Doroteia Aparecida Höfelmann

Auto-avaliação de saúde entre trabalhadores de uma indústria no sul do Brasil

OBJETIVO: Analisar a prevalencia de auto-avaliacao de saude negativa e seus fatores associados, entre trabalhadores industriais. METODOS: Estudo transversal com amostra probabilistica de 482 trabalhadores de industria metal-mecânica de Joinville, estado de Santa Catarina, em 2005. As informacoes foram obtidas por meio de questionario auto-administrado e medidas antropometricas. Para estimar a magnitude de associacao entre a auto-avaliacao e variaveis, foram calculadas as razoes de chances (RC) com intervalos de confianca de 95%. Foram obtidos modelos logisticos multiplos por meio de analise de regressao logistica utilizando um referencial teorico hierarquico. RESULTADOS: A taxa de resposta foi de 98,6%. A auto-avaliacao de saude negativa foi referida por 16,6% dos trabalhadores. A maioria era do sexo masculino (84,8%) e desenvolvia atividades predominantemente ligadas ao setor produtivo (79,4%). A queixa mais comum entre os trabalhadores foi dor nas costas (30,9%). Apos modelagem estatistica, as seguintes variaveis permaneceram associadas a auto-avaliacao negativa de saude: sexo feminino (RC=3,0; IC 95%: 1,5;6,2), inatividade fisica (RC=1,8; IC 95%: 1,0;3,4), tensao psicologica (RC=3,0; IC 95%: 1,6;5,6), falta de controle sobre a vida (RC=3,0; IC 95%: 1,5;6,1), referencia a uma (RC=3,2; IC 95%: 1,4;7,2) ou duas ou mais doencas cronicas (RC=7,7; IC 95%: 3,4;17,8), licenca de saude de curta duracao (RC=2,9; IC 95%: 1,5;5,5) e doenca limitante (RC=2,8; IC 95%: 1,2;6,6). CONCLUSOES: A prevalencia de auto-avaliacao de saude negativa esteve associada as dimensoes socioeconomica/demografica, estilo de vida, psicossocial e situacao de saude. A variavel que mais influenciou na auto-avaliacao negativa foi a referencia a mais de duas doencas cronicas.

Excesso de peso entre trabalhadores de uma indústria: prevalência e fatores associados

O excesso de peso tomou proporcoes epidemicas nas ultimas decadas. Estudo transversal, com amostra probabilistica, objetivou estimar a prevalencia e fatores associados ao excesso de peso entre trabalhadores de uma industria metal-mecânica, em Joinville, Santa Catarina. Para a coleta de dados foram aferidos dados antropometricos e entregue questionario auto-administrado. As razoes de prevalencia (RP) brutas e ajustadas, e os Intervalos de Confianca de 95% (IC 95) foram calculados por meio da Regressao de Poisson. A taxa de resposta foi de 98,6% (n = 475), sendo 84,8% homens, empregados no setor produtivo (79,4%). A prevalencia de excesso de peso foi de 53,0% (IC 95% 48,5% - 57,6%). Apos analise ajustada, as mulheres apresentaram menor prevalencia do desfecho (RP 0,19 IC 95% 0,05 - 0,73). As prevalencias foram superiores entre aqueles com idade superior a 30 (RP 1,69 IC 95% 1,33 - 2,15) ou 40 anos (RP 2,00 IC 95% 1,56 - 2,57), com doencas cronicas referidas (RP 1,23 IC 95% 1,04 - 1,45) ou que avaliaram sua saude como pior (RP 1,23 IC 95% 1,02 - 1,49). Alem disso, observou-se uma interacao entre escolaridade e sexo: entre homens com ensino fundamental a prevalencia de sobrepeso foi 30% menor do que entre aqueles com maior escolaridade (RP 0,71 IC 95% 0,51 - 0,99), enquanto entre mulheres com ensino fundamental a prevalencia foi praticamente seis vezes maior do que entre aquelas com ensino superior (RP 5,57 IC 95% 1,28 - 24,25). Os resultados reforcam as diferencas entre os generos e diferentes indicadores socioeconomicos na prevalencia do excesso de peso.

