Maria do Rosário Dias de Oliveira Latorre

Severidade de cárie em crianças e relação com aspectos sociais e comportamentais

OBJECTIVE To identify social and behavioral conditions that could act as risk factors to the severity of dental caries in 12-year-old children. METHODS Based on the oral health survey data obtained in Florianópolis, Brazil, in 1995, social and behavior conditions were compared between two 12-year-old children groups with dental caries with different severity: high and very high severity, and very low severity. In the interview, there were questions about each family were part of the interview, besides social-economic conditions and behavior aspects. RESULTS/CONCLUSIONS The multivariate logistic regression analysis showed that the risk factors for dental caries with high severity were candy intake and family income. Children who consumes cariogenic products 2 or 3 times a day on a daily basis has 4.41 more chance of having dental caries with high severity when compared to children who consumes these same products only once a day - CI (OR) = [1.18; 16.43] ). Family income was the most important socialeconomic factor. Children whose family income is lower than five minimum wages has 4.18 more chance of having high severity dental caries when compared to children whose family income is higher than five minimum wages - CI (OR) = [1.16; 15.03]. The purpose of this study was to have a a better knowledge of dental caries occurrence in 12-year-old children who, in most cases, have a complete permanent dentition that showed the illness history.OBJECTIVE: To identify social and behavioral conditions that could act as risk factors to the severity of dental caries in 12-year-old children. METHODS: Based on the oral health survey data obtained in Florianopolis, Brazil, in 1995, social and behavior conditions were compared between two 12-year-old children groups with dental caries with different severity: high and very high severity, and very low severity. In the interview, there were questions about each family were part of the interview, besides social-economic conditions and behavior aspects. RESULTS/CONCLUSIONS: The multivariate logistic regression analysis showed that the risk factors for dental caries with high severity were candy intake and family income. Children who consumes cariogenic products 2 or 3 times a day on a daily basis has 4.41 more chance of having dental caries with high severity when compared to children who consumes these same products only once a day ¾ CI (OR) = [1.18; 16.43] ). Family income was the most important socialeconomic factor. Children whose family income is lower than five minimum wages has 4.18 more chance of having high severity dental caries when compared to children whose family income is higher than five minimum wages ¾ CI (OR) = [1.16; 15.03]. The purpose of this study was to have a a better knowledge of dental caries occurrence in 12-year-old children who, in most cases, have a complete permanent dentition that showed the illness history.

Escores de consumo alimentar e níveis lipêmicos em população de São Paulo, Brasil

Descritores Consumo de alimentos. # Lipidios, sangue. # Colesterol, sangue. # Lipoproteinas. # Gorduras na dieta. # Abstract Objective To study food patterns assessed using scores of consumption and their relationship with serum total cholesterol (TOTAL-C), low density lipoprotein-cholesterol (LDL- C) and high density lipoproteins (HDL-C) concentration in the population of the metropolitan area of Sao Paulo, Brazil.

A study of the validity and reliability of the Brazilian version of the Body Shape Questionnaire (BSQ) among adolescents

