Contexte: Les facteurs de risque comportementaux, notamment l’inactivité physique, le comportement sédentaire, le tabagisme, la consommation d’alcool et le surpoids sont les principales causes modifiables de maladies chroniques telles que le cancer, les maladies cardiovasculaires et le diabète. Ces facteurs de risque se manifestent également de façon concomitante chez l’individu et entraînent des risques accrus de morbidité et de mortalité. Bien que les facteurs de risque comportementaux aient été largement étudiés, la distribution, les patrons d’agrégation et les déterminants de multiples facteurs de risque comportementaux sont peu connus, surtout chez les enfants et les adolescents. Objectifs: Cette thèse vise 1) à décrire la prévalence et les patrons d’agrégation de multiples facteurs de risque comportementaux des maladies chroniques chez les enfants et adolescents canadiens; 2) à explorer les corrélats individuels, sociaux et scolaires de multiples facteurs de risque comportementaux chez les enfants et adolescents canadiens; et 3) à évaluer, selon le modèle conceptuel de l’étude, l’influence longitudinale d’un ensemble de variables distales (c’est-à-dire des variables situées à une distance intermédiaire des comportements à risque) de type individuel (estime de soi, sentiment de réussite), social (relations sociales, comportements des parents/pairs) et scolaire (engagement collectif à la réussite, compréhension des règles), ainsi que de variables ultimes (c’est-à-dire des variables situées à une distance éloignée des comportements à risque) de type individuel (traits de personnalité, caractéristiques démographiques), social (caractéristiques socio-économiques des parents) et scolaire (type d’école, environnement favorable, climat disciplinaire) sur le taux d’occurrence de multiples facteurs de risque comportementaux chez les enfants et adolescents canadiens. Méthodes: Des données transversales (n = 4724) à partir du cycle 4 (2000-2001) de l’Enquête longitudinale nationale sur les enfants et les jeunes (ELNEJ) ont été utilisées pour décrire la prévalence et les patrons d’agrégation de multiples facteurs de risque comportementaux chez les jeunes canadiens âgés de 10-17 ans. L’agrégation des facteurs de risque a été examinée en utilisant une méthode du ratio de cas observés sur les cas attendus. La régression logistique ordinale a été utilisée pour explorer les corrélats de multiples facteurs de risque comportementaux dans un échantillon transversal (n = 1747) de jeunes canadiens âgés de 10-15 ans du cycle 4 (2000-2001) de l’ELNEJ. Des données prospectives (n = 1135) à partir des cycle 4 (2000-2001), cycle 5 (2002-2003) et cycle 6 (2004-2005) de l’ELNEJ ont été utilisées pour évaluer l’influence longitudinale des variables distales et ultimes (tel que décrit ci-haut dans les objectifs) sur le taux d’occurrence de multiples facteurs de risque comportementaux chez les jeunes canadiens âgés de 10-15 ans; cette analyse a été effectuée à l’aide des modèles de Poisson longitudinaux. Résultats: Soixante-cinq pour cent des jeunes canadiens ont rapporté avoir deux ou plus de facteurs de risque comportementaux, comparativement à seulement 10% des jeunes avec aucun facteur de risque. Les facteurs de risque comportementaux se sont agrégés en de multiples combinaisons. Plus précisément, l’occurrence simultanée des cinq facteurs de risque était 120% plus élevée chez les garçons (ratio observé/attendu (O/E) = 2.20, intervalle de confiance (IC) 95%: 1.31-3.09) et 94% plus élevée chez les filles (ratio O/E = 1.94, IC 95%: 1.24-2.64) qu’attendu. L’âge (rapport de cotes (RC) = 1.95, IC 95%: 1.21-3.13), ayant un parent fumeur (RC = 1.49, IC 95%: 1.09-2.03), ayant rapporté que la majorité/tous de ses pairs consommaient du tabac (RC = 7.31, IC 95%: 4.00-13.35) ou buvaient de l’alcool (RC = 3.77, IC 95%: 2.18-6.53), et vivant dans une famille monoparentale (RC = 1.94, IC 95%: 1.31-2.88) ont été positivement associés aux multiples comportements à risque. Les jeunes ayant une forte estime de soi (RC = 0.92, IC 95%: 0.85-0.99) ainsi que les jeunes dont un des parents avait un niveau d’éducation postsecondaire (RC = 0.58, IC 95%: 0.41-0.82) étaient moins