Identificar los conocimientos, actitudes y experiencias respecto a la mutilación genital de un grupo de mujeres originarias de los países africanos donde es una tradición. Metodología: Estudio de naturaleza cualitativa que utiliza el método historias de vida. Los su-jetos son 24 mujeres procedentes de Senegal, Nigeria y Gambia que residen en la región de Murcia (España) desde hace 3 a 15 años. Los criterios de selección fueron: pertenecer a un país en que la mutilación genital femenina se practique de forma habitual, haber sufrido mutilación de sus genitales o tener vastos cono-cimientos sobre el tema, haber vivido hasta los 18 años en su país de origen. La recolección de datos se realizó mediante narración de historia de vida grabada y posteriormente transcrita. El análisis temático se realizó según Bardin y la cate-gorización según Minayo. RESULTADOS: Las mujeres entrevistadas fueron mutiladas genitalmente en su infancia o ado-lescencia, sin previo consentimiento, sin analgesia y bajo medidas higiénicas muy deficientes. La mujer encargada de realizarles el corte, adquiere un estatus social alto dentro de la comunidad. La mutilación genital femenina tiene impor-tantes consecuencias para su salud física, psicológica y sexual. Ésta práctica continúa realizándose por motivos religiosos, de limpieza, por tradición, como rito de paso de niña a mujer y por presión social. Ante las penas de cárcel que la legislación española prescribe para las mutilaciones genitales femeninas, las mu-jeres que se posicionan a favor de perpetuar la práctica en sus hijas, la conside-ran un ataque a su cultura. Las mujeres que se posicionan en contra de cortar a sus hijas encuentran un respaldo en la legislación y relacionan su cambio de acti-tudes con la información que recibieron sobre sus consecuencias. CONCLUSIONES: Las mujeres que se posicionan en contra de la mutilación genital femenina tie-nen más información sobre la práctica, que las que lo hacen a favor, también son conscientes de la vulneración de derechos que supone y advierten de la impor-tancia de la información, especialmente en las consecuencias para la salud, como factor clave para el cambio de actitudes que conduzca a su erradicación. Es por esto, que los profesionales de enfermería deben abordar la prevención de la mu-tilación de los genitales de las niñas mediante la educación de las familias pro-cedentes de países en los que se realiza habitualmente esta práctica. / To identify the knowledge, attitudes and experiences regarding the genital muti-lation of a group of women from the African countries where it is a tradition. METHODOLOGY Qualitative study that uses the life story method. The subjects are 24 women from Senegal, Nigeria and Gambia residing in the region of Murcia (Spain) for the last 3-15 years. The selection criteria were: belonging to a country where female genital mutilation is practiced regularly, having suffered genital mutila-tion or having vast knowledge on the subject and having lived up to the age of 18 in his home country. Data collection was performed by using recorded life story narration that was later transcribed. Thematic analysis was performed ac-cording to Bardin and categorization according Minayo. RESULTS The women interviewed underwent genital mutilation during their childhood or adolescence without consent, without analgesia and under very poor hygienic conditions. The circumciser acquires a high social status within the community. Female genital mutilation has important consequences on their physical, psycho-logical and sexual health. This practice continues due to social pressure, reli-gious and hygienic reasons and as a traditional rite of passage to womanhood. Faced with the prison sentences prescribed by Spanish law for female genital mutilation, the women who are in favour of continuing the practice on their daughters regard it as an attack on their culture. Women who are against cutting their daughters feel supported by law and relate their attitude change to the in-formation they received about their consequences. CONCLUSIONS Women who are positioned against female genital mutilation have more infor-mation on that practice than those who favour it. They are also aware that it in-volves rights violation and warn about the importance of information, especially about their consequences on health. For this reason, nurses must address the pre-vention of genital mutilation of girls by educating families from countries where it is usually practiced.