OBJECTIVES: to produce evidence of the validity and reliability of the Body Shape Questionnaire (BSQ) - a tool for measuring an individuals attitude towards his or her body image. METHODS: the study covered 386 young people of both sexes aged between 10 and 18 from a private school and used self-applied questionnaires and anthropometric evaluation. It evaluated the internal consistency, the discriminant validity for differences from the means, according to nutritional status (underweight, eutrophic, overweight and obese), the concurrent validity by way of Spearmans correlation coefficient between the scale and the Body Mass Index (BMI), the waist-hip circumference ratio (WHR) and the waist circumference (WC). Reliability was tested using Wilcoxons Test, the intraclass correlation coefficient and the Bland-Altman figures. RESULTS: the BSQ displayed good internal consistency (±=0.96) and was capable of discriminating among the total population, boys and girls, according to nutritional status (p<0.001). It correlated with the BMI (r=0.41; p<0.001), WHR (r=-0.10; p=0.043) and WC (r=0.24; p<0.001) and its reliability was confirmed by intraclass correlation (r=0.91; p<0.001) for the total population. The questionnaire was easy to understand and could be completed quickly. CONCLUSIONS: the BSQ presented good results, thereby providing evidence of its validity and reliability. It is therefore recommended for evaluation of body image attitudes among adolescents.OBJETIVOS: verificar evidencia de validade e confiabilidade do Body Shape Questionnaire (BSQ) - instrumento que mensura o aspecto atitudinal da imagem corporal. METODOS: PArticiparam 386 jovens, de ambos os sexos, na faixa etaria de 10-18 anos de uma escola particular de ensino, por meio de questionarios auto-aplicaveis e avaliacao antropometrica. Avaliou-se a consistencia interna, a validade discriminante pelas diferencas das medias, segundo estado nutricional (baixo peso, eutrofico, sobrepeso e obesidade), a validade concorrente por meio do coeficiente de correlacao de Spearman entre a escala e o Indice de Massa Corporal (IMC), a razao circunferencia quadril (RCQ) e a circunferencia da cintura (CC). Para confiabilidade, utilizou-se o teste de Wilcoxon, o coeficiente de correlacao intraclasse e as Figuras de Bland-Altman. RESULTADOS: o BSQ apresentou boa consistencia interna (±=0,96) e foi capaz de discriminar populacao total, meninos e meninas, segundo estado nutricional (p<0,001). Correlacionou-se com o IMC (r=0,41; p<0,001), RCQ (r=-0,10; p=0,043) e CC (r=0,24; p<0,001) e confirmou sua confiabilidade por meio da correlacao intra-classe (r=0,91; p<0,001) para populacao total. Registrou-se boa compreensao e tempo de finalizacao. CONCLUSOES: O BSQ apresentou bons resultados confirmando as evidencias de validade e confiabilidade, sendo recomendado para avaliacao do aspecto atitudinal da imagem corporal para adolescentes.

Análise de séries temporais em epidemiologia: uma introdução sobre os aspectos metodológicos

