Maria C. Almeida

Adolescência e reprodução no Brasil: a heterogeneidade dos perfis sociais

This study aims to estimate the prevalence of adolescent pregnancy (AP) in three Brazilian cities Salvador, Rio de Janeiro, and Porto Alegre and to examine the profiles of pregnant girls and their partners in relation to pregnancy outcomes. Data for a retrospective assessment of AP were collected using an interview-based household survey applied to a stratified sample of males and females aged 18-24. A total of 4,634 individuals were interviewed (85.2 % of the eligible individuals). 21.4% of males and 29.5% of females aged 20-24 reported AP, but few such pregnancies had taken place before age 15 (0.6% and 1.6%). Pregnancy between adolescent partners was reported by 55.1% of males and 27.9% of females. 79.8% of the latter became pregnant while involved in a stable relationship with an older partner. AP levels varied inversely to schooling and income levels. 72.2% of females and 34.5% of males carried their first AP to completion, and more cases of induced abortion were reported by male partners in pregnancies (41.3%) than by females (15.3%). With the birth of the first child, 25.0% of women interrupted their studies temporarily and 17.3% definitively. However, 42.1% of primiparous mothers were already outside school before pregnancy.

Uso de contracepção por adolescentes de escolas públicas na Bahia

OBJETIVO: O interesse sobre o comportamento contraceptivo de adolescentes vem crescendo, especialmente pela relevância social conferida a gravidez nessa faixa etaria. Assim, realizou-se estudo para investigar fatores associados ao uso de metodos anticoncepcionais entre adolescentes escolares. METODOS: Estudo transversal que utilizou um questionario auto-aplicado em 4.774 alunos de ambos os sexos, entre 11 e 19 anos. Calcularam-se as prevalencias de uso de contraceptivos na primeira e na ultima relacao sexual e em ambas as situacoes (uso consistente). A regressao logistica foi utilizada para a analise simultânea dos fatores e calculo de medidas ajustadas. RESULTADOS: Entre 1.664 estudantes com iniciacao sexual, os fatores associados positivamente ao uso consistente de contraceptivos pelos rapazes incluiram a iniciacao sexual mais tardia, com parceria estavel, contar com a familia como fonte potencial de contraceptivos e acesso a servicos de saude; entre as mocas, ter iniciado a vida sexual ha pouco tempo e ter o pai como fonte de informacao sobre sexualidade, contracepcao e prevencao DST/Aids. A gravidez foi relatada por 6,4% dos rapazes e 18,1% das mocas, sendo sua ausencia associada ao uso consistente de contraceptivos por elas (OR=3,83; 2,06-7,15). CONCLUSOES: Os resultados confirmam a complexidade da determinacao do comportamento contraceptivo entre adolescentes e a necessidade de que os programas educativos incorporem as multiplas dimensoes da questao para que tenham efetividade.

School trajectory and teenage pregnancy in three Brazilian state capitals

This paper describes the relationship between school trajectory and incidence of teenage pregnancy. A cross-sectional residence-based questionnaire was applied, interviewing 4,634 youth ages 18 to 24 years, selected through a stratified three-stage sample. For the present study, young people ages 20 to 24 years (65.6%) were chosen, with teenage pregnancy rates of 29.5% for females and 21.4% for males (in relation to their partners). Sexual debut was reported by 87% of women and 95.3% of men. The majority of young people reported irregular school trajectory, with 39% enrolled in school at the time of the study. Nearly half of those who had interrupted their studies at least once reported a teenage pregnancy. The main reasons for interrupting their studies were pregnancy and children for women and work for men. School dropout due to teenage pregnancy was mentioned by 40.1% of women for whom the outcome of pregnancy was a child. However, 20.5% had already dropped out of school before becoming pregnant.

Práticas contraceptivas e iniciação sexual entre jovens de três capitais brasileiras

This study investigated contraceptive use during first sexual intercourse among 2.790 young men and women. The GRAVAD household survey in three Brazilian capital cities involved interviews in a probabilistic sample. A hierarchical logistic regression analysis was used. Variables grouped as: macro-social, socialization and sexual initiation, context of sexual initiation, and characteristics of the interviewee and his or her partner. The prevalence of contraceptive use was 68.3% for women and 65.3% for men. Among women, contraception use was associated to: per capita monthly family income, color/race, and the use of womens magazines as a source of information on pregnancy and contraception. For both genders, use was more frequent when partners discussed pregnancy prevention before intercourse, when sexual initiation was delayed and in a motel, and when the partner was patient. The interval between the start of the relationship and sexual initiation appeared associated to use during sexual initiation for men. Results suggest that macro-social factors determine more frequent contraception use during sexual initiation for women, while for men the relational context is more important.

Hypertension in a female nursing staff-pattern of occurrence, diagnosis, and treatment

OBJECTIVE To report the pattern of occurrence, diagnosis, and treatment of hypertension in a female nursing staff of an emergency hospital. METHODS We carried out a cross-sectional study that included interviews and blood pressure measurements of 494 nursing professionals at an emergency hospital in the city of Salvador, in the state of Bahia, Brazil. We considered hypertensive all individual with blood pressure > or = 140/90 mmHg or normal pressure if on regular treatment. RESULTS We found a prevalence of hypertension of 36.4%. Only 18.3% of the individuals ignored their hypertensive condition, and 64.2% admitted not being having regular treatment. Of those individuals who were having treatment, 69.4% had elevated blood pressure on examination. The major reasons for not being on treatment was the occasional elevation of blood pressure (22.2%) and medical counseling (20.0%). CONCLUSION The results point to the need to introduce hypertension control measures in this occupational group, because of the magnitude of the disease and the potential impact on diffusion of knowledge and measures to control hypertension.