El objetivo global de esta tesis es examinar nuevos enfoques metodológicos referentes al análisis de costes y resultados para la evaluación económica de intervenciones sanitarias. Estos nuevos enfoques se aplican en tres estudios empíricos independientes, los cuales se presentan en los capítulos 2, 3 y 4. En el Capítulo 2 se analiza si la calidad de vida relacionada con la salud (CVRS) y la satisfacción con la vida están relacionadas de forma simultánea y se cuantifica el sesgo que se comete en caso de no tener en cuenta dicha simultaneidad. Los datos del estudio se obtuvieron de una encuesta con 870 individuos, representativos de la población general española en términos de edad y sexo. Los resultados obtenidos a partir de un sistema de ecuaciones simultáneas ponen de manifiesto que, efectivamente, la relación entre la CVRS y la satisfacción con la vida es simultánea, siendo el efecto de la CVRS sobre la satisfacción superior (casi un 20%) al efecto opuesto. Más importante, el hecho de no tener en cuenta la interdependencia entre la CVRS y la satisfacción con la vida da lugar a estimaciones sesgadas, infravalorando de forma considerable el efecto de la satisfacción con la vida sobre la CVRS (en torno a un 18%) y, en menor medida, el efecto contrario (aproximadamente un 6%). La existencia de una influencia mutua entre la CVRS y la satisfacción con la vida supone que las ganancias en CVRS no solo se pueden obtener por medio de intervenciones y políticas sanitarias, sino también gracias a otro tipo de acciones y políticas públicas (tales como educación y empleo) que, a través de su impacto directo sobre la satisfacción, pueden inducir efectos colaterales positivos sobre la CVRS. A su vez, las intervenciones y políticas sanitarias también se configuran como potentes herramientas para la mejora del bienestar subjetivo. Asimismo, el hecho de que la relación entre la CVRS y la satisfacción con la vida sea simultánea resalta la conveniencia de valorar de forma más amplia los resultados de las intervenciones sanitarias, no solo teniendo en cuenta aspectos estrictamente relacionados con la salud, sino también con la satisfacción con la vida. Por su parte, el Capítulo 3 presenta un estudio de valoración monetaria de los cuidados informales a personas en situación de dependencia a partir de las preferencias de cuidadores informales y no cuidadores. El estudio se basa en una encuesta en la que participaron 402 sujetos (202 cuidadores y 200 no cuidadores). A todos ellos se les presentó un escenario referido a una determinada situación hipotética de cuidados informales y se les plantearon tres preguntas en las que debían indicar la mínima compensación monetaria que demandarían –es decir, su disposición a aceptar (DAA)– por una hora extra de cuidados al día en términos generales, por una hora adicional diaria realizando la tarea menos preferida, y por una hora extra al día desempeñando la tarea más preferida. Además, a los cuidadores también se les preguntó por la compensación que requerirían en caso de tener que dedicar una hora adicional de cuidados al día a la persona bajo su cuidado. Los valores obtenidos en las tres preguntas de DAA relativas al escenario hipotético presentaron distribuciones similares en las dos muestras, ascendiendo los valores medios/medianos de la DAA (en términos generales) a 6,4 €/5,5 € en la muestra de cuidadores y a 6,5 €/5,5 € en la muestra de no cuidadores. En general, las valoraciones de los dos grupos fueron sensibles a y consistentes con las preferencias de los encuestados entre distintas tareas de cuidados, aunque una considerable proporción de sujetos (en torno a 25% en cada muestra) indicaron la misma cantidad en las tres preguntas de DAA referidas a la situación hipotética. A nivel agregado, los cuidadores exigieron una menor compensación monetaria por cuidar a su propio ser querido durante una hora extra al día (valores medio/mediano: 5,2 €/4,5 €) que si esa hora adicional la tuvieran que dedicar a cuidar a la persona descrita en el escenario hipotético. No obstante, más de la mitad de los cuidadores ofrecieron la misma cantidad bajo las dos situaciones (hipotética y real), lo cual sugiere que las valoraciones de este grupo se vieron influidas por su propia experiencia prestando cuidados informales. Por último, en el Capítulo 4 se investiga si el fenómeno de la inversión de preferencias –o preference reversal (PR)–– entre decisiones de elección y valoración se atenúa conforme los individuos aprenden mediante la adquisición de experiencia con dichas tareas. Para ello, se realizó un experimento, dividido en dos sesiones independientes, con el fin de distinguir entre el efecto de la mera repetición de tareas (primera sesión) y el efecto combinado de la repetición junto con la retroalimentación (segunda sesión). La muestra se compuso de 319 estudiantes de Grado de la Universidad de Murcia y se dividió en tres grupos atendiendo a la naturaleza de los resultados ofrecidos en las loterías: “dinero”, “años de vida” y “días sin dolor de espalda”. En ambas sesiones se obtuvo el típico patrón asimétrico de PR, siendo la inversión de preferencias estándar –o standard preference reversal (SPR)– mucho más frecuente que la inversión de preferencias no estándar –o non-standard preference reversal (NSPR). En concreto, en término medio, un 50% y 53% de encuestados mostraron SPR en las sesiones 1 y 2, respectivamente, mientras que tan solo un 1,5% y un 2,9% de individuos incurrieron en NSPR en las mismas sesiones. El efecto combinado de la repetición de tareas y de la retroalimentación contribuyó a reducir de forma significativa la frecuencia de SPR, al contrario que la repetición de tareas por sí misma. Como consecuencia de ello, el número de respuestas consistentes aumentó significativamente a lo largo de la segunda sesión, aunque dicha mejora se vio limitada debido a la tendencia creciente de NSPR en la misma sesión. Además, se obtuvo una mayor proporción de SPR en los dos grupos que fueron expuestos a resultados en salud (especialmente en el grupo en el que los resultados de las loterías se expresaron en términos de años de vida) que en el grupo en el que se emplearon resultados monetarios. A pesar de que PR es un fenómeno robusto y persistente, los resultados de