A time series, also denominated historical series, is a sequence of data obtained in regular intervals of time during a specific period. In the analysis of a time series, one first wants to model the study phenomenon and, from this, to describe the behaviour of the series, to make estimates, and, in the end, to evaluate the factors that may have influenced the behaviour of the series, with the objective of defining cause-effect relationships between two or more series. For this, there is a set of available statistical techniques which depend upon the defined model (or that estimated for the series), the type of the study series, and of the objective of the work. To analyse trends, it is possible to adjust polynomial regression models based on the whole series or on the neighbourhood of a specific point. This can also be done with mathematical functions. A seasonal phenomenon is defined as the one that occurs regularly in fixed periods of time and, if there is seasonality considered as deterministic in the series, one can use regression models which include functions like seno or cosseno to the variable time. In the analysis of the behaviour of a time series without trend and seasonality, the auto-regressive models (AR) or models which incorporate moving averages (ARMA) can be used. When trend is present, one can use auto-regressive models integrated with moving averages (ARIMA) and to incorporate the seasonality component the SARIMA models are used. The generalized linear models constitute another class of models. In this group of statistical models, the response variable is a counting process and the independent variables are those which are candidates to explain the behaviour of the series throughout the time. This class of models is indicated when the study variables do not follow the Normal distribution, mainly because they are counting processes. These models represent a group of probability distributions known as exponential family of distributions that incorporates many additive functions like the linear regression, Poisson, logistic, log-linear, etc. The generalized additive models are an extension of this class of models, in which each independent variable analysed does not enter in the model with its own value, but adopting a non parametric function in a non specific manner, which is estimated from smoothing curves.Este e um artigo introdutorio sobre analise de series temporais, onde se pretende apresentar, de maneira sumaria, alguns modelos estatisticos mais utilizados em analise de series temporais . Uma serie temporal, tambem denominada serie historica, e uma sequencia de dados obtidos em intervalos regulares de tempo durante um periodo especifico. Na analise de uma serie temporal, primeiramente deseja-se modelar o fenomeno estudado para, a partir dai, descrever o comportamento da serie, fazer estimativas e, por ultimo, avaliar quais os fatores que influenciaram o comportamento da serie, buscando definir relacoes de causa e efeito entre duas ou mais series. Para tanto, ha um conjunto de tecnicas estatisticas disponiveis que dependem do modelo definido (ou estimado para a serie), bem como do tipo de serie analisada e do objetivo do trabalho. Para analise de tendencias, podem se ajustar modelos de regressao polinomial baseados na serie inteira ou em vizinhanca de um determinado ponto. Isso tambem pode ser realizado com funcoes matematicas. Define-se como um fenomeno sazonal aquele que ocorre regularmente em periodos fixos de tempo e, se existir sazonalidade dita deterministica na serie, podem-se utilizar modelos de regressao que incorporem funcoes do tipo seno ou cosseno a variavel tempo. Os modelos auto-regressivos formam outra classe de modelos. Na analise do comportamento de uma serie historica livre de tendencia e de sazonalidade podem ser utilizados modelos auto-regressivos (AR) ou que incorporem medias moveis (ARMA). Quando ha tendencia, utilizam-se os modelos auto-regressivos integrados de medias moveis (ARIMA) e, para incorporar o componente de sazonalidade, utilizam-se os modelos SARIMA. Por ultimo ha os modelos lineares generalizados. Neste grupo de modelos estatisticos, a variavel resposta e um processo de contagem e as variaveis independentes sao variaveis candidatas a explicar o comportamento da serie ao longo do tempo. Estes modelos sao indicados quando as variaveis em estudo nao tem aderencia a distribuicao normal, principalmente pelo fato de serem processos de contagem . Estes modelos compoem um grupo de distribuicoes de probabilidades conhecido como familia exponencial de distribuicoes que englobam diversas funcoes aditivas, como a regressao linear, de Poisson, logistica, log-linear etc. Os modelos aditivos generalizados sao uma extensao desta classe de modelos, nos quais cada variavel independente analisada nao entra no modelo com o seu valor, mas sim, adotando uma funcao nao parametrica de forma nao especificada, estimada a partir de curvas de alisamento.

Avaliação do sistema de informação sobre nascidos vivos e o uso de seus dados em epidemiologia e estatísticas de saúde

O Ministerio da Saude, considerando a existencia de falhas do ponto de vista quantitativo (cobertura) no registro de nascidos vivos, no Brasil, e a impossibilidade de conhecer a distribuicao dos nascidos vivos segundo algumas variaveis importantes sob a optica clinico/epidemiologica (peso ao nascer, Indice de Apgar, duracao da gestacao, tipo de parto, paridade, idade e instrucao da mae), implantou em 1990, no Brasil, o Sistema de Informacoes sobre Nascidos Vivos - SINASC- tendo como documento-base a Declaracao de Nascido Vivo - DN - com a finalidade de suprir essas lacunas. Com o objetivo de avaliar a cobertura e a fidedignidade das informacoes geradas pelo SINASC, foi analisada a distribuicao dos nascidos vivos hospitalares segundo caracteristicas epidcmiologicas relativas ao produto de concepcao, a gravidez, ao parto e a mae. A populacao de estudo compreendeu 15.142 nascidos vivos hospitalares ocorridos em cinco municipios do Estado de Sao Paulo, Brasil, no periodo de janeiro a julho de 1992. Os resultados permitiram reconhecer excelente cobertura do SINASC (emissao de DN acima de 99,5%) e otima fidedignidade do preenchimento das DNs, para a maioria das variaveis, quando comparadas aos documentos hospitalares. Para algumas caracteristicas foi observada maior fragilidade (Indice de Apgar, duracao da gestacao, instrucao da mae, numero total de filhos tidos e nome do pai). Sao apresentadas sugestoes para o aperfeicoamento do SINASC e recomendados treinamentos/reciclagens do pessoal envolvido no preenchimento das DNs. O estudo confirma o fato de os dados permitirem analise valida para o conhecimento de aspectos ligados a saude materno-infantil. Do ponto de vista epidemiologico, o estudo permitiu detectar proporcoes elevadas de parto operatorio (48,4%), maes adolescentes (17,5%) e o valor estimado para o baixo peso ao nascer foi de 8,5%.