susceptibles d’avoir de multiples facteurs de risque comportementaux. Enfin, les variables de type social distal (tabagisme des parents et des pairs, consommation d’alcool par les pairs) (Log du rapport de vraisemblance (LLR) = 187.86, degrés de liberté = 8, P < 0,001) et individuel distal (estime de soi) (LLR = 76.94, degrés de liberté = 4, P < 0,001) ont significativement influencé le taux d’occurrence de multiples facteurs de risque comportementaux. Les variables de type individuel ultime (âge, sexe, anxiété) et social ultime (niveau d’éducation du parent, revenu du ménage, structure de la famille) ont eu une influence moins prononcée sur le taux de cooccurrence des facteurs de risque comportementaux chez les jeunes. Conclusion: Les résultats suggèrent que les interventions de santé publique devraient principalement cibler les déterminants de type individuel distal (tel que l’estime de soi) ainsi que social distal (tels que le tabagisme des parents et des pairs et la consommation d’alcool par les pairs) pour prévenir et/ou réduire l’occurrence de multiples facteurs de risque comportementaux chez les enfants et les adolescents. Cependant, puisque les variables de type distal (telles que les caractéristiques psychosociales des jeunes et comportements des parents/pairs) peuvent être influencées par des variables de type ultime (telles que les caractéristiques démographiques et socioéconomiques), les programmes et politiques de prévention devraient également viser à améliorer les conditions socioéconomiques des jeunes, particulièrement celles des enfants et des adolescents des familles les plus démunies. / Background: Behavioural risk factors including physical inactivity, sedentary behaviour, cigarette smoking, alcohol drinking, and being overweight are major modifiable causes of chronic diseases such as cancer, cardiovascular diseases and diabetes. These lifestyle risk factors also co-occur in individuals and lead to increased risks of chronic diseases morbidity and mortality. Although single behavioural risk factors have been extensively studied, little is known about the distribution, clustering patterns and potential determinants of multiple behavioural risk factors for chronic diseases, particularly in children and adolescents. Objectives: This thesis aims 1) to describe the prevalence and clustering patterns of multiple chronic disease behavioural risk factors in Canadian children and adolescents; 2) to explore potential individual, social and school correlates of multiple chronic disease behavioural risk factors in Canadian children and adolescents; and 3) to assess, based on the conceptual framework of this study, the longitudinal influence of selected individual (sense of self, sense of achievement), social (social relations, others’ behaviours) and school (collective commitment to success, comprehension of rules) distal variables (variables situated at an intermediate distance from behaviours), as well as selected individual (demographics and personality traits), social (parental socioeconomic characteristics) and school (type of school, supportive environment, disciplinary climate) ultimate variables (variables situated at an utmost distance from behaviours) on the rate of occurrence of multiple chronic disease behavioural risk factors in Canadian children and adolescents. Methods: Cross-sectional data (n = 4724) from Cycle 4 (2000-2001) of the National Longitudinal Survey of Children and Youth (NLSCY) were used to describe the prevalence and clustering patterns of multiple behavioural risk factors in Canadian youth aged 10-17 years. Clustering was assessed using an observed to expected ratio method. Ordinal logistic regression was used to explore correlates of multiple behavioural risk factors in a cross-sectional sample (n = 1747) of Canadian youth aged 10-15 years from Cycle 4 (2000-2001) of the NLSCY. Prospective data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the NLSCY were used to assess the longitudinal influence of selected distal and ultimate variables (as described above in the objectives) on the rate of occurrence of multiple behavioural risk factors in Canadian youth aged 10-15 years; this