Cross-cultural adaptation of discrimination and vigilance scales in ELSA-Brasil.

OBJECTIVE: To describe the process of cross-cultural adaptation for the use in Brazil of the everyday discrimination scale (EDS) and the heightened vigilance scale (HVS) applied in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Conceptual, item and semantic equivalence analyses were conducted by a group of four epidemiologists; evaluation of measurement equivalence (factorial analysis of configural, metric and scalar structures, according to sociodemographic characteristics) and reliability. A total of 11,987 participants responded to the discrimination scale, and a subsample of 260 people participated in the test-retest study. In the case of HVS, 8,916 people responded, while 149 individuals did so in the test-retest study. RESULTS: The scales presented conceptual, item and semantic equivalence pertinent in the Brazilian context, in addition to adequate correspondence of referential/denotative meaning of terms and also of the general/connotative of the items. The confirmatory factor analysis of EDS revealed a unidimensional structure, with residual correlations between two pairs of items, presenting configural and metric invariance among the four subgroups evaluated. Scalar invariance was identified according to sex and age group, but it was not observed for race/color and education. Heightened vigilance showed low loads and high residuals, with inadequate adjustment indicators. For the items of the discrimination scale the weighted kappa coefficient (Kp) ranged from 0.44 to 0.78, and the intraclass correlation coefficient (ICC) was 0.87. For HVS items, the Kp ranged from 0.47 to 0.59 and the ICC was 0.83. CONCLUSIONS: Although there are correlated items, it was concluded that the EDS is a promising scale to evaluate experiences of perceived discrimination in Brazilian daily life. However, the heightened vigilance scale did not present equivalence of measurement in the current format.

Iniciativas da sociedade e comunidades no apoio social a grupos vulneráveis no território: papel da ESF na pandemia / Civil society and community social support initiatives for vulnerable groups in primary care center catchment areas: the role of the FHS during the pandemic

Resumo A pandemia ressaltou novos e antigos riscos à saúde que demandam ações sanitárias e formas de apoio social. Este artigo analisou o conhecimento dos profissionais de saúde de UBSs sobre iniciativas da sociedade e dos serviços de saúde, articulados ou separadamente na promoção de saúde e apoio social a grupos vulneráveis. Partiu-se da revisão teórica sobre o conceito e sua aplicação e da análise de dados empíricos do estudo multidimensional "Desafios à APS no enfrentamento da COVID-19", de desenho transversal, com amostra representativa das UBSs brasileiras, em nível nacional e regional. Gerou-se escore a partir de variáveis selecionadas e agregadas e estimou-se proporções de ações selecionadas e IC (95%), no Brasil e suas regiões. Ações a partir das UBSs e da população mostraram-se heterogêneas entre as regiões, sendo significativamente mais frequentes na região NE e em municípios não urbanos e de menor IDH, associando-se às ações desenvolvidas no território pelos ACS. Identificaram-se desafios, lacunas e necessidade de novas investigações; amplificação da magnitude e escopo de ações intra/intersetoriais; fortalecimento de laços entre diferentes atores e reversão dos efeitos da pandemia que aprofundaram desigualdades e iniquidades em saúde.

Abstract The pandemic highlighted new and old health risks that require health actions and social support. This study analyzed the knowledge of health professionals working in primary health care centers (PHCCs) regarding civil society and health service separately or along with health promotion and social support initiatives targeting vulnerable groups. The article begins by discussing the concept of social support and then goes on to present an analysis of empirical data from the multidimensional cross-sectional study "Challenges facing primary health care in the response to COVID-19 in the SUS", conducted using a nationally representative sample of PHCCs. Scores were calculated for selected and aggregated variables, and we calculated percentages for selected actions together with 95% confidence intervals at national and regional level. The percentage of PHCCs that supported actions and where the local community developed initiatives in the catchment area varied across regions, with rates being significantly higher in the Northeast and in non-urban municipalities with low MHDI, which was associated with actions developed in the catchment area by community health workers. The findings reveal several gaps and challenges, including the need to amplify the magnitude and scope of intra and intersectoral actions, strengthen ties between different actors, reverse the effects of the pandemic on health inequities and promote further research.

Association between job stress and quality of life in nutritionists working in public hospitals in Rio de Janeiro, Brazil.

Occupational stress has been the object of research in different populations. The aim of this study is to analyze the association between psychosocial job stress and quality of life of nutritionists working in public hospitals in Rio de Janeiro, Brazil. Cross-sectional study in public hospitals with nutritionists working as civil servants and CLT. Psychosocial job stress was assessed through the Demand-Control-Support Questionnaire. Quality of life was assessed through the WHOQOL-Bref. The outcome was modeled by means of multiple linear regression and adjusted by covariates. Job demands were inversely associated with quality of life in the physical and environment domains. Job control was directly associated with quality of life in the psychological domain. High strain, in comparison to low strain, was inversely associated with quality of life in the physical and psychological domains. Social support was directly associated with all fields of quality of life domains. Psychosocial job stress, as expressed by psychological job demands and job control, affects self-assessed quality of life, especially in the physical domain.

