Trends in healthy life expectancy among older Brazilian women between 1998 and 2008

OBJECTIVE To analyze conditional and unconditional healthy life expectancy among older Brazilian women.METHODS This cross-sectional study used the intercensal technique to estimate, in the absence of longitudinal data, healthy life expectancy that is conditional and unconditional on the individual’s current health status. The data used were obtained from the Pesquisa Nacional por Amostra de Domicílios (National Household Sample Survey) of 1998, 2003, and 2008. This sample comprised 11,171; 13,694; and 16,259 women aged 65 years or more, respectively. Complete mortality tables from the Brazilian Institute of Geography and Statistics for the years 2001 and 2006 were also used. The definition of health status was based on the difficulty in performing activities of daily living.RESULTS The remaining lifetime was strongly dependent on the current health status of the older women. Between 1998 and 2003, the amount of time lived with disability for healthy women at age 65 was 9.8%. This percentage increased to 66.2% when the women already presented some disability at age 65. Temporal analysis showed that the active life expectancy of the women at age 65 increased between 1998-2003 (19.3 years) and 2003-2008 (19.4 years). However, life years gained have been mainly focused on the unhealthy state.CONCLUSIONS Analysis of conditional and unconditional life expectancy indicated that live years gained are a result of the decline of mortality in unhealthy states. This pattern suggests that there has been no reduction in morbidity among older women in Brazil between 1998 and 2008.

Inequality in Healthy Life Expectancy at Birth by National Deciles of Area Deprivation: England, 2010-12

This release from the Office for National Statistics contains a reference table providing Healthy Life Expectancy (HLE) and Life Expectancy (LE) at birth for national deciles of area deprivation in England. It also provides two measures of inequality, the range and Slope Index of Inequality (SII), for the period 2010-12.Key findingsMales in the most deprived areas have a life expectancy 9.1 years shorter (when measured by the range) than males in the least deprived areas; they also spend a smaller proportion of their shorter lives in ‘Good’ health (70.8% compared to 85.0%).Females in the most deprived areas have a life expectancy 6.8 years shorter (when measured by the range) than females in the least deprived areas; they also expect to spend 17.2% less of their life in ‘Good’ health (66.1% compared to 83.2%).Males in the most advantaged areas can expect to live 19.4 years longer in ‘Good’ health than those in the least advantaged areas as measured by the Slope Index of Inequality (SII). For females this was 19.8 years.Read the release here.��

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015

Fermanagh - Your Life in Your Hands

This project intends to build on the success in equipping individuals with mental health problems, who are obese, with the skills necessary to make healthier lifestyle choices.Particpants will work as a group and support each other. A range of sessions were held on health issues of importance to clients (stress, exercise, mental health) through information workshops, training, pharmacy clinics, cooking etc. For the participants involved in the project their confidence has grown and they are able to share their learning with others at the centre. The clients are aware of other services and how to access them. The pharmacist role played a visit to the doctors to help clients get the best out of their appointment. The mental health of those involved has also imporved and has spurred them on to make changes in their overall lifestyle.

Healthy eating for people with Type 2 diabetes

This booklet has been prepared for those who have recently been diagnosed with Type 2 Diabetes. Type 2 Diabetes is a very common medical condition. While it is a condition that is on the increase, a lot is now known about Type 2 Diabetes and it can be successfully treated and managed so that the person with Diabetes can live a long and healthy life.

Behavioral determinants of healthy aging

With global trends in population aging, many nations are developing and implementing healthy aging policies to promote quality as well as years of healthy life. To broaden the evidence base for such policy development, a review of the literature was conducted to summarize the existing evidence regarding the behavioral determinants of health), aging. Such research is needed so that the efficacy of modes of intervention can be better understood. The Outcome of: healthy or successful aging was selected for this review since this nomenclature dominates the literature describing a global measure of multidimensional functioning at the positive end of the health continuum in older age. Studies published between 1985 and 2003 that reported statistical associations between baseline determinants and healthy aging Outcome were identified from a systematic search of medical, psychological, sociological, and gerontological databases. Eight studies satisfied the search criteria. Modifiable risk factors among the behavioral determinants included smoking status, physical activity level, body mass index, diet, alcohol use, and health practices. On the basis of these findings, effective healthy aging policies need to enhance opportunities across the life span for modification of lifestyle risk factors. Efforts to standardize concepts and terminology will facilitate further research activity in this important area. (Am J Prev Med 2005;28(3):298-304) (c) 2005 American Journal of Preventive Medicine.