analysis was performed using longitudinal Poisson models. Results: Sixty-five percent of Canadian youth had two or more behavioural risk factors compared to only 10% with no risk factor. Behavioural risk factors clustered in multiple combinations. Specifically, the simultaneous occurrence of all five risk factors was 120% greater in males (observed/expected (O/E) ratio = 2.20, 95% confidence interval (CI): 1.31-3.09) and 94% greater in females (O/E ratio = 1.94, 95% CI: 1.24-2.64) than expected by chance. Older age (odds ratio (OR) = 1.95, 95% CI: 1.21-3.13), caregiver smoking (OR = 1.49, 95% CI: 1.09-2.03), reporting that most/all of one’s peers smoked (OR = 7.31, 95% CI: 4.00-13.35) or drank alcohol (OR = 3.77, 95% CI: 2.18-6.53), and living in a lone-parent family (OR = 1.94, 95% CI: 1.31-2.88) increased the likelihood of having multiple health risk behaviours. Youth with high self-esteem (OR = 0.92, 95% CI: 0.85-0.99) and youth from families with post-secondary education (OR = 0.58, 95% CI: 0.41-0.82) were less likely to have a higher number of behavioural risk factors. Finally, social distal variables (caregiver smoking, peer smoking, peer drinking) (Log-likelihood ratio (LLR) = 187.86, degrees of freedom = 8, P < 0.001) and individual distal variables (such as self-esteem) (LLR = 76.94, degrees of freedom = 4, P < 0.001) significantly influenced the rate of occurrence of multiple behavioural risk factors. Individual ultimate variables (age, sex, anxiety) and social ultimate variables (parental education, household income, family structure) exerted a less pronounced influence on the rate of co-occurrence of behavioural risk factors among youth. Conclusion: The results suggest that public health interventions should primarily target the individual distal (such as self-esteem) and social distal variables (such as parental smoking, peer smoking and peer drinking) to reduce or prevent the occurrence of multiple behavioural risk factors among youth. However, since distal variables (such as psychosocial characteristics and others’ behaviours) may be influenced by ultimate variables (such as demographic and socioeconomic characteristics), prevention programs and policies should also aim to improve the socioeconomic conditions of children and adolescents, particularly those of youth from less affluent families.

No description available.

This qualitative study focuses on the experiences of adults with Charcot-Marie-Tooth disease (CMT), a neuromuscular condition, and explores what living with this disease encompasses. The study is structured around two fundamental research questions that amount to people's experiences regarding how (in which areas) the disease affects them, and how they continuously deal with it. In order to address the research questions, data gathered from participants was qualitatively analysed, using grounded theory methodology. The study culminated in the formulation of a substantive grounded theory as to how affected people manage the disease's manifestations in order to optimise their continuous adaptation and well-being. A tripartite of concerns comprised the core concern, whereas the basic social psychological process of engaging with CMT emerged as the core strategy used by affected people to deal with the concerns. The core's three sub processes constituted three mostly sequential stages that CMT-affected people pass through in their adaptation to the disease. The identified theory and existing stage models of adaptation to chronic illnesses and disabilities were juxtaposed and discussed. The three stages were compared to and integrated with the relevant literature. These actions revealed that there are a number of new formulations and processes contained in all three stages, and that the first and last stages (orientating and optimising) are themselves unique. It emerged that there is no theoretical end-point to the adaptation process, but that a relative saturation point amounted to a variant of an outcome, called qualified wellness. For most, the core strategy was successful in resolving the main concern. A few, however, still experienced fear and agony about inheritance and dependency issues. This study contributes, via the route of knowledge and insight empowerment, to the well-being of people with CMT, including those who are struggling but do not know that they have this disease. Broadening of insight may also benefit medical help professionals and streamline service delivery. / Psychology / D. Litt. et Phil. (Psychology)

