Introdução: Diferentes estudos evidenciam que a doença periodontal em jovens tem uma prevalência baixa, e que seu comportamento na perda de nível de inserção é mais localizado que generalizado. (AL-GHUTAIMEL, H. et al, 2014; LÓPEZ; FERNANDEZ; BAELUM, 2006). Entretanto a periodontite é um problema de saúde pública e seu aumento na prevalência nos adultos é cada vez mais alta. Objetivo: Descrever a prevalência da periodontite em jovens e adultos da Colômbia, sua associação com fatores de risco socioeconômicos e demográficos. Metodologia: Para este estudo foram utilizados dados de indivíduos jovens de 18 anos e adultos entre 20-79anos avaliados no IV Estudo Nacional de Saúde Bucal na Colômbia. (COLÔMBIA, 2014 a) A amostra incluiu um total de 9150 sujeitos que corresponderam a 1802 jovens e 7348 adultos.Foi realizada uma comparação dos parâmetros periodontais entre jovens e adultos e das variáveis sociodemográficas. (testes Mann Whitnney e testes Kruskall Wallis p<0.05). Adicionalmente, a prevalência da periodontite foi estimada de acordo com a classificação do ENSAB IV e por uma reclassificação baseada na literatura. Finalmente se observou associação da doença com os fatores de risco sociodemográficos e clínicos de acordo com a reclassificação, numa ánalise de regressão logística com Odds proporcionais parciais. Resultados: Foram observadas diferenças estatisticamente significantes entre os dois grupos nas variáveis avaliadas (sexo, estrato socioeconômico, adesão ao sistema de saúde, região, doença inflamatória Crônica, perda de dentes por cárie e por outra causa). De acordo com a classificação do ENSAB IV, os indivíduos jovens apresentaram 40,3% de prevalência na categoria sem periodontite, adultos 99% na categoria grave e 94.3% na categoria moderada. Enquanto na reclassificação prevaleceu a periodontite leve em jovens 26,1%, e nos adultos as categorias grave e moderada tiveram porcentagens similares que na classificação do ENSAB IV. Na análise bivariada e multivariada faixa setárias entre 65-79 e 35-44, o sexo masculino, o cadastro no regime subsidiado e sem adesão ao sistema de saúde, a perda de dentes por cárie e por outra causa foram significantemente associadas com periodontites grave e moderada (p<0.05). Conclusões: A prevalência da doença periodontal foi relativamente alta mesmo na faixa etária de jovens. O diagnóstico precoce da periodontite e uma oportuna intervenção em indivíduos com gengivite, principalmente para aqueles que apresentem fatores de risco, deve ser reforçada como uma política pública visando prevenir a doença e diminuir a prevalência de adultos com periodontite / Introduction: Different studies show that periodontal disease in young people has a low prevalence, and that its behavior in loss of insertion level is more localized than generalized. (Al-GHUTAIMEL, H. et al, 2014; LÓPEZ; FERNANDEZ; BAELUM, 2006). However, periodontitis is a public health problem and its increase in adult prevalence is growing. Objective: To describe the prevalence of periodontitis in young people and adults in Colombia, its connection between socioeconomic and demographic risk factors. Methodology: This study used data from 18-year-olds and adults aged 20-79 evaluated in the IV National Oral Health Study in Colombia. (COLOMBIA, 2014 a) The sample included 9150 subjects corresponding to 1802 young people and 7348 adults. A comparison of the periodontal parameters between young people and adults and sociodemographic variables was performed. (Mann Whitnney tests and Kruskall Wallis tests p<0.05). In addition, the prevalence of periodontitis was estimated according to the ENSAB IV classification and to a reclassification based on the literature. Finally, a connection between the disease and sociodemographic and clinical risk factors was observed according to the reclassification in a logistic regression analysis with partial proportional Odds. Results: Statistically significant differences were observed between the two groups in the evaluated variables (sex, socioeconomic status, affiliation to the health system, region, chronic inflammatory disease, loss of teeth due to tooth decay and other causes). According to the ENSAB IV classification, young individuals presented a 40.3% prevalence in the category without periodontitis, adults presented 99% in the severe category and 94.3% in the moderate category. While the reclassification prevailed to mild periodontitis in youngsters 26.1%, and in adults the severe and moderate categories had similar percentages to the classification of ENSAB IV. In the bivariate and multivariate analysis, age ranges between 65-79 and 35-44, in male sex, enrollment in the subsidized regimen and no affiliation to the health system, loss of teeth due to tooth decay and other causes were significantly associated with severe periodontitis and moderate (p<0.05). Conclusions: Diagnosing and timely intervention in individuals with gingivitis presenting risk factors could prevent the disease and decrease the prevalence of adults with periodontitis

