As investigações acerca da relação entre as áreas de saúde e ambiente são atuais no debate sobre desenvolvimento sustentável, embora abordem fenômenos complexos e envolvendo incerteza de conhecimento. O uso de medidas síntese representa uma maneira de apreender parte da realidade nesses temas a fim de subsidiar atividades e tomadas de decisões. O objetivo dessa tese foi integrar informações de saúde e de ambiente e propor um indicador para avaliação de países desenvolvidos e em desenvolvimento. Para tanto foram desenvolvidos dois estudos com o uso de fundamentos da Teoria de Conjuntos Fuzzy. O primeiro estudo destinava- se a avaliar os estados e capitais do Brasil, com base em indicadores no escopo da atenção primária em saúde e cobertura de serviços de saneamento básico, integrados em uma medida síntese: o Índice Agregado de Saúde Ambiental. Os resultados do modelo fuzzy, comparados com outras medidas de sustentabilidade, sugerem situações de desigualdades no país. As regiões norte, nordeste e parte da centro-oeste apresentaram os menores valores do indicador em contrapartida aos maiores valores encontrados nas regiões sul e sudeste. O Índice Agregado de Saúde Ambiental tem potencial para formulação de hipóteses e também colaborar no debate acerca do desenvolvimento sustentável. O segundo estudo visou classificar o cenário de saneamento ambiental dos municípios do Algarve, litoral de Portugal, com uso de informações quantitativas, qualitativas e, também, medidas de opinião. A medida síntese integrada recebeu a denominação de Índice de Saneamento Ambiental. A elaboração do modelo fuzzy envolveu a participação de especialistas do Ministério da Saúde de Portugal. Os resultados do modelo fuzzy sugerem uma assimetria intra- regional com um grupo de municípios Alcoutim, Monchique e Silves que reúnem os menores valores dessa medida síntese e de outros indicadores de sustentabilidade. Por fim, as medidas de ambos os estudos foram comparadas com outras de sustentabilidade e encerram evidências da viabilidade de medidas integradas de saúde e ambiente e apontam para propriedades do uso de métodos com a lógica fuzzy. / The relation between environmental characteristics and health is one of the priorities in the debate about sustainable development. The environmental health area addresses complex phenomena and involves uncertainty regarding knowledge. The apprehension of a portion of the reality in this area using indicators is important to decision support. The main objective of this study is to present two proposals based on the Fuzzy Logic which aggregate specific indicators of health and environment in order to produce an index to the analysis of developing and developed countries. The first proposal has been designed to evaluate Brazils states and capitals based on indicators in the scope of primary health care and coverage of sanitations services. The indicators have been integrated into a summary measure named Index of Environmental Health. The results have been compared with other measures of sustainability. The northern, northeastern and central-western regions of Brazil have shown the lowest index. In contrast, the highest values of that index have been found in the south and the southeast regions of Brazil. These results may reveal situations of inequality in Brazil. The Index of Environmental Health has shown the potential for formulating hypotheses in the debate about sustainable development. The second proposal has aimed to classify the environmental sanitation status in the Algarvians cities, in Portugal, using quantitative and qualitative information and also opinion based measures. The integrated summary measure has been named Index of Environmental Sanitation. The development of this measure has involved the participation of experts from the Ministry of Health. The results have been compared with sustainability measures. They have shown that the worst values of this summary measure have occurred in Alcoutim, Monchique and Silves. In conclusion this study evidences some contributions for decision support obtained from environmental health integrated measures using fuzzy logic.

