Cardiovascular risk and allostatic load in nursing professionals working in oncology: psychosocial and work-related variables

Abstract

Studies indicate that job characteristics of nursing professionals can influence the presence of Cardiovascular Risk Factors (CRF). Among the nurses who work in the care of patients with cancer, cardiovascular diseases are a major cause of absenteeism and stress is one of the most prevalent CRF. The analysis of mediators related to the reaction adaptive to stress, the allostatic load, has been used to indirectly assess the functioning of the cardiovascular, immune, metabolic and neuroendocrine systems to predict morbidity and mortality in some population segments. However, to date, nationally no study was conducted using this strategy for risk stratification. Objectives: assess the prevalence of CRF, especially the arterial hypertension and profile of allostatic load in nursing professionals working in oncology care. Method: A simple random sample of nursing professionals from units of internment of the National Cancer Institute José Alencar Gomes da Silva (INCA) will be undertaken and the sample size calculated was estimated in 211 individuals. The research project was approved by the Ethical Research Committees (CAAE: 13329513.3.0000.5392) of USP School of Nursing (Opinion 320.343) and INCA (Opinion 46/13). Psychosocial and work-related factors will be measured through: a) Maslach Inventory Burnout, which assesses whether the individual is in Burnout; b) Beck Depression Inventory to assess the presence of anxiety and depressive symptoms; c) Self Reporting Questionnaire (SRQ 20), used for tracing possible common mental disorders; d) Bianchi Stress Questionnaire to assess the level of stress in the performance of work activities; and e) Pittsburg Sleep Quality Index (PSQI) to assess the quality and sleep related disorders. Participants will be asked about personal and family history and lifestyle habits. The casual blood pressure measurement will be performed with a validated automatic device. The ambulatory blood pressure monitoring (ABPM) with oscillometric device, for 24 hours (measured every 20 minutes for 24 hours). A blood sampling will be undertaken with the participant in 12-hour of fasting to perform tests: blood glucose, total cholesterol and fractions, triglycerides, glycated hemoglobin, plasma cortisol, fibrinogen and C-reactive protein ultrasensitive. Anthropometric measurements of height and weight will be undertaken to determine body mass index and waist circumference. Risk stratification will be performed by the Framingham Risk Score and Index of Allostatic Load, obtained through Stress Biomarkers. The prevalence of cardiovascular risk factors will be described in absolute numbers (n) and percentage (%) and by the descriptive statistics of the relevant factors. The analysis of the relationship between cardiovascular risk and allostatic load index and the nominal and ordinal factors will be determined by the Chi-square or likelihood ratio test. For continuous variables, the Mann-Whitney test or T-Student test will be used. The variables that show statistically significant associations in the univariate analysis will be subjected to multivariate analysis (Poisson regression with robust variance) and the results will be presented in a table containing estimated parameter, standard error, prevalence ratio and confidence interval. The significance level will be 5% and the data will be analyzed using the statistical program R version 2.7.1 and SPSS v.18.0. (AU)