Este foi um estudo populacional de caráter transversal, com o objetivo de determinar a prevalência da síndrome da fragilidade entre idosos em Ribeirão Preto e o perfil sócio demográfico e clínico desta população, além de avaliar associações entre fragilidade e alterações metabólicas. A amostra foi obtida de forma casualizada por conglomerados por área. Foram excluídos indivíduos com déficit cognitivo grave, acamados, em uso de cadeira de roda, portadores de sequelas grave de Acidente Vascular Cerebral, com Doença de Parkinson grave, idosos que estavam em estágio terminal ou em tratamento para câncer, exceto o de pele. Um instrumento padrão de avaliação foi elaborado incluindo várias características. Este estudo adotou critérios de fragilidade de acordo com a definição de Fried e colaboradores. Foram realizadas medidas do peso, altura, circunferência abdominal e da pressão arterial. As variáveis analisadas neste projeto são relativas às características sócio-demográficas, medidas antropométricas, pressão arterial e dados clínicos, além dos critérios do fenótipo da fragilidade. Ao total, 385 voluntários foram selecionados, sendo 64,7% do sexo feminino. A idade média dos participantes foi 73,9 ± 6,5 anos. Houve predominância da etnia branca, nível de escolaridade de 1 a 4 anos, estado civil casado, possuir quatro ou mais filhos. Treze por cento das mulheres referiu viver só. Entre os homens, 96,4% referiram ainda trabalhar e 77,9% referiram representar o principal sustento da casa. A renda familiar média foi de R$ 1.749,00. Hipertensão arterial sistêmica foi a doença auto-referida mais prevalente. Trinta por cento dos voluntários ingeriam dois ou três medicamentos ao dia. Mulheres utilizavam mais medicamentos que os homens (p=0,004). Não se observou diferença entre os níveis de pressão arterial sistólica ou diastólica e pressão arterial sistólica e diastólica ortostática entre os sexos. Idosos apresentaram maior média de circunferência abdominal (p<0,01), porém, 74,3% das mulheres encontravam-se com a circunferência abdominal acima do valor considerado como normal. A média do índice de massa corpórea dos homens foi de 26,6 ± 4,5 Kg/m2 e das mulheres foi de 27, 7± 5,3 Kg/m2 (p=0,03), No presente estudo, foram considerados como frágeis 9,1% da amostra, 49,6% como pré-frágeis e 41,3% como não-frágeis. Quanto aos critérios da síndrome da fragilidade 12,5% dos participantes apresentaram perda de peso no último ano; 20,5% fadiga; 17,1% lentidão; 24,4% baixo nível de atividade física e 20,5% baixa força de preensão palmar. O grupo dos frágeis apresentou maior média de idade (p<0,01). Quanto mais idoso o indivíduo, mais critérios ele pontuou para fragilidade. Idosos frágeis foram em mais consultas médicas (p=0,03) e tiveram maior chance de internação (p<0,001) no período de 12 meses. A circunferência abdominal e o índice de massa corpórea foram semelhantes em todos os níveis de fragilidade. Não foi observada diferença em relação à pressão arterial sistólica e diastólica nos três grupos de fragilidade. Ao comparar-se a pressão arterial ortostática entre os grupos, houve diferença limítrofe (p=0,06) quanto à diastólica, verificando-se, na análise pós-teste (Bonferroni), valor menor da pressão arterial no grupo dos frágeis do que no grupo dos não-frágeis (p=0,03). A pressão arterial ortostática sistólica foi semelhante em todos os grupos. Observa-se que houve forte correlação do índice de massa corpórea apenas com a circunferência abdominal, o que foi observado nos três níveis de fragilidade. Concluiu-se que 9,1% dos idosos de Ribeirão Preto são frágeis. Os idosos frágeis são mais velhos e tem maior chance de internação. A pressão arterial diastólica em ortostase tende a ser menor entre os frágeis. Há uma forte correlação entre índice de massa corpórea e circunferência abdominal em todos os níveis de fragilidade / This was across-sectional population study, with the objective of determining the prevalence of the syndrome of frailty among older individuals in Ribeirão Preto and sociodemographic and clinical profile of this population. And to evaluate associations between frailty and metabolic changes. The sample was randomly by clusters area. Exclusion criteria: severe cognitive impairment, bedridden, using a wheelchair, people with severe sequelae of stroke, severe Parkinson\'s disease, terminally ill or in treatment for cancer, except skin. A standard assessment