Rosane Harter Griep

Validade de constructo de escala de apoio social do Medical Outcomes Study adaptada para o português no Estudo Pró-Saúde

This paper evaluates the construct validity of the Medical Outcomes Studys social support scale adapted to Portuguese, when utilized in a cohort study among non-faculty civil servants at a university in Rio de Janeiro, Brazil (Pró-Saúde Study). Baseline data were obtained in 1999, when 4,030 participants (92.0% of those eligible) completed a multidimensional self-administered questionnaire at the workplace. From the original scales five social support dimensions, factor analysis of the data extracted only three dimensions: positive social interaction/affective support; emotional/information support; and material support. We estimated associations between social support dimensions and socio-demographic, health, and well being-related characteristics. We confirmed the hypotheses that less isolated individuals, those with better self-rated health, those who reported more participation in group activities, and those with no evidence of common mental disorders reported better perception of social support. In conclusion, we found good evidence for a high construct validity of this scale, supporting its use in future analyses in the Pró-Saúde Study and in similar population groups.

Afericoes e exames clinicos realizados nos participantes do ELSA-Brasil

The article describes assessments and measurements performed in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Some assessments including anthropometric assessment, casual blood pressure measurement, and ankle-brachial index have an established clinical application while others including pulse wave velocity, heart rate variability, and carotid intima-media thickness have no established application and do not have reference values for healthy Brazilian population but may be important predictors of cardiovascular outcomes. Blood pressure measurement following postural change maneuver was included in the ELSA-Brasil because it has not been much tested in epidemiological studies. Innovative approaches were developed for assessing the ankle-brachial index using an automatic device instead of the mercury column to measure blood pressure and for assessing the anterior-posterior diameter of the right lobe of the liver by ultrasound for quantitative assessment of nonalcoholic fatty liver disease. All ELSA-Brasil subjects were younger (35 years or more) than those included in other cohorts studying subclinical atherosclerosis. The inclusion of younger individuals and a variety of assessments make the ELSA-Brasil a relevant epidemiology study nationwide and worldwide.

Conhecimentos, atitudes e prática do exame de Papanicolaou entre mulheres argentinas

OBJECTIVES: To evaluate the knowledge, attitudes, and practice regarding the Papanicolaou test in an Argentinean community. METHODS: Two hundred women were interviewed at their homes in Puerto Leoni, Misiones, Argentina. Women were selected by simple random sampling. Answers were described in terms of knowledge, attitudes, and practice, ant their respective adequacies with respect to the Papanicolaou test, as previously defined. Adequacy was compared between the categories of the control variables by c2 test with a 5% significance level. RESULTS: Knowledge and practice of the Papanicolaou test were adequate in 49.5% and 30.5% of subjects, respectively, although the attitude towards the test was considered adequate in 80.5% of subjects. Another important finding was that women reported as the main reason for not undergoing the test the lack of a request by a physician or healthcare professional. CONCLUSIONS: Our results show a need for increasing the information provided to the public, especially by healthcare services and professionals, thus generating knowledge among the population of the advantages and benefits of Papanicolaou testing.

