Márcia Guimarães de Mello Alves

Estresse no trabalho e hipertensão arterial em mulheres no Estudo Pró-Saúde: 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.

Adaptacao transcultural e confiabilidade de medidas de caracteristicas autorreferidas de vizinhanca no ELSA-Brasil

OBJETIVO: Descrever o processo de adaptacao de escalas de medida de caracteristicas de vizinhanca para o portugues brasileiro. METODOS: As dimensoes abordadas foram coesao social, ambiente propicio para atividade fisica, disponibilidade de alimentos saudaveis, seguranca em relacao a crimes, violencia percebida e vitimizacao. No processo de adaptacao foram avaliados aspectos de equivalencia entre as escalas originais e respectivas versoes para o portugues. A confiabilidade teste-reteste foi avaliada em submostra de 261 participantes do Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) que responderam ao mesmo questionario em dois momentos distintos em um intervalo de tempo de sete a 14 dias entre as duas aplicacoes. RESULTADOS: Os aspectos de equivalencia avaliados mostraram-se adequados. O coeficiente de correlacao intraclasse variou entre 0,83 (IC95% 0,78;0,87) para Coesao Social e 0,90 (IC95% 0,87;0,92) para Ambiente para Atividade Fisica. As escalas apresentaram consistencia interna (alfa de Cronbach) que variaram entre 0,60 e 0,84. CONCLUSOES: As medidas autorreferidas de caracteristicas de vizinhanca tiveram reprodutibilidade muito boa e boa consistencia interna. Os resultados sugerem que essas escalas podem ser utilizadas em estudos com populacao brasileira que apresente caracteristicas similares aquelas do ELSA-Brasil.

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.

Fatores condicionantes para o acesso às equipes da Estratégia Saúde da Família no Brasil

O artigo analisa o acesso as equipes certificadas pelo Programa Nacional de Melhoria de Acesso e da Qualidade da Atencao Basica, tendo por categoria central o acesso potencial e duas dimensoes: acolhimento e disponibilidade. A partir de questoes selecionadas dos instrumentos da Avaliacao Externa do Programa, geraram-se escores e tres estratos. Os resultados confirmam que os fatores favoraveis ao acesso potencial foram: localizacao na regiao Sudeste, em capitais e municipios de maior porte e com maior numero de equipes por unidade. Apesar dos progressos, os resultados indicam a necessidade de politicas e acoes voltadas a qualificacao da atencao prestada, especialmente nos municipios de pequeno porte.

Job stress is associated with migraine in current workers: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Migraine is an important source of social burden and work‐related costs. Studies addressing the association of migraine with job stress are rare.

Experiências de avaliação do setor suplementar de saúde: contribuições da integralidade

This work identifies aspects of comprehensiveness in the proposals for healthcare evaluation of the Agencia Nacional de Saude Suplementar (ANS) in Brazil, and of the National Commitee Quality Assurance (NCQA) in the U.S.A. The investigation was based on a documental analysis of the proposals found in the websites of both institutions in the second semester of 2006. The data were systemized according to pre-established attributes, building an analytical matrix for evaluating the following three dimensions: management practices and service organization; quality of knowledge and of practices of the health workers; and quality of the control practices of the society. In the Brazilian case there was an emphasis on the first and the third dimensions. The evaluation focalized the operators; the health plans were not evaluated. In the American case there was a balance between the three sets of attributes and the evaluation was focused on the health plans. Both proposals measured the satisfaction of the beneficiaries and made the results of the evaluations available in their websites. In conclusion we emphasize the importance of evaluative concepts and approaches for measuring the integrality of private health plan operators in the Brazilian supplementary health sector.

Capital social no ELSA-Brasil: confiabilidade teste-reteste do Resource Generator scale

OBJETIVO: Estimar a confiabilidade teste-reteste dos itens do Resource Generator scale para avaliacao de capital social no Estudo Longitudinal de Saude do Adulto (ELSA-Brasil). METODOS: A escala de capital social foi aplicada em subamostra de 281 participantes dos seis Centros de Investigacao do ELSA, em duas oportunidades, com intervalo de sete a 14 dias. O instrumento e constituido por 31 itens que representam situacoes concretas para avaliar o acesso a diferentes tipos de recursos, alem de avaliar a fonte dos recursos disponiveis (familiares, amigos ou conhecidos). A analise estatistica foi realizada por meio de estatisticas kappa (k) e kappa ajustado pela prevalencia (ka). RESULTADOS: Os recursos sociais investigados foram encontrados com grande frequencia (acima de 50%). Em relacao a presenca ou ausencia dos recursos, as estimativas de confiabilidade ajustadas pela prevalencia (ka) variaram de 0,54 a 0,97. No que se refere a fonte de recurso, essas estimativas variaram de ka = 0,45 (alguem que tenha bons contatos com a midia) a ka = 0,86 (alguem que se formou no Ensino Medio). CONCLUSOES: A escala apresentou niveis adequados de confiabilidade, que variaram de acordo com o tipo de recurso.

Interobserver reliability of the international classification of primary care at a primary health care unit

We evaluated the International Classification of Primary Care interobserver reliability for coding the complaints reported at a primary public health unit. The study sample consisted of 300 appointments. Reasons for appointment were registered by physicians on the medical record and coding was performed by two investigators. Reliability among the classifiers as to the number of coded reasons was calculated by weighted kappa. Crude kappa coefficients were used for the remaining analyses (chapter codes and full codes). A total of 634 reasons were coded by the first classifier and 699 by the second one. Crude reliability of numbers of reasons was moderate, with a 0.71 weighted kappa (95% Confidence Interval [95%CI]: 0.68-0.73). Regarding chapter codes and full codes, reliability was substantial (kappa = 0.89; 95%CI: 0.87-0.91) and moderate (kappa = 0.72; 95% CI: 0.68-0.76), respectively. Our results suggest a good performance of the Classification for coding reasons for visit in primary care, even when data are obtained from physician consultation notes.

Demographic and mortality trends in Niterói, Rio de Janeiro, Brazil, 1979 to 1997

An analysis of the 1979-1997 historical series points to demographic and mortality trends in Niterói, Rio de Janeiro State, over the course of those two decades. There was a drop in the rate of population increase, with a significant change in the age structure. In the time series, there was a decline in mortality from cardiovascular diseases and an overall downward trend in mortality from infectious and parasitic diseases, albeit with a sharp increase beginning in 1996 resulting in a change in disease classification (ICD-9 to ICD-10). As for infant mortality, there was a predominance of deaths in the neonatal group. An analysis of major groups of diseases and injuries highlights the importance of ischemic heart disease and cerebrovascular diseases, homicides, traffic accidents, and AIDS.

A promoção da saúde e a prevenção integrada dos fatores de risco para doenças cardiovasculares: até quando ficaremos "enxugando o gelo"?

A promocao da saude e a prevencaointegrada dos fatores de risco para doencascardiovasculares: ate quando ficaremos“enxugando o gelo”?The Promotion of Health and the IntegratedPrevention of Risk Factors forCardiovascular Diseases: until when we willbe “mopping up the ice”?Marcia Guimaraes de Mello Alves