Gina Torres Rego Monteiro

Confiabilidade em Questionários para Qualidade: Um Estudo com o Coeficiente Alfa de Cronbach

O setor de servicos ocupa na sociedade atual um papel de destaque em relacao ao setor industrial, uma vez que os produtos industrializados tendem a possuir uma qualidade intrinseca semelhante, tornando o servico oferecido junto com este produto um importante diferencial competitivo. O setor de servico tambem se destaca em empresas que oferecem a sociedade servicos puros, ou seja, nao agregados a nenhum outro produto. Dada a importância deste setor, e preciso avaliar se a qualidade dos servicos ofertados esta de acordo com as expectativas dos clientes. Este trabalho faz uma analise de confiabilidade de questionarios para avaliar a qualidade de servicos em geral, por meio de um experimento realizado em um estudo de caso. Os resultados sao significativos e levam a conclusao que o coeficiente utilizado deve ser mais difundido pela literatura nacional.

Confiabilidade e validade dos atestados de óbito por neoplasias. I. Confiabilidade da codificação para o conjunto das neoplasias no Estado do Rio de Janeiro

Mortality records are often used in epidemiological studies, particularly in cancer studies. This paper aims to evaluate reliability and accuracy of cancer mortality data in Rio de Janeiro, Brazil. A systematic random sample of 394 death certificates was obtained from a total of 12615 cancer deaths. This sample was recoded by an independent codifier. A kappa coefficient of 0.89 (95% C.I. 0.86-0.92) was obtained to the third digit, which increases to 0.95 (95% C.I. 0.94-0.96) when restricted to the mortality list used in international publications. The positive predictive value was 95.7% for this sample. These results reveal a high standard reliability of cancer mortality records in the State of Rio de Janeiro making them suitable for use in epidemiological research.

Confiabilidade e validade das declarações de óbito por câncer de boca no Município do Rio de Janeiro

Mortality statistics are frequently employed in cancer epidemiology studies. The aim of this research was to evaluate the reliability and validity of oral cavity cancer as the underlying cause of death reported on death certificates in the Municipality of Rio de Janeiro, Brazil. All death certificates since 1999 reporting this underlying cause of death were selected from the Municipal Mortality Information System. The death certificates were re-coded by an independent technician, and a standardized questionnaire was designed to collect clinical and laboratory data for diagnostic confirmation from patient records. Histopathological results and/or clinical history were considered as the gold standard to establish the diagnosis of cancer of the mouth. Reliability analysis showed a simple percentage agreement of 95.1% and a kappa coefficient of 0.93. Positive predictive value was 86.5%. Mortality statistics for oral cancer in Rio de Janeiro Municipality demonstrate good reliability and validity, possibly because diagnostic confirmation is facilitated by easy access to the tumor site.

Confiabilidade e validade dos atestados de óbito por neoplasias. II. Validação do câncer de estômago como causa básica dos atestados de óbito no Município do Rio de Janeiro

Quality of data is a central concern in epidemiological studies, particularly when using secondary data. This study aims to carry out on reliability and accuracy of stomach cancer mortality data in the city of Rio de Janeiro. A simple random sample of 97 death certificates was obtained from a total of 645 stomach cancer deaths in 1990, and was used for validation. A questionnaire specifically designed to obtain clinical and laboratory data was completed for each case. Two physicians read this questionnaire and completed the new death certificates, allowing analysis of the instruments reliability. A total of 86 cases were studied as a consequence of 11 losses (11.3%). Reliability analysis of questionnaires revealed 90.7% agreement according to stomach cancer diagnosis (kappa = 0.73). Accuracy was calculated by positive predictive value: 90.7%. Eight cases were discharged after clinical and laboratory revision. The study concludes that mortality data by stomach cancer in the city of Rio de Janeiro are very reliable, and that their level of accuracy is adequate for use in epidemiological studies.

Mortalidade por tumores de cérebro no Brasil, 1980-1998

Brain tumors are rare, but their incidence and mortality have increased in different countries, including Brazil, especially among the elderly. This paper presents the mortality pattern of brain tumors in Brazil, including distribution of mortality rates by gender, age, topography, and tumor staging, from 1980 to 1998. Age-adjusted (by world population) brain cancer mortality rates increased from 2.24/100,000 to 3.35/100,000 inhabitants among the overall population during this period (an increase of 50%). Observed rates were higher during childhood than adolescence and increased with age, reaching the highest levels among the elderly. Among individuals 70 years of age and older, an average annual increase of 6% was observed in the series. Brain and meningeal tumor rates are presented for the entire country and selected State capitals. Further study is needed to elucidate the role of both new diagnostic technologies and environmental exposures potentially associated with the observed changes in brain cancer mortality rates.

Epidemiologia da doença meningocócica na cidade do Rio de Janeiro: modificações após vacinação contra os sorogrupos B e C

Meningococcal disease has been a serious public health problem in the city of Rio de Janeiro, with high attack rates among younger children, high case fatality rates, and predominance of serogroup B. In December 1994 the second vaccination drive against B and C meningococcal disease was performed with the objective of protecting children ages 6 months to 13 years. A total of 950 thousand children received 2 doses of vaccine produced by the Finlay Institute of Cuba. In 1995 a change was observed in the disease pattern with a predominance of serogroup C and a higher global attack rate, particularly among children under 1 year of age, teenagers, and young adults. In vaccinated groups the attack rate was lower than in 1994, due to a decrease in serogroup B. No change was observed in the case fatality rate.