Objetivo. Este estudo foi realizado com o objetivo de avaliar a autopercepção das condições bucais em idosos. Material e Métodos. Participaram do estudo 337 pessoas, com 60 anos e mais de idade, funcionalmente independentes, que freqüentavam um centro de saúde em Araraquara, SP. Foi aplicado formulário com questões sobre as características sócio-demográficas da amostra, autopercepção da condição bucal e o índice GOHAI. Realizou-se exame clínico para determinar a prevalência das principais doenças bucais. Os testes estatísticos realizados tiveram como objetivo determinar a associação entre as variáveis sócio-demográficas, clínicas e o índice GOHAI com a autopercepção e também identificar os preditores da auto-avaliação. Resultados. O exame clínico revelou que 40,4% das pessoas eram desdentadas, e entre os dentados a cárie e a doença periodontal tiveram grande prevalência. Entre os dentados, 42,7% avaliaram sua condição bucal como regular, enquanto 55,8% dos desdentados afirmaram que era boa. As variáveis associadas à auto-avaliação foram: a classe social, o GOHAI, os dentes cariados e com extração indicada entre os dentados, e a escolaridade e o GOHAI entre os desdentados. A análise multivariada mostrou que os preditores da auto-avaliação foram o GOHAI (em dentados e desdentados), os dentes com extração indicada e o CPITN em dentados. Estes preditores explicaram no máximo 30% da variabilidade da auto-avaliação. Conclusões. Entre outros aspectos concluiu-se que a percepção teve pouca influência das condições clínicas e por isso seria importante o desenvolvimento de ações educativas e preventivas junto a esta população. / Objective. The purpose of this study was to assess the self-perception of oral health status of the elderly. Methods. Results are based on interviews and clinical assessment of 337 subjects aged 60 years and over, functionally independents and who used to go to a Health Care in Araraquara, Brazil. A questionnaire with questions about the social characteristics of the sample, self-perception of oral health status and the GOHAI index was applied. A clinical examination was made to determine the prevalence of the main oral diseases. The objective of statistical tests was to determine the association among the social and clinic variables and the GOHAI index with the self-perception. Moreover the tests had to identify the self-assess predictors. Results. The clinical examination revealed that 40.4% of the people were edentulous and among the dentate the dental caries and the periodontal disease had a significant prevalence. 42.7% of the dentate assessed their oral health status as regular and 55.8% of the edentulous assessed theirs as good. The social class, the GOHAI index and the decayed and missing teeth among the dentate, and also the level of education and the GOHAI among the edentulous, were associated to the self-assess. The multivariate analysis showed that the predictors of the self-assess were the GOHAI index (among dentate and edentulous), the missing teeth and the CPITN among dentate. These predictors explained 30% of the self-assess variability. Conclusions. As the perception had a small influence on the clinical conditions, the development of educated and preventive actions for these people are recommended.

