Maria de Jesus Mendes da Fonseca

Validade de peso e estatura informados e índice de massa corporal: estudo pró-saúde

OBJECTIVE Evaluate the validity of self-reported weight and height and the body mass index (BMI). METHODS A study was made of 3,713 employees of a public university in Rio de Janeiro, in which they were participants in Phase 1 of a longitudinal study. Information was obtained through a self-administered questionnaire, and measurements were carried out after its application. Students paired t-test, Bland & Altmans graphs and the intraclass correlation coefficient (ICC) were utilized to evaluate the differences between the measured and the reported parameters. The sensitivity and specificity of the various BMI categories were estimated. RESULTS There was high agreement between the measured and reported weights (ICC=0.977) and heights (ICC=0.943). The BMI sensitivity, in its various categories, was around 80%, and the specificity was close to 92%. There was a slight and uniform tendency toward self-reported weight underestimation and self-reported height overestimation in both sexes. CONCLUSIONS Self-reported and measured weight and height information had good agreement and validity. In similar populations, when few resources are available, it is possible to use self-reported data instead of actual measurements.

Drug utilization and polypharmacy among the elderly: a survey in Rio de Janeiro City, Brazil

OBJECTIVES To describe drug utilization by Brazilian retirees with an emphasis on inappropriate use. METHODS Cross-sectional study with a simple random sample of 800 retirees of the Brazilian Institute of Social Security, 60 years of age and older, residing in Rio de Janeiro City, through face-to-face interviews. RESULTS Medication use in the 15 days before the study was reported by 85% of the sample, with a mean of 3.7 products per person (standard deviation=2.9). About half the sample used one to four medications and a third used five or more. The highest number of drugs used per patient was 24. More women than men used multiple medications. There is a tendency toward positive association (P<0.001) between drug use and variables relating to disease and health care. This trend continues in the analysis by gender. Men who reported five or more diseases were five times more likely to use multiple drugs than men with up to two (zero, one, or two) diseases (prevalence ratio 5.21, 95% confidence interval=2.48-10.90). Women who reported five or more diseases were nearly four times more likely to use multiple drugs than women with up to two diseases (prevalence ratio 3.67, 95% confidence interval=2.24-6.02). Of the active substances used by the sample, 10% were considered inappropriate. CONCLUSIONS To improve drug therapy for the elderly, health practitioners can take measures to reduce unwarranted use of medication and to optimize the benefits from important drugs. Further studies should be conducted to adjust lists of medications inappropriate for the elderly to the situation in developing countries.

Reprodutibilidade e validade relativa do Questionário de Frequência Alimentar do ELSA-Brasil

Avaliou-se a reprodutibilidade e a validade do Questionario de Frequencia Alimentar (QFA) utilizado no Estudo Longitudinal de Saude do Adulto (ELSA-Brasil). Foram aplicados tres registros alimentares e um QFA em dois momentos no periodo de um ano (n = 281). Valores de energia e nutrientes dos registros alimentares foram deatenuados e Log transformados. Para avaliacao da reprodutibilidade e validade foi aplicado o teste de correlacao intraclasse (CCI) e calculados percentuais de concordância do consumo de nutrientes apos categorizacao por tercis. Na avaliacao da reprodutibilidade, coeficientes de CCI variaram de 0,55-0,83 para proteina e vitamina E, respectivamente; na avaliacao da validade, variaram de 0,20-0,72 para selenio e calcio, respectivamente. Concordâncias exata e adjacente entre metodos variaram de 82,9% para vitamina E a 89% para lipidio e calcio (media = 86%). Foi encontrada uma discordância media de 13,6%. Conclui-se que o QFA ELSA-Brasil apresenta confiabilidade satisfatoria para todos nutrientes e validade relativa razoavel para energia, macronutrientes, calcio, potassio e vitaminas E e C.

Associações entre escolaridade, renda e Índice de Massa Corporal em funcionários de uma universidade no Rio de Janeiro, Brasil: estudo Pró-Saúde

This study focuses on associations between schooling, income, and body mass index (BMI). The analyses are based on data from 3,963 public university employees in Rio de Janeiro, Brazil, participating in phase 1 of a longitudinal study (the Pró-Saúde Study). ANOVA, Wald test, and generalized linear models were used to analyze differences between subgroups. Obesity prevalence was inversely associated with schooling, especially among women (p < 0.001). In regression analyses, schooling and per capita income were not associated with BMI among men. In women, schooling but not income was significantly and inversely associated with BMI (p < 0.001). Thus, low schooling plays an important role in the social determination of obesity, especially among women.