Environmental exposure and breast cancer among young women in Rio de Janeiro, Brazil.

Increasing breast cancer rates among young women (<40 years old) have been reported by the population-based cancer registries in Brazil. A case series study was carried out in Rio de Janeiro aiming to obtain epidemiological information allowing the generation of hypotheses to be further evaluated in analytical studies. One hundred and ten women 20–35 years old diagnosed with breast cancer were interviewed to determine the role environment plays in patients cased upon residential location. A comprehensive questionnaire including personal information (medical and lifestyle antecedents, reproductive history, family history of cancer, chemical and radiation exposure) was employed, and the obtained data were further compared with data provided by controls (women without cancer). An unconditional logistic regression was further employed to ascertain the respective odds ratios (OR) and their 95% confidence intervals (CI). Seventy-one percent of cancer cases were sporadic breast cancer, and familial aggregation (first degree relatives) was observed in just 3.5% (5.5% including second-degree relatives). Forty (51.3%) of the cancer cases were reported to have resided at a distance of less than 20 m from an electrical power transformer. Bivariate analysis revealed OR = 5.62 (95% CI 2.63–12) for residential use of pesticides during adulthood, OR = 2.15 (95% CI 1.22–3.77) for dental diagnostic x-rays, and OR= 1.53 (95% 0.77–3.04) for living nearby an electrical power transformer. Further multivariate analysis showed an adjusted OR = 3.5 (95% CI 1.11–11.0) for residential use of pesticides, and an adjusted OR = 2 (95% CI 1.24–3.23) for dental diagnostic x-rays during adulthood. The observed results highlight the importance of exploring the contribution of selected environmental agents possibly involved in breast carcinogenesis among young women.

Brain cancer mortality among farm workers of the State of Rio de Janeiro, Brazil: A population-based case–control study, 1996–2005

BACKGROUND Farm workers seem to be at an increased risk of developing some cancers, notably in the brain. One of the hypotheses rose to explain such elevated risk is the intense exposure to pesticides. AIM To estimate the brain cancer mortality risk among agricultural workers exposed to pesticides in the State of Rio de Janeiro, Brazil. METHODS A case-control study based on death certificates of males, 18 years or older, resident in the State Rio de Janeiro who died between 1996 and 2005. Cases (n=2040) were defined as individuals with brain cancer as the underlying cause of death. For each case two controls (n=4140) were randomly selected in the same database, matched for age group and region of residence. Besides the descriptive analysis, crude and adjusted odds ratios and mortality odds ratio (MOR) according to quartiles of potential exposure to pesticides, were calculated. RESULTS Agricultural workers showed higher brain cancer mortality risk estimates when compared with non-farm workers (aOR: 1.82, 95% CI 1.21-2.71). In addition, the magnitude of this association was higher among white patients, with higher education, and residence in an agricultural region. CONCLUSION This study suggests an association between agricultural work and brain cancer mortality in Rio de Janeiro state. It also suggests that pesticide exposure may play a role in such risk.

Trends in childhood leukemia mortality over a 25-year period.

OBJECTIVE To analyze trends in childhood leukemia mortality in the state of Rio de Janeiro, Brazil, between 1980 and 2006. METHOD Gender-stratified leukemia mortality data for children aged < 15 years from 1980 to 2006 were retrieved from the Brazilian Mortality Information System for the state of Rio de Janeiro. Data were stratified by place of death (city of Rio de Janeiro proper, the state capital; Rio de Janeiro Metropolitan Region, excluding the capital; and rest of the state). Leukemia deaths were defined according to death certificate ICD-9 and ICD-10 coding (for deaths occurring in 1980-1995 and 1996-2006, respectively). Leukemia mortality rates were calculated by age and calendar year and age-adjusted to a standard world population. Polynomial linear regression with a 5% significance level was used to evaluate mortality trends in the study regions. RESULTS The three studied regions revealed similar trends, with a continuous downward pattern; the most substantial decline was detected in the municipality of Rio de Janeiro (city proper). In all studied areas, leukemia mortality was highest among males. CONCLUSION A downward trend in childhood leukemia mortality was detected throughout the state of Rio de Janeiro. The most pronounced reduction occurred in the state capital.

Características de acesso ao preventivo de câncer de colo do útero: três etapas metodológicas da adaptação do instrumento de coleta de informação

The article describes the initial steps in the Portuguese-language adaptation of an instrument to measure characteristics of access to cervical cancer prevention. A universalist approach was adopted to assess conceptual, item, and semantic equivalence. The methodology included a literature review and participation by both experts and women representing the general population. Conceptual and item equivalence was established with participation by experts. Semantic equivalence was analyzed in five stages. Two translations into Portuguese and two back-translations into English were performed independently and evaluated by a third researcher from the public health field. The back-translations showed good referential and connotative similarity to the original, and a consensus version was formulated. Twenty-eight women participated in the pretest, eight of whom in the focus group format. The version proved comprehensible, underwent some modifications, and is ready for the complementary stages in the cross-cultural adaptation process.