Eduardo Faerstein

Gender and leisure-time physical activity.

This article discusses the relationship between gender and the social construction of the body, specifically focusing on physical exercise during leisure time. The Pró-Saúde Project is a prospective study consisting of 4,030 employees of a university in Rio de Janeiro, in which we analyzed the answers on leisure-time physical activity (LTPA) by 3,740 participants. The results show a prevalence of males in LTPA. Age, schooling, and per capita family income were directly associated with exercise among women, as compared to per capita family among men. Men were more frequently involved in group sports and physical activities that required more strength than women, including football, tennis, volleyball, martial arts, jogging, and weight lifting. Women performed more individual physical activities and those demanding less strength, like walking, dance, gymnastics, and hydrogym. The results suggest that LTPA is a domain of daily life that is organized according to certain conventions, amongst which gender-related conceptions concerning the ideal body, where men and women display distinct behaviors in relation to physical exercise.

Técnicas de análise de sobrevida

Statistical methods known as survival analyses are useful for analyzing time-related events, in which time from a benchmark event to an endpoint is the focus of interest. Survival analysis describes not only patient survival statistics (as suggested by the name), but also other dichotomous outcomes such as time of remission, time of breastfeeding, etc. This paper discusses survival analysis techniques, commenting and comparing their utilization, especially in the field of oncology. It also presents and discusses types of epidemiological studies and data sources to which this type of analysis is applied. The authors take into account the difference between hospital-based or clinical series and population-based approaches. Interpretation of results is also discussed.

Job strain and hypertension in women: Estudo Pró-Saúde (Pro- Health Study)

This study aimed to analyze the association between job strain and hypertension in the female population. A cross-sectional study was performed with 1,819 women who participated in the Estudo Pró-Saúde (Pro-Health Study), in the city of Rio de Janeiro, Southeastern Brazil, between 1999 and 2001. The Brazilian version of the short version of the Job Stress Scale (demand-control model) was used. Overall prevalence of measured hypertension (> or =140/90 mmHg and/or antihypertensive drug use) was 24%. Compared to participants with jobs classified as low strain, adjusted prevalence ratios for hypertension in women who performed passive and active high-strain jobs were, respectively, 0.93 (95% CI: 0.72;1.20), 1.06 (95% CI: 0.86;1.32) and 1.14 (95% CI: 0.88;1.47). Longitudinal analyses should be performed to clarify the role of these work environment psychosocial characteristics as a determinant of hypertension.

Situação atual da detecção precoce do câncer cérvico-uterino no Brasil

As neoplasias malignas foram responsaveis, em 1980, por 9,5% das mortes registradas no pais. Entre as mulheres acima de 15 anos, constituiram a segunda causa de mortalidade proporcional, sendo superadas apenas pelas doencas do aparelho circulatorio. O câncer cervico-uterino ocupou posicao de destaque, correspondendo a quase 10% dos obitos nesse grupo. A experiencia internacional tem demonstrado a eficacia da deteccao precoce atraves da citopatologia vaginal no controle desta neoplasia. No Brasil, no entanto, avaliacao realizada, em 1984, evidenciou que as Secretarias Estaduais de Saude desenvolvem esta atividade em apenas 7% das unidades da rede basica, nao alcancando 2% de cobertura das mulheres adultas. O INAMPS, maior prestador de cuidados medico-assistenciais no pais, nao tem informacoes sobre os exames citologicos realizados. A cobertura da assistencia ginecologica e de apenas 15% das mulheres acima de 15 anos. E portanto necessario um amplo esforco de articulacao interinstitucional para superacao do estagio rudimentar em que se situa o controle do câncer cervico-uterino no pais. A definicao de estrategias comuns no aproveitamento dos recursos existentes e a insercao da atividade de deteccao precoce na assistencia integral a saude da mulher podem resultar em expressiva expansao da cobertura, garantindo-se, ainda, o aumento dos graus de efetividade e eficiencia.

Sobrevida em pacientes com câncer gástrico em Campinas, São Paulo, Brasil

This study analyzes the survival of gastric cancer patients in the city of Campinas, São Paulo State, Brazil. Data from the Campinas Population-Based Cancer Registry (RCBP) related to gastric cancer cases diagnosed from 1991 to 1994 were analyzed. Observed and relative survival rates were calculated, and to compare rates between different groups and international populations, the relative mortality risk was used. One-year relative survival rate for patients with gastric cancer was 33%, and five-year relative survival was 9%, confirming the poor prognosis of gastric cancer. Gender had no influence on survival, while the prognosis was better for young people. There was a gradient of severity from the localized to the metastatic state, not statistically significant. The group with undifferentiated adenocarcinomas had longer survival, with 47% of patients alive after the first year, whereas only 7% of those without a histological classification survived the first year after diagnosis. Compared with international results like the pool of European registries, the risk was greater, especially considering the five-year survival rates.