Patterns of benzodiazepine and antidepressant use among middle-aged adults. The Brazilian longitudinal study of adult health (ELSA-Brasil)

BACKGROUND Antidepressant and benzodiazepine medicines are widely prescribed in high-income countries. Our aim was to investigate and describe clinical and demographic characteristics of their use in a large cohort from a middle-income country. METHODS Participants (n=15,105) from the Brazilian Health Longitudinal Study (ELSA-Brasil), a civil servant cohort from six different sites in Brazil were asked about antidepressant and benzodiazepine use. The Clinical Interview Schedule-Revised was used for psychiatric assessment. Sociodemographic and clinical data were also collected. RESULTS Current use of antidepressant and benzodiazepine medicines was respectively reported by 6.87% and 3.88% of participants. These numbers were higher in major depression-MDD (16.5% and 13.9%), generalized anxiety disorder-GAD (14% and 9.5%) and any mental disorder (11.7% and 7.8%). The use of antidepressant and benzodiazepine was directly associated with clinical comorbidities and psychiatry diagnosis. In addition, older age was associated with benzodiazepine use and more years of schooling, with antidepressant use. Finally, the use of these medicines was strongly associated (odds ratio=8.48, p<0.001). LIMITATIONS Our cohort does not include younger adults (18-34 years), although it includes older (65-75 years) participants. DISCUSSION Antidepressant and benzodiazepine use in Brazil is lower than in high-income countries. We found that factors such as age and education level were associated with the use of these medicines, whereas MDD and GAD were poor predictors of psychopharmacotherapy use, suggesting misuse/overuse of psychopharmacotherapy among individuals without psychiatric illness and underuse among those with psychiatric conditions in Brazil.

Abordagem multifatorial do absenteísmo por doença em trabalhadores de enfermagem

OBJECTIVE To analyze factors associated with self-reported sickness absenteeism among nursing workers. METHODS Cross-sectional study with 1,509 workers from three public hospitals in the city of Rio de Janeiro (Southeastern Brazil) in 2006. Absenteeism was classified in three levels: no day, a few days (1-9 days) and many days (> 10 days), based on the answer to a question of the work ability index questionnaire. The logistic regression analysis considered a conceptual model based on distal (socioeconomic status), intermediate I (occupational characteristics), intermediate II (lifestyle characteristics), and proximal (diseases and health conditions) determinants. RESULTS The frequencies of sickness absenteeism were 20.3% and 16.6% for a few days and many days, respectively. Those who reported more than one job, musculoskeletal diseases and rated their health as poor or regular had higher odds of absenteeism. Compared to nurses, nursing assistants were less likely to mention a few days, and technicians were more likely to have many days of absence. Higher odds of mentioning many days of absence were observed among public servants, compared to contract workers (OR = 3.12; 95%CI 1.86;5.22), and among married (OR = 1.73; 95%CI 1.14;2.63) and separated, divorced and widowed individuals (OR = 2.06, 95%CI 1.27;3.35), compared to singles. CONCLUSIONS Different variables were associated with the two forms of absenteeism, which suggests its multiple and complex determination related to factors from different levels that cannot be exclusively explained by health problems.OBJETIVO: Analisar fatores associados ao absenteismo por doenca autorreferido em trabalhadores de enfermagem. METODOS: Estudo transversal com 1.509 trabalhadores de tres hospitais publicos no municipio do Rio de Janeiro, RJ, em 2006. O absenteismo foi classificado em tres niveis: nenhum dia, poucos dias (um a nove dias) e muitos dias (> 10 dias), a partir da resposta a uma pergunta do questionario de avaliacao do indice de capacidade para o trabalho. As analises de regressao logistica levaram em conta um modelo conceitual com base em determinantes distais (condicoes socioeconomicas), de niveis intermediarios I (caracteristicas ocupacionais) e II (caracteristicas do estilo de vida), e proximais (doencas e condicoes de saude). RESULTADOS: As frequencias de absenteismo por doenca foram de 20,3% e 16,6% para poucos e muitos dias, respectivamente. Aqueles que referiram mais de um emprego, doencas osteomusculares e avaliaram sua saude como ruim ou regular apresentaram chances mais elevadas de absenteismo. Comparados aos enfermeiros, os auxiliares tiveram menor chance de referir poucos dias e os tecnicos, maiores chances de apresentar muitos dias de ausencia. Chances mais elevadas de referir muitos dias de ausencia foram observadas entre os servidores publicos em relacao aos contratados (OR = 3,12; IC95% 1,86;5,22) e entre os casados (OR = 1,73; IC95% 1,14;2,63) e separados, divorciados e viuvos (OR = 2,06; IC95% 1,27;3,35), comparados aos solteiros. CONCLUSOES: Diferentes variaveis foram associadas as duas modalidades de absenteismo, o que sugere sua determinacao multipla e complexa, relacionada a fatores de diversos niveis que nao podem ser explicados apenas por problemas de saude.