Association between job stress and quality of life in nutritionists working in public hospitals in Rio de Janeiro, Brazil / Associação entre estresse no trabalho e qualidade de vida em nutricionistas que trabalham em hospitais públicos do Rio de Janeiro, Brasil

Abstract Occupational stress has been the object of research in different populations. The aim of this study is to analyze the association between psychosocial job stress and quality of life of nutritionists working in public hospitals in Rio de Janeiro, Brazil. Cross-sectional study in public hospitals with nutritionists working as civil servants and CLT. Psychosocial job stress was assessed through the Demand-Control-Support Questionnaire. Quality of life was assessed through the WHOQOL-Bref. The outcome was modeled by means of multiple linear regression and adjusted by covariates. Job demands were inversely associated with quality of life in the physical and environment domains. Job control was directly associated with quality of life in the psychological domain. High strain, in comparison to low strain, was inversely associated with quality of life in the physical and psychological domains. Social support was directly associated with all fields of quality of life domains. Psychosocial job stress, as expressed by psychological job demands and job control, affects self-assessed quality of life, especially in the physical domain.

Resumo O estresse ocupacional tem sido objeto de pesquisas em diferentes populações. O objetivo deste estudo é analisar a associação entre estresse psicossocial no trabalho e qualidade de vida de nutricionistas que trabalham em hospitais públicos do Rio de Janeiro, Brasil. Estudo seccional em hospitais da rede pública do município do Rio de Janeiro, Brasil. Participaram do estudo os nutricionistas com regime de trabalho estatutário ou celetista. O estresse psicossocial no trabalho foi avaliado por meio do questionário de demanda-controle-apoio social (DCSQ). A qualidade de vida foi avaliada por meio do WHOQOL-Bref. O desfecho foi modelado por meio de regressão linear múltipla e ajustado por covariáveis. A demanda de trabalho associou-se inversamente à qualidade de vida nos domínios físico e meio ambiente. O controle do trabalho esteve diretamente associado à qualidade de vida no domínio psicológico. O alto desgaste, em comparação ao baixo desgaste, esteve inversamente associado à qualidade de vida nos domínios físico e psicológico. O apoio social esteve diretamente associado a todos os domínios de qualidade de vida. O estresse psicossocial no trabalho, expresso pelas demandas psicológicas e pelo controle do trabalho, afeta a autoavaliação da qualidade de vida, principalmente no domínio físico.

Cross-cultural adaptation of discrimination and vigilance scales in ELSA-Brasil / Adaptação transcultural de escalas de discriminação e vigilância no ELSA-Brasil

ABSTRACT OBJECTIVE To describe the process of cross-cultural adaptation for the use in Brazil of the everyday discrimination scale (EDS) and the heightened vigilance scale (HVS) applied in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS Conceptual, item and semantic equivalence analyses were conducted by a group of four epidemiologists; evaluation of measurement equivalence (factorial analysis of configural, metric and scalar structures, according to sociodemographic characteristics) and reliability. A total of 11,987 participants responded to the discrimination scale, and a subsample of 260 people participated in the test-retest study. In the case of HVS, 8,916 people responded, while 149 individuals did so in the test-retest study. RESULTS The scales presented conceptual, item and semantic equivalence pertinent in the Brazilian context, in addition to adequate correspondence of referential/denotative meaning of terms and also of the general/connotative of the items. The confirmatory factor analysis of EDS revealed a unidimensional structure, with residual correlations between two pairs of items, presenting configural and metric invariance among the four subgroups evaluated. Scalar invariance was identified according to sex and age group, but it was not observed for race/color and education. Heightened vigilance showed low loads and high residuals, with inadequate adjustment indicators. For the items of the discrimination scale the weighted kappa coefficient (Kp) ranged from 0.44 to 0.78, and the intraclass correlation coefficient (ICC) was 0.87. For HVS items, the Kp ranged from 0.47 to 0.59 and the ICC was 0.83. CONCLUSIONS Although there are correlated items, it was concluded that the EDS is a promising scale to evaluate experiences of perceived discrimination in Brazilian daily life. However, the heightened vigilance scale did not present equivalence of measurement in the current format.