Submitted by Daniella Santos (daniella.santos@ufma.br) on 2017-06-23T12:50:43Z No. of bitstreams: 1 Vanessa Moreira.pdf: 1547178 bytes, checksum: 5519c8294a22598f515b9072289a761b (MD5) / Made available in DSpace on 2017-06-23T12:50:43Z (GMT). No. of bitstreams: 1 Vanessa Moreira.pdf: 1547178 bytes, checksum: 5519c8294a22598f515b9072289a761b (MD5) Previous issue date: 2017-01-12 / FAPEMA / Noncommunicable Chronic Diseases (NCD), especially Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM) are a worldwide problem, related to high morbidity and mortality rates in several countries. They are still the greatest burden of the health systems in the world impacting those with chronic conditions, their families and society. In this context, the monitoring and evaluation of health indicators for the treatment and control of SAH and DM is fundamental. This research aimed to analyze health indicators of people with chronic conditions of arterial hypertension and diabetes mellitus in a historical series of 17 years in the State of Maranhão, registered in the Basic Health Care Information System (SIAB) and in HiperDia System. This study is descriptive and observational with a quantitative approach, using secondary data with methodologically based in the Theory of Practical Intervention of Nursing in Collective Health (TIPESC). The findings indicated an increase in the enrollment of people with SAH and DM in SIAB and in SIS-HiperDia in Maranhão. However, the enrollment of people with both NCDs in SIS-HiperDia occurred in an anomalous way, not following tendency of growth or decline. There was also a discrepancy in the quantitative registration of both systems. The macro-region of São Luís had the highest percentages of people with SAH and DM in most of the years, in SIAB and SIS-HiperDia, and the lowest percentage were recorded in the macro-region of Balsas. As for the profile of the enrollees in the SIS-HiperDia, there was a prevalence of the NCD studied in the female sex and in the age group of 60 to 79 years. The stroke complication and the sedentary risk factor were the most frequently mentioned. It was identified that the number of registered in the SIAB was below the estimate of individuals with the two diseases in the State. The state Maranhão reached a satisfactory average number of visits per person with both pathologies, being in most of the years above that established by the Ministry of Health, however, the professionals registered the productivity in the SIAB and did not feed satisfactorily the SIS-HiperDia. The follow-up by the ACS reached percentages above 90% for the two NCDs. The epidemiological indicators - specific mortality rate for DM and prevalence rates of SAH and DM - increased over the 17 years analyzed. It is concluded that even with the implementation of Primary Health Care actions, since 1998, with a gradual increase in the coverage and growth of enrollment and follow-up of people with SAH and DM, there was no reduction in the morbidity and mortality of the two NCDs in Maranhão. / As Doenças Crônicas Não Transmissíveis (DCNT), em especial a Hipertensão Arterial Sistêmica (HAS) e o Diabetes Mellitus (DM) são um problema de ordem mundial, relacionadas a altos índices de morbimortalidade nos mais diversos países. São ainda o maior ônus dos sistemas de saúde no mundo impactando os portadores de condições crônicas, suas famílias e a sociedade. Nesse contexto, é fundamental o monitoramento e a avaliação de indicadores de saúde para o tratamento e controle da HAS e do DM. Esta pesquisa objetivou analisar indicadores de saúde de pessoas com condições crônicas de Hipertensão Arterial e Diabetes Mellitus numa série histórica de 17 anos no Estado do Maranhão, cadastrados no Sistema de Informação da Atenção Básica (SIAB) e no Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos (SIS-HiperDia). Estudo observacional, descritivo, com abordagem quantitativa, utilizando dados secundários com delineamento fundamentado metodologicamente na Teoria da Intervenção Práxica da Enfermagem em Saúde Coletiva (TIPESC). Os achados indicaram ampliação do cadastramento de pessoas com HAS e DM no SIAB e no SIS-HiperDia no Maranhão ao longo dos 17 anos estudados, contudo o cadastramento de pessoas com as duas DCNT no SIS-HiperDia deu-se de maneira anômala, não seguindo tendência de crescimento ou decrescimento. Observou-se ainda discrepante diferença no quantitativo de cadastros de ambos os sistemas. A macrorregional de São Luís apresentou maiores percentuais de cadastramento de pessoas com HAS e DM, na maioria dos anos, no SIAB e no SIS-HiperDia, e os menores percentuais foram registrados na macrorregional de Balsas. Quanto ao perfil dos cadastrados no SIS-HiperDia, houve prevalência das DNCT estudadas no sexo feminino e na faixa etária de 60 a 79 anos. A complicação AVC e o fator de risco sedentarismo foram os mais referidos. Identificou-se que o número de cadastrados no SIAB esteve aquém da estimativa de indivíduos com os dois agravos no Estado. O Maranhão alcançou satisfatória média de atendimentos por pessoa com as duas patologias, estando na maioria dos anos acima do estabelecido pelo Ministério da Saúde, contudo os profissionais registraram a produtividade no SIAB e não alimentaram de maneira satisfatória o SIS-HiperDia. O acompanhamento realizado pelos ACS alcançou porcentagens superiores a 90% para as duas DCNT. Os indicadores epidemiológicos - taxa de mortalidade específica por DM e taxas de prevalência de HAS e DM - ascenderam ao longo dos 17 anos analisados. Conclui-se que mesmo com a implantação de ações da Atenção Primária em Saúde, a partir de 1998, com aumento gradual da cobertura e crescimento do cadastramento e acompanhamento de pessoas com HAS e DM não houve redução da morbimortalidade das duas DCNT no Maranhão.

