Alberto Lopes Najar

Programas e campanhas de promoção da atividade física

O incentivo a pratica regular da atividade fisica vem sendo apontado como importante acao na area da saude publica, o que vem ensejando iniciativas de larga abrangencia populacional, na forma de programas e campanhas em prol de estilos de vida ativos. Neste artigo, fazemos reflexoes sobre o processo de adesao a pratica regular de atividades fisicas e sobre as acoes costumeiramente adotadas nesse sentido em programas de promocao da atividade fisica (especialmente Agita Sao Paulo e Programa de Educacao e Saude atraves do Exercicio Fisico e do Esporte). Identificamos que os objetivos, estrategias e avaliacoes dos programas enfocam o aumento do nivel de atividade fisica da populacao e a ampliacao de seus conhecimentos sobre os beneficios da atividade fisica. Tendo em vista a complexidade da adesao a pratica de atividades fisicas, apontamos a necessidade de se ampliar o numero de variaveis sobre as quais devem repousar as acoes e a avaliacao dos programas. A nosso ver, alem do quantitativo de pessoas fisicamente ativas, e preciso considerar variaveis como oferta, acessibilidade e qualidade de espacos para traduzir melhor o desempenho das acoes adotadas, tornando mais consistentes a elaboracao e a avaliacao desses programas de promocao da atividade fisica de larga abrangencia populacional.

Psychometric evaluation of the SF-36 (v.2) questionnaire in a probability sample of Brazilian households: results of the survey Pesquisa Dimensões Sociais das Desigualdades (PDSD), Brazil, 2008.

BackgroundIn Brazil, despite the growing use of SF-36 in different research environments, most of the psychometric evaluation of the translated questionnaire was from studies with samples of patients. The purpose of this paper is to examine if the Brazilian version of SF-36 satisfies scaling assumptions, reliability and validity required for valid interpretation of the SF-36 summated ratings scales in the general population.Methods12,423 individuals and their spouses living in 8,048 households were selected from a stratified sample of all permanent households along the country to be interviewed using the Brazilian SF-36 (version 2). Psychometric tests were performed to evaluate the scaling assumptions based on IQOLA methodology.ResultsData quality was satisfactory with questionnaire completion rate of 100%. The ordering of the item means within scales clustered as hypothesized. All item-scale correlations exceeded the suggested criteria for reliability with success rate of 100% and low floor and ceiling effects. All scales reached the criteria for group comparison and factor analysis identified two principal components that jointly accounted for 67.5% of the total variance. Role emotional and vitality were strongly correlated with physical and mental components, respectively, while social functioning was moderately correlated with both components. Role physical and mental health scales were, respectively, the most valid measures of the physical and mental health component. In the comparisons between groups that differed by the presence or absence of depression, subjects who reported having the disease had lower mean scores in all scales and mental health scale discriminated best between the two groups. Among those healthy and with one, two or three and more chronic illness, the average scores were inverted related to the number of diseases. Body pain, general health and vitality were the most discriminating scales between healthy and diseased groups. Higher scores were associated with individuals of male sex, age below 40 years old and high schooling.ConclusionsThe Brazilian version of SF-36 performed well and the findings suggested that it is a reliable and valid measure of health related quality of life among the general population as well as a promising measure for research on health inequalities in Brazil.

Brazilian normative data for the Short Form 36 questionnaire, version 2

METHODS The study Pesquisa Dimensões Sociais das Desigualdades (PDSD) (Social Dimensions of Inequalities) involves 12,423 randomly selected Brazilian men and women aged 18 years old or more from urban and rural areas of the five Brazilian regions, and the information collected included the SF-36 as a measure of health-related quality of life. This provided a unique opportunity to develop age and gender-adjusted normative data for the Brazilian population. RESULTS Brazilian men scored substantially higher than women on all eight domains and the two summary component scales of the SF-36. Brazilians scored less than their international counterparts on almost all of SF-36 domains and both summary component scales, except on general health status (US), pain (UK) and vitality (Australia, US and Canada). CONCLUSION The differences in the SF-36 scores between age groups, genders and countries confirm that these Brazilian norms are necessary for comparative purposes. The data will be useful for assessing the health status of the general population and of patient populations, and the effect of interventions on health-related quality of life.