tool was developed including various features. This study adopted criteria of frailty according to the definition of Fried et al. Weight, height, waist circumference and blood pressure were measured. The variables analyzed in this project are related to socio-demographic characteristics, anthropometric measurements, blood pressure and clinical profile, in addition to the criteria of the phenotype of frailty. In total, 385 volunteers were selected. The mean age was 73.9±6.5 years, with prevalence of female gender (64,7%), caucasian, married status, with education of 1-4 years, four or more children .Thirteen percent of women reported living alone. Among men, 96.4% reported still working and 77.9% reported that they represented the main breadwinner of the home. The median household income was R$ 1,749.00. Hypertension was the more prevalent self-reported disease.. Thirty percent of the volunteers ingested two or three medicines daily, with women using more than men (p=0.004). No difference was observed between the levels of systolic or diastolic blood pressure and systolic or diastolic orthostatic blood pressure between the sexes. Men had higher mean waist circumference (p <0.01), however, 74.3% of women were with waist circumference above of the considered normal. The mean of body mass index was 26.6±4.5 Kg/m2 for men and for women was 27.7±5.3 Kg/m2 (p =0.03). In the present study, 9.1% of the sample were considered as frail, 49.6% as pre-frail, and 41.3% were non-frail. Criteria used to define of frailty syndrome were evaluated and 12.5% of participants had weight loss in the last year, 20.5% exhaustion, 17.1% had slowness, 24.4% low activity and 20.5% had weakness. The frail group had higher mean age (p <0.01). Older individuals scored more criteria for frailty. Frail individuals were in more doctor visits (p=0.03)and had a greater chance of hospitalization (p <0.001) at 12 months. Waist circumference and body mass index were similar in all levels of frailty. There was no difference in systolic blood pressure and diastolic blood pressure in the 3 groups of frailty. When comparing orthostatic blood pressure among groups, there was borderline difference (p=0.06) in diastolic blood pressure. In the post-test analysis (Bonferroni), the frail group had lower diastolic blood pressure in orthostatic when compared with non-frail (p=0.03). Orthostatic systolic blood pressure was similar in all groups. It was observed that there was a strong correlation between body mass index with waist circumference, which was observed at all three levels of frailty. It was concluded that 9.1% of the elderly individuals in RibeirãoPreto are frail. The frail individuals are older and have a greater chance to hospitalization. Diastolic blood pressure while standing tends to be lower among frail ones. There is a strong correlation between body mass index and waist circumference in all levels of frailty.

Adult physical activity is important for prevention of chronic diseases and to minimize health issues; therefore, the motivational influences of sociodemographic variables on participation in organized physical activity events warrant an investigation. The purpose of this quantitative study was to investigate differences in motivational influences between various sociodemographic variables as related to physical activity events in organized settings. The theoretical framework that guided this research study consisted of the theory of reasoned action (TRA), and the health belief model (HBM). The TRA was applied to study the intention of health behavior, while the HBM was used to investigate individuals' motivation to engage in organized physical activity events. A cross-sectional study design in which an online survey consisting of the 40 item Physical Activity and Leisure Motivation Scale was used to collect data from adults who participated in an organized 5K or 10K running or walking event. The inferential statistical tests of the independent t test, one-way ANOVA, and ordinal logistic regression were used to determine the statistical relationships. The main research finding suggested that 6 motivational influences showed statistically significant relationship with organized physical activity events, which consisted of others' expectations (p = .025), competition/ego (p = .001), appearance (p = .001), affiliation (p = .034), mastery (p = .001), and psychological condition (p = .002) as it relates to their age group and gender. The research findings may be used to influence engagement in future organized physical activity events by understanding the sociodemographic variables relating to participation rates that may result in increased physical activity behavior within the community.

