Prevenção do tabagismo na gravidez: importância do conhecimento materno sobre os malefícios para a saúde e opções de tratamento disponíveis

Objetivo: Examinar o padrão de consumo do tabaco e conhecimentos sobre as doenças relacionadas ao tabaco, assim como identificar os tipos mais populares de mídias entre gestantes para aprimorar estratégias para a prevenção e a cessação do tabagismo entre essas mulheres. Métodos: Estudo transversal com 61 gestantes atendidas em um hospital universitário e em unidades básicas de saúde em Botucatu, SP. A Escala Hospitalar de Ansiedade e Depressão foi aplicada a todas as participantes. Para aquelas com história de tabagismo, também foi aplicado o Teste de Fagerström para Dependência de Nicotina, e foi avaliado o grau de motivação para cessação tabágica nas fumantes. Resultados: Das 61 gestantes avaliadas, 25 (40,9%) eram fumantes (média de idade, 26,4 ± 7,4 anos), 24 (39,3%) eram ex-fumantes (média de idade, 26,4 ± 8,3 anos), e 12 (19,8%) nunca fumaram (média de idade, 25,1 ± 7,2 anos). A exposição passiva foi relatada por 39 gestantes (63,9%). Das 49 fumantes/ex-fumantes, 13 (29,6%) conheciam as consequências pulmonares do tabagismo; somente 2 (4,9%) conheciam os riscos cardiovasculares; 23 (46,9%) acreditavam que fumar não causa nenhum problema para o feto ou o recém-nascido; 21 (42,9%) consumiram álcool durante a gestação; 18 (36,7%) relataram aumento no consumo de cigarros quando bebiam; 25 (51,0%) experimentaram cigarros com sabores; e 12 (24,5%) fumaram narguilé. Entre as 61 gestantes avaliadas, a televisão foi o tipo de mídia mais disponível e favorita (85,2%), assim como a mais preferida (49,2%). Conclusões: Entre gestantes, o fumo ativo, o fumo passivo e o uso de formas alternativas de consumo de tabaco parecem ser altamente prevalentes, e tais mulheres parecem possuir poucos conhecimentos sobre as consequências do uso de tabaco. Programas educacionais que incluam informações sobre as consequências de todas as formas de uso de tabaco, utilizando formatos novos e efetivos para esta população específica, devem ser desenvolvidos para promover a prevenção/cessação do tabagismo entre gestantes. Amostras adicionais para explorar diferenças culturais e regionais são necessárias.

Obsessive-compulsive symptoms among alcoholics in outpatient treatment: prevalence, severity and correlates

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Tobacco in adolescence: importance to knowledge the health hazards and preventive measures

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação nutricional e capacidade funcional de idosos institucionalizados em Botucatu/SP

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Características sociodemográficas e clínicas que afetam a qualidade de vida em pacientes estomizados intestinais

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Men's health: a population-based study on social inequalities

This study evaluates social inequalities in health according to level of schooling in the male population. This was a cross-sectional, population-based study with a sample of 449 men ranging from 20 to 59 years of age and living in Campinas, Sao Paulo State, Brazil. The chi-square test was used to verify associations, and a Poisson regression model was used to estimate crude and adjusted prevalence ratios. Men with less schooling showed higher rates of alcohol consumption and dependence, smoking, sedentary lifestyle during leisure time, and less healthy eating habits, in addition to higher prevalence of bad or very bad self-rated health, at least one chronic disease, hypertension, and other health problems. No differences were detected between the two schooling strata in terms of use of health services, except for dental services. The findings point to social inequality in health-related behaviors and in some health status indicators. However, possible equity was observed in the use of nearly all types of health services.

