresentaram desempenho geral mediano em relação às atividades de adesão. Serviços de boa qualidade organizacional e de pequeno porte associaram-se ao melhor desempenho e/ou à realização de atividades específicas. Ao contrário do esperado, houve predomínio de associações inversas da adesão com a qualidade, a complexidade assistencial (segundo o porte) e a realização de atividades de adesão. Discussão: O estudo indicou a necessidade de ações para aprimorar o trabalho em adesão realizado nos serviços, incluindo: promoção da adesão ao horário; priorização de pessoas com dificuldades de adesão e de populações que requerem intervenções específicas; padronização do monitoramento; maior investimento no gerenciamento técnico, no enfoque multidisciplinar, em atividades específicas de apoio à adesão, e em parcerias com a sociedade civil organizada. A exploração de novos modelos de análise em futuros estudos deverá contribuir para a melhor compreensão das relações entre adesão e características dos serviços / Background: Adherence to antiretroviral therapy (ART) is crucial for HIV/AIDS treatment success. In spite of recommendations provided for adherence promotion in HIV outpatient care facilities of the Brazilian Unified Health System (Sistema Único de Saúde - SUS), there are no standard measures for adherence monitoring in the facilities and there is little information available about adherence strategies actually implemented. This study aimed at: describing national ART adherence measures and adherence strategies conducted in public HIV care facilities; investigating relationships between adherence and care site characteristics. Methods: Between 2009 and 2011, a cross-sectional study of ART adherence was conducted with a national sample of patients treated in public health care facilities. Randomly selected study participants were: 1) care sites of different quality levels (according to a previous national evaluation of HIV care organization), located in different country regions; 2) patients receiving ART at selected sites, 18 years or older, non-pregnant. Adherence measurement was based on the WebAd-Q Questionnaire, a pre-validated web-based self-report tool that approaches three adherence dimensions: drugs, dose (number of pills) and time schedule. Answers were weighted according to patients\' probability of selection. Site characteristics were obtained based on two self-report tools answered by managers and health care teams: 1) the Qualiaids Questionnaire, which evaluates HIV care overall organizational quality; 2) the Adherence Strategies Questionnaire, which focuses on aspects specifically related to adherence promotion. Other site characteristics analyzed were: geographic region, site size (number of patients receiving ART) and municipality size (number of inhabitants). Care site performance in relation to adherence strategies was evaluated based on five domains: monitoring; adherence investigation; multidisciplinary care; group activities and strategies for special populations; professionals\' training and update. Associations between adherence measures and site characteristics were tested in logistic regression models (CI 95%, p < 0.05). Associations between adherence strategies and other site characteristics were also investigated. Results: From a total of 2,424 participants, who were receiving care at 55 facilities, 61.1% (CI 95% 58.5-63.7) reported non-adherence to one or more of the dimensions analyzed. The dimension with the largest non-adherence proportion was timing (50.9%). Overall, the facilities presented a medium performance on adherence strategies. Good organizational quality and small size were associated with better site performance and/or with conduction of specific strategies. Contrary to expectations, inverse associations of adherence with quality, care complexity (according to size) and implementation of adherence strategies were predominant. Discussion: This study indicated actions required to improve adherence work developed in the facilities, including: timing adherence promotion; prioritization of people facing adherence difficulties and populations requiring specific interventions; monitoring standardization; more efforts focusing on technical management, multidisciplinary approach, specific strategies to support adherence, and partnerships with organized civil society. The development of new analysis models in future studies should contribute to improve understanding of the relationships between adherence and care site characteristics