Maria da Conceição C Almeida

Recrutamento de participantes no Estudo Longitudinal de Saude do Adulto

OBJETIVO: Apresentar as estrategias de comunicacao e recrutamento no Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) e discutir os resultados alcancados na constituicao da coorte. METODOS: As estrategias foram voltadas a divulgacao, a institucionalizacao e ao recrutamento propriamente dito. As acoes de comunicacao pretenderam promover o fortalecimento de imagem institucional positiva para o estudo, a gestao de conhecimentos e o dialogo eficaz com seu publico-alvo. Foi criado web site oficial visando dialogar com diferentes publicos, funcionar como difusor cientifico e contribuir para a consolidacao da imagem do estudo perante a sociedade. RESULTADOS: Foram recrutados 16.435 mulheres e homens, servidores ativos e aposentados de seis instituicoes publicas de ensino e pesquisa para constituir a coorte de 15.105 participantes. As metas de recrutamento foram plenamente alcancadas nos seis centros, com leve predominio de mulheres e daqueles mais jovens, e um pouco menos de servidores com menor escolarizacao. CONCLUSOES: As estrategias utilizadas se mostraram adequadas e essenciais para o sucesso da captacao e participacao dos servidores.

Factors associated with leisure time physical activity among ELSA-Brasil participants: Ecological model.

The main objective of the study was identify the prevalence and factors associated with leisure time physical activity (LTPA) in adult participants of the Longitudinal Study of Adult Health (ELSA-Brasil). The LTPA was measured using the International Physical Activity Questionnaire (IPAQ), long version. A hierarchical ecological model was built with the possible factors associated with LTPA distributed across blocks. We estimated crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression. In men, being more educated, having a high family income, living in environments with conditions and opportunities for PA, being retired and being overweight were positively associated, while current smoking, obesity and abdominal obesity were associated negatively with the LTPA. Among women, being over 60years old, being more educated, having a high family income, living in an environment with conditions and opportunities for PA practice and being retired were positively associated, while being overweight, obese and having abdominal obesity were associated negatively with the LTPA. The proposed ecological model explains the LTPA through the social, physical and personal environment and highlights gender differences in physical activity.

Electrocardiographic Findings in Brazilian Adults without Heart Disease: ELSA-Brasil

Background The electrocardiogram (ECG) is widely used in population-based studies. However, there are few studies on electrocardiographic findings in Latin America and in Brazil. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) comprised 15,105 participants (35-74 years) from six Brazilian capitals. Objectives To describe electrocardiographic findings in Brazilian adults without heart disease, stratified by sex, age and race/skin color. Methods Cross-sectional study with baseline data of 11,094 adults (44.5% men) without heart disease from ELSA-Brasil. The ECGs were recorded with the Burdick Atria 6100 machine and stored at the Pyramis System. ECG analysis was automatically performed using the Glasgow University software. A descriptive analysis of heart rate (HR), P, QRS and T waves’ duration, PR and QT intervals, and P, R and T axes was performed. After stratification by sex, race/color and age, the groups were compared by the Wilcoxon and Kruskal-Wallis test at a significance level of 5%. Linear regression models were used to evaluate the behavior of electrocardiographic parameters over age. Major electrocardiographic abnormalities defined by the Minnesota code were manually revised. Results Medians values of the electrocardiographic parameters were different between men and women: HR 63 vs. 66 bpm, PR 164 vs.158 ms, QT corrected 410 vs. 421 ms, QRS duration 92 vs. 86 ms, P-wave duration 112 vs. 108 ms, P-wave axis 54 vs. 57 degrees, R-wave axis 35 vs. 39 degrees, T-wave axis 39 vs. 45 degrees (p < 0.001 for all). The 2nd and the 98th percentiles of each variable were also obtained, and graphs were constructed to illustrate the behavior of the electrocardiographic findings over age of participants stratified by sex and race/skin color. Conclusions The values for the electrocardiographic measurements herein described can be used as reference for Brazilian adults free of heart disease, stratified by sex. Our results suggest that self-reported race/skin color have no significant influence on electrocardiographic parameters.

Avaliação da qualidade da atenção ao aborto: protótipo de questionário para usuárias de serviços de saúde

