Ana Glória Godoi Vasconcelos

A influência das doenças crônicas na capacidade funcional dos idosos do Município de São Paulo, Brasil

The main focus of this study was the effect of chronic disease (hypertension, diabetes mellitus, heart disease, lung disease, cancer, and arthropathy) on the functional status (activities of daily living - ADL, instrumental activities of daily living - IADL) among the elderly, controlling for age, gender, living arrangements, education, and comorbidity. The analysis was based on information provided by the SABE Project, from the city of Sao Paulo, Brazil, including individuals 60 years of age and over (n = 1,769), from January 2000 to March 2001. A multinomial logistic regression model was used. Compared to the absence of dependency category, heart disease (OR = 1.82), arthropathy (OR = 1.59), lung disease (OR = 1.50), and hypertension (OR = 1.39) were the main diseases that affected the IADL dependency category. Lung disease (OR = 2.58), arthropathy (OR = 2.27), hypertension (OR = 2.13), and heart disease (OR = 2.10) had important impact on the IADL and ADL dependency categories. The results were statistically significant (p < 0.05).

Associação do índice CPO-D com indicadores sócio-econômicos e de provisão de serviços odontológicos no Estado do Paraná, Brasil

This ecological study investigated the associations between dental caries, socioeconomic indicators, and the supply of dental services in the State of Paraná, Brazil, for the year 1996. Two types of information were collected: (1) data on caries prevalence (DMFT at 12 years) for the municipalities (or counties) in the State; (2) data on socioeconomic conditions and the supply of dental services. Based on simple linear regression analysis, the study demonstrated a significant correlation between the caries index in municipalities and various social and dental services supply indicators. Results of the analysis of multiple linear regression showed that one indicator of income inequality remained significantly associated with dental caries, demonstrating that the worst oral health conditions cannot be dissociated from income disparities. A significant negative correlation was observed between DMFT and the proportion of the population that received fluoridated water, principally in the municipalities with the worst income inequality indicators. This highlights the importance of fluoridation for the reduction of caries rates, as well as to attenuate the impact of socioeconomic inequalities on the prevalence of dental caries.

Proposta de modelo hierarquizado aplicado à investigação de fatores de risco de óbito infantil neonatal

Theoretical-conceptual models aim to integrate social, biological, behavioral, and other factors and to explain their interrelations in the determination of health outcomes. In the case of determination of neonatal death in Brazil, few studies have analyzed the mechanisms by which numerous variables and constructs interrelate. This article offers a theoretical discussion of the possible components of a hierarchical framework for studying neonatal mortality. The proposed model sought to include factors that have traditionally been identified as relevant to the occurrence of neonatal death and others that have been studied more recently (like race, social support, and violence during pregnancy). The components were distributed in 11 dimensions allocated to four hierarchical levels (one distal, two intermediary, and one proximal). The proposed framework should be adjusted to the Brazilian reality for neonatal death in large cities and raises various aspects for discussion that have not been explored previously in Brazil.

Fatores de risco para morte por pneumonia em menores de um ano em uma região metropolitana do sudeste do Brasil: um estudo tipo caso-controle

In a case-control study, a sample of post-neonatal deaths from pneumonia occurring in the Metropolitan Area of Rio de Janeiro, Brazil (1986-1987) were compared with healthy controls who lived in the same neighborhood. Risk factors investigated were variables related to the mothers pregnancy history and the childs birth, to the familys social condition and to the use of health services. Using the univariate logistic regression model, the coefficients of each independent variable, the relative risk and its confidence limits were first estimated. Birth weight and age of weaning were strongly associated with the dependent variable. After adjustment by means of the multiple logistic regression model, only 4 variables remained statistically associated with mortality: age of weaning, birth weight, over crowding, and BCG vaccination. Based on the available data, it was concluded that mortality from pneumonia in children under 1 year of age is significantly related to the social condition of the family, particularly to that of the mother.Atraves de um estudo tipo caso-controle, foi comparada uma amostra de obitos pos-neonatais por pneumonia ocorridos na Regiao Metropolitana do Rio de Janeiro, Brasil (1986-1987) e controles sadios, moradores na vizinhanca. Os fatores de risco investigados foram variaveis relacionadas a historia gestacional da mae e ao nascimento da crianca, as condicoes sociais da familia e a utilizacao de servicos de saude. Na primeira etapa de analise, atraves de um modelo de regressao logistica univariada, foram estimados os coeficientes de cada variavel independente, o risco relativo e seus limites de confianca. O peso ao nascer e a idade do desmame mostraram-se das mais fortemente associadas com a variavel dependente. Na segunda etapa, foi feito o ajuste pelo modelo de regressao logistica multipla e somente 4 variaveis permaneceram estatisticamente associadas com a mortalidade: idade do desmame, peso ao nascer, numero de moradores da casa e aplicacao da vacina BCG. Conclui-se que a mortalidade por pneumonia em menores de um ano esta fortemente associada as condicoes sociais da familia, em particular da mae.

The path analysis approach for the multivariate analysis of infant mortality data.

PURPOSE This paper reviews the use of the Path Analysis (PA) methodology in health determinants modeling, with special reference to infant mortality modeling. METHODS A review of the literature on PA applications in the modeling of infant mortality and similar problems is presented, together with a discussion of the conceptual basis of PA and its relation to other multivariate statistical techniques. Important aspects of the technique are discussed: 1) criteria for path formulation; 2) parameter estimation methods; 3) direct, indirect, spurious, and joint effects; and 4) goodness-of-fit and modification indices. RESULTS AND CONCLUSION The review of the literature suggests that PA represents a methodological improvement regarding multivariate techniques used in modeling some health-related issues. PA allows investigation of more complex models, providing information that could have been previously overlooked, such as how the interrelations among independent variables in a model affect the dependent ones.