Self-rated health and working conditions among workers from primary health care centers in Brazil

This cross-sectional study with 1,249 workers from all 49 municipal primary health care centers was conducted in Florianópolis, Santa Catarina State, Brazil, with the objective of investigating the prevalence of poor self-rated health and its association with working conditions and other factors. Multivariate statistical analyses were conducted using Poisson regression. The prevalence of poor self-rated health was 21.86% (95%CI: 19.56%-24.15%). The largest prevalence was found among dental assistants (35.71%), and the lowest among physicians (10.66%). In the adjusted analysis, the outcome was associated with female gender (PR = 1.48; 95%CI: 1.03-2.14), older age (PR = 1.29; 95%CI: 1.05-1.59), higher education (PR = 0.69; 95%CI: 0.55-0.87), more time working at the primary care center (PR = 1.57; 95%CI: 1.29-1.98), higher workload score (PR = 1.67; 95%CI: 1.35-2.05), obesity (PR = 1.74; 95%CI: 1.37-2.21), and often or always experiencing musculoskeletal symptoms (PR = 2.69; 95%CI: 1.90-3.83). A higher workload score remained associated with the outcome, suggesting an association between working conditions and self-rated health.

Is income area level associated with blood pressure in adults regardless of individual-level characteristics? A multilevel approach

This population-based health survey was carried out in Florianopolis, Brazil, to assess the association between adult systolic blood pressure (SBP) and contextual income level, after controlling for potential individual-level confounders. A statistically significant negative association between SBP levels and contextual income was identified after adjusting for individual-level characteristics. SBP levels in the highest and in the intermediate tertiles of contextual income were 5.78 and 2.82 mm Hg lower, respectively, than that observed in the bottom tertile. The findings suggest an association between income area level and blood pressure, regardless of well-known individual-level hypertension risk factors.

Contextual and individual indicators associated with the presence of teeth in adults

OBJECTIVE The objective of this study was to analyze whether socioeconomic conditions and the period of availability of fluoridated water are associated with the number of teeth present. METHODS This cross-sectional study analyzed data from 1,720 adults between 20 and 59 years of age who resided in Florianópolis, SC, Southern Brazil, in 2009. The outcome investigated was the self-reported number of teeth present. The individual independent variables included gender, age range, skin color, number of years of schooling, and per capita household income. The duration of residence was used as a control variable. The contextual exposures included the period of availability of fluoridated water to the households and the socioeconomic variable for the census tracts, which was created from factor analysis of the tract’s mean income, education level, and percentage of households with treated water. Multilevel logistic regression was performed and inter-level interactions were tested. RESULTS Residents in intermediate and poorer areas and those with fluoridated water available for less time exhibited the presence of fewer teeth compared with those in better socioeconomic conditions and who had fluoridated water available for a longer period (OR = 1.02; 95%CI 1.01;1.02). There was an association between the period of availability of fluoridated water, per capita household income and number of years of education. The proportion of individuals in the poorer and less-educated stratum, which had fewer teeth present, was higher in regions where fluoridated water had been available for less time. CONCLUSIONS Poor socioeconomic conditions and a shorter period of availability of fluoridated water were associated with the probability of having fewer teeth in adulthood. Public policies aimed at reducing socioeconomic inequalities and increasing access to health services such as fluoridation of the water supply may help to reduce tooth loss in the future.

Sobrevida em dez anos e fatores prognósticos em mulheres com câncer de mama em Joinville, Santa Catarina, Brasil

Breast cancer has the highest incidence among women, and reduces survival among female sufferers. This article aims to evaluate the survival and its prognostic factors in women with breast cancer, treated by public sector, in Joinville, Santa Catarina, Brazil. Retrospective cohort study nested in a case-control. The data has been obtained by a questionnaire, by the review of records and death certifications. In the analysis of survival it has been applied the Kaplan-Meiers statistical method and the Coxs method. 170 women have been evaluated. The survival in ten years was 83.1% (95% CI 74.1 to 89.3%), and 21 (12.4%) deaths were identified at the time period. The probability of being alive was smaller for those in advanced stages of cancer; the risk of death was higher among those who had another kinds of cancer associated, and among those unsatisfied with life. The deaths ratio was 17.1 times bigger among women diagnosed in advanced stages. The variable staging presented higher association with the survival in evaluated women. Detecting the disease early minimizes the mortality by breast cancer.