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Estudo da postura corporal e aspectos nutricionais em escolares do ensino fundamental da rede publica

Universidade Estadual de Campinas. Faculdade de Educação Física

O segredo da longevidade segundo as percepções dos próprios longevos

Estudos apontam fatores que podem aumentar a longevidade; no entanto, muitas questões pertinentes a este tema ainda não foram elucidadas. Percepções do próprio longevo a respeito dos fatores contribuintes para longevidade são importantes, permitindo levantamento de cada fator e suas interações com demais variáveis que promovem a longevidade. O presente artigo relata dados da investigação sobre "o segredo da longevidade", segundo percepções dos próprios longevos, analisados pelo referencial metodológico da grounded theory. Foram entrevistados trinta ferroviários longevos do município de Botucatu (SP). A análise das falas dos longevos possibilitou determinar que a percepção dos fatores se aglutina em torno de categorias progressivamente abrangentes que culminam na representação coletiva de que a longevidade é dependente do embate entre fatores prejudiciais que aniquilam a vida e fatores saudáveis que geram e preservam a vida, sobre o qual a falta de controle social e do Estado torna pessimista a visão do futuro.

Sensitivity and uncertainty analyses for burden of disease and risk factor estimates

Epidemiological studies report confidence or uncertainty intervals around their estimates. Estimates of the burden of diseases and risk factors are subject to a broader range of uncertainty because of the combination of multiple data sources and value choices. Sensitivity analysis can be used to examine the effects of social values that have been incorporated into the design of the disability–adjusted life year (DALY). Age weight, where a year of healthy life lived at one age is valued differently from at another age, is the most controversial value built into the DALY. The discount rate, which addresses the difference in value of current versus future health benefits, also has been criticized. The distribution of the global disease burden and rankings of various conditions are largely insensitive to alternate assumptions about the discount rate and age weighting. The major effects of discounting and age weighting are to enhance the importance of neuropsychiatric conditions and sexually transmitted infections. The Global Burden of Disease study also has been criticized for estimating mortality and disease burden for regions using incomplete and uncertain data. Including uncertain results, with uncertainty quantified to the extent possible, is preferable, however, to leaving blank cells in tables intended to provide policy makers with an overall assessment of burden of disease. No estimate is generally interpreted as no problem. Greater investment in getting the descriptive epidemiology of diseases and injuries correct in poor countries will do vastly more to reduce uncertainty in disease burden assessments than a philosophical debate about the appropriateness of social value

Beyond sex and cooking: Health education for individuals with intellectual disability

Issues of health education programming for people with intellectual disability are discussed. As environments in which such individuals live become more inclusive, and they are encouraged to make their own choices, the issue of whether current health education is sufficient to enable them to make healthy life choices is considered. More attention should be focused on programs in schools and the community to fulfill this need. Three aspects of health education programming are considered: physical activity, general health knowledge, and social supports for health. Continuity of information is viewed as important in policy development as well as in interprofessional coordination and cooperation to assure that these individuals are not further handicapped by poor health.

Estimates of global and regional potential health gains from reducing multiple major risk factors