Índice de desenvolvimento da família: uma análise comparativa em 21 municípios do Estado do Rio de Janeiro, Brasil

This article presents an adaptation of the family development index, with a detailed description of the results of its application in 21 municipalities in the State of Rio de Janeiro, Brazil, in 2000. The research is part of the Baseline Study on the Project for Expansion and Consolidation of the Family Health Strategy and was proposed as an instrument for monitoring and analyzing the municipal reality in the context of a family-centered public policy. The results show a serious-to-severe situation for families in the State of Rio de Janeiro. The most critical dimensions relate to inequalities in results, availability of resources, and labor market access, in addition to a key aspect involving inequality of opportunities, namely access to knowledge. The most vulnerable groups consist of families headed by individuals over 65 years of age and families headed by women.

A sociologia urbana, os modelos de análise da metrópole e a saúde coletiva: uma contribuição para o caso brasileiro

A luz da antiga relacao entre a epidemiologia e o espaco geografico e dos diversos modelos de producao das cidades, apresenta-se uma sistematizacao das nocoes de espaco/territorio, a partir da decada de 1970 no Brasil. Discutem-se os principais modelos analiticos das grandes cidades brasileiras, cujas raizes conceituais encontram-se em disciplinas como a sociologia urbana, a geografia humana, a economia regional e o planejamento urbano. Sugere-se que a distribuicao de investimentos publicos guarda relacao com a estrutura social cristalizada no espaco. Procura-se ampliar as bases de um dialogo entre a literatura que apoia as analises das chamadas desigualdades socioespaciais e a saude coletiva. Apresenta-se sugestao de arcabouco para o desenvolvimento de tipologias de analise socioespacial. Considera-se que se encontram disponiveis diversas tecnicas computacionais que popularizam o emprego de variaveis passiveis de expressao espacial. No entanto, essas facilidades ressentem a falta de um aporte mais sociologico, ou humanistico.

Desigualdades sociais e gestão em saúde: metodologia de seleção de áreas urbanas visando à diminuição das desigualdades socioespaciais em regiões metropolitanas

O artigo apresenta metodologia, a qual se deu o nome de Rio 40 graus, para estudar a regiao metropolitana do Rio de Janeiro, utilizando como unidade de agregacao da informacao o setor censitario, disponibilizando o acesso a uma ferramenta coadjuvante no processo de alocacao de recursos e de gestao em saude. O objetivo e minimizar as desigualdades de natureza social, sendo de especial interesse para o espaco urbano-metropolitano. Nessa perspectiva, todas as secretarias, municipais e estaduais, que integram a area social de um governo, podem tirar proveito de tal metodologia. As tecnicas utilizadas sao: analise exploratoria de dados, geracao de indicadores basicos, analise de componentes principais e cluster. O nivel de detalhe alcancado e funcao da escala de agregacao dos dados do setor censitario. O produto final foi desenvolvido e implementado em midia eletronica (CD-ROM), contendo todas as bases de dados, permitindo a analise das mesmas segundo necessidades do usuario, com enfase especial no planejamento de acoes e programas sociais e apoio a decisao. O resultado final pode oferecer suporte a analises do espaco metropolitano, de perfis de qualidade de vida, de investimentos publicos, eleitorais, dentre outras.

A divisão social da cidade e a promoção da saúde: a importância de novas informações e níveis de decupagem

The article examines the complex relationships among the sociological concept of socio-spatial segregation, urban poverty and health promotion, suggesting research topics that could contribute to a detailed analysis of the Brazilian social reality within the public health context, underpinning decisions on healthcare. Initially, the main aspects of the social division problems in major cities are examined from the historical and sociological viewpoints. The inaccuracies and problems related to the concept of segregation are then discussed analytically, referenced to discussions of urban sociology. The importance of new information and the decoupage of other levels of social ties are also addressed, taking the problems of health promotion into account. Finally, four themes are listed that might well constitute a research agenda: analysis of socio-spatial segregation structures; comparison of social structures and socialization practices in poverty-stricken neighborhoods; a study of the middle class and its space distribution; and Government policies, regulations curtailing segregation and urban inequalities.