RESUMO OBJETIVO Descrever o processo de adaptação transcultural para o uso no Brasil das escalas de discriminação no dia a dia (EDD) e vigilância intensificada (EVI), aplicadas no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). MÉTODOS Foram realizadas análises das equivalências conceitual, de itens e semântica conduzidas por um grupo de quatro epidemiologistas; avaliação da equivalência de mensuração (análise fatorial das estruturas configural, métrica e escalares, segundo características sociodemográficas) e a confiabilidade. Responderam à escala de discriminação 11.987 participantes e uma subamostra de 260 pessoas participaram do estudo teste-reteste. No caso da EVI, 8.916 pessoas responderam e 149 indivíduos no estudo teste-reteste. RESULTADOS As escalas apresentaram equivalências conceitual, de itens e semântica pertinentes no contexto brasileiro, além de adequada correspondência de significado referencial/denotativa de termos e também da geral/conotativa dos itens. A análise fatorial confirmatória da EDD revelou estrutura unidimensional, com correlações residuais entre dois pares de itens, apresentando invariância configural e métrica entre os quatro subgrupos avaliados. Identificou-se invariância escalar segundo sexo e faixa etária, mas não foi observada para recortes de raça/cor e escolaridade. A vigilância intensificada apresentou cargas baixas e resíduos altos, com indicadores de ajuste inadequados. Para os itens da escala de discriminação o coeficiente de concordância kappa ponderado (Kp) variou de 0,44 a 0,78, e o coeficiente de correlação intraclasse (CCI) foi 0,87. Para os itens da EVI, o Kp variou de 0,47 a 0,59 e o CCI foi 0,83. CONCLUSÕES Embora haja itens correlacionados, concluiu-se que a EDD é uma escala promissora para avaliar experiências de discriminação percebidas no cotidiano brasileiro. Entretanto, a EVI não apresentou equivalência de mensuração no formato atual.

Infection and mortality of nursing personnel in Brazil from COVID-19: A cross-sectional study.

BACKGROUND: Health care personnel (HCP) worldwide are at-risk for contracting the novel Coronavirus disease (COVID-19). Among health care personnel, nurses are at a particularly high risk due to the physical proximity and duration of time spent providing direct care. Documenting accurate rates of COVID-19 infection and deaths among nurses worldwide has been problematic, and many countries such as the USA have no systematic mechanism for collecting this information. Brazil is unique in that it prioritized the implementation of a dedicated database, the Nursing Observatory to collect accurate and timely data regarding COVID-19 and Brazilian nursing personnel. OBJECTIVES: The aim of this study was to analyze COVID-19 infections and deaths among nurses registered in the centralized and dedicated Brazilian database called the Nursing Observatory. DESIGN: A cross-sectional study using secondary data from the Brazilian Nursing Observatory was conducted. PARTICIPANTS: Data are reported for two occupational categories: professional Nurse and technical nurse by country regions. All cases or deaths of professional Nurse and technical nurse registered between the 12th and 31st epidemiological weeks of 2020 were included. METHODS: From a unique numerical identification, the appropriate records of nursing personnel affected by COVID-19 were entered by the Technical Responsible Nurse for each service, according to the condition regarding COVID-19. All suspected, confirmed or unconfirmed infections were considered "cases", and all confirmed or unconfirmed deceased as "deaths". Cases and deaths were analyzed according to the variables: 1. region of the country where the case occurred, 2. nursing category and 3. epidemiological week. Universal protocols for collecting and cleaning data were used throughout the country. Infection and mortality rates (per 100,000) were obtained from the relationship between deaths registered and the population of nursing personnel by category and region. RESULTS: Nursing personnel in the Northern, Northeast and Southeast Regions of Brazil had the highest number of COVID-19 infections and deaths overall with an ascending curve occurring mainly after Epidemiological Week 19. COVID-19 infections and deaths spread later to the Midwest and Southern regions also showing an ascending curve, although the total numbers were less. CONCLUSIONS: All occupational categories of nursing personnel showed higher than expected rates of infection and death. Inequalities and a lack of adequate healthcare resources, hospital beds and Personal Protective Equipment varied by region in Brazil. The politicization of COVID-19 and the lack of a coherent national pandemic plan is a factor to be taken into account. Tweetable abstract: This cross-sectional study shows the evolution of cases and deaths of Brazilian nursing personnel over the first months of the COVID-19 pandemic.

A formação discursiva da Medicina de Família e Comunidade no Brasil / Discursive formation of Family and Community Medicine

Resumo Realizamos uma análise crítica sobre a formação discursiva da Medicina de Família e Comunidade (MFC). A MFC é pensada como uma prática atravessada por relações políticas e sociais e que se produz historicamente enquanto uma formação discursiva, através de um jogo complexo e aberto entre os diversos atores, que compreendem, formulam e disputam o formato e o sentido dessa prática. Investigamos essa formação com base em revisão bibliográfica e análise do discurso de documentos que descrevem a emergência da MFC e de entrevistas com personagens ligados diretamente a ela. Pudemos identificar que a formação discursiva da MFC é atravessada pelas histórias da prática médica generalista, familiar e comunitária; da estruturação da Atenção Primária em Saúde; dos programas de Medicina Comunitária; e da formação da Saúde Coletiva no Brasil. Além disso, encontra-se atrelada ao campo científico da medicina generalista e familiar internacional e a sua afirmação como especialidade médica. Enquanto sociedade científica, vem apresentando dubiedades no que se refere às pautas históricas do movimento sanitário e na defesa de um sistema de saúde público, universal e antiprivatista. No entanto, para evitar cristalizações institucionais, entendemos ser necessário pensar a MFC como um campo heterogêneo e sem uma história única.