Background Estimates of the disease burden due to multiple risk factors can show the potential gain from combined preventive measures. But few such investigations have been attempted, and none on a global scale. Our aim was to estimate the potential health benefits from removal of multiple major risk factors. Methods We assessed the burden of disease and injury attributable to the joint effects of 20 selected leading risk factors in 14 epidemiological subregions of the world. We estimated population attributable fractions, defined as the proportional reduction in disease or mortality that would occur if exposure to a risk factor were reduced to an alternative level, from data for risk factor prevalence and hazard size. For every disease, we estimated joint population attributable fractions, for multiple risk factors, by age and sex, from the direct contributions of individual risk factors. To obtain the direct hazards, we reviewed publications and re-analysed cohort data to account for that part of hazard that is mediated through other risks. Results Globally, an estimated 47% of premature deaths and 39% of total disease burden in 2000 resulted from the joint effects of the risk factors considered. These risks caused a substantial proportion of important diseases, including diarrhoea (92%-94%), lower respiratory infections (55-62%), lung cancer (72%), chronic obstructive pulmonary disease (60%), ischaemic heart disease (83-89%), and stroke (70-76%). Removal of these risks would have increased global healthy life expectancy by 9.3 years (17%) ranging from 4.4 years (6%) in the developed countries of the western Pacific to 16.1 years (43%) in parts of sub-Saharan Africa. Interpretation Removal of major risk factors would not only increase healthy life expectancy in every region, but also reduce some of the differences between regions, The potential for disease prevention and health gain from tackling major known risks simultaneously would be substantial.

Indoor air quality in primary schools

Clean air is a basic requirement of life. The Indoor Air Quality (IAQ) has been the object of several studies due to an increasing concern within the scientific community on the effects of indoor air quality upon health, especially as people tend to spend more time indoors than outdoors. The quality of air inside homes, offices, schools or other private and public buildings is an essential determinant of healthy life and people’s well-being. People can be exposed to contaminants by inhalation, ingestion and dermal contact. In the past, scientists have paid much attention to the study of exposure to outdoor air contaminants, because they have realised the seriousness of outdoor air pollution problems. However, each indoor microenvironment has unique characteristics, determined by the local outdoor air, specific building characteristics and indoor activities. Indeed, hazardous substances are emitted from buildings, construction materials and indoor equipment or due to human activities indoors.

Política(s) de saúde no trabalho : um inquérito sociológico às empresas portuguesas