Sexuality of women living with HIV/AIDS in São Paulo

The social and cultural setting which increases female vulnerability to HIV does not disappear when women living with HIV/AIDS discover that they are infected. Following diagnosis, new challenges arise in their emotional lives, an issue which has received little attention in the literature. This study interviewed 1068 women living with HIV/AIDS using a questionnaire consisting of both open and closed questions, aimed at describing aspects of their sexual and reproductive lives and how they perceive counseling at Reference Centers in two cities in the State of São Paulo, where they have access to free antiretroviral therapy. Of the women with stable sexual partners, 63% used condoms in all their sexual relations, or three times the national average; 43% of the partners were HIV-negative and 14% had unknown serological status; 73% of the women had children and 15% were considering becoming pregnant. Knowledge on mother-to-child transmission was less than expected, and the interviewees complained of limited space and receptiveness for discussing sexuality, especially with regard to their childbearing wishes. Counseling on sexuality should be a continuing process and requires interdisciplinary training for the professional team working in health care services, with an emphasis on sexual and reproductive rights.

Técnicas de análise de sobrevida

Statistical methods known as survival analyses are useful for analyzing time-related events, in which time from a benchmark event to an endpoint is the focus of interest. Survival analysis describes not only patient survival statistics (as suggested by the name), but also other dichotomous outcomes such as time of remission, time of breastfeeding, etc. This paper discusses survival analysis techniques, commenting and comparing their utilization, especially in the field of oncology. It also presents and discusses types of epidemiological studies and data sources to which this type of analysis is applied. The authors take into account the difference between hospital-based or clinical series and population-based approaches. Interpretation of results is also discussed.

WORK ABILITY OF HEALTH CARE SHIFT WORKERS: WHAT MATTERS?

This paper aims at identifying variables associated with inadequate work ability among nursing personnel at a public hospital, considering factors related to socio‐demographic, lifestyles, working conditions, and health outcomes. A cross‐sectional study was conducted in a university hospital in São Paulo, Brazil, as part of a larger research study on tolerance to 12 h night work. Nursing staff included registered nurses, nurse technicians, and nurse aides; in total, there were 996 healthcare workers (878 female; 118 male) at the time of the study. Some 696 workers (69.9%) of the population agreed to participate. Data collection (October 2004–July 2005) was based on a comprehensive questionnaire about living and working conditions (including incivility at work, work demands, work control, and support), mental and physical health symptoms (fatigue and sleep problems), and work ability. This report presents analyses of the adapted Brazilian version of the Work Ability Index (WAI) and associated variables. The study population worked one of the following shift schedules at this hospital: 12 h nights followed by 36 h off or 9 h or 6 h day (morning or afternoon) shifts. The mean age of the respondents was 34.9 (S.D.±10.4) years of age; 31.5% of the participants held two jobs. Statistical analyses using a hierarchical multiple logistic regression model were performed to evaluate the factors associated with inadequate (moderate and low scores) of the WAI. The significantly associated factors were socio‐demographic (income responsibility, sole breadwinner, raising kids, age group), working conditions (thermal discomfort, organization of the workplace, and verbal abuse), and health outcomes (high body mass index, obesity, sleep problems, and fatigue). In spite of limitations of the study design, results indicate that the nursing profession is associated with stressful working conditions, contributing to inadequate WAI. This is in addition to bad living conditions and precarious work. Intervention measures, either at the workplace or at individual levels, are necessary to prevent a decrease in work ability, even in this quite young working population.