Psychosocial aspects of work and musculoskeletal disorders in nursing workers

This study aimed to evaluate the association between psychological demands and control on work and the occurrence of musculoskeletal disorders among nursing workers. This cross-sectional study involved 491 nursing workers from a University hospital in Rio Grande do Sul. Brazilian versions of the Nordic Musculoskeletal Questionnaire and the Job Content Questionnaire were used. Among the participants, 96.3% reported some pain in any given part of the body last year, 73.1% in the last seven days and 65.8% reported difficulty in their daily routine. The chances of shoulder pain (OR=1.97; CI95%=1.07-3.64), in the thoracic spine (OR=1.83; CI95%=1.02-3.35) and in the ankles (OR=2.05; CI95%=1.05-4.02) were higher in the high work demand quadrant when compared to the low demand quadrant, after adjustments for potentially confusing factors Intervention measures in the organizational structure are needed, redefining demand levels and control at work.Este estudo objetivou avaliar a associacao entre demandas psicologicas e controle sobre o trabalho e a ocorrencia de disturbios musculoesqueleticos em trabalhadores de enfermagem. Trata-se de estudo transversal, envolvendo 491 trabalhadores de enfermagem de um hospital universitario do Rio Grande do Sul, Brasil. Utilizaram-se versoes brasileiras do Nordic Musculoskeletal Questionnaire e do Job Content Questionnaire. Dos participantes, 96,3% referiram dor em alguma regiao do corpo no ultimo ano, 73,1% nos ultimos sete dias e 65,8% relataram dificuldade nas atividades diarias. As chances de dor nos ombros (OR=1,97; IC95%=1,07-3,64), na coluna toracica (OR=1,83; IC95%=1,02-3,35) e nos tornozelos (OR=2,05; IC95%=1,05-4,02) foram maiores no quadrante de trabalho em alta exigencia quando se comparou ao de baixa exigencia, apos ajuste por potenciais fatores de confusao. Faz-se necessaria a adocao de medidas interventivas na estrutura organizacional, redimensionando os niveis de demanda e de controle no trabalho.

A gender approach to work ability and its relationship to professional and domestic work hours among nursing personnel

The association between working hours and work ability was examined in a cross-sectional study of male (N=156) and female (N=1092) nurses in three public hospitals. Working hours were considered in terms of their professional and domestic hours per week and their combined impact; total work load. Logistic regression analysis showed a significant association between total work load and inadequate work ability index (WAI) for females only. Females reported a higher proportion of inadequate WAI, fewer professional work hours but longer domestic work hours. There were no significant differences in total work load by gender. The combination of professional and domestic work hours in females seemed to best explain their lower work ability. The findings suggest that investigations into female well-being need to consider their total work load. Our male sample may have lacked sufficient power to detect a relationship between working hours and work ability.

Beyond simple approaches to studying the association between work characteristics and absenteeism: Combining the DCS and ERI models

Abstract The Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models assess different psychosocial factors. This study investigates whether a combination of these models increases their ability to predict sickness absence, as compared to results based on each model separately. A cross-sectional study with nursing personnel (N = 1307) in Brazil was performed. Regression analyses were conducted in three stages: analysis of each scale of the models and sickness absences; assessment of the independent association of each model with sickness absences; assessment of the associations of three combinations of models/scales with sickness absences: DC and social support (SS), ERI and overcommitment, and DC and ERI. As regards comparisons between the stress models, ERI was shown to be independently associated with short (up to 9 days) and long (10 days or more) spells of absenteeism. The same result held true for low social support. The combinations DC-ERI and DC-SS were better predictors for short spells than each model/scale separately, whereas for long spells, the combination DC-SS was the best predictor. ERI seems to be a good instrument for predicting absenteeism if used alone, whereas DC performed better when combined with ERI or SS. An improved risk estimation of sickness absences by combining information from the two models was observed.

Condições de trabalho e características sócio-demográficas relacionadas à presença de distúrbios psíquicos menores em trabalhadores de enfermagem

