Impact of worksite health-promotion programs in hospital admission costs and medical leaves in a sample of brazilian companies

Programas de saúde e bem-estar têm sido adotados por empresas como forma de melhorar a saúde de empregados, e muitos estudos descrevem retornos econômicos positivos sobre os investimentos envolvidos. Entretanto, estudos mais recentes com metodologia melhor têm demonstrado retornos menores. O objetivo deste estudo foi investigar se características de programas de saúde e bem-estar agem como preditores de custos de internação hospitalar (em Reais correntes) e da proporção de funcionários que têm licença médica, entre Abril de 2014 e Maio de 2015, em uma amostra não-aleatória de empresas no Brasil, através de parceria com uma empresa gestora de ‘big data’ para saúde. Um questionário sobre características de programas de saúde no ambiente de trabalho foi respondida por seis grandes empresas brasileiras. Dados retirados destes seis questionários (presença e idade de programa de saúde, suas características – inclusão de atividades de screening, educação sobre saúde, ligação com outros programas da empresa, integração do programa à estrutura da empresa, e ambientes de trabalho voltado para a saúde – e a adoção de incentivos financeiros para aderência de funcionários ao programa), bem como dados individuais de idade, gênero e categoria de plano de saúde de cada empregado , foram usados para construir um banco de dados com mais de 76.000 indivíduos. Através de um modelo de regressão múltipla e seleção ‘stepwise’ de variáveis, a idade do empregado foi positivamente associada e a idade do programa de saúde e a categoria ‘premium’ de plano de saúde do funcionário foram negativamente associadas aos custos de internação hospitalar (como esperado). Inesperadamente, a inclusão de programas de screening e iniciativas de educação de saúde nos programas de saúde e bem-estar nas empresas foram identificados como preditores positivos significativos para custos de admissão hospitalar. Para evitar a inclusão errônea de licenças-maternidade, apenas os dados de licença médica de pacientes do sexo masculino foram analisados (dados disponíveis apenas para duas entre as companhias incluídas, com um total de 18.957 pacientes do sexo masculino). Analisando estes dados através de um teste Z para comparação de proporções, a empresa com programa de saúde que inclui atividades voltadas a cessação de hábitos ruins (como tabagismo e etilismo), controle de diabetes e hipertensão, e que adota incentivos financeiros para a aderência de funcionários ao programa tem menor proporção de empregados com licençca médica no período analisado, quando comparada com a outra empresa que não tem estas características (também conforme esperado). Entretanto, a companhia com menor proporção de funcionários com licença médica também foi aquela que adota programa de screening entre as atividades de seu programa de saúde. Potenciais fontes de ameaça à validade interna e externa destes resultados são discutidas, bem como possíveis explicações para a associação entre programas de screening e educação médica a piores indicadores de saúde nesta amostra de companhias são discutidas. Novos estudos com melhor desenho, com amostras maiores e randômicas são necessários para validar estes resultados e possivelmente melhorar a validade interna e externa destes resultados.

Lifestyle factors, direct and indirect costs for a Brazilian airline company

OBJECTIVE: To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS: In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS: Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS: Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

