Sitting-time and 9-year all-cause mortality in older women

Background Studies of mid-aged adults provide evidence of a relationship between sitting-time and all-cause mortality, but evidence in older adults is limited. The aim is to examine the relationship between total sitting-time and all-cause mortality in older women. Methods The prospective cohort design involved 6656 participants in the Australian Longitudinal Study on Women's Health who were followed for up to 9 years (2002, age 76–81, to 2011, age 85–90). Self-reported total sitting-time was linked to all-cause mortality data from the National Death Index from 2002 to 2011. Cox proportional hazard models were used to examine the relationship between sitting-time and all-cause mortality, with adjustment for potential sociodemographic, behavioural and health confounders. Results There were 2003 (30.1%) deaths during a median follow-up of 6 years. Compared with participants who sat <4 h/day, those who sat 8–11 h/day had a 1.45 times higher risk of death and those who sat ≥11 h/day had a 1.65 times higher risk of death. These risks remained after adding sociodemographic and behavioural covariates, but were attenuated after adjustment for health covariates. A significant interaction (p=0.02) was found between sitting-time and physical activity (PA), with increased mortality risk for prolonged sitting only among participants not meeting PA guidelines (HR for sitting ≥8 h/day: 1.31, 95% CI 1.07 to 1.61); HR for sitting ≥11 h/day: 1.47, CI 1.15 to 1.93). Conclusions Prolonged sitting-time was positively associated with all-cause mortality. Women who reported sitting for more than 8 h/day and did not meet PA guidelines had an increased risk of dying within the next 9 years.

Generalised growth models for aquatic species with an application to blacklip abalone (Haliotis rubra)

This paper presents a maximum likelihood method for estimating growth parameters for an aquatic species that incorporates growth covariates, and takes into consideration multiple tag-recapture data. Individual variability in asymptotic length, age-at-tagging, and measurement error are also considered in the model structure. Using distribution theory, the log-likelihood function is derived under a generalised framework for the von Bertalanffy and Gompertz growth models. Due to the generality of the derivation, covariate effects can be included for both models with seasonality and tagging effects investigated. Method robustness is established via comparison with the Fabens, improved Fabens, James and a non-linear mixed-effects growth models, with the maximum likelihood method performing the best. The method is illustrated further with an application to blacklip abalone (Haliotis rubra) for which a strong growth-retarding tagging effect that persisted for several months was detected. (C) 2013 Elsevier B.V. All rights reserved.

On probability-based inference under data missing by design

Whether a statistician wants to complement a probability model for observed data with a prior distribution and carry out fully probabilistic inference, or base the inference only on the likelihood function, may be a fundamental question in theory, but in practice it may well be of less importance if the likelihood contains much more information than the prior. Maximum likelihood inference can be justified as a Gaussian approximation at the posterior mode, using flat priors. However, in situations where parametric assumptions in standard statistical models would be too rigid, more flexible model formulation, combined with fully probabilistic inference, can be achieved using hierarchical Bayesian parametrization. This work includes five articles, all of which apply probability modeling under various problems involving incomplete observation. Three of the papers apply maximum likelihood estimation and two of them hierarchical Bayesian modeling. Because maximum likelihood may be presented as a special case of Bayesian inference, but not the other way round, in the introductory part of this work we present a framework for probability-based inference using only Bayesian concepts. We also re-derive some results presented in the original articles using the toolbox equipped herein, to show that they are also justifiable under this more general framework. Here the assumption of exchangeability and de Finetti's representation theorem are applied repeatedly for justifying the use of standard parametric probability models with conditionally independent likelihood contributions. It is argued that this same reasoning can be applied also under sampling from a finite population. The main emphasis here is in probability-based inference under incomplete observation due to study design. This is illustrated using a generic two-phase cohort sampling design as an example. The alternative approaches presented for analysis of such a design are full likelihood, which utilizes all observed information, and conditional likelihood, which is restricted to a completely observed set, conditioning on the rule that generated that set. Conditional likelihood inference is also applied for a joint analysis of prevalence and incidence data, a situation subject to both left censoring and left truncation. Other topics covered are model uncertainty and causal inference using posterior predictive distributions. We formulate a non-parametric monotonic regression model for one or more covariates and a Bayesian estimation procedure, and apply the model in the context of optimal sequential treatment regimes, demonstrating that inference based on posterior predictive distributions is feasible also in this case.