Resumo Política(s) de saúde no trabalho: um inquérito sociológico às empresas portuguesas A literatura portuguesa sobre políticas, programas e actividades de Segurança, Higiene e Saúde no Trabalho (abreviadamente, SH&ST) é ainda escassa. Com este projecto de investigação pretende-se (i) colmatar essa lacuna, (ii) melhorar o conhecimento dos sistemas de gestão da saúde e segurança no trabalho e (iii) contribuir para a protecção e a promoção da saúde dos trabalhadores. Foi construída uma tipologia com cinco grupos principais de políticas, programas e actividades: A (Higiene & Segurança no Trabalho / Melhoria do ambiente físico de trabalho); B (Avaliação de saúde / Vigilância médica / Prestação de cuidados de saúde); C (Prevenção de comportamentos de risco/ Promoção de estilos de vida saudáveis); D (Intervenções a nível organizacional / Melhoria do ambiente psicossocial de trabalho); E (Actividades e programas sociais e de bem-estar). Havia uma lista de mais de 60 actividades possíveis, correspondendo a um índice de realização de 100%. Foi concebido e desenhado, para ser auto-administrado, um questionário sobre Política de Saúde no Local de Trabalho. Foram efectuados dois mailings, e um follow-up telefónico. O trabalho de campo decorreu entre a primavera de 1997 e o verão de 1998. A amostra (n=259) é considerada representativa das duas mil maiores empresas do país. Uma em cada quatro é uma multinacional. A taxa de sindicalização rondava os 30% da população trabalhadora, mas apenas 16% dos respondentes assinalou a existência de representantes dos trabalhadores eleitos para a SH&ST. A hipótese de investigação principal era a de que as empresas com um sistema integrado de gestão da SH&ST seriam também as empresas com um (i) maior número de políticas, programas e actividades de saúde; (ii) maior índice de saúde; (iii) maior índice de realização; e (iv) maior percentagem dos encargos com a SH&ST no total da massa salarial. As actividades de tipo A e B, tradicionalmente associadas à SH&ST, representavam, só por si, mais de 57% do total. Os resultados, correspondentes às respostas da Secção C do questionário, apontam, para (i) a hipervalorização dos exames de medicina do trabalho; e por outro para (ii) o subaproveitamento de um vasto conjunto de actividades (nomeadamente as de tipo D e E), que são correntemente levadas a cabo pelas empresas e que nunca ou raramente são pensadas em termos de protecção e promoção da saúde dos trabalhadores. As actividades e os programas de tipo C (Prevenção de comportamentos de risco/Promoção de estilos de vida saudáveis), ainda eram as menos frequentes entre nós, a seguir aos Programas sociais e de bem-estar (E). É a existência de sistemas de gestão integrados de SH&ST, e não o tamanho da empresa ou outra característica sociodemográfica ou técnico-organizacional, que permite predizer a frequência de políticas de saúde mais activas e mais inovadores. Os três principais motivos ou razões que levam as empresas portuguesas a investir na protecção e promoção da saúde dos seus trabalhadores eram, por ordem de frequência, (i) o absentismo em geral; (ii) a produtividade, qualidade e/ou competitividade, e (iii) a filosofia de gestão ou cultura organizacional. Quanto aos três principais benefícios que são reportados, surge em primeiro lugar (i) a melhoria da saúde dos trabalhadores, seguida da (ii) melhoria do ambiente do ambiente de trabalho e, por fim, (iii) a melhoria da produtividade, qualidade e/ou competitividade.Quanto aos três principais obstáculos que se põem, em geral, ao desenvolvimento das iniciativas de saúde, eles seriam os seguintes, na percepção dos respondentes: (i) a falta de empenho dos trabalhadores; (ii) a falta de tempo; e (iii) os problemas de articulação/ comunicação a nível interno. Por fim, (i) o empenho das estruturas hierárquicas; (ii) a cultura organizacional propícia; e (iii) o sentido de responsabilidade social surgem, destacadamente, como os três principais factores facilitadores do desenvolvimento da política de saúde no trabalho. Tantos estes factores como os obstáculos são de natureza endógena, susceptíveis portanto de controlo por parte dos gestores. Na sua generalidade, os resultados deste trabalho põem em evidência a fraqueza teóricometodológica de grande parte das iniciativas de saúde, realizadas na década de 1990. Muitas delas seriam medidas avulsas, que se inserem na gestão corrente das nossas empresas, e que dificilmente poderão ser tomadas como expressão de uma política de saúde no local de trabalho, (i) definida e assumida pela gestão de topo, (ii) socialmente concertada, (iii) coerente, (iv) baseada na avaliação de necessidades e expectativas de saúde dos trabalhadores, (v) divulgada, conhecida e partilhada por todos, (vi) contingencial, flexível e integrada, e, por fim, (vii) orientada por custos e resultados. Segundo a Declaração do Luxemburgo (1997), a promoção da saúde engloba o esforço conjunto dos empregadores, dos trabalhadores, do Estado e da sociedade civil para melhorar a segurança, a saúde e o bem-estar no trabalho, objectivo isso que pode ser conseguido através da (i) melhoria da organização e das demais condições de trabalho, da (ii) participação efectiva e concreta dos trabalhadores bem como do seu (iii) desenvolvimento pessoal. Abstract Health at work policies: a sociological inquiry into Portuguese corporations Portuguese literature on workplace health policies, programs and activities is still scarce. With this