Background: Because immigration is a stressful life event accompanied by acculturation pressure in a new country, it inevitably influences the mental health of immigrants. Thus, the goal of this dissertation is to investigate the mental health status and utilization of professional mental health services among immigrant women at least 50 years of age and to identify barriers and protective factors associated with mental disorders and access to mental health services. Method: This secondary cross-sectional study utilizing the National Institute of Mental Health Collaborative Psychiatric Epidemiology Survey (CPES), which comprises three nationally representative surveys conducted between 2001 and 2003 including the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL) and the National Latino and Asian American Survey (NLAAS). The information on county-level characteristics was derived from the 2000 U.S. Census data. Descriptive, bivariate, and multivariable analyses, including multilevel modeling, were performed. Result: Twenty-seven percent of all immigrant women ages 50 and older met the criteria for a diagnosable psychiatric disorder. Compared to Black immigrant women, Latinas were more likely to have anxiety and mood disorders. Both Asian and Latina women demonstrated a higher probability of seriously considering suicide than Black women. Among those with a diagnosable mental health condition, successfully accessing professional mental health services was positively associated with younger age, being Latina, more frequent communication with others about their problems, and being covered by health insurance. Asian women living in the US who perceived themselves as having a high social status were more likely to use professional mental health services than Asian women who considered themselves to be of a lower social status. Although aggregated county-level characteristics explained 2% of the variance for experiencing mental disorders in the empty model, the county-level socioeconomic disadvantages, racial density and residential mobility, were not significantly associated with any mental disorder. Conclusion: Racial disparities exist in four mental disorders among middle and older immigrant women in the US. Women of older age and Asian ethnicity were less likely to utilize professional mental health services. The primary factors that enabled aging immigrant women with mental disorders to obtain professional mental health services were insurance status and effective communication about problems in daily life. Therefore, increasing insurance coverage, and improving the quality of medical care are strategies that should be considered for future policies aiming to address the underutilization of mental health services among aging immigrant women with mental disorders. / acase@tulane.edu

Le polyhandicap est consécutif à une lésion sur un cerveau immature, il associe déficience mentale profonde, déficit moteur, restriction de l’autonomie. Objectifs 1) décrire les caractéristiques médicales, la prise en charge du PLH et son adéquation, 2) évaluer l’impact du polyhandicap sur le vécu des aidants. Méthodologie : étude de cohorte. Sept centres (SSR et médico sociaux) ont participés. Patients inclus: répondant à la définition du PLH, pour chaque patient sont inclus aidants professionnels et familiaux. Données recueillies : patient :médicales, modalités de prise en charge, aidants: sociodémographiques et vécu. Résultats : 875 patients ont été inclus, âge moyen 24 ans, enfants 45.8%, adultes 54.2, principales comorbidités :infections pulmonaires, troubles orthopédiques, épilepsie. L’adéquation objective de la prise en charge en SSR est de 60% au regard de la sévérité du PLH. Le polyhandicap de l’enfant a un retentissement considérable sur le vécu des parents et des soignants. / Polyhandicap (PLH) is a chronic affliction occurring in an immature brain, leading to the combination of profound mental retardation and serious motor deficit. The French health system allows care management in specialized rehabilitation centers (SRC), residential facilities (RF), and home care. The aims of this study were i) To describe PLH patients ‘health status and to estimate the adequacy of care management ii) To assess the QoL of parents and health-care workers.Method: inclusions: PLH patients, parents and institutional HCWs of each included patients. Data collection: socio demographic, clinical, modalities of care management, caregivers' QOL. Results: 875 PLH patients were included: main comorbidities were pulmonary infections, orthopedic and epilepsy. Global objective adequacy was higher for patients cared for in SRC.The QoL scores of all dimensions were significantly lower for parents and health care workers than for controls.

<p>Long term care and social services (LTCaS) for older people are an important part of the Scandinavian welfare state. The fast growing number of elderly people in Sweden has caused many concerns about increases in future needs (and particularly costs) of age-related social programs such as LTCaS. The general aim of this dissertation is to examine how projected demographic changes may affect future needs for long-term care and services in Sweden assuming different trends in morbidity and mortality. The following data sources are used: national population registers, register data on inpatient/outpatient health care from region Skåne, the Swedish National Survey on Living Conditions (SNSLC) for the period 1975-1999. Three alternative methods to inform simple demographic extrapolations of needs for health and social care for the elderly are presented. Furthermore, a new method for demographic projections has been developed. According to our studies, the health of older people (measured as the prevalence of severe ill-health) has improved during the study period. Taking into account health status, when projecting future needs for LTCaS, will result in a fairly substantial reduction of the rate of the demographically influenced increase in projected LTCaS needs. The changes in population composition regarding education and mortality differentials per educational level may have a significant impact on the number of the elderly in the future. On the other hand, the projected increase in the number of older people suffering from severe ill-health, as a consequence of population ageing, may be counterbalanced to a large extent by changes in the educational composition towards a higher proportion of the population having a high educational level and lower prevalence of severe ill-health. We need to improve our planning tools in order to support policy-makers to plan for uncertainty concerning future needs and demand for LTCaS.</p>