People expenencmg chronic pain encounter increases m needs and endure the consequences of failure to satisfy needs. In much of the management of people with chronic pain, chronic pain is considered an abstract phenomenon with little attention given to the human experience. Numerous literature focus on a mechanistic reductionistic approach in management of chronic pain. Most literature is written by medical practitioners, nurses and psychologists from a health-care oriented methodology, whereas minimal research literature was contributed from a pastoral care and counselling perspective. This dissertation explores the needs and feelings of people with chronic pain to identify their needs at the various developmental stages of their pain experience, and within their relevant ecosystems, in order to develop a pastoral response. / Philosophy, Practical and Systematic Theology / M. Th. (Practical Theology)

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Design in the Faculty of Informatics and Design at the Cape Peninsula University of Technology, 2012 / Home-Based Health Care (HBHC) is the provision of health services and social assistance to individuals in their homes. It is an indispensable service to communities in need; presently in South Africa, these health care services are provided by local non-profit and non-governmental organizations. It is mainly targeted at poverty-stricken and under resourced communities and is an important aspect of healthcare in South Africa. A lot of communities in South Africa are still under-resourced and live in impoverished conditions. This is reflected in poor living standards characterized by unemployment, uneasy access to basic amenities, unequal distribution of wealth, poor medical facilities in rural communities, etc. The prevalence of the HIV/AIDS endemic has also worsened the situation. However, the South African government has constantly supported initiatives to enhance better healthcare in rural communities. This research presents a case study of caregivers working in Du Noon, an informal settlement in Western Cape, South Africa. Du Noon is overpopulated and home to lots of foreigners who have migrated in search of better living standards thus stretching an already over-burdened community. Naturally, this development supports poor health practices which encourage the spread of diseases within the community. Health facilities do not sufficiently cater for the ever-increasing healthcare demands and as such lots of people depend on NGOs such as SALT (Sharing Abundant Life Together) who through the help of caregivers and community workers have been providing for some of the healthcare needs of the Du Noon community since 2000. Findings reveal that although caregivers in this community have lots of stories to share about their work practices, they do not have a platform to share these stories. This research focuses on identifying processes involved in capturing these stories and moderating them into educative and entertaining visual contents for the purpose of sharing the stories within the community. Using qualitative research methods, empirical and field study provides the needed data as well as understanding of the multi-dynamism of this community. Data analysis is done through interpretive methods for the purpose of understanding the data collected and analysed during the research process. Finally, as a possible research contribution, the research concludes by examining how other technology can enhance the storytelling experience using interaction design methods that enables caregivers participate in the entire design process. Suggestions are also given as to direction for further research within the subject area.

