DSpace Collection:http://hdl.handle.net/1843/3912024-03-19T07:44:09Z2024-03-19T07:44:09ZExperiências adversas na infância e capacidade física no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)http://hdl.handle.net/1843/653652024-03-06T10:46:09Z2023-06-14T00:00:00ZTitle: Experiências adversas na infância e capacidade física no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)
Abstract: The aim of this study was to investigate associations of an exposure score and also of specific aspects of adverse childhood experiences (ACEs) with physical capability in adulthood, in a Brazilian context. Data from the third visit of the Longitudinal Study of Adult Health (ELSA-Brasil), carried out between 2017 and 2019, were used. A total of 10,896 Brazilian civil servants, active and retired, aged between 41 and 84 years, and who had available data on physical capability and exposure to ACEs, were included. Physical capability was measured using the Short Physical Performance Battery (SPPB), whose final score ranges from 0 to 12. This score was transformed into a nominal variable with two categories: low physical capability (≤7 points) and high physical capability (≥8 points). The investigation of exposure to ACEs was carried out using five questions from the International Questionnaire of Adverse Childhood Experiences and two questions developed by ELSA-Brasil researchers which, together, assessed exposure to family dysfunction (separation or divorce of parents; death of parents or guardians; having lived with a family member who abused alcohol and/or drugs and/or medication, who had depression or another mental illness, and who had been arrested or condemned) and to child labor in the first fourteen years of life. Exposures were analyzed using a four-level score, relative to the number of reported exposures: no exposure (score=0), exposure to one type of ACE (score=1), exposure to two types (score=2) and exposure to three or more types (score≥3); and separately. Descriptive analyzes and binary logistic regressions were performed, adjusted for possible confounding factors: age, sex, race/skin color, maternal and paternal education. The mean age of participants was 59.2 years (SD=8.71) and 55.1% were female. Exposure to at least one type of ACE was reported by 42.2% of the population and low physical capability was observed in 28% of participants. Individuals exposed to one type of ACE (OR=1.18; 95%CI=1.07;1.32), two types (OR=1.19; 95%CI=1.02;1.39) and three or more types (OR=1.36; 95%CI=1.05;1.75) had more chances of low physical capability when compared to unexposed individuals. Specifically, having lived with family members who had been arrested or condemned (OR=1.43; 95%CI=1.02;1.99), death of parents or guardians (OR=1.22; 95%CI=1.05;1.41) and separation or divorce of parents (OR=1.17; 95%CI=1.01;1.36) were associated with low physical capability regardless of confounding factors. The evidence from this investigation points to a possible negative effect of ACEs on the physical capability of adulthood, highlighting the need for actions to prevent these exposures and their damage.
Type: Dissertação2023-06-14T00:00:00ZAssociação da calcificação nas artérias coronárias e aorta com a performance cognitiva no ELSA-Brasil: um estudo longitudinalhttp://hdl.handle.net/1843/649492024-02-29T14:01:44Z2023-08-10T00:00:00ZTitle: Associação da calcificação nas artérias coronárias e aorta com a performance cognitiva no ELSA-Brasil: um estudo longitudinal
Abstract: INTRODUCTION: Arterial calcification assessed by computed tomography provides reliable estimates of subclinical atherosclerosis. The presence of calcification and the severity of calcification in coronary arteries and other vascular beds, but more robustly in the coronary arteries, has been widely associated with cardiovascular and even non-cardiovascular clinical outcomes. Atherosclerosis is thought to be associated with cognitive decline and with an increased risk of dementia. However, evidence of an association between arterial calcification and worse cognitive performance comes, for the most part, from cross-sectional studies and, even so, with some conflicting results.
OBJECTIVES: To investigate whether the presence and severity of calcification in the coronary artery (CAC), total thoracic aorta (TAC) and its segments [ascending thoracic aorta (ATAC), aortic arch (AAC) and descending thoracic aorta (DTAC)] are longitudinally associated with changes in cognitive performance at 4 years of follow-up in Brazilian adults from the ELSA-Brasil cohort.