The influence of lifestyle and gender on sickness absence in brazilian workers

Background: Despite an increasing body of knowledge concerning gender and lifestyle factors as determinants of sickness absence in well-developed countries, the relationship between these variables has not been elucidated in emerging economic power countries, where the burden of non-communicable diseases is particularly high. This study aimed to analyze the relationships among lifestyle-related factors and sick leave and to examine whether gender differences in sickness absence can be explained by differences in socio-demographic, work and lifestyle-related factors among Brazilian workers. Methods: In this longitudinal study with a one year follow-up among 2.150 employees of a Brazilian airline company, sick leave was the primary outcome of interest. Independent variables collected by interview at enrolment in the study were gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity and smoking). In addition, the risk for coronary heart disease was determined based on measurement of blood pressure, total cholesterol and glucose levels. The total number of days on sick leave during 12 months follow-up was available from the company register. Logistic regression analysis was used to determine the influence of socio-demographic, type of work and lifestyle-related factors on sick leave. Results: Younger employees, those with lower educational level, those who worked as air crew members and those with higher levels of stress were more likely to have sick leave. Body mass index and level of physical activity were not associated with sick leave. After adjustment by socio-demographic variables, increased odds for 10 or more days of sick leave were found in smokers (OR = 1.51, CI = 1.05-2.17), and ex-smokers (OR = 1.45, CI = 1.01-2.10). Women were more likely to have 10 or more days of sick leave. Gender differences were reduced mainly when adjusted for type of work (15%) and educational level (7%). Conclusions: The higher occurrence of sick leave among women than among men was partly explained by type of work and educational level. Our results suggest that type of work, a stressful life, and smoking are important targets for health promotion in this study population

The economics of wage-led recovery: analysis and policy recommendations

The financial crisis and Great Recession have been followed by a jobs shortage crisis that most forecasts predict will persist for years given current policies. This paper argues for a wage-led recovery and growth program which is the only way to remedy the deep causes of the crisis and escape the jobs crisis. Such a program is the polar opposite of the current policy orthodoxy, showing how much is at stake. Winning the argument for wage-led recovery will require winning the war of ideas about economics that has its roots going back to Keynes’ challenge of classical macroeconomics in the 1920s and 1930s. That will involve showing how the financial crisis and Great Recession were the ultimate result of three decades of neoliberal policy, which produced wage stagnation by severing the wage productivity growth link and made asset price inflation and debt the engine of demand growth in place of wages; showing how wage-led policy resolves the current problem of global demand shortage without pricing out labor; and developing a detailed set of policy proposals that flow from these understandings. The essence of a wage-led policy approach is to rebuild the link between wages and productivity growth, combined with expansionary macroeconomic policy that fills the current demand shortfall so as to push the economy on to a recovery path. Both sets of measures are necessary. Expansionary macro policy (i.e. fiscal stimulus and easy monetary policy) without rebuilding the wage mechanism will not produce sustainable recovery and may end in fiscal crisis. Rebuilding the wage mechanism without expansionary macro policy is likely to leave the economy stuck in the orbit of stagnation.

Revisiting modern portfolio theory

This paper revisits Modern Portfolio Theory and derives eleven properties of Efficient Allocations and Portfolios in the presence of leverage. With different degrees of leverage, an Efficient Portfolio is a linear combination of two portfolios that lie in different efficient frontiers - which allows for an attractive reinterpretation of the Separation Theorem. In particular a change in the investor risk-return preferences will leave the allocation between the Minimum Risk and Risk Portfolios completely unaltered - but will change the magnitudes of the tactical risk allocations within the Risk Portfolio. The paper also discusses the role of diversification in an Efficient Portfolio, emphasizing its more tactical, rather than strategic character

Síndrome de Burnout : um estudo com guias de turismo regional em Natal-RN

Burnout is a psychological syndrome triggered in response to continuous exposure to interpersonal stressors. It is considered a multifactorial construct, which is commonly characterized by three dimensions: emotional exhaustion, dehumanization, and lack of personal accomplishment.This study aimed to verify if the three characteristics of burnout (exhaustion, lack of dehumanization and personal accomplishment) are present in people working as guides Tourism in Natal - RN. It is a descriptive and quantitative study. 109 subjects were surveyed. Data collection was done through the use of questionnaires, the instrument used was the characterization of the Burnout Scale (ECB) created and validated in Brazil by Trocoli and Tamayo (2000). In order to analyze data we used descriptive statistics, analysis of core measures, exploratory and confirmatory factor analysis, reliability analysis, cluster analysis, multiple discriminant and Spearman correlation. Factor analysis identified four factors that explain 58.3% of the total variance. Those factors were named exhaustion, deception, avoidance, and dehumanization. The reliability of the instrument, as measured by Cronbach's Alpha was 0.918, which is considered excellent reliability. The 109 subjects were grouped into three cluster, which had the deception, avoidance, and dehumanization as discriminant. It is possible to conclude that the characteristics of burnout syndrome are present in the studied population where 19 people are on the high level of burnout, moderate in 32 and 56 in the light. The correlations between socio-demographic variables studied and the dimensions of burnout, were few and weak. The variable leave for health reasons in the study appeared to be related to feelings of exhaustion and avoidance behavior appeared related to younger individuals and who work only in the activity of Receptive Tourism Guide. Verification of the incidence of burnout in individuals surveyed suggest the need to adopt intervention strategies are individual, organizational and / or combined