este experimento reflejan que una posible vía para mitigar su aparición pasa por obtener preferencias en sesiones interactivas, donde los encuestados, además de realizar varias veces las mismas tareas, también tengan la oportunidad de reflexionar sobre las consecuencias de las decisiones adoptadas en dichas tareas. No obstante, esta solución puede dar origen a nuevos sesgos, tales como el aumento de NSPR observado en la segunda sesión del experimento. / The overall aim of this thesis is to examine new methodological approaches pertaining to the assessment of costs and outcomes for the economic evaluation of health care interventions. These new approaches are applied in the context of three independent empirical studies, which are reported in Chapters 2, 3 and 4. Chapter 2 aims to examine whether health-related quality of life (HRQoL) and life satisfaction are simultaneously related, as well as to quantify the bias that occurs if simultaneity is not accounted for. The study sample consisted of 870 respondents, representative of the Spanish adult general population. The results derived from a simultaneous equations system reveal that the relationship between HRQoL and life satisfaction is actually simultaneous, with the effect from HRQoL to life satisfaction being higher (almost 20%) than the opposite effect. More important, the fact of estimating the relationship between life satisfaction and HRQoL under a unidirectional approach yields biased estimates, substantially undervaluing the effect of life satisfaction on HRQoL (by around 18%) and, to a lesser extent, the reverse effect (by approximately 6%). The presence of a mutual influence between HRQoL and life satisfaction entails that HRQoL gains can be achieved not only by means of health care interventions and health policies, but also thanks to other types of actions and policies (such as education and employment) which, through their direct impact on life satisfaction, can prompt positive side effects on HRQoL. In turn, health care interventions and health policies can be effective tools for enhancing subjective well-being. Likewise, the fact that HRQoL and life satisfaction are simultaneously associated stresses the appropriateness of assessing the outcomes of health care interventions more broadly, considering not only aspects strictly related to health, but also to life satisfaction. On the other hand, Chapter 3 reports the results of a study for the monetary valuation of informal care based on the preferences of both informal carers and non-carers. The study is based on a survey with a sample of 402 individuals (202 informal carers and 200 non-carers). All respondents faced a hypothetical caring scenario and were asked three questions in which they had to state the minimum monetary compensation they would demand –that is, their willingness to accept (WTA)– for one extra hour of care per day in general terms, for one additional hour performing the most unpleasant task, and for one extra hour undertaking the least unpleasant task. Furthermore, informal carers were also asked for the compensation they would require if they had to be in charge of their actual care recipient for one extra hour per day. The values elicited in the three WTA questions referred to the hypothetical situation followed similar distributions in the two samples, with carers’ and non-carers’ mean/median WTA values (in general terms) amounting to €6.4/€5.5 and €6.5/€5.5, respectively. Overall, respondents’ valuations were sensitive to and consistent with their preferences over the tasks to be carried out in the extra hour of informal care, although a considerable proportion of subjects (around 25% in each group) provided the same value in the three hypothetical WTA questions. At the aggregate level, carers’ required a lower monetary compensation for one extra hour taking care of their loved one (mean/median WTA values €5.2/€4.5) than if they had to devote that time to look after the hypothetical care recipient. However, more than half of carers stated the same value under both situations (hypothetical and actual), which suggests that carers’ valuations were influenced by their own experience providing informal care. Finally, Chapter 4 tests whether the preference reversal (PR) phenomenon between choice and valuation decisions is attenuated as individuals learn through the acquisition of experience with those tasks. To that end, an experiment was conducted over two separate sessions, in order to distinguish the effect of the mere repetition of tasks (first session) from the joint effect of repetition and feedback (second session). Participants in the experiment were 319 undergraduate students at the University of Murcia (Spain). The sample was split into three groups, according to the nature of the lottery outcomes used: ‘money’, ‘years of life’ and ‘days without back pain’. The typical asymmetric pattern of PR was found in both sessions, being standard preference reversal (SPR) much more frequent than non-standard preference reversal (NSPR). To be exact, on average, 50% and 53% of respondents incurred in SPR in sessions 1 and 2, respectively, whereas the rate of NSPR in the same sessions was only 1.5% and 2.9%. The repetition of tasks in combination with feedback contributed significantly to attenuate the frequency of SPR, unlike the repetition of tasks on its own. This led to a significant rise in the number of consistent responses over the second session, although this improvement was limited due to the upward trend in NSPR over the same session. On the other hand, the rate of SPR was higher among those subjects who were exposed to health outcomes (especially in the group where the outcomes of the gambles were expressed in terms of years of life) than among those who faced monetary outcomes. Despite PR is a robust and persistent phenomenon, the results of this experiment reveal that a possible way to reduce its presence is to elicit preferences in interactive sessions, where respondents not only make the same tasks several times, but also have the opportunity to reflect on the consequences of the decisions made in those tasks. Nevertheless, this solution can lead to new biases, such as the rise in NSPR observed in the second session of the experiment.