Cardiovascular risk factors in patients with first-episode psychosis in Sao Paulo, Brazil

Objective: The objective was to evaluate the cardiovascular profile of first-episode psychosis patients in Sao Paulo, Brazil, an issue that has not been sufficiently explored in low-/middle-income countries. Method: A cross-sectional study was performed 1 to 3 years after an initial, larger survey that assessed first-episode psychosis in sao Paulo. We evaluated cardiovascular risk factors and lifestyle habits using standard clinical examination and laboratory evaluation. Results: Of 151 contacted patients, 82 agreed to participate (mean age=35 years; 54% female). The following diagnoses were found: 20.7% were obese, 29.3% had hypertension, 39.0% had dyslipidemia, 19.5% had metabolic syndrome, and 1.2% had a >20% 10-year risk of coronary heart disease based on Framingham score. Also, 72% were sedentary, 25.6% were current smokers, and 7.3% reported a heavy alcohol intake. Conclusion: Compared to other samples, ours presented a distinct profile of higher rates of hypertension and diabetes (possibly due to dietary habits) and lower rates of smoking and alcohol intake (possibly due to higher dependence on social support). Indirect comparison vs. healthy, age-matched Brazilians revealed that our sample had higher frequencies of hypertension, diabetes and metabolic syndrome. Therefore, we confirmed a high cardiovascular risk in first-episode psychosis in Brazil. Transcultural studies are needed to investigate to which extent lifestyle contributes to such increased risk. (C) 2012 Elsevier Inc. All rights reserved.

Gender differences in drinking patterns and alcohol-related problems in a community sample in Sao Paulo, Brazil

OBJECTIVE: To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. METHODS: A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of Sao Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month non-heavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. RESULTS: Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. CONCLUSIONS: Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level.

SOBRECARGA E DESCONFORTO EMOCIONAL EM CUIDADORES DE IDOSOS

A finalidade deste estudo foi descrever a sobrecarga e o desconforto emocional dos cuidadores de idosos. Estudo epidemiológico e transversal conduzido em 2009 com 124 cuidadores residentes na comunidade de Ribeirão Preto-SP, por meio dos instrumentos: Escala de Sobrecarga de Zarit e Self-Reporting Questionaire (SRQ-20) para o cuidador. A análise dos dados foi realizada no aplicativo SPSS, 15.0, de forma descritiva, univariada (tabelas de frequência) e bivariada (tabelas de contingência para variáveis qualitativas). Os cuidadores, 85,6% do sexo feminino, média de 56,5 anos, utilizaram, em média, 12,4 horas diárias para o cuidar e 57,6% dos cuidadores apresentaram de leve a moderada sobrecarga. Dependência funcional do idoso, sexo do cuidador e tempo em horas para o cuidado, foram preditores da sobrecarga (p<0,05). Encontrou-se, também, que a sobrecarga é fator de risco para desconforto emocional (p<0,05). Cabe aos enfermeiros utilizarem protocolos de avaliação, com base nos fatores de risco, para prevenir a sobrecarga.

Risk factors for hepatitis C virus infection in Inland Brazil: An analysis of pooled epidemiological sectional studies

In order to assess the contribution of different parenteral routes as risk exposure to the hepatitis C virus (HCV), samples from nine surveys or cross-sectional studies conducted in two Brazilian inland regions were pooled, including a total of 3,910 subjects. Heterogeneity among the study results for different risk factors was tested and the results were shown to be homogeneous. Anti-HCV antibodies were observed in 241 individuals, of which 146 (3.7%, 95% CI?=?3.24.4) had HCV exposure confirmed by immunoblot analysis or PCR test. After adjustment for relevant variables, a correlation between confirmed HCV exposure and injection drug use, tattooing, and advance age was observed. In a second logistic model that included exposures not searched in all nine studies, a smaller sample was analyzed, revealing an independent HCV association with past history of surgery and males who have sex with other males, in addition to repeated injection drug use. Overall, these analyses corroborate the finding that injection drug use is the main risk factor for HCV exposure and spread, in addition to other parenteral routes. J. Med. Virol. 84:756762, 2012. (C) 2012 Wiley Periodicals, Inc.

Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Duke Anticoagulation Satisfaction Scale

Aim. The aim of this study was to evaluate the internal reliability and validity of the BrazilianPortuguese version of Duke Anticoagulation Satisfaction Scale (DASS) among cardiovascular patients. Background. Oral anticoagulation is widely used to prevent and treat thromboembolic events in several conditions, especially in cardiovascular diseases; however, this therapy can induce dissatisfaction and reduce the quality of life. Design. Methodological and cross-sectional research design. Methods. The cultural adaptation of the DASS included the translation and back-translation, discussions with healthcare professionals and patients to ensure conceptual equivalence, semantic evaluation and instrument pretest. The BrazilianPortuguese version of the DASS was tested among subjects followed in a university hospital anticoagulation outpatient clinic. The psychometric properties were assessed by construct validity (convergent, known groups and dimensionality) and internal consistency/reliability (Cronbachs alpha). Results. A total of 180 subjects under oral anticoagulation formed the baseline validation population. DASS total score and SF-36 domain correlations were moderate for General health (r = -0.47, p < 0.01), Vitality (r = -0.44, p < 0.01) and Mental health (r = -0.42, p < 0.01) (convergent). Age and length on oral anticoagulation therapy (in years) were weakly correlated with total DASS score and most of the subscales, except Limitation (r = -0.375, p < 0.01) (Known groups). The Cronbachs alpha coefficient was 0.79 for the total scale, and it ranged from 0.76 (hassles and burdens)0.46 (psychological impact) among the domains, confirming the internal consistency reliability. Conclusions. The BrazilianPortuguese version of the DASS has shown levels of reliability and validity comparable with the original English version. Relevance to clinical practice. Healthcare practitioners and researchers need internationally validated measurement tools to compare outcomes of interventions in clinical management and research tools in oral anticoagulation therapy.

Use of alcohol and other drugs among Brazilian college students: effects of gender and age

Objective: To assess the frequency of drug use among Brazilian college students and its relationship to gender and age. Methods: A nationwide sample of 12,721 college students completed a questionnaire concerning the use of drugs and other behaviors. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-WHO) criteria were used to assess were used to assess hazardous drug use. A multivariate logistic regression model tested the associations of ASSIST-WHO scores with gender and age. The same analyses were carried out to measure drug use in the last 30 days. Results: After controlling for other sociodemographic, academic and administrative variables, men were found to be more likely to use and engage in the hazardous use of anabolic androgenic steroids than women across all age ranges. Conversely, women older than 34 years of age were more likely to use and engage in the hazardous use of amphetamines. Conclusions: These findings are consistent with results that have been reported for the general Brazilian population. Therefore, these findings should be taken into consideration when developing strategies at the prevention of drug use and the early identification of drug abuse among college students.

Gender differences in drinking patterns and alcohol-related problems in a community sample in São Paulo, Brazil

OBJECTIVE: To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. METHODS: A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of São Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month nonheavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. RESULTS: Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. CONCLUSIONS: Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level.