research project the author intends (i) to improve knowledge on the Occupational Health and Safety (shortly thereafter, OSH) management systems and (ii) contribute to the development of health promotion initiatives at a corporate level. Five categories of workplace health initiatives have been identified: (i) Occupational Hygiene and Safety / Improvement of Physical Working Environment (type A programs); (ii) Health Screening, Medical Surveillance and Other Occupational Health Care Provision (type B programs); (iii) Preventing Risk Behaviours / Promoting Healthy Life Styles (type C programs); (iv) Organisational Change / Improvement of Psycho-Social Working Environment (type D programs); and (v) Industrial and Social Welfare (type E programs). A mail questionnaire was sent to the Chief Executive Officer of the 1500 largest Portuguese companies, operating in the primary and secondary sectors (≥ 100 employees) or tertiary sector (≥ 75 employees). Response rate has reached about 20% (259 respondents, representing about 300 companies). Carried out between Spring 1997 and Summer 1998, the fieldwork has encompassed two direct mailings and one phone follow-up. Sample is considered to be representative of the two thousand largest companies. One in four is a multinational. Union membership rate is about 30%, but only 16% has reported the existence of a workers’ health and safety representative. The most frequent workplace health initiatives were those under the traditional scope of the OSH field (type A and B programs) (57% of total) (e.g., Periodical Medical Examinations; Individual Protective Equipment; Assessment of Working Ability). In SMEs (< 250) it was less likely to find out some time-consuming and expensive activities (e.g., Training on OSH knowledge and skills, Improvement of environmental parameters as ventilation, lighting, heating).There were significant differences in SMEs, when compared with the larger ones (≥ 250) concerning type B programs such as Periodical medical examinations, GP consultation, Nursing care, Other medical and non-medical specialities (e.g., psychiatrist, psychologist, ergonomist, physiotherapist, occupational social worker). With regard to type C programs, there were a greater percentage of programs centred on Substance abuse (tobacco, alcohol, and drug) than on Other health risk behaviours. SMEs representatives reported very few prevention- oriented programs in the field of Drug abuse, Nutrition, Physical activity, Off- job accidents, Blood pressure or Weight control. Frequency of type D programs included Training on Human Resources Management, Training on Organisational Behaviour, Total Quality Management, Job Design/Ergonomics, and Workplace rehabilitation. In general, implementation of this type of programs (Organisational Change / Improvement of Psychosocial Working Environment) is not largely driven by health considerations. Concerning Industrial and Social Welfare (Type E programs), the larger employers are in a better position than SMEs to offer to their employees a large spectrum of health resources and facilities (e.g., Restaurant, Canteen, Resting room, Transport, Infra-structures for physical activity, Surgery, Complementary social protection, Support to recreational and cultural activities, Magazine or newsletter, Intranet). Other workplace health promotion programs like Training on Stress Management, Employee Assistance Programs, or Self-help groups are uncommon in the Portuguese worksites. The existence of integrated OSH management systems, not the company size, is the main variable explaining the implementation of more active and innovative workplace health policies in Portugal. The three main prompting factors reported by employers for health protection and promotion initiatives are: (i) Employee absenteeism; (ii) Productivity, quality and/or competitiveness; and (iii) Corporate culture/management philosophy. On the other hand, (i) Improved staff’s health, (ii) Improved working environment and (iii) Improved productivity, quality and/or competitiveness were the three main benefits reported by companies’ representatives, as a result of successful implementation of workplace health initiatives. (i) Lack of staff commitment; (ii) Lack of time; and (iii) Problems of co-operation and communication within company or establishment (iii) are perceived to be the main barriers companies must cope with. Asked about the main facilitating factors, these companies have pointed out the following ones: (i) Top management commitment; (ii) Corporate culture; and (iii) Sense of social responsibility. This sociological research report shows the methodological weaknesses of workplace health initiatives, carried out by Portuguese companies during the last ‘90s. In many cases, these programs and actions were not part of a corporate health strategy and policy, (i) based on the assessment of workers’ health needs and expectancies, (ii) advocated by the employer or the chief executive officer, (ii) planned and implemented with the staff consultation and participation or (iv) evaluated according to a cost-benefit analysis. In short, corporate health policy and action were still rather based on more traditional OSH approaches and should be reoriented towards Workplace Health Promotion (WHP) approach. According to the Luxembourg Declaration of Workplace Health Promotion in the European Union (1997), WHP is “a combination of: (i) improving the work organisation and