Psychological demands and control are psychosocial dimensions of work that may generate high levels of stress in nursing work. This study evaluates the association between psychological demands and control in nursing work and the occurrence of minor psychic disorders among nursing workers. This transversal study includes 491 nursing workers from a university hospital in Rio Grande do Sul, Brazil. In order to evaluate the minor psychic disorders and the psychosocial dimensions, Brazilian versions of the Self-Report questionnaire-20 and the Job Content Questionnaire were used, during the period of March to September of 2006. An 18.7% prevalence of minor psychic disorders was observed . After adjustments for potentially confusing elements, the chance for minor psychic disorders was higher (OR=2.76; IC 95%: 1.21-6.27) in the high demand working quadrant when compared to workers in the low demand working quadrant. We consider it necessary to have organizational and participatory management which includes the workers in the process of changes and improvements in the working environment, mainly those that affect demands and control in work. DESCRIPTORS: Work. Working environment. Mental disorders. Occupational health. Nursing.Psychological demands and control are psychosocial dimensions of work that may generate high levels of stress in nursing work. This study evaluates the association between psychological demands and control in nursing work and the occurrence of minor psychic disorders among nursing workers. This transversal study includes 491 nursing workers from a university hospital in Rio Grande do Sul, Brazil. In order to evaluate the minor psychic disorders and the psychosocial dimensions, Brazilian versions of the Self-Report questionnaire-20 and the Job Content Questionnaire were used, during the period of March to September of 2006. An 18.7% prevalence of minor psychic disorders was observed . After adjustments for potentially confusing elements, the chance for minor psychic disorders was higher (OR=2.76; IC 95%: 1.21-6.27) in the high demand working quadrant when compared to workers in the low demand working quadrant. We consider it necessary to have organizational and participatory management which includes the workers in the process of changes and improvements in the working environment, mainly those that affect demands and control in work. DESCRIPTORS: Work. Working environment. Mental disorders. Occupational health. Nursing.

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.

Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil

The ELSA-Brasil (Estudo Longitudinal de Saude do Adulto - Brazilian Longitudinal Study for Adult Health) is a cohort study composed of 15,105 adults followed up in order to assess the development of chronic diseases, especially diabetes and cardiovascular disease. Its size, multicenter nature and the diversity of measurements required effective and efficient mechanisms of quality assurance and control. The main quality assurance activities (those developed before data collection) were: careful selection of research instruments, centralized training and certification, pretesting and pilot studies, and preparation of operation manuals for the procedures. Quality control activities (developed during data collection and processing) were performed more intensively at the beginning, when routines had not been established yet. The main quality control activities were: periodic observation of technicians, test-retest studies, data monitoring, network of supervisors, and cross visits. Data that estimate the reliability of the obtained information attest that the quality goals have been achieved.

Aspectos psicossociais do trabalho e distúrbio musculoesquelético em trabalhadores de enfermagem

This study aimed to evaluate the association between psychological demands and control on work and the occurrence of musculoskeletal disorders among nursing workers. This cross-sectional study involved 491 nursing workers from a University hospital in Rio Grande do Sul. Brazilian versions of the Nordic Musculoskeletal Questionnaire and the Job Content Questionnaire were used. Among the participants, 96.3% reported some pain in any given part of the body last year, 73.1% in the last seven days and 65.8% reported difficulty in their daily routine. The chances of shoulder pain (OR=1.97; CI95%=1.07-3.64), in the thoracic spine (OR=1.83; CI95%=1.02-3.35) and in the ankles (OR=2.05; CI95%=1.05-4.02) were higher in the high work demand quadrant when compared to the low demand quadrant, after adjustments for potentially confusing factors Intervention measures in the organizational structure are needed, redefining demand levels and control at work.Este estudo objetivou avaliar a associacao entre demandas psicologicas e controle sobre o trabalho e a ocorrencia de disturbios musculoesqueleticos em trabalhadores de enfermagem. Trata-se de estudo transversal, envolvendo 491 trabalhadores de enfermagem de um hospital universitario do Rio Grande do Sul, Brasil. Utilizaram-se versoes brasileiras do Nordic Musculoskeletal Questionnaire e do Job Content Questionnaire. Dos participantes, 96,3% referiram dor em alguma regiao do corpo no ultimo ano, 73,1% nos ultimos sete dias e 65,8% relataram dificuldade nas atividades diarias. As chances de dor nos ombros (OR=1,97; IC95%=1,07-3,64), na coluna toracica (OR=1,83; IC95%=1,02-3,35) e nos tornozelos (OR=2,05; IC95%=1,05-4,02) foram maiores no quadrante de trabalho em alta exigencia quando se comparou ao de baixa exigencia, apos ajuste por potenciais fatores de confusao. Faz-se necessaria a adocao de medidas interventivas na estrutura organizacional, redimensionando os niveis de demanda e de controle no trabalho.