No Brasil, sao escassas as pesquisas sobre a qualidade da atencao ao aborto inseguro. O presente artigo visa a apresentar a primeira etapa da construcao de instrumento para estudo sobre a assistencia hospitalar prestada pelo Sistema Unico de Saude em tres cidades. Foram definidas quatro dimensoes essenciais da atencao – acolhimento e orientacao, qualidade tecnica do cuidado, continuidade da atencao, insumos/ambiente fisico – e respectivos criterios. Procedeu-se a adaptacao transcultural de conjunto de itens propostos pela Organizacao Mundial da Saude. Para dar conta de dimensoes e criterios nao contemplados pelo conjunto original de perguntas, optou-se por adaptar questoes de outros estudos e adicionar outras elaboradas pela propria equipe. O questionario foi pre-testado em 52 usuarias, nas tres cidades, para avaliar a aceitacao e compreensao, o tempo de aplicacao e ajustes finais. O instrumento totalizou 55 itens, organizados segundo os momentos assistenciais, cujo uso mais amplo depende de avaliacoes psicometricas em desenvolvimento e que se seguirao em outros artigos.Little research in Brazil has focused on the quality of care following unsafe abortion. This article presents the first step in the development of an instrument to assess hospital care provided by the Brazilian Unified National Health System in three cities of Brazil. Along with related criteria, four key dimensions of care were defined: wellcome and guidance, technical quality of care, continuity of care, and supplies and physical environment. The authors performed a cross-cultural adaptation of a set of items proposed by the World Health Organization. Following an assessment of the dimensions and criteria not captured by this set, the researchers decided to adapt questions from related studies and to add others developed by the research team itself. The questionnaire was pretested in 52 patients from three cities to assess the acceptance, understanding, and time of application and to make final adjustments. The instrument totaled 55 items organized according to different stages of care. Its expanded use depends on subsequent psychometric assessments, currently underway.

Gender, time use and overweight and obesity in adults: Results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Perceived time constraints have been highlighted in sociological studies as representing a core issue in determining quality of life. The objective of this study was to test the hypothesis that gender inequalities regarding insufficiency of time play a role in the development of overweight and obesity in adults. The study used baseline data (2008–2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), which monitors a cohort of 15,105 civil servants of 35 to 74 years of age. Insufficient time for personal care and leisure due to professional and domestic duties, as detailed in a structured questionnaire, comprised the main exposure variable. The outcome variable was overweight/obesity measured according to body mass index. Prevalence ratios were calculated using multinomial logistic regression. A greater proportion of women compared to men reported insufficient time for personal care and leisure (34.5% versus 23.8%, respectively). The prevalence of overweight was greater in men, while obesity was more common in women. Insufficient time for personal care and leisure was associated with overweight (PR = 1.29; 95% CI: 1.04–1.61) and obesity (PR = 1.65; 95% CI: 1.28–2.12) only in women working over 40 hours/week. No significant association was found for males. These results suggest that the length of the working week influences factors underlying weight gain, possibly issues linked to behavior and/or stress mechanisms. The fact that such an association was restricted to women suggests that the results originate from gender inequalities involving relationships between time and health. The findings of this study provide data on which to base public policies aimed at encouraging the redistribution of domestic responsibilities in the direction of gender equity, as well as macrosocial policies such as providing public schools for workers’ children.

Gender and psychosocial factors associated with healthy lifestyle in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort: a cross-sectional study

Objectives It has been estimated that over 50% of the premature deaths occurring in Western countries can be attributed to causes rooted in lifestyle. In turn, leading a healthy lifestyle has also been associated with a wide range of psychosocial factors. Today, it is known that these differ among men and women. The present article aimed to identify, from a gender-based perspective, the psychosocial factors associated with healthy lifestyles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort, the largest study concerning adult health conducted in Latin America to date. Design This cross-sectional study was conducted using ELSA-Brasil baseline data, collected between 2008 and 2010. Setting Six Brazilian public higher education and research institutions. Participants The ELSA-Brasil cohort consists of approximately 15u2009000 employees (8218 women and 6887 men), both currently working and retired. Main outcome measures The lifestyle indicator was constructed by summing the scores attributed to four different behaviours. Results The women of the ELSA-Brasil cohort have healthier lifestyles than men. In women, strong associations were found between a healthy lifestyle and age 60 years or older, Asian race and university level of education or higher. In men, being 60 years or older, of Asian or Caucasian race, having a high-school equivalent level of education or higher, being retired, having a housekeeper, having a good or very good self-perception of health and being satisfied with body image were the psychosocial factors associated with leading a healthy lifestyle. Conclusions The factors that influenced healthy lifestyles were found to differ among men and women, a fact that must be addressed when developing programmes designed to promote health.

Leisure-Time Physical Activity, but not Commuting Physical Activity, is Associated with Cardiovascular Risk among ELSA-Brasil Participants

Background Despite reports in the literature that both leisure-time physical activity (LTPA) and commuting physical activity (CPA) can promote health benefits, the literature lacks studies comparing the associations of these domains of physical activity with cardiovascular risk scores. Objective To investigate the association between LTPA and CPA with different cardiovascular risk scores in the cohort of the Longitudinal Study of Adult Health ELSA-Brasil. Methods Cross-sectional study with data from 13,721 participants of both genders, aged 35-74 years, free of cardiovascular disease, from ELSA Brazil. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ). Five cardiovascular risk scores were used: Framingham score - coronary heart disease (cholesterol); Framingham score - coronary heart disease (LDL-C); Framingham score - cardiovascular disease (cholesterol); Framingham score - cardiovascular disease (body mass index, BMI); and pooled cohort equations for atherosclerotic cardiovascular disease (ASCVD). Associations adjusted for confounding variables between physical activity and different cardiovascular risk scores were analyzed by logistic regression. Confidence interval of 95% (95%CI) was considered. Results LTPA is inversely associated with almost all cardiovascular risk scores analyzed, while CPA shows no statistically significant association with any of them. Dose-response effect in association between LTPA and cardiovascular risk scores was also found, especially in men. Conclusions LTPA was shown to be associated with the cardiovascular risk scores analyzed, but CPA not. The amount of physical activity (duration and intensity) was more significantly associated, especially in men, with cardiovascular risk scores in ELSA-Brasil.