Facets of Gender : Analyses of the Family and the Labour Market

This thesis contains four different studies on the dynamics of gender in households and workplaces. The relationship between family life and work life is in focus, particularly in the paper on labour market outcomes after divorce. In the introductory chapter, the Swedish context is briefly described. The description focuses on gender differences in the labour market and in the home. Theories concerning the division of work in the household are discussed, as are two theories on labour market discrimination, viz. taste discrimination and statistical discrimination. The theory part is concluded with a discussion of social closure processes and gendered organizational structures. The Reproduction of Gender. Housework and Attitudes Towards Gender Equality in the Home Among Swedish Boys and Girls. The housework boys and girls age 10 to 18 do, and their attitudes towards gender equality in the home are studied. One aim is to see whether the work children do is gendered and if so, whether they follow their parents’, often gendered, pattern in housework. A second aim is to see whether parents’ division of work is related to the children’s attitude towards gender equality in the home. The data used are taken from the Swedish Child Level of Living Survey (Child-LNU) 2000. Results indicate that girls and boys in two-parent families are more prone to engage in gender-atypical work the more their parent of the same sex engages in this kind of work. The fact that girls still do more housework than boys indicates that housework is gendered work also among children. No relation between parents’ division of work and the child’s attitude towards gender equality in the home was found. Dependence within Families and the Household Division of Labor – A Comparison between Sweden and the United States. This paper assesses the relative explanatory value of the resource-bargaining perspective and the doing-gender approach in analysing the division of housework in the United States and Sweden from the mid-1970s to 2000. Data from the Swedish Level of Living Survey (LNU) and the Panel Study of Income Dynamics (PSID) were used. Overall results indicate that housework is truly gendered work in both countries during the entire period. Even so, the results also indicate that gender deviance neutralization is more pronounced in the United States than in Sweden. Unlike Swedish women, American women seem to increase their time spent in housework when their husbands are to some extent economically dependent on them, as if to neutralize the presumed gender deviance. Divorce and Labour Market Outcomes. Do Women Suffer or Gain? In this paper, the interconnected nature of work and family is studied by looking at labour market outcomes after divorce. The data used are retrospective work and family histories collected in LNU 1991. A hazard regression model with competing risks reveals that women’s chances of improving their occupational prestige appear to be better after divorce compared to before. Increased working hours and perhaps also increased energy invested in the job may pay off in better occupational opportunities. Worth noting, however, is that the outcome among women with a less firm labour market attachment is more often to a job of lower prestige than one of higher prestige. Hence, the labour market outcome for women after divorce is to some extent conditioned by their labour market attachment at the time of divorce. Men, on the other hand, in most cases seem to suffer occupationally from divorce. For separated men the risk of negative changes in occupational prestige is greater than for cohabiting men. Formal On-the-job Training. A Gender-Typed Experience and Wage- Related Advantage? Formal on-the-job training (FOJT) can have a positive impact on wages and on promotion opportunities. According to theory and earlier research, a two-step model of gender inequality in FOJT is predicted: First, women are less likely than men to take part in FOJT and, second, once women do get the more remunerative training, they are not rewarded for their new skills to the same extent as men are. Pooled cross-sectional data from the Swedish Survey of Living Conditions (ULF) in the mid-nineties were used. Results show that women are significantly less likely than men to take part in FOJT. Among those who do receive training, women are more likely to take part in industry-specific training, whereas men are more likely to participate in general training and training that increases promotion opportunities. The two latter forms of training significantly raise a man’s annual earnings but not a woman’s. Hence, the theoretical model is supported and it is argued that this gender inequality is partly due to employers’ discriminatory practices.

Testing the structural and cross-cultural validity of the KIDSCREEN-27 quality of life questionnaire

OBJECTIVES: The aim of this study is to assess the structural and cross-cultural validity of the KIDSCREEN-27 questionnaire. METHODS: The 27-item version of the KIDSCREEN instrument was derived from a longer 52-item version and was administered to young people aged 8-18 years in 13 European countries in a cross-sectional survey. Structural and cross-cultural validity were tested using multitrait multi-item analysis, exploratory and confirmatory factor analysis, and Rasch analyses. Zumbo's logistic regression method was applied to assess differential item functioning (DIF) across countries. Reliability was assessed using Cronbach's alpha. RESULTS: Responses were obtained from n = 22,827 respondents (response rate 68.9%). For the combined sample from all countries, exploratory factor analysis with procrustean rotations revealed a five-factor structure which explained 56.9% of the variance. Confirmatory factor analysis indicated an acceptable model fit (RMSEA = 0.068, CFI = 0.960). The unidimensionality of all dimensions was confirmed (INFIT: 0.81-1.15). Differential item functioning (DIF) results across the 13 countries showed that 5 items presented uniform DIF whereas 10 displayed non-uniform DIF. Reliability was acceptable (Cronbach's alpha = 0.78-0.84 for individual dimensions). CONCLUSIONS: There was substantial evidence for the cross-cultural equivalence of the KIDSCREEN-27 across the countries studied and the factor structure was highly replicable in individual countries. Further research is needed to correct scores based on DIF results. The KIDSCREEN-27 is a new short and promising tool for use in clinical and epidemiological studies.