Introdução: A realização do eletrocardiograma (ECG), através do Sistema de Tele- ECG, é ferramenta fundamental para aprimorar a assistência às Doenças Crônicas Não Transmissíveis (DCNT) na Atenção Primária de Saúde (APS). Aprimorar o conhecimento dos enfermeiros que atuam nesse âmbito da assistência na realização e avaliação do ECG adequadamente deve contribuir diretamente na prevenção das Doenças Cardíacas. Objetivo: Desenvolver um Caderno Didático para apoio do Enfermeiro na Realização e Avaliação do Eletrocardiograma na APS. Método: Tratase de uma pesquisa qualitativa do tipo estudo de caso. Os dados foram coletados em diferentes fontes, tais como o banco de dados do Sistema Tele-ECG do Instituto Dante Pazzanese de Cardiologia relativos à população atendida no Ambulatório da Várzea do Carmo de São Paulo, prontuários disponíveis nesse ambulatório e revisão de literatura. Resultados: Os dados apontaram que no período de 2010 a 2015, o perfil dos pacientes atendidos no Ambulatório Várzea do Carmo era 58% feminina e 42% masculina; a maior faixa etária era de 51 a 60 anos em ambos os sexos; uso de medicamentos ocorre em 41% dessa população. O diagnóstico de ECG normal foi em média 44% para ambos os sexos. Na faixa etária de 51 a 60 anos foi de 41%, e foram decrescentes em todas as faixas etárias acima desta e na faixa etária de 0 a 11 meses. A alteração eletrocardiográfica ocorreu em 30% dos diagnósticos totais e as principais arritmias foram: bradicardia sinusal, extrassístole, fibrilação atrial, ritmo ectópico, flutter atrial, bloqueios de ramo, sobrecarga e infartos cicatrizados. O defeito técnico na execução da técnica foi de 7,29% dos exames realizados no total de 62.850. A revisão de literatura sistematizada realizada nas bases de dados SibiUSP, IEEEXplore, Proquest, Pubmed, BVS, Cinahal, não localizou evidências de manuais de educação permanente para enfermeiros da APS sobre a temática, além de referências em plataformas correlacionadas ao Ministério da Saúde do Brasil, Diretrizes e Normas Técnicas sobre ECG e Arritmias. Face ao perfil da população usuária e as evidências encontrada na literatura construiu-se um caderno de recomendações práticas para os enfermeiros que atuam na Estratégia Saúde da Família (ESF). Esse caderno foi elaborado com os seguintes itens: conceito de ECG, técnicas para realização e avaliação do traçado eletrocardiográfico, avaliação de risco das arritmias e outros achados do ECG, breve apresentação das urgências cardiológicas. Conclusão: Pretende-se que o Caderno Didático produzido possa apoiar a educação permanente sobre o ECG, a assistência, controle e prevenção das DCNT no âmbito da APS e colaborar na expansão com qualidade do acesso a este procedimento nas unidades especializadas. / Introduction: Electrocardiogram (ECG), through the Tele-ECG System, is a fundamental tool to improve the assistance to Chronic Non-communicable Diseases (CNCD) in Primary Health Care (PHC). Improving the knowledge of nurses working in this area of care in the performance and evaluation of ECG should contribute directly to the prevention of heart disease. Objective: Develop a Didactic Booklet for Nurse Support in the Performance and Evaluation of the Electrocardiogram in APS. Method: This is a qualitative case-study research. The data were collected in different sources, such as the database of the Tele-ECG System of the Dante Pazzanese Institute of Cardiology related to the population attended in the Várzea do Carmo Outpatient Clinic of São Paulo, charts available in this outpatient clinic and literature review. Results: The data showed that in the period from 2010 to 2015, the profile of the patients attended at the Várzea do Carmo Outpatient Clinic was 58% female and 42% male; the largest age group was 51 to 60 years old in both genders; drug use occurs in 41% of this population. The diagnosis of normal ECG was on average 44% for both genders. In the age group of 51 to 60 years was 41%, and were decreasing in all age groups above this and in the age group of 0 to 11 months. The electrocardiographic alteration occurred in 30% of the total diagnoses and the main arrhythmias were: sinus bradycardia, extrasystole, atrial fibrillation, ectopic rhythm, atrial flutter, branch block, overload and healed infarction. The technical defect in the execution of the