Obesity is a public health problem. The global obesity problem has been attributed to unhealthy diet, inactivity, and hereditary factors. However, phthalates may also contribute to the obesity epidemic. The purpose of this cross-sectional study was to examine whether there was a relationship between exposure to phthalates and obesity among adults 18 years and older in the United States. The theoretical framework was based on the socioecological model. The quantitative, cross-sectional design, and data analysis were based on the National Health and Nutrition Examination Survey, 2011-2012 database. Descriptive statistics and multiple regression analysis were used to analyze the association between phthalates, obesity, and other independent variables (phthalates exposure, socioeconomic status, gender, age, race/ethnicity, physical activity and place of residence) According to study results, exposure to phthalates does not have a statistically significant effect on the odds of obesity. In terms of the influence of the sociodemographic variables such as race, age, and gender on the relationship between total phthalate exposure and obesity, only race showed statistical significance at p < 0.05. In addition, physical activity did not have influence on relationship between total phthalate exposure and obesity among adults 18 years and older in the United States. Despite the lack of significant relationships, the results of this study are useful in addressing the concerns about the exacerbation of obesity. The results of this study could enhance academic research by showing the effect of phthalate chemical exposure, age, gender, race/ethnicity, physical activity, income, and educational level on obesity.

The purpose of this study is to evaluate eighth grade students&rsquo / environmental literacy (knowledge, attitude, sensitivity and concern) level and to assess effects of socio-demographic variables (gender, parents&rsquo / educational level, parents&rsquo / work status and source of information about environmental knowledge) on their environmental literacy level. A total of 437 (212 girls and 225 boys) eight grade public school students are administered Environmental Literacy Test which includes four parts / knowledge (20 items), attitude (10 items), sensitivity (19 items), concern (12 items). Descriptive analysis showed that students have positive attitude and high degrees of concern and sensitivity toward environment / however they have low to moderate levels of environmental knowledge. In order to evaluate the role of socio-demographic variables on students&rsquo / environmental literacy level, six separate one-way MANOVAs were conducted. The results revealed that / a) there is significant effect of gender on students&rsquo / environmental literacy regarding to concern, in favor of girls, b) there is a significant effect of parents&rsquo / educational level on students&rsquo / environmental literacy / c) there is a significant effect of mothers&rsquo / work status on students&rsquo / environmental literacy and d) there is not a significant effect of source of information about environment on students&rsquo / environmental literacy.

Kūdikio maitinimas krūtimi yra natūralus fiziologinis procesas, bet turintis svarbų biologinį bei emocinį poveikį motinos ir vaiko sveikatai, tačiau daugelis besilaukiančių moterų renkasi kūdikių maitinimą pieno pakaitalais. Maitinimas krūtimi - sąmoningas procesas, kuriam būtinas motinos apsisprendimas. Šį pasirinkimą daugiausia lemia būsimosios mamos požiūris į kūdikio maitinimo būdus. Remiantis nėščiųjų asmeninio požiūrio modeliu, analizuojamas maitinimo krūtimi ar buteliuku privalumų ir trūkumų suvokimas bei socialinis palaikymas, kuris galimai įtakoja moters asmeninį požiūrį. Tikslas - nustatyti nėščių moterų požiūrio į maitinimo krūtimi sąsajas su sociodemografiniais rodikliais ir socialiniu palaikymu. Tiriamieji – 103 nėščiosios, besilankančios Mažeikių pirminės sveikatos priežiūros centre „Sveikata šeimai“. Tiriamųjų amžiaus vidurkis – 24 metai, vidutinė nėštumo trukmė – 20 savaičių. Matavimo priemonės – naudota penkių klausimynų anketa. Pirmoji sudaryta iš klausimų apie moters sociodemografinius rodiklius. Požiūrio įvertinimui skirtas Dungry požiūrio į kūdikio maitinimą krūtimi klausimynas (Dungry, 1994, pagal Shaker ir kiti, 2004), o įvairiems požiūrio aspektams nustatyti naudotas Chabrol (Chabrol ir kiti, 2004) požiūrio į maitinimo būdus klausimynas. Ketvirtas – Glazier (2002) sukonstruotas suvokiamo galimo socialinio palaikymo klausimynas, kuris kaip ir McLeod (2006) sukurtas medicinos specialistų suvokiamo palaikymo klausimynas yra pritaikyti specialiai... [toliau žr. visą tekstą] / Breastfeeding is natural physiological process, which have significant biological