Prognostic value of GRACE scores versus TIMI score in acute coronary syndromes

BACKGROUND Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS A total of 154 patients aged 71 +/- 13 years, of which 56% were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4% (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an chi2 of 5.3 (P = 0.72), whereas the TIMI score presented an chi2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95%CI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95%CI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.Resumen Fundamento: Aunque el Score de Riesgo TIMI sea el mas utilizado en sindromes coronarios agudos sin supradesnivel del segmento ST (SCA), el Score GRACE tiene potencial superioridad pronostica, pues fue creado a partir de un registro observacional, parte de las variables son tratadas de forma semicuantitativa y la funcion renal se computa en su calculo.Objetivo: Probar la hipotesis de que el Score de Riesgo GRACE tiene superior valor pronostico hospitalario, comparado con el Score TIMI en pacientes ingresados con SCA.Metodos: Fueron incluidos individuos con angina inestable o infarto de miocardio sin supradesnivel del segmento ST, consecutivamente internados en Unidad Coronaria entre agosto de 2007 y enero de 2009.Resultados: Fueron estudiados 154 pacientes, edad 71 ± 13 anos, el 56% del sexo femenino, mediana de GRACE de 117 y mediana de TIMI de 3. Durante el periodo de internacion, la incidencia de eventos fue del 8,4% (12 fallecimientos y 1 infarto no fatal). El test de Hosmer-Lemeshow aplicado al Score GRACE presento χ

Valor prognóstico do Escore de Risco GRACE versus Escore de Risco TIMI em síndromes coronarianas agudas

BACKGROUND Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS A total of 154 patients aged 71 +/- 13 years, of which 56% were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4% (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an chi2 of 5.3 (P = 0.72), whereas the TIMI score presented an chi2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95%CI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95%CI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.Resumen Fundamento: Aunque el Score de Riesgo TIMI sea el mas utilizado en sindromes coronarios agudos sin supradesnivel del segmento ST (SCA), el Score GRACE tiene potencial superioridad pronostica, pues fue creado a partir de un registro observacional, parte de las variables son tratadas de forma semicuantitativa y la funcion renal se computa en su calculo.Objetivo: Probar la hipotesis de que el Score de Riesgo GRACE tiene superior valor pronostico hospitalario, comparado con el Score TIMI en pacientes ingresados con SCA.Metodos: Fueron incluidos individuos con angina inestable o infarto de miocardio sin supradesnivel del segmento ST, consecutivamente internados en Unidad Coronaria entre agosto de 2007 y enero de 2009.Resultados: Fueron estudiados 154 pacientes, edad 71 ± 13 anos, el 56% del sexo femenino, mediana de GRACE de 117 y mediana de TIMI de 3. Durante el periodo de internacion, la incidencia de eventos fue del 8,4% (12 fallecimientos y 1 infarto no fatal). El test de Hosmer-Lemeshow aplicado al Score GRACE presento χ

Valor Pronóstico del Score de Riesgo GRACE versus Score de Riesgo TIMI en Síndromes Coronarios Agudos

BACKGROUND Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS A total of 154 patients aged 71 +/- 13 years, of which 56% were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4% (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an chi2 of 5.3 (P = 0.72), whereas the TIMI score presented an chi2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95%CI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95%CI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.Resumen Fundamento: Aunque el Score de Riesgo TIMI sea el mas utilizado en sindromes coronarios agudos sin supradesnivel del segmento ST (SCA), el Score GRACE tiene potencial superioridad pronostica, pues fue creado a partir de un registro observacional, parte de las variables son tratadas de forma semicuantitativa y la funcion renal se computa en su calculo.Objetivo: Probar la hipotesis de que el Score de Riesgo GRACE tiene superior valor pronostico hospitalario, comparado con el Score TIMI en pacientes ingresados con SCA.Metodos: Fueron incluidos individuos con angina inestable o infarto de miocardio sin supradesnivel del segmento ST, consecutivamente internados en Unidad Coronaria entre agosto de 2007 y enero de 2009.Resultados: Fueron estudiados 154 pacientes, edad 71 ± 13 anos, el 56% del sexo femenino, mediana de GRACE de 117 y mediana de TIMI de 3. Durante el periodo de internacion, la incidencia de eventos fue del 8,4% (12 fallecimientos y 1 infarto no fatal). El test de Hosmer-Lemeshow aplicado al Score GRACE presento χ

Conflito trabalho-família e uso do tempo: avaliação psicométrica de um instrumento no ELSA-Brasil

ABSTRACT In this study, we evaluated the psychometric properties of the items to measure the work-family conflict and the time use for personal care and leisure, included in the baseline questionnaire of the Longitudinal Study of Adult Health (ELSA-Brazil). We evaluated temporal stability (7-14 days) using kappa statistic and the validity of the construct by the correlation of Kendall’s tau with other variables. Test-retest stability was discreet to moderate and the correlations were compatible with the underlying theory. Future studies in the context of ELSA-Brazil and in other populations will complement the assessment of its relevance.

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.