Abstract We performed a critical analysis on the discursive formation of Family and Community Medicine (FCM). FCM is thought of as a practice crossed by political and social relations that takes place historically as a discursive formation, through a complex and open game between the various actors, who understand, formulate and dispute the format and meaning of this practice. We investigated this training based on bibliographic review and discourse analysis of documents that describe the emergence of FCM and interviews with individuals directly linked to it. We were able to identify that the discursive formation of the FCM is traversed by the histories of general medical practice, family and community; the structuring of Primary Health Care; of Community Medicine programs; and the formation of Collective Health in Brazil. In addition, it is linked to the scientific field of general medicine and international family and its affirmation as a medical specialty. As a scientific society, it has been presenting doubts regarding the historical guidelines of the health movement and the defense of a public, universal and anti-privatization health system. However, in order to avoid institutional crystallization, we believe it is necessary to think of FCM as a heterogeneous field and without a single history.

Using Gamma and Quantile Regressions to Explore the Association between Job Strain and Adiposity in the ELSA-Brasil Study: Does Gender Matter?

This paper explores the association between job strain and adiposity, using two statistical analysis approaches and considering the role of gender. The research evaluated 11,960 active baseline participants (2008-2010) in the ELSA-Brasil study. Job strain was evaluated through a demand-control questionnaire, while body mass index (BMI) and waist circumference (WC) were evaluated in continuous form. The associations were estimated using gamma regression models with an identity link function. Quantile regression models were also estimated from the final set of co-variables established by gamma regression. The relationship that was found varied by analytical approach and gender. Among the women, no association was observed between job strain and adiposity in the fitted gamma models. In the quantile models, a pattern of increasing effects of high strain was observed at higher BMI and WC distribution quantiles. Among the men, high strain was associated with adiposity in the gamma regression models. However, when quantile regression was used, that association was found not to be homogeneous across outcome distributions. In addition, in the quantile models an association was observed between active jobs and BMI. Our results point to an association between job strain and adiposity, which follows a heterogeneous pattern. Modelling strategies can produce different results and should, accordingly, be used to complement one another.

Oferta de vagas de graduação e residência médicas no estado do Rio de Janeiro a partir do Programa Mais Médicos (2013-2015) / Offering medical degree and residency positions in the state of Rio de Janeiro from Program More Doctors (2013-2015)

O Programa Mais Médicos (PMM) se apresenta como uma das principais políticas federais para o fortalecimento da Atenção Primária à Saúde (APS). Entretanto, a dimensão da formação profissional foi pouco avaliada pela literatura. Este artigo teve como objetivo descrever os resultados iniciais do PMM no Estado do Rio de Janeiro em relação ao eixo da formação médica, desde a implantação do PMM. Foi realizada uma análise descritiva a partir de dados coletados do Portal Mais Médicos; do E-MEC e do IBGE. Observamos a tendência crescente de privatização da graduação médica identificada também em outros estudos nacionais. O processo de interiorização das vagas de graduação no Estado é evidente, mas não está clara sua contribuição para a fixação dos médicos nos municípios. A expansão dos programas de residência médica no interior, em especial de MFC, pode diminuir a concentração de médicos na capital do Estado e facilitar a fixação no interior.

The More Doctors Program (PMM) is one of the main federal policies in order to improve Primary Health Care (PHC). However, its professional education aspect was few evaluated by medical literature. This article aims to describe the initial results of PMM in Rio de Janeiro State, related to the medical education during the first two years of the program implementation. A descriptive analysis using secondary data collected from PMM website, Education Ministry and IBGE was realized. As results, we have observed a progressive tendency of privatization on the medical colleges, also identified by other national studies. The increase of graduation vacancies outside the capital was evident, but it may not contribute to the physicians setting on those cities; neither guarantee their future insertion into PHC programs. The expansion of residence programs outside the capital, specially Family Practice programs, may reduce the physicians concentration in the capital

Transcultural adaptation to Brazilian Portuguese and reliability of the effort-reward imbalance in household and family work.