and emotional impact on mother’s and infant’s health but a lot of pregnant women choose to bottle-feed. Breastfeeding -conscious process, requireing mothers’s decision. This decision is influenced most by expectant woman’s attitude. According to pregnant women’s personal attitudes model was analized perception of breastfeeding or bottlefeeding advantages and disadvantaged and social support as it may possibly influence mother’s personal attitude. Purpose – to identify interface of pregnant women attitudes toward breastfeeding with sociodemographic factors and social support. Contingent – 103 pregnant women, attending prime health care center “Sveikata šeimai“ in Mažeikiai. Respondent’s mean age – 24 years, mean pregnancy term – 20 weeks. Measures – Used five questionnaire form. First – questions about women’s sociodemographic indexes. Dungry’s infant feeding attitude scale was used to assess women’s attitude toward breastfeeding, Chabrol infant feeding quoestionary helped to identify various attitude aspects. Forth – questionary of perceived social support, made-up by Glazier (2002), adapted specialy for pregnant women as questionary of perceived social support of health care providers (McLeod, 2006). Results – it was observed that 30% respondents sure or surely will bottlefeed their infant. After analysis, results showed that decision to breastfeed is linked with more positive attitude... [to full text]

This thesis examines localities in the vicinity of cities, starting with Ekeby- Almby which is situated near Örebro. In the past twenty years, Ekeby- Almby has experienced vast sociodemographic changes. These lines of development give rise to a number of questions. For example, does the socioeconomic change of Ekeby-Almby reflect a general trend for this kind of locality? What are the perspectives and concepts that characterise the planning of these localities, and what is the significance of these suburban areas for the urban development as a whole? The purpose of this thesis is to examine the peri-urban localities, their role in, and their significance to, the development of cities. The thesis is made up of three empirical parts. Some of the main results are that the peri-urban localities can bedescribed as continuously growing, even during periods of shrinking towns and growing countryside (70s and 80s), and re-urbanisation (90s and 00s). Other results from the study are that layers of peri-urban localities with partially separatesocioeconomic profiles become apparent. Together these localities are, in various ways, part of the city’s socioeconomic differentiation. Finally, the result from the study indicates that the development of localities is shaped by a series of structures, and actors operating in relation to these. The development of the peri-urban localities can, theoretically, be seen as an urban counter- urbanisation, but perhaps primarily as a Swedish periurbia, and thus as an extension of the city, often described as an urban sprawl. This study also discusses the role of the peri-urban locality in the city’s social geography, where it among other things can be described as the ”hidden” space of the segregated city. Another aspect of the peri-urban locality is that it can be seen as a place which is important in an intermunicipal competition in population growth.

Submitted by Oliveira Santos Dilzaná (dilznana@yahoo.com.br) on 2016-05-06T12:41:53Z No. of bitstreams: 1 Dissertação Quele de Souza Gomes Santos.pdf: 996061 bytes, checksum: fe62269601dbabb818880759138ef74d (MD5) / Approved for entry into archive by Oliveira Santos Dilzaná (dilznana@yahoo.com.br) on 2016-05-11T13:38:24Z (GMT) No. of bitstreams: 1 Dissertação Quele de Souza Gomes Santos.pdf: 996061 bytes, checksum: fe62269601dbabb818880759138ef74d (MD5) / Made available in DSpace on 2016-05-11T13:38:25Z (GMT). No. of bitstreams: 1 Dissertação Quele de Souza Gomes Santos.pdf: 996061 bytes, checksum: fe62269601dbabb818880759138ef74d (MD5) / O envolvimento paterno é um fenômeno complexo, influenciado por fatores individuais, contextuais e culturais, porém, existem controvérsias acerca do impacto desses fatores sobre a forma como o pai participará das atividades e cuidados que envolvem a criança. Nesse sentido, o objetivo deste estudo foi caracterizar o envolvimento paterno em pais de diferentes níveis socioeconômicos: nível socioeconômico alto, médio e baixo. Esperava-se que os pais de nível socioeconômico alto apresentassem maiores níveis de envolvimento paterno do que os pais de nível socioeconômico médio que, por sua vez, apresentariam maior níveis de envolvimento paterno do que os pais de nível socioeconômico baixo. Participaram do estudo 81 pais de crianças entre 4 e 6 anos de idade, de ambos os sexos, recrutados em