environment; (ii) promoting active participation; (iii) encouraging personal development”.Résumée Politique(s) de santé au travail: une enquête sociologique aux entreprises portugaises Au Portugal on ne sait presque rien des politiques de santé au travail, adoptés par les entreprises. Avec ce projet de recherche, on veut (i) améliorer la connaissance sur les systèmes de gestion de la santé et de la sécurité au travail et, au même temps, (ii) contribuer au développement de la promotion de la santé des travailleurs. Une typologie a été usée pour identifier les politiques, programmes et actions de santé au travail: A. Amélioration des conditions de travail / Sécurité au travail; B. Médecine du travail /Santé au travail; C. Prévention des comportements de risque / Promotion de styles de vie sains; D. Interventions organisationnelles / Amélioration des facteurs psychosociaux au travail; E. Gestion de personnel et bien-être social. Un questionnaire postal a été envoyé au représentant maximum des grandes entreprises portugaises, industrielles (≥ 100 employés) ou des services (≥ 75 employés). Le taux de réponse a été environ 20% (259 répondants, concernant trois centaines d’entreprises et d’établissements). La recherche de champ, conduite du printemps 1997 à l’été 1998, a compris deux enquêtes postales et un follow-up téléphonique. L´échantillon est représentatif de la population des deux miles plus grandes entreprises. Un quart sont des multinationales. Le taux de syndicalisation est d’environ 30%. Toutefois, il y a seulement 16% de lieux de travail avec des représentants du personnel pour la santé et sécurité au travail. Les initiatives de santé au travail les plus communes sont celles concernant le domaine plus traditionnel (types A et B) (57% du total): par exemple, les examens de médecine du travail, l’équipement de protection individuelle, les tests d’aptitude au travail. En ce qui concerne les programmes de type C, les plus fréquents sont le contrôle et la prévention des addictions (tabac, alcool, drogue). Les interventions dans le domaine de du système technique et organisationnelle du travail peuvent comprendre les courses de formation en gestion de ressources humaines ou en psychosociologie des organisations, l’ergonomie, le travail posté ou la gestion de la qualité totale. En général, la protection et la promotion de la santé des travailleurs ne sont pas prises en considération dans l’implémentation des initiatives de type D. Il y a des différences quand on compare les grandes entreprises et les moyennes en matière de politique de gestion du personnel e du bien-être (programmes de type E, y compris l’allocation de ressources humaines ou logistiques comme, par exemple, restaurant, journal d’entreprise, transports, installations et équipements sportifs). D’autres activités de promotion de la santé au travail comme la formation en gestion du stress, les programmes d’ assistance aux employés, ou les groupes de soutien et d’auto-aide sont encore très peu fréquents dans les entreprises portugaises. C’est le système intégré de gestion de la santé et de la sécurité au travail, et non pas la taille de l’entreprise, qui aide à prédire l’existence de politiques actives et innovatrices dans ce domaine. Les trois facteurs principaux qui encouragent les actions de santé (prompting factors, en anglais) sont (i) l’absentéisme (y compris la maladie), (ii) les problèmes liés à la productivité, qualité et/ou la compétitivité, et aussi (iii) la culture de l’entreprise/philosophie de gestion. Du coté des bénéfices, on a obtenu surtout l’amélioration (i) de la santé du personnel, (ii) des conditions de travail, et (iii) de la productivité, qualité et/ou compétitivité.Les facteurs qui facilitent les actions de santé au travail sont (i) l’engagement de la direction, (ii) la culture de l’entreprise, et (iii) le sens de responsabilité sociale. Par contre, les obstacles à surmonter, selon les organisations qui ont répondu au questionnaire, seraient surtout (i) le manque d’engagement des travailleurs et de leur représentants, (ii) le temps insuffisant, et (iii) les problèmes de articulation/communication au niveau interne de l’entreprise/établissement. Ce travail de recherche sociologique montre la faiblesse méthodologique des services et activités de santé et sécurité au travail, mis en place par les entreprises portugaises dans les années de 1990, à la suite des accords de concertation sociale de 1991. Dans beaucoup de cas, (i) ces politiques de santé ne font pas partie encore d’un système intégré de gestion, (ii) il n’a pas d’évaluation des besoins et des expectatives des travailleurs, (iii) c’est très bas ou inexistant le niveau de participation du personnel, (iv) on ne fait pas d’analyse coût-bénéfice. On peut conclure que les politiques de santé au travail sont plus proches de la médecine du travail et de la sécurité au travail que de la promotion de la santé des travailleurs. Selon la Déclaration du Luxembourg sur la Promotion de la Santé au Lieu de Travail dans la Communauté Européenne (1997), celle-ci « comprend toutes les mesures des employeurs, des employés et de la société pour améliorer l'état de santé et le bien être des travailleurs » e « ceci peut être obtenu par la concentration des efforts dans les domaines suivants: (i) amélioration de l'organisation du travail et des conditions de travail ; (ii) promotion d'une participation active des collaborateurs ; (iii) renforcement des compétences personnelles ».