Impact of malnutrition on 12-month mortality following acute hip fracture

Background Studies investigating the relationship between malnutrition and post-discharge mortality following acute hip fracture yield conflicting results. This study aimed to determine whether malnutrition independently predicted 12-month post-fracture mortality after adjusting for clinically relevant covariates. Methods An ethics approved, prospective, consecutive audit was undertaken for all surgically treated hip fracture inpatients admitted to a dedicated orthogeriatric unit (November 2010–October 2011). The 12-month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. Demographic (age, gender, admission residence) and clinical covariates included fracture type, time to surgery, anaesthesia type, type of surgery, post-surgery time to mobilize and post-operative complications (delirium, pulmonary and deep vein thrombosis, cardiac complications, infections). The Charlson Comorbidity Index was retrospectively applied. All diagnoses were confirmed by the treating orthogeriatrician. Results A total of 322 of 346 patients were available for audit. Increased age (P = 0.004), admission from residential care (P < 0.001), Charlson Comorbidity Index (P = 0.007), malnutrition (P < 0.001), time to mobilize >48 h (P < 0.001), delirium (P = 0.003), pulmonary embolism (P = 0.029) and cardiovascular complication (P = 0.04) were associated with 12-month mortality. Logistic regression analysis demonstrated that malnutrition (odds ratio (OR) 2.4 (95% confidence interval (CI) 1.3–4.7, P = 0.007)), in addition to admission from residential care (OR 2.6 (95% CI 1.3–5.3, P = 0.005)) and pulmonary embolism (OR 11.0 (95% CI 1.5–78.7, P = 0.017)), independently predicted 12-month mortality. Conclusions Findings substantiate malnutrition as an independent predictor of 12-month mortality in a representative sample of hip fracture inpatients. Effective strategies to identify and treat malnutrition in hip fracture should be prioritized.

Cyclosporine population pharmacokinetics in pediatric renal transplant recipients

Cyclosporine is an immunosuppressant drug with a narrow therapeutic index and large variability in pharmacokinetics. To improve cyclosporine dose individualization in children, we used population pharmacokinetic modeling to study the effects of developmental, clinical, and genetic factors on cyclosporine pharmacokinetics in altogether 176 subjects (age range: 0.36–20.2 years) before and up to 16 years after renal transplantation. Pre-transplantation test doses of cyclosporine were given intravenously (3 mg/kg) and orally (10 mg/kg), on separate occasions, followed by blood sampling for 24 hours (n=175). After transplantation, in a total of 137 patients, cyclosporine concentration was quantified at trough, two hours post-dose, or with dose-interval curves. One-hundred-four of the studied patients were genotyped for 17 putatively functionally significant sequence variations in the ABCB1, SLCO1B1, ABCC2, CYP3A4, CYP3A5, and NR1I2 genes. Pharmacokinetic modeling was performed with the nonlinear mixed effects modeling computer program, NONMEM. A 3-compartment population pharmacokinetic model with first order absorption without lag-time was used to describe the data. The most important covariate affecting systemic clearance and distribution volume was allometrically scaled body weight i.e. body weight**3/4 for clearance and absolute body weight for volume of distribution. The clearance adjusted by absolute body weight declined with age and pre-pubertal children (< 8 years) had an approximately 25% higher clearance/body weight (L/h/kg) than did older children. Adjustment of clearance for allometric body weight removed its relationship to age after the first year of life. This finding is consistent with a gradual reduction in relative liver size towards adult values, and a relatively constant CYP3A content in the liver from about 6–12 months of age to adulthood. The other significant covariates affecting cyclosporine clearance and volume of distribution were hematocrit, plasma cholesterol, and serum creatinine, explaining up to 20%–30% of inter-individual differences before transplantation. After transplantation, their predictive role was smaller, as the variations in hematocrit, plasma cholesterol, and serum creatinine were also smaller. Before transplantation, no clinical or demographic covariates were found to affect oral bioavailability, and no systematic age-related changes in oral bioavailability were observed. After transplantation, older children receiving cyclosporine twice daily as the gelatine capsule microemulsion formulation had an about 1.25–1.3 times higher bioavailability than did the younger children receiving the liquid microemulsion formulation thrice daily. Moreover, cyclosporine oral bioavailability increased over 1.5-fold in the first month after transplantation, returning thereafter gradually to its initial value in 1–1.5 years. The largest cyclosporine doses were administered in the first 3–6 months after transplantation, and thereafter the single doses of cyclosporine were often smaller than 3 mg/kg. Thus, the results suggest that cyclosporine displays dose-dependent, saturable pre-systemic metabolism even at low single doses, whereas complete saturation of CYP3A4 and MDR1 (P-glycoprotein) renders cyclosporine pharmacokinetics dose-linear at higher doses. No significant associations were found between genetic polymorphisms and cyclosporine pharmacokinetics before transplantation in the whole population for which genetic data was available (n=104). However, in children older than eight years (n=22), heterozygous and homozygous carriers of the ABCB1 c.2677T or c.1236T alleles had an about 1.3 times or 1.6 times higher oral bioavailability, respectively, than did non-carriers. After transplantation, none of the ABCB1 SNPs or any other SNPs were found to be associated with cyclosporine clearance or oral bioavailability in the whole population, in the patients older than eight years, or in the patients younger than eight years. In the whole population, in those patients carrying the NR1I2 g.-25385C–g.-24381A–g.-205_-200GAGAAG–g.7635G–g.8055C haplotype, however, the bioavailability of cyclosporine was about one tenth lower, per allele, than in non-carriers. This effect was significant also in a subgroup of patients older than eight years. Furthermore, in patients carrying the NR1I2 g.-25385C–g.-24381A–g.-205_-200GAGAAG–g.7635G–g.8055T haplotype, the bioavailability was almost one fifth higher, per allele, than in non-carriers. It may be possible to improve individualization of cyclosporine dosing in children by accounting for the effects of developmental factors (body weight, liver size), time after transplantation, and cyclosporine dosing frequency/formulation. Further studies are required on the predictive value of genotyping for individualization of cyclosporine dosing in children.