METHODS: A longitudinal analysis was performed with approximately 4 years of follow-up between arterial calcification and cognitive performance of 1,331 individuals (mean age 62.4 years) from the ELSA-Brasil cohort in the state of Minas Gerais who participated in waves 2 (2012-2014) and 3 (2017-2019). The explanatory variables (CAC, TAC, ATAC, DTAC) were obtained by computed tomography during visit 2 and analyzed dichotomously (present or absent) and in levels (0, 1-399UA and ≥ 400UA); the response variable (cognitive performance) was evaluated in tests (B trails test, verbal fluency and memory test) applied in visits 2 and 3. Sociodemographic parameters (gender, education, race/color), behavioral (smoking and leisure-time physical activity) and clinical parameters (hypertension, diabetes and body mass index)] were ascertained through face-to-face interviews in visit 2. For the statistical analysis, linear regression models with mixed effects were used.
RESULTS: We observed that, regardless of cardiovascular risk factors, the presence of calcification in the descending thoracic aorta, but not in other vessel beds, was associated with worse performance in verbal fluency tests, in the Trail B test and in Factor G at baseline. When arterial calcification was analyzed by levels, there were associations between CAC≥ 400UA and worse performance in the Factor G and associations between TAC≥ 400UA and AAC≥ 400UA and worse performance in the Trail B test. Besides that, we found a graded association between greater calcifications in levels of DTAC and worse performance in the verbal fluency tests and test of trails B and factor G. Although there was a positive association between DTAC≥ 400UA and performance in the memory test in the baseline, DTAC≥ 400UA was also associated with worse longitudinal performance in this cognitive domain at follow-up, as well as worse global cognitive performance at the end of the study period.
CONCLUSION: The results suggest that calcification in different vascular beds is distinctly associated with worse cognitive performance in different cognitive domains, regardless of cardiovascular risk factors. In addition, higher levels of calcification in the descending thoracic aorta artery predicted greater speed in cognitive decline over time.
Type: Dissertação2023-08-10T00:00:00ZEstresse no trabalho e dor lombar crônica - uma análise longitudinal da coorte Elsa-Brasil Musculoesquelético (ELSA- Brasil MSK)http://hdl.handle.net/1843/621032023-12-20T13:20:44Z2022-12-20T00:00:00ZTitle: Estresse no trabalho e dor lombar crônica - uma análise longitudinal da coorte Elsa-Brasil Musculoesquelético (ELSA- Brasil MSK)
Abstract: INTRODUCTION: Low back pain is the main cause of years lived with disability worldwide and is the most disabling musculoskeletal pain site. It is estimated that approximately 70% of the years lived with disability associated with low back pain occur in people of working age (20-65 years) and it is possible that exposure to work stress may at least partially explain the greater burden of chronic low back pain. (CLBP) in this population group. However, this hypothesis was not verified by a longitudinal study. OBJECTIVES: To investigate the association between stress at work, according to the effort-reward imbalance model (ERI), and the cumulative incidence of CLBP in 4 years of follow-up, considering the number of episodes of pain in the period and the intensity and/or disability of the pain. METHODS: This is a longitudinal study with a three-year follow-up of the cohort of the Longitudinal Study of Adult Health - Musculoskeletal (ELSA-Brasil MSK). Baseline data (2012-2014) and the first three annual telephone interviews were used. A total of 1733 participants without CLBP (lasting >6 months) in the year prior to inclusion in the cohort were included, with information for the ERI scale at baseline of the ELSA-Brasil MSK and for CLBP in the three annual telephone follow-ups. In the follow-ups, CLBP was defined by the presence of low back pain with moderate/severe/very severe intensity and duration >3 months in the last month. The present study had three response variables: 1) Accumulated incidence of CLD (yes/no); 2) Number of CLBP episodes (0, 1, ≥2 episodes); 3) Accumulated incidence of CLD according to intensity/disability (absent/very mild/mild; moderate; severe/very severe and/or disabling). Stress at work was assessed using the long version of the ERI questionnaire. Thus, the explanatory variables of interest were: the effort-reward imbalance, assessed by the effort/reward ratio, and each dimension of the ERI scale (effort, reward and overcommitment) separately. All dimensions were categorized into tertiles of their distributions. We used the causal diagram (Direct Acyclic Graph - DAG) as an auxiliary instrument in defining the variables to be considered in the adjustments of the models that considered prior knowledge about common risk factors for stress at work and low back pain available in the literature. Thus, sociodemographic variables [age (in years); sex; race/color (white/yellow, brown, black/indigenous) and schooling (complete higher education; complete high school; elementary school - complete/incomplete) and occupation characteristics [nature of occupation (non-routine non-manual, non-routine manual and manual) and work shift (only day, night or mixed)]. The estimation for the associations between each of the variables of stress at work and the cumulative incidence of CLBP were made using Poisson regression models. The