OBJECTIVE: To describe the steps in the transcultural adaptation of the scale in the Effort-reward imbalance model to household and family work to the Brazilian context. METHODS: We performed the translation, back-translation, and initial psychometric evaluation of the questionnaire that comprised three dimensions: (i) effort (eight items, emphasizing quantitative workload), (ii) reward (11 items that seek to capture the intrinsic value of family and household work, societal esteem, recognition from the spouse/partner, and affection from the children), and (iii) overcommitment (four items related to intrinsic effort). The scale was included in a sectional study conducted with 1,045 nursing workers. A subsample of 222 subjects answered the questionnaire for a second time, seven to 15 days thereafter. The data were collected between October 2012 and May 2013. The internal consistency of the scale was evaluated using Cronbach's alpha and test-retest reliability analysis, square weighted kappa, prevalence and bias adjusted Kappa, and intraclass correlation coefficient. RESULTS: Prevalence and bias-adjusted Kappa (ka) of the scale dimensions ranged from 0.80-0.83 for overcommitment, 0.78-0.90 for effort, and 0.76-0.93 for reward. In most dimensions, the values of minimum and maximum scores, average, standard deviation, and Cronbach's alpha were similar in test and retest scores. Only on societal esteem subdimension (reward) was there little variation in standard deviation (test score of 2.24 and retest score of 3.36) and in Cronbach's alpha coefficient (test score of 0.38 and retest score of 0.59). CONCLUSIONS: The Brazilian version of the scale was found to have proper reliability indices regarding time stability, which suggests adapting it to be used in population with characteristics that are similar to the one in this study. OBJETIVO: Descrever as etapas da adaptação transcultural da escala do Effort-reward imbalance model to household and family work para o contexto brasileiro. MÉTODOS: Efetuou-se a tradução, retrotradução e avaliação psicométrica inicial do instrumento composto por três dimensões: (i) esforço (oito itens, enfatizando a carga quantitativa de trabalho), (ii) recompensa (11 itens que buscam captar o valor intrínseco da família e do trabalho doméstico, a estima social, o reconhecimento do cônjuge ou companheiro e a afeição dos filhos) e (iii) o excesso de comprometimento (quatro itens relacionados ao esforço intrínseco). A escala foi incluída em um estudo seccional aplicado em 1.045 trabalhadoras de enfermagem. Uma subamostra de 222 participantes respondeu ao questionário pela segunda vez, com intervalo de sete a 15 dias. Os dados foram coletados entre outubro de 2012 e maio de 2013. A consistência interna da escala foi avaliada pelo coeficiente de alpha de Cronbach e a confiabilidade teste-reteste, pelo índice kappa ponderado quadrático, pelo kappa ajustado pela prevalência e pelo coeficiente de correlação intraclasse. RESULTADOS: A confiabilidade ajustada pela prevalência (ka) das dimensões da escala variou de 0,80-0,83 para o excesso de comprometimento, 0,78-0,90 para o esforço e 0,76-0,93 para a recompensa. Na maioria das dimensões, os valores do escore mínimo e máximo, média, desvio-padrão e alpha de Cronbach no teste e no reteste foram semelhantes. Somente na subdimensão estima social (recompensa) houve pequena variação no desvio padrão (2,24 no teste e 3,36 no reteste) e no coeficiente de alpha de Cronbach (0,38 no teste e 0,59 no reteste). CONCLUSÕES: A versão brasileira da escala apresentou índices adequados de fidedignidade quanto à estabilidade temporal, o que sugere a adequação da escala para uso em populações com características semelhantes à do estudo.

Transcultural adaptation to Brazilian Portuguese and reliability of the effort-reward imbalance in household and family work / Adaptação transcultural para o Português brasileiro e confiabilidade da escala esforço-recompensa no trabalho doméstico

ABSTRACT OBJECTIVE To describe the steps in the transcultural adaptation of the scale in the Effort-reward imbalance model to household and family work to the Brazilian context. METHODS We performed the translation, back-translation, and initial psychometric evaluation of the questionnaire that comprised three dimensions: (i) effort (eight items, emphasizing quantitative workload), (ii) reward (11 items that seek to capture the intrinsic value of family and household work, societal esteem, recognition from the spouse/partner, and affection from the children), and (iii) overcommitment (four items related to intrinsic effort). The scale was included in a sectional study conducted with 1,045 nursing workers. A subsample of 222 subjects answered the questionnaire for a second time, seven to 15 days thereafter. The data were collected between October 2012 and May 2013. The internal consistency of the scale was evaluated using Cronbach's alpha and test-retest reliability analysis, square weighted kappa, prevalence and bias adjusted Kappa, and intraclass correlation coefficient. RESULTS Prevalence and bias-adjusted Kappa (ka) of the scale dimensions ranged from 0.80-0.83 for overcommitment, 0.78-0.90 for effort, and 0.76-0.93 for reward. In most dimensions, the values of minimum and maximum scores, average, standard deviation, and Cronbach's alpha were similar in test and retest scores. Only on societal esteem subdimension (reward) was there little variation in standard deviation (test score of 2.24 and retest score of 3.36) and in Cronbach's alpha coefficient (test score of 0.38 and retest score of 0.59). CONCLUSIONS The Brazilian version of the scale was found to have proper reliability indices regarding time stability, which suggests adapting it to be used in population with characteristics that are similar to the one in this study.