Distribution, Demography, and Conservation of Lion-tailed Macaques (Macaca silenus) in the Anamalai Hills Landscape, Western Ghats, India

The status of the endemic and endangered lion-tailed macaque (Macaca silenus) has not been properly assessed in several regions of the Western Ghats of southern India. We conducted a study in Parambikulam Forest Reserve in the state of Kerala to determine the distribution, demography, and status of lion-tailed macaques. We laid 5km(2) grid cells on the map of the study area (644km(2)) and made four replicated walks in each grid cell using GPS. We gathered data on lion-tailed macaque group locations, demography, and site covariates including trail length, duration of walk, proportion of evergreen forest, height of tallest trees, and human disturbance index. We also performed occupancy modeling using PRESENCE ver. 3.0. We estimated a minimum of 17 groups of macaques in these hills. Low detection and occupancy probabilities indicated a low density of lion-tailed macaques in the study area. Height of the tallest trees correlated positively whereas human disturbance and proportion of evergreen forest correlated negatively with occupancy in grid cells. We also used data from earlier studies carried out in the surrounding Anamalai Tiger Reserve and Nelliyampathy Hills to discuss the conservation status in the large Anamalai Hills Landscape. This landscape harbors an estimated population of 1108 individuals of lion-tailed macaques, which is about one third of the entire estimated wild population of this species. A conservation plan for this landscape could be used as a model for conservation in other regions of the Western Ghats.

Identifying regions for conservation of sloth bears through occupancy modelling in north-eastern Karnataka, India

In the absence of information on species in decline with contracting ranges, management should emphasize remaining populations and protection of their habitats. Threatened by anthropogenic pressure including habitat degradation and loss, sloth bears (Melursus ursinus) in India have become limited in range, habitat, and population size. We identified ecological and anthropogenic determinants of occurrence within an occupancy framework to evaluate habitat suitability of non-protected regions (with sloth bears) in northeastern Karnataka, India. We employed a systematic sampling methodology to yield presence absence data to examine a priori hypotheses of determinants that affected occupancy. These covariates were broadly classified as habitat or anthropogenic factors. Mean number of termite mounds and trees positively influenced sloth bear occupancy, and grazing pressure expounded by mean number of livestock dung affected it negatively. Also, mean percentage of shrub coverage had no impact on bear inhabitance. The best fitting model further predicted habitats in Bukkasagara, Agoli, and Benakal reserved forests to have 38%, 75%, and 88%, respectively, of their sampled grid cells with high occupancies (>0.70) albeit little or no legal protection. We recommend a conservation strategy that includes protection of vegetation stand-structure, maintenance of soil moisture, and enrichment of habitat for the long-term welfare of this species.