Tesi doctoral que determina, a partir d'estudis quantitatius i qualitatius, quin és el procés a través del qual els nens i nenes en etapa preadolescent (9-12 anys) interioritzen valors i esterotips adults difosos a través de la publicitat convencional i no convencional i la possible incidència d'aquest procés en futurs trastorns del comportament alimentari.L'estudi aprofundeix en la interrelació entre aquesta interpretació preadolescent d'aquests estereotips publicitaris i l'aparició d'indicis d'una simptomatologia pròpia dels trastorns del comportament alimentari relacionada amb l'intent infantil de començar a adequar-se a uns determinats cànons estètics habituals en la publicitat adreçada a un públic objectiu adult. La present recerca analitza de forma comparativa la publicitat adreçada al públic objectiu adult i la que es dirigeix a un públic infantil, tot parant especial atenció a les similituds i a les divergències de les fórmules persuasives utilitzades, als hàbits difosos a través dels espots estudiats i a la generació d'estereotips físics, psíquics, socials i culturals. / Doctoral thesis that determines the process through preadolescents addopt values and stereotypes created and diffused by means of conventional and non-conventional advertising. Secondly, the research analizes the possible incidence of this process on future adolescent Eating Disorders. The study deepens on the relation between this preadolescent interpretation of the advertising stereotypes, and the apparition of signs of a symptom characteristic of Eating which use to appear on adult advertising. The research establishes, from a comparative point of view, the advertising strategies used for an adult target and the creative discourse addressed to children, paying special attention to resemblances and divergencies on the persuasive structures used on the advertising strategies, the behaviour habits diffused through the spots, and the generation of phisical, psychic, social and cultural stereotypes.

Coronary heart disease (CHD) is a leading cause of morbidity and mortality in the industrialised world, and places a heavy burden on society in terms of personal disability and health care costs. The first signs of CHD often present acutely as a myocardial infarction (AMI), commonly known as a heart attack. Survivors of a heart attack remain vulnerable to poor health-related quality of life (HRQOL), further cardiac events, and increased morbidity due to a progression of CHD. Thus, the implementation of interventions to reduce these risks is an important public health strategy. To date, secondary prevention and rehabilitation efforts post-AMI focus primarily on the patient. However, it is argued that recovery from AMI occurs within a social context, and that risk reduction strategies are likely to be enhanced if interventions take into account the impact of the event on the quality of life of patients and their partners. Evidence from a review of couple relationship literature indicates that a significant proportion of couples experiences poor HRQOL (i.e., physical and emotional wellbeing) when coping with stressful life events, and that interactive aspects of a couple relationship (i.e., dyadic functioning and behaviour) are associated with individual well-being at such a time. Information from studies of couples dealing with recovery from heart attack is sparse, but tends to reflect the findings from the broader literature. Further research is required with post-AMI couples, though, as there are a number of shortcomings associated with the existing evidence. For instance, it is derived from studies conducted with, mostly small, samples of convenience; many different instruments are used to collect the data; and no studies specifically measure HRQOL. Analytically, most evidence is obtained with univariate and bivariate statistics, and data are analysed as groups of patients or partners, as opposed to dyads. Where multivariable analyses are undertaken a number of bivariate relationships are no longer significant after accounting for covariates such as age and gender; and few researchers investigate predictive associations between dyadic functioning/behaviour and HRQOL outcomes. Finally, there is a paucity of information from comparative analyses. Thus, it is not known whether the well-being of post-AMI couples over time is better than, similar to, or worse than, for example, that in the general population. The research program underpinning this thesis, the QUT-AMI Project, comprised two studies designed to address these methodological issues. The first was an observational, cross-sectional, pilot study conducted in 1998 with 26 post-AMI couples. The main investigation was a prospective cohort study of 93 post-AMI couples undertaken in 1999-2000. In both studies the samples comprised a consecutive series of adult males younger than 75 years who had experienced a first AMI, and their female partners. The average couple in both studies was middle-aged, had been married for many years, and both members of the dyad were working at the time of the heart attack. Prospective participants were identified in major clinical centres that admit cardiac patients, and couples were recruited to the project soon after the patient's heart attack. Clinical data were collected in hospital. Further data were collected with self-administered questionnaires during a home visit at 1 month (pilot and main study), and by mailed questionnaire or during a home visit at 6 months(main study) after the heart attack. The pilot study was undertaken to test recruitment and data collection procedures in preparation for the second (main) study, measure couples' HRQOL at 1 month after the event using the SF-36, and qualitatively investigate life issues for couples coping with recovery from AMI. In the main study couples' HRQOL outcomes were measured at 1 and 6 months post-AMI using the SF-36, and examined for changes over that time. The outcomes were also compared with those from matched population norms to estimate the impact of a heart attack on couples' HRQOL during