Gestão do marketing de relacionamento: um estudo em empresas hoteleiras de Natal - RN

The present study it analyzes the Management of the Marketing of strategy Relationship as distinguishing for the host s companies of the city of Natal - RN. To carry through this analysis interviews with managers had been carried through, as well as the direct comment of processes, documents, actions and strategies developed for the hotels, with intention to know the level of perception and valuation of the relationship with customers, to verify resources and technologies used in the Management of the Relationship Marketing, identification, segmentation and differentiation of customers, personalization of products and services, and results of the emphasis in the relationship with customers for the host s companies. The research can be classified as exploratory - descriptive, and its universe is limited to the city of Natal, having enclosed hotels that have carried through tourist activity in 2005 and 2006. Still on the criteria of election of the sample, the study it investigated host s companies who if fit in the category superior luxury, or either, five stars, pertaining the national nets and international. How much to the treatment and analysis of the data the was made to leave of the theoretical support of the authors who work the thematic one and of the analysis of the interviews with managers, documents and processes observed for the researcher in the studied hotels. The research sample that the interviewed ones understand the importance to work the Management of the Marketing of Relationship in the host s companies me intention to get sustainable competitive advantage. One still evidenced that the searched hotels make use of strategies and instruments of Management of the Marketing of Relationship, however without an ample theoretical knowledge and yes only as base in the experience of the managers and spread processes already, generating one moment competitive advantage and not relationships of long duration

Arquitetura residencial em João Pessoa-PB a experiência moderna nos anos 1970

In the mid-1980s, the magazine Projeto published the Actual Brazilian Architecture catalogue presenting texts by Hugo Segawa and Ruth Verde Zein with a corpus of works and engaged architects of the 1960s and 1970s. To comprehend the Brazilian architectural production post-1964, in those years of the 1980s, became a significant mission to reactivate the Brazilian architectural debate weakened by the military dictatorship. In his doctoral thesis Spadoni (2003) deals with the different ways which characterizes the Brazilian architectural production of the 1970s. Marked by inventiveness, this production was in tune with the modern thinking and in the transition period between the 1970s and the 1980s it synchronized with the international debate about post-modern architecture. Considering Spadoni s doctoral thesis, this work deals with the modern experience observed in the one-family-houses built in the seventies in João Pessoa. Some modern experiences were not clear outside, to observe it, it was necessary to search for the type of experience into the spatial disposition and of the know-how constructive, because into the appearance some houses not make explicit the use of the modern language. Other observed experiences allude to the repertoire of the Brazilian period in the years 1940s-1960s, to the experience of the modern architecture in São Paulo of the 1960s, to the experiences in which the climate of the Northeastern region strongly influenced the architectural conception. We can also find in a reduced number of houses a particular experience: it refers to experiences that expose the constructive doing, which leave the material apparent and apply to the residential type the experience of the industrial pre-fabricated buildings

Efeito dos nutrientes (nitrogênio e fósforo) sobre o desenvolvimento da Gracilaria birdiae: crescimento e possível uso como biofiltro