<p>Bakgrund: När människor drabbas av venösa bensår kan vardagen drastiskt förändras. Ett stort antal individer drabbas av bensår och incidensen ökar med åldern. För att kunna ge en god omvårdnad behöver vårdpersonalen ökade kunskaper för att förstå bensårens inverkan på individens dagliga liv. Syfte: Syftet med studien var att beskriva hur det är att leva med venösa bensår. Metod: Studien utfördes som en allmän litteraturstudie. Fjorton empiriska studier ingick. Resultat: I samband med bensår förekommer en rad faktorer som på olika sätt påverkar det dagliga livet. Framträdande faktorer var smärta, svullna ben, lukt och läckage, rädsla och välbefinnande. Smärta var det funktionella hälsotillstånd som hade störst inverkan på det dagliga livet. Smärtan ledde till störd nattsömn, försämrad rörlighet och social isolering. Slutsats: Patienter med smärtsamma bensår har svårt att leva det liv som de önskar. Om distriktssköterskan synliggör sambandet mellan dagligt liv och funktionellt hälsotillstånd, kan specifika omvårdnadsåtgärder genomföras. Patienterna kan då uppnå ett önskvärt dagligt liv oavsett funktionellt hälsotillstånd.</p> / <p>Background: When people suffer from venous leg ulcers, their everyday life can be drastically changed. A large number of individuals suffer from leg ulcers and the incidences increase with age. In order to provide good nursing, care staff need more knowledge in order to understand the effects of the ulcers on the individual's daily life. Purpose: The purpose of this study was to describe what it is like to live with venous leg ulcers. Method: The study was carried out as a general literature review. Fourteen observational studies were included. Results: In connection with leg ulcers there are a number of factors that affect the patients’ daily lives in different ways. Important factors were pain, swollen legs, odor and leakage, fear and well-being. Pain was the functional state of health which had the greatest impact on daily life. The pain led to interrupted sleep, impaired mobility and social isolation. Conclusion: Patients with painful leg ulcers have difficulty living the life they desire. If the district nurse makes the connection between daily life and functional health status explicit, specific care measures can be implemented. Then patients can achieve a desirable everyday life regardless their functional state of health.</p>

<p>Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. </p><p>A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. </p><p>To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.</p>

<p>There is very little data on physical and psychological long-term outcome after severe burn injury. The aim of the present thesis was to improve current instruments for assessment of these issues, to assess long-term outcome in a cohort of patients with burn injuries, and to explore the contribution of the individual factors of personality and coping on perceived outcome.</p><p>Patients treated at the Burn Unit, Uppsala University Hospital, between 1980 and 1995 were included on a consecutive basis if they were 18 years of age or older at follow-up, had burn injuries of ten percent or more, or hospitalization times of seven days or more. A total of 350 patients fulfilled these inclusion criteria.</p><p>A factor analytic approach was used to derive a 40-item instrument called the Burn Specific Health Scale-Brief (BSHS-B), resulting in nine well-defined domains. Most burn patients reported a very good perceived outcome but a subgroup reported problems years after injury. On a group level most problems were related to Heat Sensitivity, Work and Body Image. The depth of injury, gender, marital status and living conditions were all related to outcome. Neurotic personality traits were related to perceived health, and were not confined only to psychological aspects of life but also included physical aspects. A 33-item burn-specific coping scale, the Coping with Burns Questionnaire (CBQ), with six clearly separated domains with acceptable internal consistencies was developed. Coping strategies were strongly related to outcome in the subgroup of patients reporting most problems in perceived health, and coping contributed more to psychosocial than physical health. Avoidant coping and Emotional support seeking had independent effects on outcome.</p><p>The observation that Neuroticism and Avoidant coping strategies are related to bad outcome after severe burn injury indicates that patients with such characteristics should be given special attention during rehabilitation.</p>

<p>Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients. </p><p>A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years. </p><p>Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group. </p><p>The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen. </p><p>The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders. </p><p>Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse. </p><p>The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.</p>