RESUMO OBJETIVO Descrever as etapas da adaptação transcultural da escala do Effort-reward imbalance model to household and family work para o contexto brasileiro. MÉTODOS Efetuou-se a tradução, retrotradução e avaliação psicométrica inicial do instrumento composto por três dimensões: (i) esforço (oito itens, enfatizando a carga quantitativa de trabalho), (ii) recompensa (11 itens que buscam captar o valor intrínseco da família e do trabalho doméstico, a estima social, o reconhecimento do cônjuge ou companheiro e a afeição dos filhos) e (iii) o excesso de comprometimento (quatro itens relacionados ao esforço intrínseco). A escala foi incluída em um estudo seccional aplicado em 1.045 trabalhadoras de enfermagem. Uma subamostra de 222 participantes respondeu ao questionário pela segunda vez, com intervalo de sete a 15 dias. Os dados foram coletados entre outubro de 2012 e maio de 2013. A consistência interna da escala foi avaliada pelo coeficiente de alpha de Cronbach e a confiabilidade teste-reteste, pelo índice kappa ponderado quadrático, pelo kappa ajustado pela prevalência e pelo coeficiente de correlação intraclasse. RESULTADOS A confiabilidade ajustada pela prevalência (ka) das dimensões da escala variou de 0,80-0,83 para o excesso de comprometimento, 0,78-0,90 para o esforço e 0,76-0,93 para a recompensa. Na maioria das dimensões, os valores do escore mínimo e máximo, média, desvio-padrão e alpha de Cronbach no teste e no reteste foram semelhantes. Somente na subdimensão estima social (recompensa) houve pequena variação no desvio padrão (2,24 no teste e 3,36 no reteste) e no coeficiente de alpha de Cronbach (0,38 no teste e 0,59 no reteste). CONCLUSÕES A versão brasileira da escala apresentou índices adequados de fidedignidade quanto à estabilidade temporal, o que sugere a adequação da escala para uso em populações com características semelhantes à do estudo.

Job strain and unhealthy lifestyle: results from the baseline cohort study, Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Unhealthy lifestyle choices, such as smoking and sedentary behavior, are among the main modifiable risk factors for chronic non-communicable diseases. The workplace is regarded as an important site of potential health risks where preventive strategies can be effective. We investigated independent associations among psychosocial job strain, leisure-time physical inactivity, and smoking in public servants in the largest Brazilian adult cohort. METHODS: We conducted a cross-sectional analysis of baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)-a multicenter prospective cohort study of civil servants. Our analytical samples comprised 11,779 and 11,963 current workers for, respectively, analyses of job strain and leisure-time physical activity and analyses of job strain and smoking. Job strain was assessed using the Brazilian version of the Swedish Demand-Control-Support Questionnaire; physical activity was evaluated using a short form of the International Physical Activity Questionnaire. We also examined smoking status and number of cigarettes smoked per day. The association reported in this paper was assessed by means of multinomial and logistic regression, stratified by sex. RESULTS: Among men, compared with low-strain activities (low demand and high control), job strain showed an association with physical inactivity (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.09-1.64) or with the practice of physical activities of less than recommended duration (OR = 1.44; 95% CI = 1.15-1.82). Among women, greater likelihood of physical inactivity was identified among job-strain and passive-job groups (OR = 1.47; 95% CI = 1.22-1.77 and OR = 1.42; 95% CI = 1.20-1.67, respectively). Greater control at work was a protective factor for physical inactivity among both men and women. Social support at work was a protective factor for physical inactivity among women, as was smoking for both genders. We observed no association between demand or control dimensions and smoking. CONCLUSIONS: Job strain, job control, and social support were associated with physical activity. Social support at work was protective of smoking. Our results are comparable to those found in more developed countries; they provide additional evidence of an association between an adverse psychosocial work environment and health-related behaviors.

The demand-control model for job strain: a commentary on different ways to operationalize the exposure variable.

Demand-control has been the most widely used model to study job strain in various countries. However, researchers have used the model differently, thus hindering the comparison of results. Such heterogeneity appears in both the study instrument used and in the definition of the main exposure variable - high strain. This cross-sectional study aimed to assess differences between various ways of operationalizing job strain through association with prevalent hypertension in a cohort of workers (Pro-Health Study). No difference in the association between high job strain and hypertension was found according to the different ways of operationalizing exposure, even though prevalence varied widely, according to the adopted form, from 19.6% for quadrants to 42% for subtraction tertile. The authors recommend further studies to define the cutoff for exposure variables using combined subjective and objective data.

Fatores condicionantes para o acesso às equipes da Estratégia Saúde da Família no Brasil / Factors affecting access to the Family Health Stategy teams in Brazil

O artigo analisa o acesso às equipes certificadas pelo Programa Nacional de Melhoria de Acesso e da Qualidade da Atenção Básica, tendo por categoria central o acesso potencial e duas dimensões: acolhimento e disponibilidade. A partir de questões selecionadas dos instrumentos da Avaliação Externa do Programa, geraram-se escores e três estratos. Os resultados confirmam que os fatores favoráveis ao acesso potencial foram: localização na região Sudeste, em capitais e municípios de maior porte e com maior número de equipes por unidade. Apesar dos progressos, os resultados indicam a necessidade de políticas e ações voltadas à qualificação da atenção prestada, especialmente nos municípios de pequeno porte.

The article aims to analyze access to teams certified by National Program for Access and Quality Improvement in Primary Care. The category studied was the potential access with two dimensions: embracement and availability. Data obtained from selected issues of instruments of External Evaluation of the program were sources of information and generate scores and three strata. The results show that favorable factors to the potential access were located in the Southeast, in capitals, bigger towns, and larger number of teams by health unit. Despite progresses, the results address to the need for policies and actions to qualify the care provided, especially in small towns.