Marine shrimp farming has grown exponentially during the last years in Brazil. In spite of the promising economical situation, this activity is facing an increasing criticism due to its environmental impact. Thus, the necessity of alternatives to mitigate environmental degradation caused by this activity. An alternative that is being studied is the policulture that is the integrated culture of two or more organisms, normally one of them a filtering organism. Among filtering organisms, macroalgae are very practicable because they are efficient in the removal of the exceeding nutrients of the water and do not leave residues in the water. Besides, the integrated culture with macroalgae allows the economical exploration of the seaweed (for the manufacture of jelly and jam, for the dairy industry, pharmaceuticals, etc.) along with possibility of a sustainable aquaculture. In the present experiment, the development of the seaweed Gracilaria birdiae, the influence and tolerance of this species to the environmental parameters, and its absorption efficiency in relation with the three kinds of macronutrients (NH4+, NO3- and PO4-3) found in the effluents of marine shrimp farming was studied. The experiment was divided in two parts: a laboratorial part and one part carried under natural conditions. The water used in the laboratory trial was collected in the shrimp ponds of Tecnarão farm and distributed in aquaria containing 20 g of G. birdiae. In the field trial, 0.5 kg of G. birdiae was inserted in PVC cages cultivated in the farm. The results of the study showed a modest growth of G. birdiae, probably due to its low tolerance to highly eutrophicated environments. However, the removal of nutrients was very expressive. Ammonia was reduced in approximately 34 %. Ortho-phosphate showed a reduction of 93.5 %. The capacity of biofiltration of the NO3- by the macro algae was of 100 %, showing that G. birdiae is a seaweed-filtered with a high level of removal for this nutrient under laboratorial conditions. In spite of the low growth of the macro algae in the experiment, the results in relation to the removal of nutrients of the water was encouraging, suggesting that this species can be an efficient biofilter and thus, a strong candidate to be used in a sustainable aquaculture

Construção, caracterização e aplicação de eletrodos para descarga por arco de cátodo oco

The system built to characterize electrodes and, consequently, deposited fine films are constituted by a hollow cathode that works to discharges and low pressures (approximately 10-3 to 5 mbar), a source DC (0 to 1200 V), a cylindrical camera of closed borossilicato for flanges of stainless steel with an association of vacuum bombs mechanical and spread. In the upper flange it is connected the system of hollow cathode, which possesses an entrance of gas and two entrances for its refrigeration, the same is electrically isolated of the rest of the equipment and it is polarized negatively. In front of the system of hollow cathode there is a movable sample in stainless steel with possibility of moving in the horizontal and vertical. In the vertical, the sample can vary its distance between 0 and 70 mm and, in the horizontal, can leave completely from the front of the hollow cathode. The sample and also the cathode hollow are equipped with cromel-alumel termopares with simultaneous reading of the temperatures during the time of treatment. In this work copper electrodes, bronze, titanium, iron, stainless steel, powder of titanium, powder of titanium and silício, glass and ceramic were used. The electrodes were investigated relating their geometry change and behavior of the plasma of the cavity of hollow cathode and channel of the gas. As the cavity of hollow cathode, the analyzed aspects were the diameter and depth. With the channel of the gas, we verified the diameter. In the two situations, we investigated parameters as flow of the gas, pressure, current and applied tension in the electrode, temperature, loss of mass of the electrode with relationship at the time of use. The flow of gas investigated in the electrodes it was fastened in a work strip from 15 to 6 sccm, the constant pressure of work was among 2.7 to 8 x 10-2 mbar. The applied current was among a strip of work from 0,8 to 0,4 A, and their respective tensions were in a strip from 400 to 220 V. Fixing the value of the current, it was possible to lift the curve of the behavior of the tension with the time of use. That curves esteem in that time of use of the electrode to its efficiency is maximum. The temperatures of the electrodes were in the dependence of that curves showing a maximum temperature when the tension was maximum, yet the measured temperatures in the samples showed to be sensitive the variation of the temperature in the electrodes. An accompaniment of the loss of mass of the electrode relating to its time of use showed that the electrodes that appeared the spherical cavities lost more mass in comparison with the electrodes in that didn't appear. That phenomenon is only seen for pressures of 10-2 mbar, in these conditions a plasma column is formed inside of the channel of the gas and in certain points it is concentrated in form of spheres. Those spherical cavities develop inside of the channel of the gas spreading during the whole extension of the channel of the gas. The used electrodes were cut after they could not be more used, however among those electrodes, films that were deposited in alternate times and the electrodes that were used to deposit films in same times, those films were deposited in the glass substrata, alumina, stainless steel 420, stainless steel 316, silício and steel M2. As the eletros used to deposit films in alternate time as the ones that they were used to deposit in same times, the behavior of the thickness of the film obeyed the curve of the tension with relationship the time of use of the electrode, that is, when the tension was maximum, the thickness of the film was also maximum and when the tension was minimum, the thickness was minimum and in the case where the value of the tension was constant, the thickness of the film tends to be constant. The fine films that were produced they had applications with nano stick, bio-compatibility, cellular growth, inhibition of bacterias, cut tool, metallic leagues, brasagem, pineapple fiber and ornamental. In those films it was investigated the thickness, the adherence and the uniformity characterized by sweeping electronic microscopy. Another technique developed to assist the production and characterization of the films produced in that work was the caloteste. It uses a sphere and abrasive to mark the sample with a cap impression, with that cap form it is possible to calculate the thickness of the film. Through the time of life of the cathode, it was possible to evaluate the rate of waste of its material for the different work conditions. Values of waste rate up to 3,2 x 10-6 g/s were verified. For a distance of the substratum of 11 mm, the deposited film was limited to a circular area of 22 mm diameter mm for high pressures and a circular area of 75 mm for pressure strip. The obtained films presented thickness around 2,1 µm, showing that the discharge of arch of hollow cathode in argon obeys a curve characteristic of the tension with the time of life of the eletrodo. The deposition rate obtained in this system it is of approximately 0,18 µm/min