Depressão : detecção, diagnóstico e tratamento. Estudo de prevalência e despite das perturbações depressivas e tratamento

RESUMO:A depressão clínica é uma patologia do humor, dimensional e de natureza crónica, evoluindo por episódios heterogéneos remitentes e recorrentes, de gravidade variável, correspondendo a categorias nosológicas porventura artificiais mas clinicamente úteis, de elevada prevalência e responsável por morbilidade importante e custos sociais crescentes, calculando-se que em 2020 os episódios de depressão major constituirão, em todo o mundo, a segunda causa de anos de vida com saúde perdidos. Como desejável, na maioria dos países os cuidados de saúde primários são a porta de entrada para o acesso à recepção de cuidados de saúde. Cerca de 50% de todas as pessoas sofrendo de depressão acedem aos cuidados de saúde primários mas apenas uma pequena proporção é correctamente diagnosticada e tratada pelos médicos prestadores de cuidados primários apesar dos tratamentos disponíveis serem muito efectivos e de fácil aplicabilidade. A existência de dificuldades e barreiras a vários níveis – doença, doentes, médicos, organizações de saúde, cultura e sociedade – contribuem para esta generalizada ineficiência de que resulta uma manutenção do peso da depressão que não tem sido possível reduzir através das estratégias tradicionais de organização de serviços. A equipa comunitária de saúde mental e a psiquiatria de ligação são duas estratégias de intervenção com desenvolvimento conceptual e organizacional respectivamente na Psiquiatria Social e na Psicossomática. A primeira tem demonstrado sucesso na abordagem clínica das doenças mentais graves na comunidade e a segunda na abordagem das patologias não psicóticas no hospital geral. Todavia, a efectividade destas estratégias não se tem revelado transferível para o tratamento das perturbações depressivas e outras patologias mentais comuns nos cuidados de saúde primários. Novos modelos de ligação e de trabalho em equipa multidisciplinar têm sido demonstrados como mais eficazes e custo-efectivos na redução do peso da depressão, ao nível da prestação dos cuidados de saúde primários, quando são atinentes com os seguintes princípios estratégicos e organizacionais: detecção sistemática e abordagem da depressão segundo o modelo médico, gestão integrada de doença crónica incluindo a continuidade de cuidados mediante colaboração e partilha de responsabilidades intersectorial, e a aposta na melhoria contínua da qualidade. Em Portugal, não existem dados fiáveis sobre a frequência da depressão, seu reconhecimento e a adequação do tratamento ao nível dos cuidados de saúde primários nem se encontra validada uma metodologia de diagnóstico simples e fiável passível de implementação generalizada. Foi realizado um estudo descritivo transversal com os objectivos de estabelecer a prevalência pontual de depressão entre os utentes dos cuidados de saúde primários e as taxas de reconhecimento e tratamento pelos médicos de família e testar metodologias de despiste, com base num questionário de preenchimento rápido – o WHO-5 – associado a uma breve entrevista estruturada – o IED. Foram seleccionados aleatoriamente 31 médicos de família e avaliados 544 utentes consecutivos, dos 16 aos 90 anos, em quatro regiões de saúde e oito centros de saúde dotados com 219 clínicos gerais. Os doentes foram entrevistados por psiquiatras, utilizando um método padronizado, o SCAN, para diagnóstico de perturbação depressiva segundo os critérios da 10ª edição da Classificação Internacional de Doenças. Apurou-se que 24.8% dos utentes apresentava depressão. No melhor dos cenários, menos de metade destes doentes, 43%, foi correctamente identificada como deprimida pelo seu médico de família e menos de 13% dos doentes com depressão estavam bem medicados com antidepressivo em dose adequada. A aplicação seriada dos dois instrumentos não revelou dificuldades tendo permitido a identificação de pelo menos 8 em cada 10 doentes deprimidos e a exclusão de 9 em cada 10 doentes não deprimidos. Confirma-se a elevada prevalência da patologia depressiva ao nível dos cuidados primários em Portugal e a necessidade de melhorar a capacidade diagnóstica e terapêutica dos médicos de família. A intervenção de despiste, que foi validada, parece adequada para ser aplicada de modo sistemático em Centros de Saúde que disponham de recursos técnicos e organizacionais para o tratamento efectivo dos doentes com depressão. A obtenção da linha de base de indicadores de prevalência, reconhecimento e tratamento das perturbações depressivas nos cuidados de saúde primários, bem como a validação de instrumentos de uso clínico, viabiliza a capacitação do sistema para a produção de uma campanha nacional de educação de grande amplitude como a proposta no Plano Nacional de Saúde 2004-2010.