Modeling non-stationarity in intensity, duration and frequency of extreme rainfall over India

Significant changes are reported in extreme rainfall characteristics over India in recent studies though there are disagreements on the spatial uniformity and causes of trends. Based on recent theoretical advancements in the Extreme Value Theory (EVT), we analyze changes in extreme rainfall characteristics over India using a high-resolution daily gridded (1 degrees latitude x 1 degrees longitude) dataset. Intensity, duration and frequency of excess rain over a high threshold in the summer monsoon season are modeled by non-stationary distributions whose parameters vary with physical covariates like the El-Nino Southern Oscillation index (ENSO-index) which is an indicator of large-scale natural variability, global average temperature which is an indicator of human-induced global warming and local mean temperatures which possibly indicate more localized changes. Each non-stationary model considers one physical covariate and the best chosen statistical model at each rainfall grid gives the most significant physical driver for each extreme rainfall characteristic at that grid. Intensity, duration and frequency of extreme rainfall exhibit non-stationarity due to different drivers and no spatially uniform pattern is observed in the changes in them across the country. At most of the locations, duration of extreme rainfall spells is found to be stationary, while non-stationary associations between intensity and frequency and local changes in temperature are detected at a large number of locations. This study presents the first application of nonstationary statistical modeling of intensity, duration and frequency of extreme rainfall over India. The developed models are further used for rainfall frequency analysis to show changes in the 100-year extreme rainfall event. Our findings indicate the varying nature of each extreme rainfall characteristic and their drivers and emphasize the necessity of a comprehensive framework to assess resulting risks of precipitation induced flooding. (C) 2014 Elsevier B.V. All rights reserved.

Simulating dynamic covariance structures for testing the adaptive behavior of variable selection algorithms (Invited Paper)

Variable selection for regression is a classical statistical problem, motivated by concerns that too large a number of covariates may bring about overfitting and unnecessarily high measurement costs. Novel difficulties arise in streaming contexts, where the correlation structure of the process may be drifting, in which case it must be constantly tracked so that selections may be revised accordingly. A particularly interesting phenomenon is that non-selected covariates become missing variables, inducing bias on subsequent decisions. This raises an intricate exploration-exploitation tradeoff, whose dependence on the covariance tracking algorithm and the choice of variable selection scheme is too complex to be dealt with analytically. We hence capitalise on the strength of simulations to explore this problem, taking the opportunity to tackle the difficult task of simulating dynamic correlation structures. © 2008 IEEE.

Linguistic Polarization and Conflict in the Basque Country

This paper investigates the relationship between linguistic polarization and conflict in the Basque Country. During the 40 years of Franco’s dictatorship the use of the Basque language was banned. Therefore, there may be some linguistic roots underlying the conflict in the Basque Country. We show that at the municipality level, linguistic polarization reduces the level of conflict. This finding is robust to various ways of measuring linguistic and ideological polarization and the inclusion of other covariates. In addition, we find that a high level of the stock of human capital is beneficial for reducing conflict intensity.

On the strategic equivalence of multiple-choice test scoring rules

A disadvantage of multiple-choice tests is that students have incentives to guess. To discourage guessing, it is common to use scoring rules that either penalize wrong answers or reward omissions. These scoring rules are considered equivalent in psychometrics, although experimental evidence has not always been consistent with this claim. We model students' decisions and show, first, that equivalence holds only under risk neutrality and, second, that the two rules can be modified so that they become equivalent even under risk aversion. This paper presents the results of a field experiment in which we analyze the decisions of subjects taking multiple-choice exams. The evidence suggests that differences between scoring rules are due to risk aversion as theory predicts. We also find that the number of omitted items depends on the scoring rule, knowledge, gender and other covariates.

