Enirtes Caetano Prates Melo

Enfermeiros dos grandes hospitais públicos no Rio de Janeiro: características sociodemográficas e relacionadas ao trabalho

O objetivo do estudo foi analisar caracteristicas sociodemograficas e de trabalho de enfermeiros que atuam em hospitais publicos. Realizou-se estudo epidemiologico, seccionais, envolvendo 3.229 enfermeiros dos dezoito maiores hospitais publicos no municipio do Rio de Janeiro. Observou-se predominância feminina (87,3%) e idade media de 39,9±10 anos. Cerca de 7% referiram ter titulo de mestrado e/ou doutorado, 58,5% formaram-se em instituicoes publicas e 24,5% trabalhavam no setor saude antes de serem enfermeiros. Metade pensou em abandonar a Enfermagem e quase um quarto se considera insatisfeito com a profissao. Cerca de 10% esteve procurando emprego fora e 30% na propria Enfermagem. Entre os homens foi mais frequente o trabalho noturno, mais de um emprego e carga semanal de trabalho mais elevada. O estudo apontou aspectos desafiadores para os enfermeiros/as. Em funcao de sua abrangencia, os resultados podem subsidiar estrategias de melhoria das condicoes de trabalho nos hospitais publicos.

Job strain and unhealthy lifestyle: results from the baseline cohort study, Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundUnhealthy lifestyle choices, such as smoking and sedentary behavior, are among the main modifiable risk factors for chronic non-communicable diseases. The workplace is regarded as an important site of potential health risks where preventive strategies can be effective. We investigated independent associations among psychosocial job strain, leisure-time physical inactivity, and smoking in public servants in the largest Brazilian adult cohort.MethodsWe conducted a cross-sectional analysis of baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)—a multicenter prospective cohort study of civil servants. Our analytical samples comprised 11,779 and 11,963 current workers for, respectively, analyses of job strain and leisure-time physical activity and analyses of job strain and smoking. Job strain was assessed using the Brazilian version of the Swedish Demand-Control-Support Questionnaire; physical activity was evaluated using a short form of the International Physical Activity Questionnaire. We also examined smoking status and number of cigarettes smoked per day. The association reported in this paper was assessed by means of multinomial and logistic regression, stratified by sex.ResultsAmong men, compared with low-strain activities (low demand and high control), job strain showed an association with physical inactivity (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.09–1.64) or with the practice of physical activities of less than recommended duration (OR = 1.44; 95% CI = 1.15–1.82). Among women, greater likelihood of physical inactivity was identified among job-strain and passive-job groups (OR = 1.47; 95% CI = 1.22–1.77 and OR = 1.42; 95% CI = 1.20–1.67, respectively). Greater control at work was a protective factor for physical inactivity among both men and women. Social support at work was a protective factor for physical inactivity among women, as was smoking for both genders. We observed no association between demand or control dimensions and smoking.ConclusionsJob strain, job control, and social support were associated with physical activity. Social support at work was protective of smoking. Our results are comparable to those found in more developed countries; they provide additional evidence of an association between an adverse psychosocial work environment and health-related behaviors.

Estratégias de identificação, investigação e classificação de desfechos incidentes no ELSA-Brasil

OBJETIVO: O artigo descreve as estrategias do Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) para a manutencao da adesao dos participantes ao longo do tempo e seu seguimento adequado. Isto e fundamental para garantir a validade interna de estudos longitudinais e identificar, investigar e classificar os desfechos incidentes de interesse. METODOS: A metodologia de seguimento da coorte combina contatos telefonicos anuais com re-exames e entrevistas a cada tres ou quatro anos. O objetivo e identificar desfechos incidentes de natureza transitoria, reversiveis ou nao; desfechos finais, de natureza irreversivel; bem como complicacoes relacionadas a evolucao das doencas cardiovasculares e diabetes, principais doencas estudadas. RESULTADOS: As entrevistas telefonicas visam monitorar a saude dos participantes e identificar possiveis eventos ocorridos, como internacoes hospitalares, exames ou procedimentos especializados definidos previamente. O participante tambem e incentivado a comunicar a ocorrencia de algum evento de saude ao Centro de Pesquisa. A partir da identificacao de um potencial evento, e iniciado um processo de investigacao, que inclui acesso a prontuarios medicos para verificacao de datas e informacoes detalhadas sobre aquele evento. Os documentos obtidos sao analisados sem identificacao do paciente, profissional ou servico de saude e classificados por um comite de especialistas medicos. A classificacao de desfechos incidentes adotada baseia-se em criterios internacionais consagrados, garantindo comparabilidade e reduzindo o erro de classificacao deles. Alem dessas estrategias, a ocorrencia de desfechos podera ser investigada por meio do relacionamento de dados com bases secundarias do Ministerio da Saude, como as de mortalidade e internacoes. CONCLUSOES: A correta identificacao de desfechos permitira estimar sua incidencia na coorte e investigar o efeito das exposicoes estudadas no ELSA-Brasil em sua linha de base e nas ondas posteriores.