Análise de correspondência como estratégia para descrição do perfil da mulher vítima do parceiro atendida em serviço especializado

Domestic violence perpetrated against women by their live-in partners may be rated as a public health problem. Knowledge of battered womens profiles helps shape specific actions that curtail this type of aggression. This paper examines the links between violence groups, and the socio-demographic status of aggressors and their victims, using the Multiple Correspondence analysis technique in order to profile the women helped by the Integrated Womens Assistance Center (CIAM). The findings showed different profiles for women assaulted by their partners in terms of the severity of the violence. Victims with severe sexually-related injuries were associated with incomplete high school educations and more than three workers resident in the home. Victims with serious physical and psychological injuries were related to university educations and graduate studies, declared as heads of families. Victims with minor physical and psychological injuries were related to relationships lasting less than five years, with high school diplomas for the women and younger aggressors, employed, and with up to three workers resident in the home.

Confirmatory factor analysis of posttraumatic stress symptoms in Brazilian primary care patients: an examination of seven alternative models.

The DSM-IV-TR postulates that PTSD symptoms are organized into 3 clusters. This assumption has been challenged by growing number of factor analytical studies, which tend to favor 4-factor, first-order models. Our objective was to investigate whether the clusters of PTSD symptoms identified in North American and European studies could be replicated in a Brazilian sample composed of 805 primary care patients living in hillside slums. Volunteers were asked to fill out the Brazilian version of the Posttraumatic Stress Disorder Checklist-Civilian Version and a confirmatory factor analysis of this scale was conducted with the software LISREL 8.80. Seven models were tested and a 4-factor, first-order solution including an emotional numbing cluster was found to provide the best fit. Although PTSD has been characterized by some critics as a Western culture-specific disorder lacking universal validity, our results seem to uphold the cross-cultural validity of the 4-factor, first-order model.

Validade e confiabilidade do índice de capacidade para o trabalho (ICT) em trabalhadores de enfermagem

This article assesses the validity and reliability of the work ability index (WAI) for 1,436 nurses in three public hospitals in Rio de Janeiro, Brazil. The study estimated the dimensional validity by means of exploratory factor analysis, as well as correlational validity, relating WAI to theoretically relevant constructs. Reliability was evaluated by internal consistency analysis, using Cronbachs alpha and McDonalds omega. Factor analysis indicated a two-dimensional structure explaining 52.8% of the accumulated variance for the principal components and 42% for the principal axes. The theoretical hypotheses for the constructs validity were confirmed, with direct and significant correlation between the WAI and the reward, control, and self-rated health scores; an inverse and significant correlation with the scale on need for recovery after work, minor psychological disorders, effort, over-commitment, and demand. In conclusion, the WAI showed adequate psychometric properties.This article assesses the validity and reliability of the work ability index (WAI) for 1,436 nurses in three public hospitals in Rio de Janeiro, Brazil. The study estimated the dimensional validity by means of exploratory factor analysis, as well as correlational validity, relating WAI to theoretically relevant constructs. Reliability was evaluated by internal consistency analysis, using Cronbachs alpha and McDonalds omega. Factor analysis indicated a two-dimensional structure explaining 52.8% of the accumulated variance for the principal components and 42% for the principal axes. The theoretical hypotheses for the constructs validity were confirmed, with direct and significant correlation between the WAI and the reward, control, and self-rated health scores; an inverse and significant correlation with the scale on need for recovery after work, minor psychological disorders, effort, over-commitment, and demand. In conclusion, the WAI showed adequate psychometric properties.

Correspondence analysis: a method for classifying similar patterns of violence against women

Violence against women has received relatively little debate in society. It includes physical, psychological, and sexual abuse that jeopardizes the victims health. Multivariate correspondence analysis and cluster analysis were applied to crimes reported to the Integrated Womens Aid Center in Rio de Janeiro, Brazil, to investigate associations between injury and define criteria for classifying the aggressions. Three groups of abuse were identified, differing according to the nature (physical, psychological, or sexual) and severity of the crimes. Less serious crimes consisted of threats and moderate physical injuries. The intermediate severity group included serious physical assault and threats. More serious crimes included death threats, rape, and sexual assault. The method thus allowed classification of the crimes in three groups according to severity.

Prevalence of obesity, overweight and abdominal obesity and its association with physical activity in a federal University

A cross sectional study to investigate the prevalence of obesity, overweight and abdominal obesity and its association with the level of physical activity (PA) measured in employees of a Rio de Janeiro University according to the International Physical Activity Questionnaire (IPAQ).299 employees selected by random sampling were interviewed. The association between PA and anthropometric markers was estimated by Poisson models (robust variance). The prevalence of obesity was 27.4% (men 22.8% and 36.3% women), the prevalence of overweight was 63.5% (men 65.0% and women 65.8%) and the prevalence of abdominal obesity was 45.2% (men 35.5% and 63.7% women). Women reported a higher prevalence of low PA (42.2%) compared to men (33.0%). The models adjusted for socio-demographic and behavioral variables and habits related to health, showed a significant association between PA and the outcomes analyzed. The low level of practice of PA (high level reference) has remained associated with the occurrence of obesity (PR = 1.89; 95%CI 1.05 - 3.42) and overweight (PR = 1.40; 95%CI 1.08 - 1.80). For the abdominal obesity, both the mid level (PR = 1.70; 95%CI 1.11 - 2.58) and the low level (PR = 1.74; 95%CI 1.14 - 2.66) were related. This study found inverse association between the practice of PA and obesity in line with what has been recommended by the WHO, and it reinforces the use of IPAQ in population studies. Specifically in relation to abdominal obesity, a remarkable gradient was not observed between levels of PA, suggesting that what is important is the high level of practice of PA.