technique was 7.29% of the examinations carried out in the total of 62,850. The systematized literature review carried out in the databases SibiUSP, IEEEXplore, Proquest, Pubmed, BVS, Cinahal, found no evidence of permanent education manuals for APS nurses on the subject, in addition to references on platforms correlated to the Brazilian Ministry of Health, Guidelines and Technical Norms on ECG and Arrhythmias. Considering the profile of the user population and the evidence found in the literature, a book of practical recommendations was developed for nurses working at the Family Health Strategy (FHS). This book was elaborated with the following items: ECG concept, techniques for conducting and evaluating the electrocardiographic tracing, risk assessment of arrhythmias and other ECG findings, brief presentation of cardiac urgencies. Conclusion: It is intended that the Didactic Book produced can support the permanent education on the ECG, the assistance, control and prevention of NCDs within the framework of the PHC and collaborate in the expansion with quality of access to this procedure in the specialized units.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-08T11:08:53Z No. of bitstreams: 2 Tese - Suzy Darlen Soares de Almeida - 2017.pdf: 3538179 bytes, checksum: 6adfbde16bd18ffdaea737e920ad8539 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-08T11:13:26Z (GMT) No. of bitstreams: 2 Tese - Suzy Darlen Soares de Almeida - 2017.pdf: 3538179 bytes, checksum: 6adfbde16bd18ffdaea737e920ad8539 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-03-08T11:13:26Z (GMT). No. of bitstreams: 2 Tese - Suzy Darlen Soares de Almeida - 2017.pdf: 3538179 bytes, checksum: 6adfbde16bd18ffdaea737e920ad8539 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-01-28 / OBJECTIVES: (i) to establish the prevalence of Metabolic Syndrome (MS) in Military Police Officers (PMs) in Goiás; (Ii) to characterize the epidemiological profile of Goiás MPs with MS; (Iii) establish its risk factors; (Iv) to establish a correlation between the prevalence of MS occurrences and police occurrences (v) to describe their spatial distribution according to the Safe Citizen Program of the State of Goiás. METHODOLOGY: A descriptive, retrospective and transversal study developed with Military Police officers of Military Police of Goiás using the study of a database for the periodic evaluations of the health status of the MPs carried out between 2009 and 2013. The sample was selected according to the selection criteria, which included those with cadastral information and multidisciplinary evaluations Complete and unpaid; And excluded those with cadastral data and incomplete, multi-disciplinary evaluations of the pregnant police officers; With duplicate and triplicate data; With misleading and incomplete typing. Total 6303 police officers, 52.5% of the total population of the study (94.5% in men and 5.5% in women), being distributed according to the regions of the Safe Citizen Program of the State of Goias. The research was divided into: 1st phase - Organization and data collection, 2nd Phase - Application of the diagnostic criteria for the National Cholesterol Education Program Revised, and 3rd Phase - Data analysis - descriptive statistics with spatial distribution using scanning scan of Kulldorff. RESULTS: Of the 6303 PM evaluated, 23.7% (n = 1495) had MS, divided into 22.6% of males and 1.1% of females. The majority were between 40 and 45 years of age (32.4%), with rates increasing above 20% from 35 years, decreasing at 55 years; Married (70.4%); With incomplete secondary education (45.1%); With physical activity below three times per week (55.2%); With Sergeant's patent (45.0%); Nonsmokers (89.8%); With normal sleep (92.1%); And Goiânia (30.3%). Of the components, 58.9% of blood pressure, 42.8% of triglycerides, 30.3% of High Density Lipoprotein, 20.9% of waist circumference and 17.4% of fasting glucose were found in the PMs. SM was not correlated with police occurrences. Body mass index and age were the risk factors associated with higher odds for MS, especially, aged between 40 and 45 years and overweight. The groups with the highest relative risk (1.22) were