Paulo Roberto Vasconcellos-Silva

Uso combinado de modelos de estresse no trabalho e a saúde auto-referida na enfermagem

OBJECTIVE To identify combinations of two models of psychosocial stress at work among nursing teams and their associations with self-rated health. METHODS This was a cross-sectional study among workers at three public hospitals in the municipality of Rio de Janeiro, Southeastern Brazil (N = 1307). In 2006, a multidimensional questionnaire including two scales for measuring stress at work (demand-control and effort-reward imbalance models) was administered. Partial and complete (including social support at work) demand-control models were considered, along with partial and complete (including excessive commitment to work) effort-reward models. Multiple logistic regression models were used to estimate adjusted odds ratios and their respective 95% confidence intervals. RESULTS The dimensions of both models were independently associated with self-rated health, with odds ratios between 1.70 and 3.37. The partial demand-control model was less associated with health (OR = 1.79; 95%CI 1.26;2.53) than was the partial effort-reward imbalance model (OR = 2.27; 95%CI 1.57;3.30). Incorporation of social support and excessive commitment to work increased the strength of the demand-control and effort-reward imbalance models, respectively. Increased strength of association was observed when the two partial models were combined. CONCLUSIONS The results indicate that the effort-reward imbalance model performed better for this specific group and for the outcome evaluated, and that there was an advantage in using complete models or combinations of partial models.OBJETIVO: Identificar combinaciones de dos modelos de estres psicossocial del trabajo en equipos de enfermeria y su asociacion con la salud auto referida. METODOS: Estudio transversal con trabajadoras de tres hospitales publicos del Municipio de Rio de Janeiro, Sureste de Brasil, (N=1307). Se aplico cuestionario multidimensional que incluyo dos escalas de estres en el trabajo (modelo demanda-control y desequilibrio esfuerzo-recompensa) en 2006. Se consideraron el modelo demando y control parcial y completo (incluye apoyo social en el trabajo), asi como el esfuerzo y recompensa parcial y completo (incluye exceso de compromiso con el trabajo). Se utilizaron modelos estadisticos multiples para estimar razones de probabilidades ajustadas y sus respectivos intervalos con 95% de confianza. RESULTADOS: Las dimensiones de ambos modelos estuvieron independientemente asociadas con la salud autoreferida, con odds ratios entre 1,70 y 3,37. El modelo parcial demanda-control se mostro menos asociado a la salud (OR=1,79; IC 95% 1,26;2,53) al compararlo con el desequilibrio esfuerzo-recompensa (OR=2,27; IC 95% 1,57;3,30). La incorporacion del apoyo social y del exceso de compromiso con el trabajo aumento la fuerza de asociacion de los modelos demanda-control y desequilibrio esfuerzo-recompensa, respectivamente. Se observo aumento en la fuerza de asociacion al combinarse los dos modelos parciales. CONCLUSIONES: Los resultados indican mejor desempeno del modelo desequilibrio esfuerzo-recompensa para este grupo especifico y para el resultado evaluado y ventaja en el uso de modelos completos o del uso combinado en modelos parciales.

New information technologies and health consumerism

Concepts related to consumption have shifted to include social processes not previously covered by traditional categories. The current review analyzes the application of classical concepts of consumerism to practices recently identified in the health field, like the phenomenon of cyberchondria. The theoretical challenge relates to the difficulty in extrapolating from the economic perspectives of consumerism to self-care issues in the context of information and communication technologies (ICTs). Drawing on recent anthropological categories, the study seeks to understand the phenomenon of self-care commodification under the imperative of self-accountability for health. New consumer identities are described in light of the unprecedented issues concerning technical improvements currently altering the nature of self-care. The study concludes that health is consumed as vitality, broken down into commercial artifacts in the context of a new bioeconomy - no longer linked to the idea of emulation and possession, but to forms of self-perception and self-care in the face of multiple risks and new definitions of the human being.