Profile of elderly admitted to public hospitals of Niterói (RJ) due to falls

OBJECTIVE to describe the common characteristics of elderly people admitted to public hospitals of Niterói (RJ) due to falls. METHODS Cross-sectional study with 110 elderly patients (60 years and more) admitted to public hospitals in Niteroi - RJ, with fractures after falls. Data were collected by a multidimensional questionnaire. Multiple correspondence and cluster analysis were used to describe the characteristics of this population. RESULTS The results indicated four groups. The first group was formed by individuals with better physical conditions who did not have a hip fracture, were more independent, used to go out more than twice a week, had good vision, had a short hospital stay, and were discharged to their homes. There was a group with worse conditions including those who were less independent, had a long hospital stay (more than 30 days), and died at the hospital. A third group was formed by those who had had a hip fracture, had poor vision, and used to go out less than once a week. The fourth group was comprised of those who stayed in the hospital from 11 to 30 days and used to go out once or twice a week. CONCLUSIONS The multiple correspondence analysis proved to be a good technique to identify subgroups with common characteristics, which provides tools for the creation of strategies for fall prevention programs.

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.

Reproducibility and relative validity of the Food Frequency Questionnaire used in the ELSA-Brasil

This study evaluated the reproducibility and relative validity of the Food Frequency Questionnaire (FFQ) used in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants (n = 281) completed the FFQ and three food records on two occasions during a 12-month period. Energy and nutrient values from food records were disattenuated and log-transformed. Reproducibility and validity were assessed by the intra-class correlation coefficient (ICC). Agreement between the two methods was evaluated by classification in tertiles. In the evaluation of reproducibility, ICC estimated ranged from 0.55 to 0.83 for protein and vitamin E, respectively. On relative validity, ICC ranged from 0.20 to 0.72 for selenium and calcium, respectively. Exact and adjacent agreement between methods varied from 82.9% for vitamin E to 89% for lipids and calcium (mean 86%). Average disagreement was 13.6%. In conclusion, this FFQ showed satisfactory reliability for all nutrients and reasonable validity, especially for energy, macronutrients, calcium, potassium, and vitamins E and C.

Life Course Socioeconomic Position and C-Reactive Protein: Mediating Role of Health-Risk Behaviors and Metabolic Alterations. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background Chronic inflammation has been postulated to be one mediating mechanism explaining the association between low socioeconomic position (SEP) and cardiovascular disease (CVD). We sought to examine the association between life course SEP and C-reactive protein (CRP) levels in adulthood, and to evaluate the extent to which health-risk behaviors and metabolic alterations mediate this association. Additionally, we explored the possible modifying influence of gender. Methods and Findings Our analytical sample comprised 13,371 participants from ELSA-Brasil baseline, a multicenter prospective cohort study of civil servants. SEP during childhood, young adulthood, and adulthood were considered. The potential mediators between life course SEP and CRP included clusters of health-risk behaviors (smoking, low leisure time physical activity, excessive alcohol consumption), and metabolic alterations (obesity, hypertension, low HDL, hypertriglyceridemia, and diabetes). Linear regression models were performed and structural equation modeling was used to evaluate mediation. Although lower childhood SEP was associated with higher levels of CRP in adult life, this association was not independent of adulthood SEP. However, CRP increased linearly with increasing number of unfavorable social circumstances during the life course (p trend <0.001). The metabolic alterations were the most important mediator between cumulative SEP and CRP. This mediation path accounted for 49.5% of the total effect of cumulative SEP on CRP among women, but only 20.2% among men. In consequence, the portion of the total effect of cumulative SEP on CRP that was mediated by risk behaviors and metabolic alterations was higher among women (55.4%) than among men (36.8%). Conclusions Cumulative SEP across life span was associated with elevated systemic inflammation in adulthood. Although health-risk behaviors and metabolic alterations were important mediators of this association, a sizable fraction of this association was not mediated by these factors, suggesting that other pathways might play a role, especially among men.