found in the regions of: Itumbiara, Cidade de Goiás, Iporá, Jataí and Rio Verde, and with the lowest relative risk (0.82) in Goiânia. CONCLUSION: The prevalence of MS among Goiás MPs was 23.7%, being more frequent in subjects aged 40-45 years, married, with incomplete secondary education, with physical activity below three times a week, Sergeants, nonsmokers, with normal sleep and crowded in Goiânia. The risk factors identified were BMI and age, respectively, the most potentiating classes, age between 40 and 45 years and overweight increase the association with MS. No correlation was found between this Syndrome and police occurrences.Concerning its spatial distribution, the biggest frequency were in the regions of: Águas Lindas de Goiás - 31.5%; Porangatu - 29.7%; Rio Verde - 28.9%; Itumbiara - 28.8%; And Iporá - 28.4%. / OBJETIVOS: (i) estabelecer a prevalência da Síndrome Metabólica (SM) em Policiais Militares (PMs) de Goiás; (ii) caracterizar o perfil epidemiológico dos PMs de Goiás portadores de SM; (iii) estabelecer seus fatores de risco; (iv)estabelecer a correlação entre a prevalência da SM com as ocorrências policiais (v) descrever a sua distribuição espacial de acordo com o Programa Cidadão Seguro do Estado de Goiás. METODOLOGIA: Estudo descritivo, retrospectivo e transversal, desenvolvido com sujeitos Policiais Militares da Policia Militar de Goiás por meio do estudo de um banco de dados referente as avaliações periódicas do estado de saúde dos PMs realizadas entre 2009 e 2013. A amostra foi selecionada de acordo com os critérios de seleção, que incluíram aqueles com infomações cadastrais e avaliações multidisciplinar completas e não aponsentados; e excluíram aqueles com dados cadastrais e avaliações por área multidisciplinar incompletos, aponsentados, do policiais grávidas; com dados duplicadas e triplicadas; com digitações equivocadas e incompletas. Totalizando 6303 policiais, 52,5% do total da população do estudo (94,5% em homens e 5,5% em mulheres), sendo distribuídos conforme as regiões do Programa Cidadão Seguro do Estado de Goías. A pesquisa foi dividida em: 1ª fase – Organização e coleta dos dados, 2ª Fase - Aplicação dos critérios de diagnóstico para a SM - National Cholesterol Education Program revisado, e 3ª Fase - Análise dos dados - estatística descritiva com distribuição espacial utilizando varredura scan de Kulldorff. RESULTADOS: Dos 6303 PMs avaliados, 23,7% (n = 1495) são portadores de SM, divididos em 22,6% de homens e 1,1% de mulheres. A maioria com o intervalo de idade entre 40 e 45 anos (32,4%), sendo que as taxas aumentam acima de 20% a partir de 35 anos, decrescendo aos 55 anos; casados (70,4%); com grau de ensino médio incompleto (45,1%); com atividade física abaixo de três vezes por semana (55,2%); com patente de Sargento (45,0%); não fumantes (89,8%); com sono normal (92,1%); e de Goiânia (30,3%). Dos componentes, encontraram-se nos PMs 58,9% de pressão arterial, 42,8% de triglicerídeos, 30,3% de High Density Lipoprotein, 20,9% de circunferência abdominal e 17,4% de glicose em jejum. A SM não foi correlacionada com as ocorrências policiais. O índice de massa corpórea e a idade foram os fatores de risco associados a maiores chances para a SM, principalmente, com idade entre 40 e 45 anos e sobrepeso. Os agrupamentos de maior risco relativo (1,22) foram encontrados nas regiões de: Itumbiara, Cidade de Goiás, Iporá, Jataí e Rio Verde, e com o menor risco relativo (0,82) em Goiânia. CONCLUSÃO: A prevalência da SM entre os PMs de Goiás foi de 23,7%, sendo mais frequente nos sujeitos com idade entre 40 e 45 anos, casados, com grau de ensino médio incompleto, com atividade física abaixo de três vezes por semana, Sargentos, não fumantes, com sono normal e lotados em Goiânia. Os fatores de risco identificados foram o IMC e a idade, respectivamente, as classes mais potencialisadoras, idade entre 40 a 45 anos e sobrepeso aumentam a associação com a SM. Não foi encontrada correlação entre esta Síndrome e as ocorrências policiais. Quanto a distribuição espacial, as regiões com maior frequência foram: Águas Lindas de Goiás - 31,5%; Porangatu - 29,7%; Rio Verde - 28,9%; Itumbiara - 28,8%; e Iporá - 28,4%.