Combined use of job stress models and self-rated health in nursing.

OBJECTIVE To identify combinations of two models of psychosocial stress at work among nursing teams and their associations with self-rated health. METHODS This was a cross-sectional study among workers at three public hospitals in the municipality of Rio de Janeiro, Southeastern Brazil (N = 1307). In 2006, a multidimensional questionnaire including two scales for measuring stress at work (demand-control and effort-reward imbalance models) was administered. Partial and complete (including social support at work) demand-control models were considered, along with partial and complete (including excessive commitment to work) effort-reward models. Multiple logistic regression models were used to estimate adjusted odds ratios and their respective 95% confidence intervals. RESULTS The dimensions of both models were independently associated with self-rated health, with odds ratios between 1.70 and 3.37. The partial demand-control model was less associated with health (OR = 1.79; 95%CI 1.26;2.53) than was the partial effort-reward imbalance model (OR = 2.27; 95%CI 1.57;3.30). Incorporation of social support and excessive commitment to work increased the strength of the demand-control and effort-reward imbalance models, respectively. Increased strength of association was observed when the two partial models were combined. CONCLUSIONS The results indicate that the effort-reward imbalance model performed better for this specific group and for the outcome evaluated, and that there was an advantage in using complete models or combinations of partial models.OBJETIVO: Identificar combinaciones de dos modelos de estres psicossocial del trabajo en equipos de enfermeria y su asociacion con la salud auto referida. METODOS: Estudio transversal con trabajadoras de tres hospitales publicos del Municipio de Rio de Janeiro, Sureste de Brasil, (N=1307). Se aplico cuestionario multidimensional que incluyo dos escalas de estres en el trabajo (modelo demanda-control y desequilibrio esfuerzo-recompensa) en 2006. Se consideraron el modelo demando y control parcial y completo (incluye apoyo social en el trabajo), asi como el esfuerzo y recompensa parcial y completo (incluye exceso de compromiso con el trabajo). Se utilizaron modelos estadisticos multiples para estimar razones de probabilidades ajustadas y sus respectivos intervalos con 95% de confianza. RESULTADOS: Las dimensiones de ambos modelos estuvieron independientemente asociadas con la salud autoreferida, con odds ratios entre 1,70 y 3,37. El modelo parcial demanda-control se mostro menos asociado a la salud (OR=1,79; IC 95% 1,26;2,53) al compararlo con el desequilibrio esfuerzo-recompensa (OR=2,27; IC 95% 1,57;3,30). La incorporacion del apoyo social y del exceso de compromiso con el trabajo aumento la fuerza de asociacion de los modelos demanda-control y desequilibrio esfuerzo-recompensa, respectivamente. Se observo aumento en la fuerza de asociacion al combinarse los dos modelos parciales. CONCLUSIONES: Los resultados indican mejor desempeno del modelo desequilibrio esfuerzo-recompensa para este grupo especifico y para el resultado evaluado y ventaja en el uso de modelos completos o del uso combinado en modelos parciales.

Cancer prevention campaigns and Internet access: promoting health or disease?

Background: The Internet has become the most popular source of reference on health-related issues. However, little has been invested in studies that use it as a tool to evaluate health-related cultural events as cancer prevention campaigns. Aims: To correlate audience patterns on the web pages of a Brazilian Ministry of Health (MOH) cancer institute (http://www.inca.gov.br) with government campaigns in this area. Methods: 24 consecutive months of observational study of a cancer site sponsored by the MOH, using a commercial software package to analyse electronic records (log files) of all visitors’ movements. Variables observed included number of visits, time spent on each visit and the monthly return rate at six selected pages (three relating to cancer as a disease and three to prevention measures). Results: The audience was observed to grow gradually over the 2 years, with peaks in the periods around the campaigns. The topics of most interest were concentrated in pages on cancer diagnostic and treatment technology. Pages on preventive measures were less visited during the campaigns, and their audience varied little over the 24 months. Conclusion: A historical analysis of log files for reference sites revealed interesting patterns that may be helpful for planning and evaluating institutional campaigns. Practical implications: in view of the results of this study, the website was improved to offer better information on preferred topics and to include more links with prevention-related pages. Log file assessment after health campaigns could provide useful input to planning.