the early and later recovery period. Additionally, the following relationships were investigated to determine the extent to which:* patients' dyadic functioning (e.g. happiness/satisfaction with relationship, measured with the Marital Adjustment Scale) and use of dyadic behaviour (e.g., hiding concerns and negative feelings from the other member of the dyad, measured with the Protective Buffering Scale) at 1 month predicted patients' emotional well-being at 6 months post-AMI;* partners' dyadic functioning and behaviour at 1 month predicted partners' emotional well-being at 6 months post-AMI;* patients' and partners' dyadic functioning at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI; and* patients' and partners' dyadic behaviour at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI. Exploratory analyses were also undertaken to determine the effect of dyadic discrepancies in functioning and behaviour, at 1 month after the heart attack, on patients' and partners' emotional well-being at 6 months after the event. Important findings were as follows:* At 1 month after an AMI the HRQOL of couples is impaired. The major impact is on physical well-being for patients, and emotional well-being for their partners.* In general, couples' HRQOL improves between 1 and 6 months after an AMI.* At 6 months after an AMI, the HRQOL of average couples is similar to that of their peers in the normal population.* There are subgroup variations in the quality of life of post-AMI couples, and these are associated with age, clinically poor physical health, and depression.* The combination of patients' and partners' use of dyadic behaviour at 1 month after an AMI explains 7% of the variation in patients' emotional well-being at 6months after the event, after adjustment for patients' concurrent physical wellbeing and prior levels of emotional well-being, as well as duration of couple relationships.* The combination of partners' perceptions of dyadic functioning and use of dyadic behaviour at 1 month after an AMI explains 5% of the variation in partners' emotional well-being at 6 months after the event, after adjustment for partners' concurrent physical well-being and prior levels of emotional well-being, as well as duration of couples' relationships.* Patients have poorer emotional well-being at 6 months after an AMI if partners use dyadic behaviour infrequently at 1 month after the event.* Partners have poorer emotional well-being at 6 months after an AMI if they are not satisfied/unhappy with the functioning of their relationships at 1 month after the event. Adjusted exploratory analyses, undertaken to determine the extent to which dyadic discrepancies in perceptions of functioning or use of protective buffering behaviour, predict emotional well-being, show that patients who are less satisfied/unhappier with functioning than their partners at 1 month after an AMI have poor emotional wellbeing at 6 months after the event; patients who use the behaviour more frequently than their partners at 1 month after an AMI have poor emotional well-being at 6months after the event; and partners who are less satisfied/unhappier with functioning than their patients at 1 month after an AMI have poor emotional well-being at 6months after the event. The evidence from the QUT-AMI Project supports the proposition that the interaction that occurs within a couple relationship, combined with individual characteristics of members of a dyad, influences the extent to which a heart attack impacts on couples' HRQOL. It is argued that it is not enough to merely focus on implementing secondary prevention strategies with post-AMI patients. Given that poor emotional well-being is known to predict adverse cardiac events, and premature mortality due to cardiac disease, it is recommended that a couple-focused intervention designed to meet specific needs should be implemented with at-risk couples as a public health strategy to improve not only the patients' quality of life but also that of his partner. Further research is recommended to determine the extent to which such an intervention improves post-AMI couples' quality of life.

Background: Prostitution has been documented in most societies, although the context in which it occurs may vary greatly. In Queensland, Australia, sex workers can operate from legal brothels or privately but all other sectors of the sex industry are prohibited. It is assumed that regulation of the sex industry through legalization leads to better health and social outcomes for sex workers and their clients. However, this assumption has rarely been subjected to empirical scrutiny. Aims: This research examined the occupational health and safety of female sex workers in Queensland and explored the relationship between legislative change, workplace violence, mental health and job satisfaction. Sex workers interviewed in 2003 (after legalisation) were compared to a prior study of this population conducted in 1991 (before official regulation of the sex industry). Further, in-depth analysis of the 2003 cohort compared sex workers employed in legal and illegal sectors, to assess violence, health status and job satisfaction. Methods: Cross-sectional, convenience sampling was used to collect data from female sex workers in 2003. This data was compared with data collected earlier (in 1991) and explored differences in the two samples using bivariate analysis. Similar recruitment strategies on both occasions were used to recruit women from all known sectors of the Queensland sex industry. The 1991 comparison sample (Boyle et al. 1997) included 200 women (aged between 16 and 46 years), and in 2003, 247 women (aged 18 to 57) participated. The 2003 sample included workers from legal brothels (n=102), private sole-operators (n=103) and illegal street-based sex workers (n=42). Using data collected in 2003, this study assessed the relationship between physical and mental health and job satisfaction and two main independent variables, i.e., current work sector and recent workplace violence. Bivariate analysis of physical health and independent variables