Use of generalised additive models to categorise continuous variables in clinical prediction

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The distribution, abundance, and ecology of larval tunas from the entrance to the Gulf of California

ENGLISH: This study is based on collections of larvae of Thunnus albacares, Euthynnus llneatus, and Auxis sp. obtained from surface and oblique net tows made during seven cruises, each along a comparable track in the entrance of the Gulf of California and each during a different month. Concomitant measurements of surface temperature, salinity, and zooplankton were made at each of the plankton stations. The catches of larval Auxis sp. were examined by analysis of variance techniques to determine which environmental features were associated with the spawning of this tuna as indicated by the distribution of larvae and to gain some insight into the behavior of the larvae themselves. The testing indicated that the spawning of Auxis sp. varied significantly among the different months of the cruises. The testing also indicated that if the larvae were capable of avoiding the sampling apparatus, this ability was not related to features associated with time of day such as light conditions. The analysis did not detect any change in the vertical distribution of the larvae among the months of the experiment. It was concluded that the larvae did not exhibit a diel vertical movement. The measurements of temperature, salinity, and zooplankton volumes were treated as covariates in the analysis. The surface temperature proved to be a highly important factor in explaining the distribution of larvae, but salinity and zooplankton volumes were not. Catches of Thunnus albaeares and Euthynnus lineatus were rare during the course of the study; these are discussed in qualitative terms with respect to the time of the year and the surface temperature. The distribution of larval tunas in the area of study was compared with the distribution of surface water masses. It appeared that these masses had no influence per se on the distribution of larvae. SPANISH: Este estudio está basado en las recolecciones de larvas de Thunnus albacares, Eutbynnus lineatus, y Auxis sp. obtenidas según los arrastres superficiales y oblicuos de la red, realizados durante siete cruceros, cada uno a la entrada del Golfo de California a lo largo de un derrotero comparable, y cada uno durante distintos meses. Las mediciones correspondientes de la temperatura superficial, salinidad y de zooplancton se realizaron en cada una de las estaciones de plancton. Las capturas de larvas Auxís sp. fueron examinadas mediante el análisis de la varianza para determinar cuales características ambientales se encontraban asociadas con el desove de este atún según lo indicaba la distribución de las larvas, y para obtener alguna idea del comportamiento de las larvas en sí mismas. Las pruebas indicaron que el desove de Auxis sp. varió significativamente entre los diferentes meses de los cruceros; indicaron también que si las larvas eran capaces de evitar el aparato de muestreo, esta habilidad no se relacionaba a las características asociadas con la hora del día de acuerdo a las condiciones de luz. El análisis no demostró ningún cambio en la distribución vertical de las larvas durante los meses del experimento. Se determinó que las larvas no exhiben un movimiento vertical diario. Las mediciones de temperatura, salinidad, y de los volúmenes de zooplancton fueron tratadas como covariables en el análisis. La temperatura superficial demostró ser un factor altamente importante en la explicación de la distribución de las larvas, pero la salinidad y los volúmenes de zooplancton no lo fueron. Las capturas de Thunnus albacares y Eutbynnus lineatus fueron pocas durante el curso de este estudio; éstas se discuten en términos cualitativos respecto a la época del año y a la temperatura superficial. La distribución de los atunes larvales en el área de estudio fue comparada con la distribución de las masas superficiales de agua. Parece que estas masas no tienen influencia per se en la distribución de las larvas. (PDF contains 40 pages.)

Violência familiar e estado nutricional de adolescentes numa unidade de saúde

O presente trabalho teve como objetivos verificar a possível associação entre violência intrafamiliar sofrida por adolescentes e estado nutricional. Foram investigadas as prevalências de agressão verbal, violências física, abuso psicológico e de estado nutricional inadequado dos adolescentes. Para tanto, foi realizado um estudo observacional de corte transversal numa amostra de 201 adolescentes de 10 a 19 anos cadastrados no Programa Bolsa Família e monitorados pelo Serviço de Nutrição de uma unidade de saúde do município do Rio de Janeiro. Junto aos adolescentes foi realizada avaliação antropométrica, e para a determinação do estado nutricional foi analisado o Índice de Massa Corporal (IMC) pelo parâmetro adotado pela OMS a partir de 2007. A violência familiar foi investigada por meio de dois instrumentos. O Conflict Tactics Scales Form R (CTS1) foi utilizado para avaliar os conflitos intrafamiliares no relacionamento entre pais e filhos e a escala de violência psicológica contra adolescentes para identificar a presença de violência psicológica contra os adolescentes. Além disso, foram avaliadas outras co-variáveis que pudessem influenciar a associação entre violência e situação nutricional da população estudada como informações sobre maturação sexual, sócio-demográficas e percepção corporal. No que diz respeito ao IMC, foram identificados 4,5% de baixo peso, 13,4% de sobrepeso e 5% de obesidade. No que se refere à violência familiar, foram observados 83,1% de agressão verbal, 50,2% de violência psicológica, 32,8% de agressão física grave e 48,3% de abuso físico menor. Através da regressão linear múltipla foi observada um associação entre violência familiar e o IMC em adolescentes do sexo feminino. A presença de agressão verbal perpetrada tanto pelo pai como pela mãe está relacionado ao IMC de forma estatisticamente significativa para as meninas. Já para os adolescentes masculinos não foi encontrada nenhuma associação significativa entre os diferentes tipos de violência familiar e o IMC, mas aponta para a redução do IMC. Outras estratégias de pesquisa de natureza qualitativa devem ser realizadas para esclarecer sobre os efeitos desfavoráveis do abuso verbal sobre o IMC junto aos pais e a sociedade já que a agressão verbal é um tipo de abuso normalmente utilizado no ambiente familiar e considerado como algo natural e aceitável

