Associação dos fatores de risco para doenças cardiovasculares e qualidade de vida entre servidores da saúde Association of cardiovascular disease risk factors and quality of life among health workers

Inúmeros problemas de saúde pública são atribuídos aos fatores induzidos pelo ambiente de trabalho que, associados ao estilo de vida sedentário, contribuem para deteriorar a qualidade de vida do trabalhador. Neste sentido, procuramos descrever o perfil, avaliar a condição física e o risco cardiovasculares dos funcionários da saúde. Foram avaliados 198 funcionários (46 ± 10 anos) que responderam uma anamnese e foram submetidos a avaliações bioquímicas, antropométricas e funcionais. Os valores foram apresentados como média ± desvio padrão da média. Foram utilizados testes de qui-quadrado (x²), taxa de "odds" e correlações de Pearson (p < 0,05). Dos avaliados, 54% apresentaram peso corporal elevado, 33% pressão arterial (PA) elevada e 56% eram sedentários. Colesterol total (CT), lipoproteína de baixa densidade e triglicerídeos (TG) acima da normalidade foram encontrados em 49%, 41% e 24% dos servidores, respectivamente e, 75% apresentaram taxas reduzidas de lipoproteína de alta densidade. As análises de x² e taxa de "odds" apontaram que os valores de TG e PA foram significativamente maiores para homens comparados às mulheres. Capacidade cardiorrespiratória ruim foi verificada em 56% dos homens e 23% das mulheres, além disso, a flexibilidade apresentou-se com níveis insatisfatórios para homens e mulheres. Observou-se que o índice de massa corporal se correlacionou positivamente com PA, CT e TG. Constatou-se, também que a idade foi fator agravante para PA, flexibilidade, CT e glicemia nas mulheres. Dessa forma, a prevalência de múltiplos fatores de risco nestes trabalhadores demonstra tratar-se de população não assistida pela saúde, motivo pelo qual sugere-se conscientização sobre sua própria saúde evitando a aposentadoria precoce<br>Several public health problems are due to environmental work, which, associated with sedentarism, contribute to reduce the quality of life of the worker. Therefore, this study aimed to describe the profile, evaluate the physical condition and cardiovascular risk factor of health workers. Health workers (198) from Bauru and Jau cities (46 ± 10 years old) were assessed. They answered a questionnaire and participated in antrophometric and functional assessments. Values are presented as means ± SD. Qui-squared (x²) analysis, odds rate and Pearson correlation were used (p < 0.05). From all workers evaluated, 54% presented high body weight, 33% high blood pressure and 56% were sedentary. Total cholesterol (TC), low-density lipoprotein and triglycerides (TG) above normal values were found in 49%, 41% and 24% of the individuals, respectively, and 75% presented low values of high-density lipoprotein. Qui-squared analysis and odds rate confirmed that TG and blood pressure (BP) were higher for men compared with women. Physical capacity was bad for 56% of men and 23% of women. Also, flexibility was unsatisfactory for men and women. Body mass index correlated positively with BP, TC and TG. Aging was an important risk factor for BP, TC, blood glucose, body mass index and flexibility only for women (p < 0.05). The prevalence of multiple risk factors among these health workers shows that this population is not adequately assisted. For this reason, a program from the government in order to make this population recognize such problems and avoid premature retirement is suggeste

Health insurance and ex ante moral hazard: evidence from Medicare

Insurance, Moral hazard, Health behavior, I12, I18,

Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis

IMPORTANCE: Identifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations, including such factors as age, sex, estimated glomerular filtration rate, and calcium and phosphate concentrations, were previously developed and validated in 2 Canadian cohorts. Validation in other regions and in CKD populations not under the care of a nephrologist is needed. OBJECTIVE: To evaluate the accuracy of the risk equations across different geographic regions and patient populations through individual participant data meta-analysis. DATA SOURCES: Thirty-one cohorts, including 721,357 participants with CKD stages 3 to 5 in more than 30 countries spanning 4 continents, were studied. These cohorts collected data from 1982 through 2014. STUDY SELECTION: Cohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease. DATA EXTRACTION AND SYNTHESIS: Data were obtained and statistical analyses were performed between July 2012 and June 2015. Using the risk factors from the original risk equations, cohort-specific hazard ratios were estimated and combined using random-effects meta-analysis to form new pooled kidney failure risk equations. Original and pooled kidney failure risk equation performance was compared, and the need for regional calibration factors was assessed. MAIN OUTCOMES AND MEASURES: Kidney failure (treatment by dialysis or kidney transplant). RESULTS: During a median follow-up of 4 years of 721,357 participants with CKD, 23,829 cases kidney failure were observed. The original risk equations achieved excellent discrimination (ability to differentiate those who developed kidney failure from those who did not) across all cohorts (overall C statistic, 0.90; 95% CI, 0.89-0.92 at 2 years; C statistic at 5 years, 0.88; 95% CI, 0.86-0.90); discrimination in subgroups by age, race, and diabetes status was similar. There was no improvement with the pooled equations. Calibration (the difference between observed and predicted risk) was adequate in North American cohorts, but the original risk equations overestimated risk in some non-North American cohorts. Addition of a calibration factor that lowered the baseline risk by 32.9% at 2 years and 16.5% at 5 years improved the calibration in 12 of 15 and 10 of 13 non-North American cohorts at 2 and 5 years, respectively (P = .04 and P = .02). CONCLUSIONS AND RELEVANCE: Kidney failure risk equations developed in a Canadian population showed high discrimination and adequate calibration when validated in 31 multinational cohorts. However, in some regions the addition of a calibration factor may be necessary

Predictors of reading literacy

Artelt C, Schiefele U, Schneider W. Predictors of reading literacy. EUROPEAN JOURNAL OF PSYCHOLOGY OF EDUCATION. 2001;16(3):363-383