------- ABSTRACT: Clinical depression is a dimensional and chronic affective disorder, evolving through remitting and recurring heterogeneous episodes with variable severity corresponding to clinically useful artificial diagnostic categories, highly prevalent and producing vast morbidity and growing social costs, being estimated that in 2020 unipolar major depression will be the second cause of healthy life years lost all over the world. In most countries, primary care are the entry point for access to health care. About 50% of all individuals suffering from depression within the community reach primary health care but a smaller proportion is correctly diagnosed and treated by primary care physicians though available treatments are effective and easily manageable. Barriers at various levels – pertaining to the illness itself, to patients, doctors, health care organizations, culture and society – contribute to the inefficiency of depression management and pervasiveness of depression burden, which has not been possible to reduce through classical service strategies. Community mental health teams and consultation-liaison psychiatry, two conceptual and organizational intervention strategies originating respectively within social psychiatry and psychosomatics, have succeeded in treating severe mental illness in community and managing non-psychotic disorders in the general hospital. However, these strategies effectiveness has not been replicated and transferable for the primary health care setting treatment of depressive disorders and other common mental pathology. New modified liaison and multidisciplinary team work models have been shown as more efficacious and cost-effective reducing depression burden at the primary care level namely when in agreement with principles such as: systematic detection of depression and approach accordingly to the medical model, chronic llness comprehensive management including continuity of care through collaboration and shared responsibilities between primary and specialized care, and continuous quality improvement. There are no well-founded data available in Portugal for depression prevalence, recognition and treatment adequacy in the primary care setting neither is validated a simple, teachable and implementable recognition and diagnostic methodology for primary care. With these objectives in mind, a cross-sectional descriptive study was performed involving 544 consecutive patients, aged 16-90 years, recruited from the ambulatory of 31 family doctors randomized within the 219 physicians working in eight health centres from four health regions. Screening strategies were tested based on the WHO-5 questionnaire in association with a short structured interview based on ICD-10 criteria. Depression ICD-10 diagnosis was reached according to the gold standard SCAN interview performed by trained psychiatrists. Any depressive disorder ICD-10 diagnosis was present in 24.8% of patients. Through the use of favourable recognition criteria, 43% of the patients were correctly identified as depressed by their family doctor and about 13% of the depressed patients were prescribed antidepressants at an adequate dosage. The serial administration of both instruments – WHO-5 and short structured interview – was feasible, allowing the detection of eight in ten positive cases and the exclusion of nine in ten non-cases. In Portugal, at the primary care level, high depressive disorder prevalence is confirmed as well as the need to improve depression diagnostic and treatment competencies of family doctors. A two-stage screening strategy has been validated and seems adequate for systematic use in health centres where technical and organizational resources for the effective management of depression are made available. These results can be viewed as primary care depressive disorders baseline indicators of prevalence, detection and treatment and, along with clinical useful instruments, the health system is more capacitated for the establishment of a national level large education campaign on depression such as proposed in the National Health Plan 2004-2010.