Proliferação das rupturas paradigmáticas: o caso da medicina baseada em evidências

The present study describes the phenomenon of paradigmatic ruptures proliferation in the biomedical literature. The current distortion is discussed, which has conferred in the last decades an opposite meaning to the term originally proposed by Thomas Khun. In most part, it is realized that pseudo-ruptures refer to technical details associated to specific contexts. It is pointed out the case of evidence- based medicine (EBM), proclaimed as one of these paradigmatic ruptures, but which essentially corroborates old concepts. Some conceptual errors are stressed as well as attempts to apply EBM assumptions to phenomena associated to subjectivity and social dynamics and other particular study subjects of social sciences. Twelve inconclusive meta-analyses are described to exemplify the paradoxes emerging from this approach. The criticism to some EBM features is summarized through the effects of epistemological bafflement, producing conceptual inaccuracies of the term; the defensive effect to which other disciplines are induced for not being adequate to such rationality; and the tendency of universal understanding of phenomena through the perspective of randomized double-blind studies.

A sociedade de risco midiatizada, o movimento antivacinação e o risco do autismo

Observam-se modificacoes epidemiologicas de doencas infecciosas entre familias de classe media de paises industrializados por forca de crencas ligadas aos riscos da vacinacao. Estas se expandem globalmente por conta de redes de sites, blogs e celebridades de ampla influencia. Em vista da complexidade de tal fenomeno cultural, em sua analitica sao articulados conceitos contemporâneos alinhados a ideia de reflexividade na sociedade de risco, assim como o da sociedade midiatizada receptora de enunciacoes de perigos e protecoes em mutua referencia e contradicao. Discute-se a frequente emergencia de tensoes derivadas de ciclos de enunciacoes e incompletudes constituidas como “biovalores” simbolicos. Enfatiza-se o efeito persistente de enunciacoes ameacadoras e fraudulentas a abastecer redes sociais virtuais que, ha quase tres decadas, ampliam o debate acerca da ligacao do autismo com as vacinas. Conclui-se que os processos de producao de sentidos interligam-se em diversos niveis nos quais circulam representacoes que sustentam a comunicacao e a identidade dos grupos com base em referenciais historico-culturais.

Panacéias disseminadas pela Internet e pacientes vulneráveis: como conter um mercado de ilusões?

This article discusses the proliferation of medical quackery and fraud appearing and disappearing daily on the Internet. The customers of these scams, made vulnerable by disease or the prospect of death, use the Internet to buy products that would probably be ignored in other contexts. This vulnerability is linked to strenuous physical demands that compromise the ability to make decisions. The attempt to control the phenomenon of fraud as strictly rational, without taking into account the vulnerability of consumers who have little to lose and not considering their demands for comprehensive care, can lead to disappointing results, since these nostrums seem to be filling the gaps left by health care structures that have been insensitive to the immaterial nature of human fears.

Word Frequency and Content Analysis Approach to Identify Demand Patterns in a Virtual Community of Carriers of Hepatitis C