showed no significant relationships and therefore further analysis was not undertaken. However, analysis of mental health and job satisfaction showed complex interactions between multiple variables and therefore linear modeling was performed to adjust for confounding. Results: Analysis of the 1991 and 2003 samples showed little apparent change over time in self-reported sexually transmitted infections (STIs). There were substantial changes over time in the types of sexual services being provided to clients, with the 2003 sample more likely to provide 'exotic' services. Violence experienced ever in their lifetime differed; in 1991, 29% reported having ever been raped compared with 42% in 2003 (p= &lt0.01). In 2003, 50% of illegal sex workers reported having ever been raped by a client compared with 12% of private sex workers and 3% of brothel-based sex workers (p=&lt0.01). Overall, the sex workers reported roughly equivalent job satisfaction to Australian women. A desire to leave the sex industry was most strongly correlated with reduced job satisfaction (p=&lt0.01). Satisfaction was also relatively low among those whose family was not aware of their sex work (p=&lt0.01). Similarly, the mental and physical health of this sample was comparable to age-matched women from the general population. Wanting to leave the sex industry was most strongly associated with poor mental health (p=&lt0.01), as was recent sexual or physical assault by a client (p=0.06) and the woman's main work sector (p=0.05). Illegal sex workers reported substantially lower mental health scores than their counterparts in legal sex work. Conclusions: Self-reported STI diagnosis was high in these samples but the prevalence appears not to have changed over time. Comparing 2003 to 1991, there were trends towards safer and more diverse sexual practices. It is likely the sex industry has 'professionalized' and now includes more sex workers providing specialist, 'exotic' services. This sample of female sex workers reported high rates of violence, with those working illegally at greatest risk. Analysis suggests a complex interaction between variables contributing to mental health and job satisfaction. In general, it appears that the majority of sex workers enjoyed at least as much job satisfaction as women working in other occupations. It also appears that this sample had equivalent mental health to women from the general population, although the sub-group of illegal workers generally had poorer health. Job satisfaction and the extent of workplace hazards (especially risk of violence) were also strongly associated with different sectors of the sex industry. It is probable that legalisation has benefited some (perhaps most) but there are health and safety concerns for those outside the legal framework. Legislative reform should focus on violence prevention, promoting reporting of violent events to police, and further exploration of the impact of legislation on the health of workers in the sex industry.

L'objectif dans cette recherche expérimentale est de contribuer à la compréhension des phénomènes de l'endommagement et de la fissuration dans les sols argileux saturés sous chargement hydrique (dessiccation) et mécanique (chemins de contrainte). L'étude mécanique est axée sur l'identification des propriétés élastiques du matériau endommagé sous chargement triaxial à différents niveaux et chemins de contrainte. Les principaux points traités étaient, l'influence de la contrainte de consolidation (p'ic), du degré de surconsolidation (OCR) et du chemin de contrainte sur la vitesse d'onde de compression. Les résultats montrent que les propriétés élastiques sont affectées et évoluent avec la déformation. La contractance semble augmenter la vitesse d'onde de compression à mesure que p'ic croît et densifie le matériau. En revanche, la dilatance semble plutôt diminuer la vitesse d'onde de compression. Par ailleurs, différents chemins triaxiaux conduits à un niveau de contrainte donné ont montré que les vitesses d'onde sont très proches si les chemins sont normalement consolidés. Les vitesses sont proches également si les chemins sont surconsolidés. En revanche, à un même état de contrainte, la vitesse d'onde est différente si on compare un chemin normalement consolidé avec un chemin surconsolidé. La deuxième partie de l'étude porte sur une analyse approfondie des mécanismes d'amorçage et de propagation des fissures sous dessiccation libre et contrôlée d'une argile initialement saturée. L'analyse via la corrélation d'images numériques (CIN) a permis, en premier lieu, une caractérisation multiéchelle du phénomène de retrait opéré au cours du séchage. Différents phénomènes ont été identifiés : le phénomène de relaxation, caractérisé par un changement de signe de la déformation locale extension / compression, le mécanisme de fissuration par extension (mode I), identifié par la cartographie des directions des déformations principales. L'étude a été complétée par des essais de traction indirecte par flexion 3 points réalisés sur des poutrelles de kaolin K13 initialement soumises à différentes succions. L'effet de la succion initiale sur la résistance à la traction a donc été observé. Les résultats montrent que plus la succion initiale est élevée, plus la pente de la courbe de variations de la résistance à la traction est élevée. D'autre part, la déformation de la zone tendue de la poutrelle atteint sa valeur critique lorsque la contrainte atteint la résistance maximale à la traction de l'argile / The objective of this experimental research is to contribute to understanding phenomena of damage and cracking in saturated clay soils under hydric loading (desiccation) and mechanical loading (stress paths). Mechanical study focuses on identifying the elastic properties of the damaged material under triaxial loading at different levels and stress paths. The main issues were the influence of; the consolidation stress (p'ic), the overconsolidation ratio (OCR) and the stress path on the compression wave velocity. The results show that the elastic properties are affected