[Social capital in ELSA-Brasil: test-retest reliability of the Resource Generator scale]. / Capital social no ELSA-Brasil: confiabilidade teste-reteste do Resource Generator scale.

OBJECTIVE: To estimate the test-retest reliability of items of the Resource Generator scale for assessing social capital in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). METHODS: The social capital was applied in a subsample of 281 participants from six ELSA investigation centers, on two occasions with an interval of seven to 14 days. The instrument consists of 31 items that represent concrete situations to evaluate the access to different types of resources. In addition, it evaluates the strength of ties (family, friends or acquaintances) for the available resources. Statistical analyses were performed through use of the kappa statistic (k) and prevalence-adjusted kappa (ka). RESULTS: A high frequency was found for social resources (above 50%). Regarding the presence or absence of resources, prevalence-adjusted reliability (ka) varied from 0.54 to 0.97. With regard to the source for the resource, the reliability estimates ranged from ka = 0.45 ("someone who has good contacts with the media") to ka = 0.86 ("someone who completed secondary education"). CONCLUSIONS: The scale presented adequate levels of reliability, which varied according to the type of resource.

[Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument]. / Questionário do ELSA-Brasil: desafi os na elaboração de instrumento multidimensional.

This article describes the development of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) questionnaire. We first address the selection of topics whose contents have to cover the knowledge available on the complex causal network of outcomes and allow comparability with similar studies. Then we deal with the "translation and adaptation of measurement instruments" including neighborhood environment rating scales, depression and anxiety disorder rating scale and a food frequency questionnaire and discuss criteria that guided "theme block sequencing". And finally we focus on the practical importance of "pretesting and pilot studies". The ELSA may provide an original contribution regarding factors that cause or aggravate the outcomes of interest in the Brazilian population, as well as protective factors.

[Cross-cultural adaptation and reliability of measurements on self-reported neighborhood characteristics in ELSA-Brasil]. / Adaptação transcultural e confi abilidade de medidas de características autorreferidas de vizinhança no ELSA-Brasil.

OBJECTIVE: To describe the process involved in adapting scales for measuring neighborhood characteristics to Brazilian Portuguese. METHODS: The dimensions addressed were social cohesion, environment suitable for physical activity, availability of healthy foods, safety, perceived violence and victimization. The adaptation process involved assessment of equivalence between the original scales and the Portuguese versions. The test-retest reliability was assessed in a subsample of 261 participants from the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil), who answered the same questionnaire on two different occasions, separated by an interval of 7 to 14 days. RESULTS: The aspects of equivalence assessed were shown to be adequate. The intraclass correlation coefficient ranged from 0.83 (95%CI 0.78;0.87) for Social Cohesion to 0.90 (95%CI 0.87;0.92) for Walking Environment. The scales showed internal consistency (Cronbach's alpha) ranging from 0.60 to 0.84. CONCLUSIONS: The measurements on self-reported neighborhood characteristics had very good reproducibility and good internal consistency (Cronbach's alpha). The results suggest that these scales can be used in studies involving Brazilian populations with characteristics similar to those of ELSA-Brasil.

O trabalho de campo como dispositivo de ensino, pesquisa e extensão na graduação de Medicina e Odontologia / Fieldwork as a teaching, research and extension device in undergraduate Medicine and Dentistry / El trabajo de campo como un dispositivo de enseñanza, investigación y extensión en los cursos de Medicina y Odontología

Descreve-se a proposta pedagógica de disciplinas nos cursos de Medicina e Odontologia da Universidade Federal Fluminense (UFF), Rio de Janeiro, Brasil, tendo o trabalho de campo: como dispositivo de articulação entre ensino, pesquisa e extensão; e, como pressuposto geral, o processo de ensino-aprendizagem baseado em: metodologias ativas, a relação dinâmica entre teoria e prática, e a proposição, ao estudante, de interação com o mundo do trabalho e reflexão sobre a realidade vivenciada. Espera-se contribuir para o debate na área de formação em saúde, em especial no campo da Saúde Coletiva, com base na reformulação determinada pelas Diretrizes Curriculares Nacionais aprovadas em 2001/2002. E, também, para a superação das formas tradicionais de atuar por outras que possibilitem conhecimento entre os pares e capacitação para o enfrentamento de alterações previsíveis ou imprevisíveis no cotidiano das escolas de formação em saúde.

This study describes the pedagogical proposals of disciplines within the medicine and dentistry courses at Universidade Federal Fluminense (UFF) Fieldwork has been backed as a means for linking teaching, research and extension, under the general assumption of a learning-teaching process based on active methodologies, a dynamic relationship between theory and practice, and proposals enabling students to interact with the world of work and reflect on the realities experienced. We hope to contribute towards the debate on healthcare training, especially with regard to the field of public health, consequent to the curriculum reformulation determined by the National Curriculum Guidelines (approved in 2001/2002). We also hope to contribute towards transforming traditional methods into other ways of acting that enable knowledge among peers and capacitation to cope with foreseeable or unforeseeable changes to the routine of healthcare training schools.