escolas, organizações públicas e privadas da cidade do Salvador. Os pais foram divididos em três grupos de níveis socioeconômicos (NSE): NSE baixo (n= 31), NSE médio (n= 21) e NSE alto (n= 29). Para mensurar o envolvimento paterno foi utilizado o Questionário de Engajamento Paterno (QEP) e para avaliar o status socioeconômico da família foi utilizada a Escala Hollingshead (1975). A análise dos dados foi realizada através de procedimentos estatísticos descritivos e dos testes correlação de Pearson, ANOVA, ANCOVA e Kruskal-Wallis. Os resultados não indicaram diferenças entre os três grupos de NSE, exceto na dimensão cuidados básicos. Contudo, foram identificadas correlações positivas entre a escolaridade materna e paterna, a renda familiar, a idade paterna e materna e a dimensão cuidados básicos, bem como entre a escolaridade paterna e materna e escore total do QEP. Adicionalmente, foi encontrada uma correlação positiva entre a carga horária de trabalho semanal materna e a dimensão disciplina, assim como correlações negativas entre a quantidade de pessoas que moravam na casa e o envolvimento do pai em atividades de suporte emocional e jogos físico. Apesar de o nível socioeconômico enquanto variável composta por diferentes indicadores combinados, não impactar diretamente na maior parte das dimensões do envolvimento paterno, os componentes específicos do NSE como escolaridade, renda e carga horária de trabalho semanal materna, foram variáveis relevantes para a compreensão do envolvimento paterno. Ressalta-se a importância de se continuar investigando o papel do pai, bem como as crenças e mecanismos culturais que podem mediar as diferentes formas com que os homens têm vivenciado novas atribuições no contexto familiar. Paternal involvement is a complex phenomenon, influenced by personal, contextual and cultural factors; however, there are controversies about the impact of these factors on how fathers participate in activities and care involving the child. In this way, the goal of this study was to characterize the involvement of fathers in families with different socioeconomic status: low, middle and high. It was expected that high socioeconomic fathers related to higher levels of parental involvement than middle socioeconomic fathers, who, in turn, related to higher levels of parental involvement than low socioeconomic fathers. In this study, participated 81 fathers of children from four to six years old, from both sexes, recruited in public and private schools in the city of Salvador, Bahia. The fathers were divided into three groups of socioeconomic status (SES): low SES (n= 31), middle SES (n= 21) and high SES (n= 29). The Paternal Engagement Questionnaire (PEQ) was used to measure the father’s involvement, and the Hollingdshead Scale (1975) was used to measure the socioeconomic status of the family. Data analysis was conducted through descriptive statistics procedures and the Pearson correlation tests, ANOVA, ANCOVA and Kruskal-Wallis. Results show no differences in the groups, with the exception of the dimension basic care. Nevertheless, it was identified positive correlations between the age and education of the mother and the father, the income and the dimension basic care, as well as mother’s and father’s education and the total score on PEQ. Additionally, it was found a positive correlation between the mother’s weekly workload and the dimension discipline, as well as negative correlations between the number of individuals living in the house and the father’s involvement in emotional support activities and physical games. Although the socioeconomic status, as a variable composed by different factors combined, constituted as a factor with no influence in the majority of the father’s involvement dimensions, specific components from the SES, such as education, income and mother’s weekly workload, contributed as important variables for understanding the father’s involvement. The importance to continue investigating the role of the father is emphasized, as well as the beliefs and cultural influences that may play a mediator role on the different ways men have experienced new attributions in the family context. Key-words:

Orientador: Jose Marcos Pinto da Cunha / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-14T00:52:20Z (GMT). No. of bitstreams: 1 Azevedo_SimoneJoseSardinhade_D.pdf: 2887543 bytes, checksum: 9a2c7651a59f760f6f0bef73a86126b4 (MD5) Previous issue date: 2009 / Resumo: O debate sobre segregação residencial, desigualdades de acesso a políticas sociais e vulnerabilidades sociodemográficas nos motivou a desenvolver o presente trabalho, cujo objetivo principal é refletir sobre as conseqüências da segregação residencial na oferta dos serviços públicos de saúde básica e seus impactos nas condições de vida da população. O trabalho procura verificar se o desempenho da política de saúde pode variar conforme sua implementação nos diferentes locais da cidade. Esta tese se aproxima das linhas de estudo que buscam verificar os efeitos do espaço sobre as políticas sociais e sobre a qualidade de vida dos grupos sociais. A problemática desta pesquisa também está diretamente envolvida com a compreensão da atuação do Estado, supondo que suas diferentes formas de atuação (ou parte de suas burocracias) podem gerar iniqüidades na oferta dos serviços de saúde, contribuindo para potencializar os riscos de morbimortalidade nos diferentes grupos populacionais. Os resultados obtidos indicam que existe uma diferenciação na oferta dos serviços de saúde básica em Campinas segundo a localização do equipamento e apontam para os diferentes graus de vulnerabilidade da população diante de tal situação / Abstract: The debate about residential segregation, differences in the access to social policies and social-demographic vulnerabilities has encouraged us to develop the present work, the main objective of which being to reflect on the consequences of residential segregation in the offer of basic public health services and their impact on the life-condition of the population. The work aims to verify if the performance of the health policies may vary according to its implementation in different places in the city of Campinas. This thesis approaches lines of study which aim to verify the effects of the location over social policies and over the quality of life of the social groups. The challenge of this research is also directly involved with the comprehension of the State performance, supposing that its different forms of action (or part of its bureaucracy) can generate iniquities in the offer of health services, thus contributing to increase the risks of morbi-mortality in different population groups. The results obtained indicate that there is a variation in the offer of basic health services in Campinas, according to the location of the equipment, and draw attention to the different degrees of vulnerability of the population facing such a situation / Doutorado / Demografia / Doutor em Demografia

Este foi um estudo populacional de caráter transversal, com o objetivo de determinar a prevalência da síndrome da fragilidade entre idosos em Ribeirão Preto e o perfil sócio demográfico e clínico desta população, além de avaliar associações entre fragilidade e alterações metabólicas. A amostra foi obtida de forma casualizada por conglomerados por área. Foram excluídos indivíduos com déficit cognitivo grave, acamados, em uso de cadeira de roda, portadores de sequelas grave de Acidente Vascular Cerebral, com Doença de Parkinson grave, idosos que estavam em estágio terminal ou em tratamento para câncer, exceto o de pele. Um instrumento padrão de avaliação foi elaborado incluindo várias características. Este estudo adotou critérios de fragilidade de acordo com a definição de Fried e colaboradores. Foram realizadas medidas do peso, altura, circunferência abdominal e da pressão arterial. As variáveis analisadas neste projeto são relativas às características sócio-demográficas, medidas antropométricas, pressão arterial e dados clínicos, além dos critérios do fenótipo da fragilidade. Ao total, 385 voluntários foram selecionados, sendo 64,7% do sexo feminino. A idade média dos participantes foi 73,9 ± 6,5 anos. Houve predominância da etnia branca, nível de escolaridade de 1 a 4 anos, estado civil casado, possuir quatro ou mais filhos. Treze por cento das mulheres referiu viver só. Entre os homens, 96,4% referiram ainda trabalhar e 77,9% referiram representar o principal sustento da casa. A renda familiar média foi de R$ 1.749,00. Hipertensão arterial sistêmica foi a doença auto-referida mais prevalente. Trinta por cento dos voluntários ingeriam dois ou três medicamentos ao dia. Mulheres utilizavam mais medicamentos que os homens (p=0,004). Não se observou diferença entre os níveis de pressão arterial sistólica ou diastólica e pressão arterial sistólica e diastólica ortostática entre os sexos. Idosos apresentaram maior média de circunferência abdominal (p<0,01), porém, 74,3% das mulheres encontravam-se com a circunferência abdominal acima do valor considerado como normal. A média do índice de massa corpórea dos homens foi de 26,6 ± 4,5 Kg/m2 e das mulheres foi de 27, 7± 5,3 Kg/m2 (p=0,03), No presente estudo, foram considerados como frágeis 9,1% da amostra, 49,6% como pré-frágeis e 41,3% como não-frágeis. Quanto aos critérios da síndrome da fragilidade 12,5% dos participantes apresentaram perda de peso no último ano; 20,5% fadiga; 17,1% lentidão; 24,4% baixo nível de atividade física e 20,5% baixa força de preensão palmar. O grupo dos