Validation and reliability of the Baecke questionnaire for the evaluation of habitual physical activity in adult men

The aim of this study was to verify validity and reliability of the scores for physical exercise in leisure (PEL), leisure and locomotion activities (LLA), and total score (TS) of the Baecke habitual physical activity questionnaire in adult males. Twenty-one students of Physical Education were evaluated. For validation, the maximum oxygen uptake (O2max) and the decrease of the heart rate in percentile (%DHR) were measured through the Coopers 12-minute walk or run test, and an annual index of physical exercise (IPE), and a week index of locomotion activities (ILA). The reliability was verified through test-retest with interval of 45 days. The Pearson correlation coefficient, and partial correlation adjusted for age and body mass index were used for validation. The intraclass correlation and paired t-test were used for reliability. The results indicated that %DHR was correlated with LLA and TS (r = 0.47 and p = 0.030; r = 0.48 and p = 0.027, respectively). IPE was correlated with PEL and TS (r = 0.56 and p = 0.008; r = 0.46 and p = 0.036, respectively). ILA was correlated with LLA and TS (r = 0.64 and p = 0.002 and r = 0.51 and p = 0.017, respectively). There was no significant difference in PEL, LLA and TS means in test-retest. The intraclass correlations were r = 0.69; r = 0.80 and r = 0.77, respectively for PEL, LLA and TS. In conclusion, the Baecke questionnaire is valid and reliable to measure habitual physical activity in Brazilian adult men.

Methodology to evaluation the habitual physical activity in men aged 50 years or more

OBJETIVO: Descrever a metodologia de avaliacao da atividade fisica habitual, utilizanda em uma pesquisa em populacao masculina, por meio de um questionario ja validado. METODOS: O questionario de atividade fisica habitual de Baecke, traduzido para a lingua portuguesa e, a seguir, foi realizado o back translation. Em sua versao final o questionario foi aplicado em estudo epidemiologico transversal, realizado com 326 homens com idade igual ou superior a 50 anos. A consistencia interna entre as questoes foi analisada pelo a de Cronbach e foram calculados os coeficientes de correlacao de Spearman entre os escores de atividade fisica habitual, bem como os coeficientes de correlacao parcial, ajustados por idade, indice de massa corporal e escolaridade. RESULTADOS: A consistencia interna mostrou-se satisfatoria nas magnitudes de atividade fisica ocupacional e exercicios fisicos no lazer. Foram obtidas correlacoes significativas entre todos os escores de atividades fisicas com o escore total de atividade fisica habitual, independente da idade, escolaridade e indice de massa corporal. CONCLUSOES: O questionario Baecke mostrou-se um instrumento pratico para avaliar a atividade fisica habitual, aliando rapidez na aplicabilidade e facilidade no entendimento para as respostas, sendo indicado para estudos epidemiologicos no Brasil.OBJECTIVE To describe the methodology for evaluating habitual physical activity that was adopted for a survey among the male population utilizing a questionnaire validated earlier. METHODS The Baecke questionnaire on habitual physical activity was translated into Portuguese and then back-translated into English by two anglophone teachers. The final version of the questionnaire was applied in a cross-sectional epidemiological study done on 326 men aged 50 years or over. The internal consistency among the questions was evaluated using the Cronbach a statistic. The Spearman correlation coefficients between the habitual physical activity scores were calculated. Partial correlation coefficients with adjustments for age, body mass index and schooling were also calculated. RESULTS There was satisfactory internal consistency in relation to the magnitudes of occupational physical activity and leisure-time physical exercises. Significant correlation was obtained between all the physical activity scores and the total habitual physical activity score, independent of age, body mass index and schooling. CONCLUSIONS The Baecke questionnaire was found to be a practical instrument for assessing habitual physical activity that is quickly applied and easily understood, and it is recommended for epidemiological studies in Brazil.