Reliability of the information about the history of diagnosis and treatment of hypertension. Differences in regard to sex, age, and educational level. The pró-saúde study

OBJECTIVEnTo assess the intraobserver reliability of the information about the history of diagnosis and treatment of hypertension.nnnMETHODSnA multidimensional health questionnaire, which was filled out by the interviewees, was applied twice with an interval of 2 weeks, in July 99, to 192 employees of the University of the State of Rio de Janeiro (UERJ), stratified by sex, age, and educational level. The intraobserver reliability of the answers provided was estimated by the kappa statistic and by the coefficient of intraclass correlation (CICC).nnnRESULTSnThe general kappa (k) statistic was 0.75 (95% CI=0.73-0.77). Reliability was higher among females (k=0.88, 95% CI=0.85-0.91) than among males (k=0.62, 95% CI=0.59-0.65). The reliability was higher among individuals 40 years of age or older (k=0.79; 95% CI=0.73-0.84) than those from 18 to 39 years (k=0.52; 95% CI=0.45-0.57). Finally, the kappa statistic was higher among individuals with a university educational level (k=0.86; 95% CI=0.81-0.91) than among those with high school educational level (k=0.61; 95% CI=0.53-0.70) or those with middle school educational level (k=0.68; 95% CI=0.64-0.72). The coefficient of intraclass correlation estimated by the intraobserver agreement in regard to age at the time of the diagnosis of hypertension was 0.74. A perfect agreement between the 2 answers (k=1.00) was observed for 22 interviewees who reported prior prescription of antihypertensive medication.nnnCONCLUSIONnIn the population studied, estimates of the reliability of the history of medical diagnosis of hypertension and its treatment ranged from substantial to almost perfect reliability.

Interobserver reliability of the International Classification of Primary Care

OBJECTIVEnThe International Classification of Primary Care was developed as an attempt to overcome the limitations of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, when used for primary health care. The aim of the study was to evaluate the interobserver reliability of the International Classification for Primary Care when coding reasons for health-related interruption of daily activities.nnnMETHODSnData analyzed pertained to 801 subjects from Phase 2 of the Pró-Saúde Study, involving the employees of a Rio de Janeiro university who reported having been prevented from carrying out any of their usual activities (work, study, or leisure) for health-related reasons in the two weeks prior to data collection. Health problems reported in response to an open question were separately coded by two classifiers. Interobserver reliability with respect to number of health problems was calculated by weighted kappa; for the remaining analyses (chapters and full codes), crude kappa coefficients were used.nnnRESULTSnA total of 1,641 health problems were coded by the first classifier, and 1,629 by the second. Interobserver reliability with respect to the number of health problems coded was substantial (weighted kappa=0.94; 95% CI: 0.93;0.94). Chapter and full codes showed substantial (kappa=0.89; 95% CI: 0.88;0.90) and moderate (0.76; 95% CI: 0.76;0.78) reliability, respectively.nnnCONCLUSIONSnThe results suggest that the International Classification of Primary Care is adequate for the coding of health-related reasons for interruption of daily activities.

Fatores associados ao uso de antiinflamatórios não esteróides em população de funcionários de uma universidade no Rio de Janeiro: Estudo Pró-Saúde

Os Antiinflamatorios Nao-Esteroides (AINE) estao entre os medicamentos mais utilizados no mundo. Estima-se que mais de 30 milhoes de pessoas tomem AINE diariamente, apesar de sua toxicidade e de seus efeitos adversos, principalmente gastrointestinais. O presente trabalho utilizou dados seccionais da Fase 1 (1999) de um estudo de coorte (Estudo Pro-Saude) coletados entre 4.030 funcionarios tecnico-administrativos de uma universidade no Rio de Janeiro, nos quais foram aplicados questionarios autopreenchiveis. Nesse estudo, os AINE apareceram entre os principais produtos consumidos nas duas semanas que antecederam a pesquisa, com prevalencia de 7%. Verificou-se que as mulheres tem maior chance de serem usuarias (OR = 2,11; IC 95%: 1,59 - 2,79). Os dados foram submetidos a analise multivariada, tendo sido propostos modelos logisticos por sexo. A carga horaria trabalhada na semana foi um importante preditor do uso de AINE (OR = 1,03; IC 95%: 1,01 - 1,04, para homens, e OR = 1,02; IC 95%: 1,00 - 1,03, para mulheres). Dor incapacitante e artrose tambem se mostraram relevantes, com OR = 2,89 (IC 95%: 1,77 - 4,71) e OR = 2,29 (IC 95%: 1,10 - 4,75), respectivamente, para os homens, e OR = 2,65 (IC 95%: 1,89 - 3,70) e OR = 2,00 (IC 95%: 1,37 - 2,93), respectivamente, para as mulheres. Outros preditores importantes foram a hernia de disco (OR = 2,27; IC 95%: 0,93 - 5,54) para os homens, e LER (OR = 1,64; IC 95%: 1,15 - 2,35), calculos vesical (OR = 1,85; IC 95%: 1,00 - 3,45) e renal (OR = 1,81; IC 95%: 1,12 - 2,91) para as mulheres. Mulheres e individuos com maior carga horaria de trabalho semanal constituem grupos mais vulneraveis, em termos de uso irracional, e, portanto, mais sujeitos a programas de intervencao. Os resultados apontam para a importância das condicoes de trabalho no processo de desencadeamento de doencas.