A gripe de longe e de perto: comparações entre as pandemias de 1918 e 2009

Neste debate, historiadores latino-americanos comparam a pandemia de gripe de 1918-1919 com a que varre o continente em 2009, sobretudo as experiências de México, Argentina e Brasil. Analisam as estratégias adotadas nos dois momentos, com ênfase em isolamento, vigilância em portos e aeroportos, intervenções nas cidades. Comparam a atuação dos Estados nacionais e governos locais, a posição dos médicos e dos meios de comunicação e o comportamento das populações, especialmente no tocante ao medo e à morte. Analisam o desempenho das estruturas de assistência às populações e as medidas terapêuticas e profiláticas recomendadas por órgãos públicos de saúde, por interesses privados ligados à venda de medicamentos e pelas medicinas populares e caseiras. O debate trata, ainda, da influência que a experiência de 1918 teve sobre as avaliações da crise atual, bem como do legado que deixará para o futuro.

Faixas de suficiência para a cultura do algodão no centro-oeste do Brasil: I. macronutrientes

The cotton growth occupies about 1.1 million hectares in Brazil and the midwest, especially the state of Mato Grosso, is the largest producer in the country. This work aimed to establish the sufficiency ranges for macronutrients in cotton crops by the method of mathematical chance. The work was carried out from 2000 to 2003 in the cities of Costa Rica (MS), Diamantino and Sapezal (MT), totaling 152 samples of plant tissue and yield. The chance mathematics method was adequate for to establish cotton macronutrients references values, can be to help parameters were the conventional research cannot to prove in the small time space. The use of different yields for the calculation of mathematical chance (4,000 and 4,500kg ha(-1)) in the population studied, no difference between the sufficiency ranges for macronutrients. The macronutrients sufficiency range was, in the mg kg(-1), 33-45; 3.8-5.3; 15-21; 20-36; 4.0-7.2 e 2.8-8.6 for N, P, K, Ca, Mg e S, respectly. The indicated range, however to similar with the recommendations published, they demonstrate improvement about to obtainment of increases productivities.