El artículo describe la propuesta pedagógica de asignaturas en los cursos de Medicina y Odontología en la Universidad Federal Fluminense, Río de Janeiro, Brasil, considerando el Trabajo de campocomo dispositivo de articulación entre enseñanza, investigación y extensión y como base general del proceso de enseñanza-aprendizaje basado en metodologías activas, la relación dinámica entre teoría y práctica y la propuesta al estudiante de la interacción con el mundo del trabajo y la reflexión sobre la realidad vivida. Se espera contribuir con el debate en el área de Formación en Salud, en especial en el campo de Salud Colectiva, a partir de la reformulación determinada por las Directrices Curriculares Nacionales aprobadas en 2001/2002. También se espera contribuir para superar las formas tradicionales de actuación, proporcionando otras que posibiliten el conocimiento entre los pares y la capacitación para el enfrentamiento de situaciones previsibles e imprevisibles en el cotidiano de las escuelas de formación en salud.

Questionario do ELSA-Brasil: desafios na elaboracao de instrumento multidimensional / Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument

O artigo apresenta o processo de elaboração do questionário utilizado no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Iniciamos pelo relato sobre a "Seleção de Temas" abordados no questionário, cujo conteúdo teria que abranger o conhecimento disponível acerca da complexa rede de causalidade dos desfechos de interesse, assim como possibilitar a comparabilidade com estudos semelhantes. Contextualizamos a "tradução e a adaptação de instrumentos de medida", necessárias no caso de escalas de avaliação de vizinhanças, do instrumento para diagnóstico de transtornos depressivos e de ansiedade, e do questionário de frequência alimentar. A seguir, comentamos os critérios que nortearam a "ordem dos blocos temáticos" e finalmente a importância prática dos "pré-testes e estudos-piloto". As relações entre o conjunto de informações reunidas no ELSA poderão constituir contribuição original sobre os fatores que causam ou agravam os desfechos de interesse no contexto brasileiro, assim como sobre seus fatores de proteção.

This article describes the development of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) questionnaire. We first address the selection of topics whose contents have to cover the knowledge available on the complex causal network of outcomes and allow comparability with similar studies. Then we deal with the "translation and adaptation of measurement instruments" including neighborhood environment rating scales, depression and anxiety disorder rating scale and a food frequency questionnaire and discuss criteria that guided "theme block sequencing". And finally we focus on the practical importance of "pretesting and pilot studies". The ELSA may provide an original contribution regarding factors that cause or aggravate the outcomes of interest in the Brazilian population, as well as protective factors.

Adaptacao transcultural e confiabilidade de medidas de caracteristicas autorreferidas de vizinhanca no ELSA-Brasil / Cross-cultural adaptation and reliability of measurements on self-reported neighborhood characteristics in ELSA-Brasil

OBJETIVO: Descrever o processo de adaptação de escalas de medida de características de vizinhança para o português brasileiro. MÉTODOS: As dimensões abordadas foram coesão social, ambiente propício para atividade física, disponibilidade de alimentos saudáveis, segurança em relação a crimes, violência percebida e vitimização. No processo de adaptação foram avaliados aspectos de equivalência entre as escalas originais e respectivas versões para o português. A confiabilidade teste-reteste foi avaliada em submostra de 261 participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) que responderam ao mesmo questionário em dois momentos distintos em um intervalo de tempo de sete a 14 dias entre as duas aplicações. RESULTADOS: Os aspectos de equivalência avaliados mostraram-se adequados. O coeficiente de correlação intraclasse variou entre 0,83 (IC95% 0,78;0,87) para Coesão Social e 0,90 (IC95% 0,87;0,92) para Ambiente para Atividade Física. As escalas apresentaram consistência interna (alfa de Cronbach) que variaram entre 0,60 e 0,84. CONCLUSÕES: As medidas autorreferidas de características de vizinhança tiveram reprodutibilidade muito boa e boa consistência interna. Os resultados sugerem que essas escalas podem ser utilizadas em estudos com população brasileira que apresente características similares àquelas do ELSA-Brasil. .

OBJECTIVE: To describe the process involved in adapting scales for measuring neighborhood characteristics to Brazilian Portuguese. METHODS: The dimensions addressed were social cohesion, environment suitable for physical activity, availability of healthy foods, safety, perceived violence and victimization. The adaptation process involved assessment of equivalence between the original scales and the Portuguese versions. The test-retest reliability was assessed in a subsample of 261 participants from the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil), who answered the same questionnaire on two different occasions, separated by an interval of 7 to 14 days. RESULTS: The aspects of equivalence assessed were shown to be adequate. The intraclass correlation coefficient ranged from 0.83 (95%CI 0.78;0.87) for Social Cohesion to 0.90 (95%CI 0.87;0.92) for Walking Environment. The scales showed internal consistency (Cronbach's alpha) ranging from 0.60 to 0.84. CONCLUSIONS: The measurements on self-reported neighborhood characteristics had very good reproducibility and good internal consistency (Cronbach's alpha). The results suggest that these scales can be used in studies involving Brazilian populations with characteristics similar to those of ELSA-Brasil. .