Access to Fluoridated Water and Adult Dental Caries: A Natural Experiment

Systematic reviews have found no evidence to support a benefit of water fluoridation (WF) to prevent dental caries in adult populations. The aim of this natural experiment was to investigate whether lifetime access to fluoridated water is associated with dental caries experience among adults from Florianópolis, Brazil. The data originated from a population-based cohort study (EpiFloripa Adult) initiated in 2009 (n = 1,720) when participants were aged 20 to 59 years. The second wave was carried out in 2012 (n = 1,140) and included a dental examination and a face-to-face questionnaire. Participants residing at the same address since the age of 7 y or before were included in the primary analyses. Sensitivity analyses were also performed. WF was implemented in the city in 2 different periods of time: 1982 (60% of the population) and 1996. Dental caries was assessed by the decayed, missing, and filled teeth (DMFT) index. A combination of residential status, participant’s age, and year of implementation of WF permitted the creation of participants’ lifetime access to fluoridated water: >75%, 50% to 75%, and <50% of a participant’s lifetime. Covariates included sex, age, socioeconomic mobility, educational attainment, income, pattern of dental attendance, and smoking. Participants who accessed fluoridate water <50% of their lifetime presented a higher mean rate ratio of DMFT (1.39; 95% CI, 1.05–1.84) compared with those living >75% of their lifetime with residential access to fluoridated water. Participants living between 50% and 75% and <50% of their lives in fluoridated areas presented a decayed and filled teeth mean ratio of 1.34 (95% CI, 1.02–1.75) and 1.47 (95% CI, 1.05–2.04) higher than those with residential access to fluoridated water >75% of their lifetime, respectively. Longer residential lifetime access to fluoridated water was associated with less dental caries even in a context of multiple exposures to fluoride.

Perceived neighborhood problems: multilevel analysis to evaluate psychometric properties in a Southern adult Brazilian population

BackgroundPhysical attributes of the places in which people live, as well as their perceptions of them, may be important health determinants. The perception of place in which people dwell may impact on individual health and may be a more telling indicator for individual health than objective neighborhood characteristics. This paper aims to evaluate psychometric and ecometric properties of a scale on the perceptions of neighborhood problems in adults from Florianopolis, Southern Brazil.MethodsIndividual, census tract level (per capita monthly familiar income) and neighborhood problems perception (physical and social disorders) variables were investigated. Multilevel models (items nested within persons, persons nested within neighborhoods) were run to assess ecometric properties of variables assessing neighborhood problems.ResultsThe response rate was 85.3%, (1,720 adults). Participants were distributed in 63 census tracts. Two scales were identified using 16 items: Physical Problems and Social Disorder. The ecometric properties of the scales satisfactory: 0.24 to 0.28 for the intra-class correlation and 0.94 to 0.96 for reliability. Higher values on the scales of problems in the physical and social domains were associated with younger age, more length of time residing in the same neighborhood and lower census tract income level.ConclusionsThe findings support the usefulness of these scales to measure physical and social disorder problems in neighborhoods.

Identification of confounders in the association between self-reported diseases and symptoms and self-rated health in a group of factory workers

Self-related health is an important predictor of morbidity and mortality, and much of its effect is influenced by the presence of chronic diseases and/or symptoms. The current study aimed to identify confounders in the association between reported chronic diseases and/or symptoms and self-rated health among workers at a metallurgical factory in Santa Catarina State, Brazil. The study design was cross-sectional, with a probabilistic sample of 482 workers. The information was obtained through a self-administered questionnaire and anthropometric measurements. Hierarchical multiple logistic regression models were adjusted. The response rate was 98.6% (n = 475), with 84.8% men, mostly employed on the factory floor (79.4%). Back pain was the most common complaint. The association between chronic diseases and self-rated health showed an odds ratio (OR) of 7.3 (95%CI: 3.7;14.5). After statistical modeling, psychosocial (-25.59%), socioeconomic (-9.29%), and occupational variables (10.54%) were identified as confounders between the outcome and chronic diseases and/or symptoms. The way diseases and/or symptoms act on self-rated health among workers transcends physical aspects.

Association of perceived neighborhood problems and census tract income with poor self-rated health in adults: a multilevel approach

Neighborhood problems constitute sources of chronic stress that may increase the risk of poor self-rated health. The associations of census tract level income and perceived neighborhood problems with self-rated health were examined in Florianópolis, Santa Catarina State, Brazil (1,720 adults). Odds ratios (OR) and their 95% confidence intervals (95%CI) of poor self-rated health were estimated through multilevel models. Residents in census tracts in the lower and intermediate tertiles of income reported poorer health than those in the highest tertile. OR of reporting poorer health was 2.44 (95%CI: 2.35- 2.54) in the higher tertile of social disorder (adjusting for mental health). The chances of reporting the poorer health with neighborhood problems ranged from 1.07 (95%CI: 1.03-1.11) to 2.02 (95%CI: 1.95-2.10) for the higher tertile of social disorder (physical health) and physical problem (health-related variables). Perceived neighborhood problems were independently associated with poor health. The perception of a neighborhood among its residents should be considered by health policymakers.