[Nurses of large public hospitals in Rio de Janeiro: socio demographic and work related characteristics].

O objetivo do estudo foi analisar caracteristicas sociodemograficas e de trabalho de enfermeiros que atuam em hospitais publicos. Realizou-se estudo epidemiologico, seccionais, envolvendo 3.229 enfermeiros dos dezoito maiores hospitais publicos no municipio do Rio de Janeiro. Observou-se predominância feminina (87,3%) e idade media de 39,9±10 anos. Cerca de 7% referiram ter titulo de mestrado e/ou doutorado, 58,5% formaram-se em instituicoes publicas e 24,5% trabalhavam no setor saude antes de serem enfermeiros. Metade pensou em abandonar a Enfermagem e quase um quarto se considera insatisfeito com a profissao. Cerca de 10% esteve procurando emprego fora e 30% na propria Enfermagem. Entre os homens foi mais frequente o trabalho noturno, mais de um emprego e carga semanal de trabalho mais elevada. O estudo apontou aspectos desafiadores para os enfermeiros/as. Em funcao de sua abrangencia, os resultados podem subsidiar estrategias de melhoria das condicoes de trabalho nos hospitais publicos.

Job strain and binge eating among Brazilian workers participating in the ELSA-Brasil study: does BMI matter?

To assess the association between job strain and binge eating as well as the effect‐modifying influence of body mass index (BMI) on this association.

FATORES DE RISCO ASSOCIADOS À HIPOGLICEMIA E ANÁLISE DE EVENTOS ADVERSOS EM UMA TERAPIA INTENSIVA

Objectives: to assess the predictive factors associated with the occurrence of severe hypoglycemia, and to analyze the adverse events related to the use of insulin and oral hypoglycemic agents in patients admitted to an intensive care unit (ICU). Method: it is a cohort study developed in a large hospital in the city of Rio de Janeiro. The process of identification of hypoglycemia occurred through the daily and prospective review of the medical records based on the trigger tool gglucose 50 . mg/dLh. Results: 355 patients were assessed and monitored throughout the intensive care unit hospitalization, and 16 insulin-related hypoglycemia events were confirmed in 10 patients, which corresponded to an incidence of 2.8% and an incidence rate of 0.6 hypoglycemia events per 100 patients-day.The risk factors associated to hypoglycemia in the studywere: liver disease (OR=3.06, CI 95%=1.22-7.66), sepsis (OR=3.53, CI 95%=1.53-8.18) and occurrence of adverse event (OR=3.89, CI 95%=2.05-7.41). The one point increase in the APACHE severity score (OR=1.15; CI 95%=1.09-1.20) and the occurrence of hypoglycemia (OR=7.46; CI 95%=3.88-14.33) increased the chance of death in the ICU. Conclusion: this study emphasizes the impact of hypoglycemia on mortality in intensive care and the predictive factors for its occurrence, as well as examines the insulin-related adverse events

Factors associated with sedentary behavior among ELSA-Brasil participants: ecological model

The main objective was to identify the prevalence and factors associated with sedentary behavior (SB). The study comprising a total of 13,765 individuals of both sexes participating in the Longitudinal Study of Adult Health (ELSA-Brasil) assessed in the second wave (2012-2014). e SB was measured using questions related to sitting time during the week and weekend. e associated factors were assessed by face-to-face interviews, with blocks of questionnaires and anthropometric measurements. A hierarchical ecological model was built with all possible factors associated with SB: sociodemographic environment (age and level of education; economic status); behavioral environment (leisure time physical activity, commuting physical activity, beer consumption, current smoking); and biological environment (overweight, obesity and abdominal obesity). Crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression. Among men and women, higher education, current smoking and abdominal obesity were positively associated with SB, while being over 51 years old and being physically active were negatively associated with SB. The proposed ecological model explains the SB through the sociodemographic, behavioral and biological environment.