Evaluación de la calidad en la atención al aborto: cuestionario prototipo para usuarias de los servicios de salud

No Brasil, sao escassas as pesquisas sobre a qualidade da atencao ao aborto inseguro. O presente artigo visa a apresentar a primeira etapa da construcao de instrumento para estudo sobre a assistencia hospitalar prestada pelo Sistema Unico de Saude em tres cidades. Foram definidas quatro dimensoes essenciais da atencao – acolhimento e orientacao, qualidade tecnica do cuidado, continuidade da atencao, insumos/ambiente fisico – e respectivos criterios. Procedeu-se a adaptacao transcultural de conjunto de itens propostos pela Organizacao Mundial da Saude. Para dar conta de dimensoes e criterios nao contemplados pelo conjunto original de perguntas, optou-se por adaptar questoes de outros estudos e adicionar outras elaboradas pela propria equipe. O questionario foi pre-testado em 52 usuarias, nas tres cidades, para avaliar a aceitacao e compreensao, o tempo de aplicacao e ajustes finais. O instrumento totalizou 55 itens, organizados segundo os momentos assistenciais, cujo uso mais amplo depende de avaliacoes psicometricas em desenvolvimento e que se seguirao em outros artigos.Little research in Brazil has focused on the quality of care following unsafe abortion. This article presents the first step in the development of an instrument to assess hospital care provided by the Brazilian Unified National Health System in three cities of Brazil. Along with related criteria, four key dimensions of care were defined: wellcome and guidance, technical quality of care, continuity of care, and supplies and physical environment. The authors performed a cross-cultural adaptation of a set of items proposed by the World Health Organization. Following an assessment of the dimensions and criteria not captured by this set, the researchers decided to adapt questions from related studies and to add others developed by the research team itself. The questionnaire was pretested in 52 patients from three cities to assess the acceptance, understanding, and time of application and to make final adjustments. The instrument totaled 55 items organized according to different stages of care. Its expanded use depends on subsequent psychometric assessments, currently underway.

Quality assessment of treatment associated with abortion: a prototype questionnaire for health services users

No Brasil, sao escassas as pesquisas sobre a qualidade da atencao ao aborto inseguro. O presente artigo visa a apresentar a primeira etapa da construcao de instrumento para estudo sobre a assistencia hospitalar prestada pelo Sistema Unico de Saude em tres cidades. Foram definidas quatro dimensoes essenciais da atencao – acolhimento e orientacao, qualidade tecnica do cuidado, continuidade da atencao, insumos/ambiente fisico – e respectivos criterios. Procedeu-se a adaptacao transcultural de conjunto de itens propostos pela Organizacao Mundial da Saude. Para dar conta de dimensoes e criterios nao contemplados pelo conjunto original de perguntas, optou-se por adaptar questoes de outros estudos e adicionar outras elaboradas pela propria equipe. O questionario foi pre-testado em 52 usuarias, nas tres cidades, para avaliar a aceitacao e compreensao, o tempo de aplicacao e ajustes finais. O instrumento totalizou 55 itens, organizados segundo os momentos assistenciais, cujo uso mais amplo depende de avaliacoes psicometricas em desenvolvimento e que se seguirao em outros artigos.Little research in Brazil has focused on the quality of care following unsafe abortion. This article presents the first step in the development of an instrument to assess hospital care provided by the Brazilian Unified National Health System in three cities of Brazil. Along with related criteria, four key dimensions of care were defined: wellcome and guidance, technical quality of care, continuity of care, and supplies and physical environment. The authors performed a cross-cultural adaptation of a set of items proposed by the World Health Organization. Following an assessment of the dimensions and criteria not captured by this set, the researchers decided to adapt questions from related studies and to add others developed by the research team itself. The questionnaire was pretested in 52 patients from three cities to assess the acceptance, understanding, and time of application and to make final adjustments. The instrument totaled 55 items organized according to different stages of care. Its expanded use depends on subsequent psychometric assessments, currently underway.

Correction: Glycemic control and diabetes management in hospitalized patients in Brazil

After publication of this work, we noted that we inadvertently failed to include the complete list of all members who took part in the Brazilian Diabetes Investigators Group. The full list of members has now been added.