and evolve with strain. Contractancy appears to increase the compression wave velocity as p'ic increase and densifies the material. However, dilatancy seems rather decrease the compression wave velocity. Moreover, various triaxial paths performed at a given stress level showed that the wave velocities are very close if the paths are normally consolidated. Velocities are also close if the paths are overconsolidated. However, at the same stress state, the wave velocity is different when comparing a normally consolidated path with an overconsolidated path. The second part of the study focuses on a thorough analysis of the cracks' initiation and propagation mechanisms under free and controlled desiccation on initial saturated clay. Analysis via the digital image correlation (DIC) allowed, first, a multi-scales characterization of the shrinkage phenomenon operated during drying. Different phenomena were identified; the relaxation phenomenon characterized by a change of the local strain's sign extension / compression, the cracking mechanism by extension (mode I) identified by the map of the directions of the principal strains. The study was completed with indirect tensile tests by bending performed on kaolin k13 beams initially submitted to different suctions. The effect of the initial suction on the tensile strength has been observed. The results show that more the initial suction is high, the greater the slope of the curve of changes in the tensile strength is high. On the other hand, strain of the tension zone of the beam reaches its critical value when the stress reaches the maximum tensile strength of the clay

The dissertation {\clq}qHealth Related Quality of Life (HRQoL) in Eating Disorders`` is divided into theoretical and practical part. In the theoretical part is analyzes the problems with eating disorders. It is especially focused on its two basics forms, anorexia nervosa and bulimia which are illnesses occasioned by hypothrepsia. The next part drala with history, symptoms, cause, medication, process, prognosis and complications resulting from these disorders, including the main diagnostic criteria and prevalence data. Women are affected by both diseases more frequently than man. Mental anorexia occurs mostly between the 14th and 15th year of the life, mental bulimia at the age of 13 to 20 years. The second part is practicaly aimed at evaluation of SF-36 forms, where I verify hypotheses how eating disorders influence quality of life of theirs carriers and how the changes in quality of life are dependant on the grade of education. The analysed results indicate the difference between the sick and the healthy individuals and also the fact the level of education is important too.

This thesis focuses on the attitudes and policies which shaped the history of pulmonary tuberculosis in the Cape from 1870 to 1920 and culminated in the passing of the Public Health Act, Act 36 of 1919. It was this act which formed the basis of public health legislation in South Africa until the 1970s. The thesis is a contribution to the history of medicine and to the history of legislation. Topics explored include pulmonary tuberculosis and its early global history. When the practice of sufferers visiting places with particular climates became fashionable, towns in the Karoo became a popular destination. Their journey to the colony, together with their experience in Cradock is the subject of a chapter. Once the disease spread to the local population, the focus shifted to the attitudes and policies of the local authorities and their failure to address its spread. In contrast, in Cape Town the city council and its medical officer of health took up the challenge, but with limited success. The fight against tuberculosis was assisted by a number of dedicated individuals such as Dr Neil Macvicar who was the founder of the Native Health Society. The Society for the Prevention of Consumption, which was officially launched in Cape Town in June 1904, also contributed to educating the public about the disease. Once the Cape Colony entered into political Union in 1910 there was the added dimension of tuberculosis on the mines and the reluctance of mine officials to take care of workers suffering from the disease. This became an issue during the proceedings of the Tuberculosis Commission. The attitudes and prejudices towards the local population became formalised in the Public Health Act, Act 36 of 1919 because the act was drafted with the health of the white population in mind. By providing a skeleton budget for local authorities to deal with tuberculosis, the legislature ensured that the healthcare of the majority of the population, especially those who were most vulnerable to the disease, was not addressed. The legacy of that decision continues to haunt South Africa to the present day. / History / D.Litt.et Phil. (History)

O presente trabalho propôs-se a investigar a conveniência e a possibilidade de introdução, no ordenamento brasileiro, de iniciativas à semelhança dos pre-action protocols (Protocolos) e da Part 36 Offer (Oferta) do direito inglês, em vigor desde o advento das Civil Procedure Rules, em 1999. Aqueles, uma espécie de procedimento que se desenrola antes do processo judicial, incentivando o diálogo e a troca de informações e produção de prova entre as partes, cujo descumprimento importaria a incidência de multa; esta, uma oferta de acordo cuja rejeição ou aceitação traria consigo conseqüências patrimoniais às partes envolvidas na controvérsia, também representada pela aplicação de uma (outra) multa. Embora não indissociáveis, acredita-se que, juntos, potencializam-se mutuamente. Observaram-se os efeitos práticos da experiência inglesa, contemplando seus pontos fortes e fracos, chegando-se a um balanço positivo. Justificados os méritos dos institutos, entendeu-se possível a implantação de sistemática semelhante no Brasil, feitos certos ajustes. Observou-se, ainda, que um dos grandes méritos dos protocolos é a promoção do acordo informado, não do acordo motivado principalmente pela ineficiência e pela demora na prestação