Estresse ocupacional segundo o modelo demanda-controle e suas repercussões na saúde do trabalhador de enfermagem: análise das variações de cortisol salivar

O objeto de estudo foi o estresse no trabalho e os níveis de cortisol salivar. O objetivo geral foi avaliar a associação entre estresse no trabalho e variações de cortisol salivar de trabalhadores de Enfermagem inseridos na assistência hospitalar no Rio de Janeiro. A hipótese do estudo foi que existe associação entre trabalhadores expostos à alta exigência no trabalho e as variações de cortisol salivar. Trata-se de estudo epidemiológico observacional analítico seccional, realizado em hospital estadual localizado no Rio de Janeiro com amostra de 103 trabalhadores. Para avaliação dos aspectos psicossociais do trabalho, utilizou-se o questionário Job Content Questionnaire. O cortisol salivar foi medido através da coleta de 04 amostras de cada participante em um dia do plantão: ao acordar, 30 minutos depois, às 12h e 18 h. A coleta de dados foi realizada entre março e abril de 2012. Utilizou-se o programa SPSS 18.0 para análise dos dados. As dimensões demanda psicológica e controle e a subtração foram utilizadas sob a forma contínua nas análises de correlação com as covariáveis e desfecho. Os níveis de cortisol foram quantificados por meio de cinco índices: o cálculo da área sob a curva em relação ao zero ou base (AUCg), área sob a curva em relação ao aumento (AUCi), o aumento médio (MnInc), a excreção do cortisol no período pós acordar (AUCtrab) e a área sob a curva em relação ao zero ou base do ciclo diurno (AUCCD). Para avaliar a associação entre as covariáveis e exposição e desfecho utilizou-se os testes de Mann Whitney e Kruskall-Wallis. As covariáveis associadas à exposição ou ao desfecho com nível de significância de 20% (p≤0,20) foram testadas no modelo de regressão linear. Realizada análise de correlação utilizando-se o coeficiente de correlação de Spearmans. Como resultado encontrou-se que os trabalhadores de Enfermagem obtiveram médias para demanda psicológica e controle que tendem para o limite superior, bem como para a subtração, caracterizando alta demanda e alto controle, ou seja, trabalho ativo. O valor médio de cortisol observado ao acordar, 30 minutos após, 12h e 18h foi de 5,82 nmol/L) (4,86), 16,60 nmol/L ( 8,31), 7,49 nmol/L ( 6,97) e 3,93 nmol/L ( 3,15), respectivamente. O aumento do cortisol entre o acordar e 30 minutos após foi em média de 64%. Já para os índices de cortisol adotados observa-se o valor médio da MnInc, AUCg, AUCi, AUCtrab e AUCCD foi de 10,78 nmol/L (6,99), 5,61 nmol/L ( 2,92) 2,69 nmol/L ( 1,75), 32,51 nmol/L ( 21,99) e 107,99 nmol/L ( 61,63), respectivamente. Este estudo demonstrou que os níveis de cortisol salivar livre não estão associados à alta exigência no trabalho, mesmo quando ajustadas pelas possíveis variáveis de confusão ou modificadoras de efeito. A hipótese do estudo não foi confirmada. Os dados obtidos neste estudo revelaram aspectos importantes dos riscos psicossociais a que estão expostos os trabalhadores de Enfermagem durante o processo de trabalho, oferecendo subsídios para que sejam implementados programas de orientação e promoção à saúde do trabalhador e fornecem um contributo para entender os caminhos biológicos pelos quais o estresse no trabalho influencia a saúde.