0028 Job stress and glycemic levels: the role of gender and educational level in the brazilian longitudinal study of adult health (elsa-brasil)

This study intends to evaluate the association between psychosocial stress at work according to the model Demand-Control and changes in glycemic levels, investigating the role of gender and educational level. The Brazilian Longitudinal Study of Adult Health (ELSA - Brasil) is a multicenter study whose. In this transversal cut, 11.922 active workers were selected at the baseline. Job strain was evaluated through the Brazilian version of the Swedish Demand-Control-Support Questionnaire (DCSQ). Glycemic levels were assessed through glycosylated haemoglobin (HbA1c). We calculated odds ratio (OR) with respective 95% of confidence intervals (CI) and multiplicative interactions for education level. The study was approved by the National Research Ethics Commission. For men with low education, the low skill discretion is strongly associated with altered glycemia (OR 1.91, 95% CI 1.56–2.25). Equivalent pattern is observed among women of low education (OR 1.51, 95% CI 1.18–1.9). Likewise, low decision authority is associated with altered glycemia among men of low education (OR 1.62, 95% CI 1.29–1.95). Among women of low educational level, there is an association between low decision authority at work and intermediate glycemic levels (OR 1.19, 95% CI 1.01–1.37) and altered (OR 1.65, 95% CI 1.28–2 , 02). The relationship between job strain and changes in glycemic levels was mediated by education level that stands out as a determining factor for glycemic changes at intermediate (pre-diabetes) and elevated (diabetes) levels, for both men and women.

Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study

This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patientsday and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence. Resumo: Este estudo teve como objetivo avaliar a ocorrência de eventos adversos e o impacto deles sobre o tempo de permanência e a mortalidade na unidade de terapia intensiva (UTI). Trata-se de um estudo prospectivo desenvolvido em um hospital de ensino do Rio de Janeiro, Brasil. A coorte foi formada por 355 pacientes maiores de 18 anos, admitidos na UTI, no período de 1º de agosto de 2011 a 31 de julho de 2012. O processo de identificação de eventos adversos baseou-se em uma adaptação do método proposto pelo Institute for Healthcare Improvement. A regressão logística foi utilizada para analisar a associação entre a ocorrência de evento adverso e o óbito, ajustado pela gravidade do paciente. Confirmados 324 eventos adversos em 115 pacientes internados ao longo de um ano de seguimento. A taxa de incidência foi de 9,3 eventos adversos por 100 pacientes-dia, e a ocorrência de evento adverso impactou no aumento do tempo de internação (19 dias) e na mortalidade (OR = 2,047; IC95%: 1,172-3,570). Este estudo destaca o sério problema dos eventos adversos na assistência à saúde prestada na terapia intensiva e os fatores de risco associados à incidência de eventos.

Eventos adversos na unidade de terapia intensiva: impacto na mortalidade e no tempo de internação em um estudo prospectivo

This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patientsday and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence. Resumo: Este estudo teve como objetivo avaliar a ocorrência de eventos adversos e o impacto deles sobre o tempo de permanência e a mortalidade na unidade de terapia intensiva (UTI). Trata-se de um estudo prospectivo desenvolvido em um hospital de ensino do Rio de Janeiro, Brasil. A coorte foi formada por 355 pacientes maiores de 18 anos, admitidos na UTI, no período de 1º de agosto de 2011 a 31 de julho de 2012. O processo de identificação de eventos adversos baseou-se em uma adaptação do método proposto pelo Institute for Healthcare Improvement. A regressão logística foi utilizada para analisar a associação entre a ocorrência de evento adverso e o óbito, ajustado pela gravidade do paciente. Confirmados 324 eventos adversos em 115 pacientes internados ao longo de um ano de seguimento. A taxa de incidência foi de 9,3 eventos adversos por 100 pacientes-dia, e a ocorrência de evento adverso impactou no aumento do tempo de internação (19 dias) e na mortalidade (OR = 2,047; IC95%: 1,172-3,570). Este estudo destaca o sério problema dos eventos adversos na assistência à saúde prestada na terapia intensiva e os fatores de risco associados à incidência de eventos.