frágeis apresentou maior média de idade (p<0,01). Quanto mais idoso o indivíduo, mais critérios ele pontuou para fragilidade. Idosos frágeis foram em mais consultas médicas (p=0,03) e tiveram maior chance de internação (p<0,001) no período de 12 meses. A circunferência abdominal e o índice de massa corpórea foram semelhantes em todos os níveis de fragilidade. Não foi observada diferença em relação à pressão arterial sistólica e diastólica nos três grupos de fragilidade. Ao comparar-se a pressão arterial ortostática entre os grupos, houve diferença limítrofe (p=0,06) quanto à diastólica, verificando-se, na análise pós-teste (Bonferroni), valor menor da pressão arterial no grupo dos frágeis do que no grupo dos não-frágeis (p=0,03). A pressão arterial ortostática sistólica foi semelhante em todos os grupos. Observa-se que houve forte correlação do índice de massa corpórea apenas com a circunferência abdominal, o que foi observado nos três níveis de fragilidade. Concluiu-se que 9,1% dos idosos de Ribeirão Preto são frágeis. Os idosos frágeis são mais velhos e tem maior chance de internação. A pressão arterial diastólica em ortostase tende a ser menor entre os frágeis. Há uma forte correlação entre índice de massa corpórea e circunferência abdominal em todos os níveis de fragilidade / This was across-sectional population study, with the objective of determining the prevalence of the syndrome of frailty among older individuals in Ribeirão Preto and sociodemographic and clinical profile of this population. And to evaluate associations between frailty and metabolic changes. The sample was randomly by clusters area. Exclusion criteria: severe cognitive impairment, bedridden, using a wheelchair, people with severe sequelae of stroke, severe Parkinson\'s disease, terminally ill or in treatment for cancer, except skin. A standard assessment tool was developed including various features. This study adopted criteria of frailty according to the definition of Fried et al. Weight, height, waist circumference and blood pressure were measured. The variables analyzed in this project are related to socio-demographic characteristics, anthropometric measurements, blood pressure and clinical profile, in addition to the criteria of the phenotype of frailty. In total, 385 volunteers were selected. The mean age was 73.9±6.5 years, with prevalence of female gender (64,7%), caucasian, married status, with education of 1-4 years, four or more children .Thirteen percent of women reported living alone. Among men, 96.4% reported still working and 77.9% reported that they represented the main breadwinner of the home. The median household income was R$ 1,749.00. Hypertension was the more prevalent self-reported disease.. Thirty percent of the volunteers ingested two or three medicines daily, with women using more than men (p=0.004). No difference was observed between the levels of systolic or diastolic blood pressure and systolic or diastolic orthostatic blood pressure between the sexes. Men had higher mean waist circumference (p <0.01), however, 74.3% of women were with waist circumference above of the considered normal. The mean of body mass index was 26.6±4.5 Kg/m2 for men and for women was 27.7±5.3 Kg/m2 (p =0.03). In the present study, 9.1% of the sample were considered as frail, 49.6% as pre-frail, and 41.3% were non-frail. Criteria used to define of frailty syndrome were evaluated and 12.5% of participants had weight loss in the last year, 20.5% exhaustion, 17.1% had slowness, 24.4% low activity and 20.5% had weakness. The frail group had higher mean age (p <0.01). Older individuals scored more criteria for frailty. Frail individuals were in more doctor visits (p=0.03)and had a greater chance of hospitalization (p <0.001) at 12 months. Waist circumference and body mass index were similar in all levels of frailty. There was no difference in systolic blood pressure and diastolic blood pressure in the 3 groups of frailty. When comparing orthostatic blood pressure among groups, there was borderline difference (p=0.06) in diastolic blood pressure. In the post-test analysis (Bonferroni), the frail group had lower diastolic blood pressure in orthostatic when compared with non-frail (p=0.03). Orthostatic systolic blood pressure was similar in all groups. It was observed that there was a strong correlation between body mass index with waist circumference, which was observed at all three levels of frailty. It was concluded that 9.1% of the elderly individuals in RibeirãoPreto are frail. The frail individuals are older and have a greater chance to hospitalization. Diastolic blood pressure while standing tends to be lower among frail ones. There is a strong correlation between body mass index and waist circumference in all levels of frailty.