Background Orkut, a Brazilian virtual social network, is responsible for popularization of the Internet among people of low income and educational level. It’s observed that rapid growth of virtual communities can be reached by low cost Internet access in community local area network houses. Orkut poses an important social resource for Brazilian patients with chronic conditions like hepatitis C virus (HCV) carriers, who face several obstacles in adapting to everyday difficulties. Objective Identify Patterns of Recurring Demands (PRD) expressed in messages posted by members of virtual communities dedicated to HCV carriers. Methods Pre-selection: we identified terms commonly associated to HCV on generic Internet searches (primary Keywords - Kps); Kps were used to identify the most representative HCV communities in a virtual community site (Orkut); all messages published along 8 years on all topics of the community were collected and tabulated; the word frequency was used to construct a “word cloud” (graphic representation of the word frequency) on which was applied a content analysis technique. Results The most cited terms expressed: search for information about medications (prescribed and “forbidden”); emphasis on counting time, which were interpreted as surviving expectations; frequent mention of God, doctors, and “husbands” (female carriers were 68%). These elements provided material for further research – they will be useful in the construction of categories in discourse analysis. Conclusions The present work is a disclosure of preliminary findings considered original and promising. The word frequency/content analysis approach expressed needs of social support and material assistance that may provide subsidies for further qualitative approach and public health policies aimed to HCV carriers. The study of PRD by word frequency may be useful in identifying demands underestimated by other means.

Work schedule and self-reported hypertension - the potential beneficial role of on-shift naps for night workers.

ABSTRACT Data on the association between shift work and hypertension are controversial. Sleep restriction is hypothesized to be involved in this relationship. Since on-shift nap can partly compensate for sleep deprivation among night workers, this investigation is aimed at (i) comparing the prevalence of hypertension among workers considering both current and former night work, (ii) testing the association between on-shift naps and hypertension among night workers, and (iii) analyzing the influence of sleep complaints in the association between on-shift nap and hypertension. Nap was defined as a sleep episode with duration shorter than the average nighttime sleep. A cross-sectional study was performed at the 18 largest public hospitals in Rio de Janeiro, Brazil, in 2010–2011 (N = 2588 female registered nurses). Nurses were informally allowed to nap for up to three consecutive hours during working nights. Workers completed a multidimensional questionnaire including self-reported information on physician diagnosis of hypertension, napping, and sleep complaints (insomnia, diurnal sleepiness, and non-satisfactory sleep). Epidemiological and statistical treatment of data included binomial logistic regression and interaction tests. Higher chances of hypertension were observed for both current and former night workers compared with workers with no previous experience in night work, i.e. exclusive day workers (OR = 1.68; CI95% 1.22–2.33 and OR = 1.40; CI95% 1.01–1.96, respectively) after adjustment for age, race/ethnicity, physical activity, smoking, alcohol consumption, insomnia, weekly work hours, and BMI. Compared with exclusive day workers, both non-nappers and nappers were at a higher likelihood of reporting hypertension (OR = 1.93 CI95% 1.35–2.79 and OR = 1.41 CI95% 1.08–2.20, respectively). An interaction was observed between napping behavior and insomnia (p = 0.037). In the whole sample of night workers, the lower OR for nappers was confirmed when they were directly compared with non-nappers (OR = 0.76 CI95% 0.59–0.98). Analysis of night workers stratified by insomnia showed a significant reduction in OR for nappers (compared to non-nappers) only among insomniacs (OR = 0.58). Napping during night work may be a protective factor for hypertension, particularly among insomniacs. Factors related to melatonin secretion, blood pressure control, and blood pressure dipping patterns are likely to be involved in the relationship between on-shift napping and blood pressure.

Diseases neglected by the media: a theoretical approach

Visibility in the media is a central condition for public awareness of social ills. Despite the increasingly large space dedicated to health in newspapers, the criteria for newsworthiness among health issues conform to journalistic and market logic. It can be understood that while intense coverage tends to exalt certain problems, the omission of others may contribute to political underrating of the latter. This paper aimed to pose the problem of ‘diseases neglected by the media’ i.e. healthcare demands about which little is published, and which are usually related to conditions of poverty and inequality, in order to develop a useful theoretical basis for studying them. For this, the following were proposed: posing the problem of media logic; reflection on the definitions of health needs and demands; analysis of the issue of media (in) visibility; and identification of the conceptual basis that situates ‘diseases neglected by the media’ as a category derived from such reflections.