associations of stress at work variables with the number of CLBP episodes and with the cumulative incidence of CLBP according to intensity/disability were investigated using multinomial logistic regression models, as these are variables with three categories. RESULTS: The cumulative incidence of CLBP in 4 years of follow-up was 24.8%. Lower reward (1st versus 3rd tertiles; RR=1.24; 95%CI=1.01-1.54) and greater overcommitment (3rd versus 1st tertiles; RR=1.23; 95%CI=1.01-1, 50) were associated with a higher incidence of CLBP. Of the total participants, 10.7% reported multiple episodes of CLBP (≥2 episodes). Greater effort (3rd versus 1st tertiles; OR=1.48; 95%CI=1.02-2.15), greater effort/reward ratio (3rd versus 1st tertiles; OR=1.67; 95%CI=1.12- 2.47) and greater overcommitment (3rd versus 1st tertiles; OR=1.67; CI=1.11-2.50) were associated with a greater chance of having multiple CLBP episodes. Severe/disabling CLBP was reported by 9.92% of participants. Lower reward (1st versus 3rd tertiles; OR=1.58; 95%CI=1.02-2.44), higher effort/reward ratio (3rd versus 1st tertiles; OR=1.70; 95%CI=1.14- 2.53), and greater overcommitment (3rd versus 1st tertiles; OR=1.57; 95%CI=0.5-2.34), were independently associated with the cumulative incidence of severe/disabling CLBP. CONCLUSION: The results showed that stress at work, especially greater overcommitment, was associated with a higher risk of CLBP, higher risk of multiple CLBP episodes, and higher risk of severe and/or disabling CLBP after 4 years of follow-up. It is suggested that measures that mitigate exposure to stress at work will possibly reduce the burden of CLBP.
Type: Dissertação2022-12-20T00:00:00ZDesempenho dos hospitais mineiros no PNASS 2015- 2016: uma análise a partir de clusters de desempenho e perfis de atendimentohttp://hdl.handle.net/1843/621012023-12-20T12:28:06Z2023-08-04T00:00:00ZTitle: Desempenho dos hospitais mineiros no PNASS 2015- 2016: uma análise a partir de clusters de desempenho e perfis de atendimento
Abstract: The Hospitals have undergone major transformations, which involve changes in their
role, beyond the technical-scientific dimension. For decades, Hospital Care has been
one of the main points of discussion about assistance in the Unified Health System
and, in the search for new perspectives for the Brazilian hospital scenario, some
strategies are pointed out as a way to induce greater systemic efficiency: including
health assessments, which provide vital diagnoses related to the quality of services.
In this context, this research aimed to relate the performance of hospitals in Minas
Gerais, which participated in the National Program for the Evaluation of Health
Services - PNASS 2015/2016, with the variables size, macro-region, management
and administrative sphere and, above all, exploring the characteristics related to its
hospital and outpatient production, as well as its participation in the context of the
Health Care Networks. In addition, an attempt was made to present the location of the
evaluated institutions using dot maps, in order to demonstrate the distribution pattern
of hospitals within the macro regions of Minas Gerais. Regarding the methodology
used, this is a descriptive, cross-sectional, quantitative study, using secondary data
obtained from the PNASS 2015/2016, SIH and SIA databases, which also involves
secondary data from deliberations by the Secretariat of Health of the State of Minas
Gerais. Statistical analysis was performed using the RStudio 4.1.0 Software, in
association with Microsoft Excel 2018, and for georeferencing, the QGIS software was
used. The findings pointed to an association between the tested variables and
performance and, in particular, there was a relationship between participation in the
Health Care Networks with better results, especially in hospitals participating in the
thematic networks of Urgency and Emergency and Maternal and Child Health. From
the perspective of hospital (approved AIH) and outpatient (procedures in the unified
table) production, a similar relationship was identified. Thus, the importance of health
assessments and the need to promote an evaluative culture in tertiary care are
highlighted and, in this scenario, the contribution of the PNASS as a public evaluation
strategy and the importance of analyzing in depth the influence of the institutional
profiles on performance.
Type: Dissertação2023-08-04T00:00:00Z