jurisdicional. Assim, propôs-se a elaboração de protocolos, preferindo-se os específicos ao genérico, incutindo na população e nos operadores do direito a cultura do diálogo e da cooperação na troca de informações. Observaram-se, ainda, os efeitos que a conduta das partes no desenrolar do protocolo geraria dentro do processo. Propôs-se, ainda, a introdução do que se chamaria de OPAc Oferta Potencializada de Acordo, à semelhança da Oferta inglesa, mas com conseqüências patrimoniais (multa) calculadas sobre a diferença apurada entre a OPAc e a condenação final, no processo, como forma de criar incentivos suficientes, mas não opressivos. / This paper seeks to investigate the desirability and the possibility of introducing, in the Brazilian law, initiatives such as the pre-action protocols (\"Protocols\") and Part 36 Offer (\"Offer\") of the English law, in force since the advent of the Civil Procedure Rules in 1999. The former, a kind of procedure that takes place before the judicial proceedings, encouraging the dialogue, the exchange of information and the disclosure of evidence between the parties, and which failure results in the application of a fine; the latter, a settlement offer which rejection or acceptance would entail financial consequences to the parties to the dispute, also represented by the application of a (another) fine. Although not inseparable, it is believed that, taken together, Protocols and Offer enhance each others effects. The analysis of the practical results of the British experience, considering its strengths and weaknesses, led to a positive balance. Once the merits of those mechanisms have been justified, the implementation in Brazil of a similar systematic provided certain adjustments are undertaken was considered possible. It was also observed that one of the great values of the Protocols is promoting well-informed agreements, instead of settlements mainly motivated by the inefficiency and delay of adjudication. Thus, the drafting of protocols was proposed, preferably the specific over the generic ones, introducing to the people as well as to the legal community a culture of dialogue and cooperation in the exchange of information and evidence. The effects that the conduct of the parties while following the Protocol would generate in the judicial proceedings were also analyzed. Moreover, we proposed the introduction of the so-called OPAc - Oferta Potencializada de Acordo (Enhanced Settlement Offer) - similar, in its concept, to the British Offer, albeit bearing financial consequences (fines) calculated over the difference between the OPAc and the amount as per the decision handed down by the judge, in order to create sufficient - but not oppressive - incentives.

Répondre aux défis du développement durable exige la prise en considération des aspects économiques, sociétaux et environnementaux des projets. Dans le domaine des terrassements, les actions portent notamment sur l'optimisation de la valorisation des matériaux extraits grâce aux techniques de traitement des sols. Le projet s'est principalement porté sur les produits de traitement dérivant de la transformation de matières premières renouvelables : solutions « enzymatiques », lignosulfonates et solutions acides. Des données factuelles concernant les effets des traitements sur les caractéristiques hydromécaniques de quatre sols (un limon, un sol argileux et deux sables) ont été acquises mettant en évidence une augmentation de l'efficacité du compactage après traitement du limon au produit enzymatique et au lignosulfonate. La recherche des mécanismes d'action s'est fondée sur une étude de la microstructure par microscopie électronique à balayage et porosimétrie au mercure complétée par l'évaluation des effets d'un ajout de produits tensioactifs sur les propriétés des sols. L'objectif de l'étude dépasse cependant l'évaluation des modalités d'action des produits et vise également à prendre en compte les préoccupations environnementales. Ainsi, une étude d'analyse du cycle de vie a été menée pour chaque application ce qui a permis d'identifier les conditions optimales pour lesquelles les traitements combinent intérêts techniques et environnementaux. Ces conditions sont réunies lors du compactage des sols secs sous réserve que l'étape de production et de transport des produits ne soit pas excessivement pénalisante comme mis en évidence lors de l'étude de sensibilité / Sustainable development principles lead earthworks companies to use all natural materials and to reduce the environmental impact of their activities. In this context, the use of industrial organic products derived from the processing of renewable matter has been proposed. In this study, three non traditional products have been selected: an enzymatic solution, a lignosulfonate and an acid solution. In a first approach, hydromechanical properties of four treated soils (a silt, a clayey soil and two sands) were investigated. The experimental results showed interesting applications for the silt when its natural water content is low. Indeed, the compaction ability of the soil was increased after enzymatic and lignosulfonate treatments. Thus, savings of water and energy could be expected during the construction stage. To gain a better understanding of the mechanisms of the treatment products, the microstructure of treated soil were investigated with scanning electron microscopy, mercury injection porosity and was completed by the study of a surfactant addition in soils. The global aim of the study was beyond the characterization of mechanical behavior of treated soils, therefore, environmental balance was also estimated for the different applications defined in accordance to the experimental results. For enzymatic and lignosulfonate treatments, a comparison of the global environmental impact was done thanks to a life cycle assessment methodology. This approach showed that technical and environmental interest are associated for the compaction of dry soils when the production and transport steps have limited environmental impact as demonstrated in the sensitivity analysis