"Reforma urbana já"; "arroz, feijão, saúde e habitação" :A luta por moradia na grande João Pessoa

Our object of study in this work concerns to the movement of fight for the housing in the Great João Pessoa, Paraíba, Brazil, and looks for to investigate the conditions and context of the occupations of building, public or private, for devoid populations that do not have where to live. Front to the absence of politics effective directed to the habitation or the cities, in a picture of unemployment and impoverishment of the population, the result of the habitation point of view, is the absolute lack of popular housings, the degradation of the cities and the growth of the number of homeless and also of its occupations. The urban occupations today represent a reply of these devoid populations that from an involvement with parties or Not Governmental Organizations, and social movements leave for the class action known by the occupation of abandoning public or private buildings. These occupations, even so initially if assume as pressure instrument or of visibility for attainment of housings, for the delay in obtaining the attention of the public agencies and a solution for the problem, becomes definitive or is drawn out per many years. E this if gives although the deficiencies, of the accumulation or families neither in an adequate, always precarious space nor in sanitary installations, that the necessary privacy does not allow. The study it consisted of an empirical research, through the participant comment and open and half-open interviews, and counted on the audiovisual register of two occupations, one in the downtown of João Pessoa City (old building of the INSS, in the Ponto dos Cem Réis) and other (Community of the Cajueiro), next to the Beach "Praia do Jacaré", in the city of Cabedelo.The choice of the Visual Anthropology as research instrument is on to a concern in better translating other ways of life, therefore the accomplishment of the video in allows them to know with more precision the reality where the citizens of the research live. We also use as methodological resource in the research the deepened interview, in intention to better understand the description of the way of life of the studied families and the movements of fight for the housing, particularly the MDM - Movement of Right for the Housing, and the MNLM- Nacional Movement of Fight for the Housing

A trajetória dos movimentos socioambientais em Sergipe : personagens, instituições e estratégias de comunicação

The research aimed to study the emergence, role, and the possibilities of environmental movements in Sergipe, running through an analysis of the period between 1983 and 2011. This goal has been guided by the core issue of research, which was to analyze the relationship between the mission, structure and action of environmental organizations in Sergipe. The research arose from the need to map and critically evaluate the environmental movement in Sergipe. The methodological procedures focused on the literature search, survey papers in Sergipe a time gap of 28 years, detailed analysis of nine "movements" and selected in-depth interviews, semi-structured interviews with dozens of social actors involved in the area. In conclusion, we observed that environmentalism in Sergipe, from its inception, was associated with recovery of consciousness regarding the environment, to combat local problems of degradation, and the search for legitimacy of public opinion. Although the environmental movement have been, at times, the attention of mass media, the movement failed to leave the niche and achieve a more representative portion of society. You can still see the deep relationship between the profile of environmental leaders, capital strength and the practical results of the environmental actions and finally, it was observed that the action of the movements has much stronger bond with the relationship of the organization and its main leaders with the other "environmentalist," than with the structure and mission of the institution

A arte rupestre como expressão comunicativa da cultura

Along their existence, through of the millenniuns, the Man registers, one way or another, their saga. One in those registration ways is the rupestrian art. Through the rupestrian art the Prehistory is brought even us, portraying in images the daily ritualist and magic of the Man, in scenes that show, among other, their cults and also their daily hard work. The Man is imposed, while registering of their existence, starting from the moment in that he is capable to leave their marks through the transformation that attributes to the Nature; also for the produced interferences and for the cultural singularities that themselves were constituted before the period of the alphabetical writing. In an artifice of duplicating utensils and in the sense of representing animals and to himself own, he delegated us a communicative system whose contexts and details were - and it continue being - an enigma to be deciphered. Starting from this argument, the research has for objective to understand the daily and the history of cultural groups that they preceded us, taking as base the reading of the rupestrian paintings found at the located archeological ranches in the Area of Seridó, more specifically in the Complexo Xique-xique, close to the Municipal district of Carnaúba dos Dantas, distant 220 kilometers of Natal, the capital of Rio Grande do Norte State