Introdução: O deslocamento ativo tem estreita relação com problemas de saúde pública da atualidade e sua promoção pode contribuir para melhorias quanto à mobilidade urbana, estado de saúde e proteção do meio ambiente. Entretanto, a maior parte das pesquisas sobre o tema tem sido desenvolvida em países de renda alta. A presente tese busca ampliar a investigação sobre o deslocamento ativo no Brasil. Objetivos: i) Descrever a frequência, a distribuição e a variação temporal de indicadores do deslocamento ativo em populações brasileiras; ii) Avaliar o impacto de mudanças no padrão de transporte da população sobre o deslocamento ativo, o tempo sedentário e desfechos de saúde em populações brasileiras. Métodos: Tese composta por sete manuscritos. O primeiro apresenta revisão sistemática de estudos com informações sobre a prática de deslocamento ativo na América Latina e Caribe; o segundo descreve estimativas representativas da população brasileira sobre a prática de deslocamento ativo para o trabalho; o terceiro e o quarto descrevem a frequência e tendência temporal do deslocamento ativo na Região Metropolitana de São Paulo (ciclistas e escolares); o quinto discute a questão da mobilidade urbana e do direito à cidade em São Paulo; o sexto e o sétimo avaliam o impacto de mudanças no padrão de mobilidade da metrópole paulistana sobre a prática de deslocamento ativo, tempo não-ativo de deslocamento e tempo total de deslocamento, bem como sobre a poluição do ar e saúde da população. Resultados: A prevalência mediana de deslocamento ativo encontrada em diferentes locais do Brasil foi de 12 por cento , variando entre 5,1 por cento em Palmas (Tocantins) a 58,9 por cento em Rio Claro (São Paulo) (Manuscrito 1). Um terço dos homens e das mulheres desloca-se a pé ou de bicicleta de casa para o trabalho no país. Em ambos os sexos, esta proporção diminui com o aumento da renda e da escolaridade e é maior entre os mais jovens, entre os que residem em áreas rurais, e na região Nordeste. Em todas as regiões metropolitanas estudadas, o quinto das pessoas de menor renda apresenta uma maior frequência de deslocamento ativo (Manuscrito 2). Entre os anos de 2007 e 2012, observamos redução no número de ciclistas em São Paulo e diferenças expressivas na proporção de ciclistas entre homens e mulheres (9,7 por mil habitantes versus 1,4 por mil habitantes em 2012) (Manuscrito 3). Também verificamos uma queda na proporção de crianças que se deslocam ativamente para a escola entre os anos de 1997 e 2012 (Manuscrito 4). O cenário epidemiológico do deslocamento ativo no país é resultante da disputa pelo direito à cidade, com repercussões na transição de mobilidade humana e na saúde e qualidade de vida da população, como podemos observar no caso de São Paulo (Manuscrito 5). A construção de uma São Paulo mais inclusiva, com menores distâncias para os deslocamentos cotidianos e maior frequência de caminhada e bicicleta, levaria à substancial redução do tempo total e do tempo sedentário despendidos nos deslocamentos, sem diminuir a duração do deslocamento ativo (Manuscrito 6). Traria também ganhos à saúde da população, sobretudo pelo aumento da prática de atividade física e da redução da poluição do ar (Manuscrito 7). Conclusões: A prática de deslocamento ativo no Brasil apresenta marcadas diferenças segundo região e características sociodemográficas. De um modo geral, esta prática vem diminuindo no país, o que deve contribuir negativamente para a saúde da população. A promoção de cidades mais inclusivas e compactas, com o favorecimento a modos ativos de deslocamento, pode contribuir para reverter esta preocupante tendência. / Introduction: Active commuting is closely related to current public health issues and its promotion can contribute to improvements in urban mobility, health and environmental protection. However, research on the subject is largely concentrated in high-income countries. This thesis aims to expand research on active commuting in Brazil. Objectives: i) To describe the frequency, distribution and time trend of active commuting indicators in Brazilian populations; ii) To assess the impact of travel pattern changes on active commuting, sedentary time and health outcomes in Brazilian populations. Methods: The thesis consists of seven manuscripts. The first manuscript is a systematic review of studies with information on active commuting practice in Latin America and the Caribbean; the second describes nationally representative estimates about active commuting to work in Brazil; the third and fourth describe active commuting frequency and time trends in São Paulo metropolitan area (cyclists and schoolchildren); the fifth discusses the issue of urban mobility and the right to the city of São Paulo; the sixth and seventh assess the impact of changes in São Paulo travel pattern on active commuting, non-active commuting and total travel time as well on air pollution and population health. Results: The median prevalence of active commuting found in Brazilian settings was 12 per cent , ranging from 5.1 per cent in Palmas (Tocantins) to 58.9 per cent in Rio Claro (Sao Paulo) (Manuscript 1). One-third of men and women walk or cycle for commuting to work in Brazil. In both sexes, this proportion decreases with increasing income and education and is higher among younger people, those living in rural areas, and in the Northeast. In all Brazilian metropolitan areas studies, people in the lowest quintile of income had a higher frequency of active commuting (Manuscript 2). Between 2007 and 2012, we observed a decreasing number of cyclists in São Paulo and marked sex differences in the proportion of cyclists (9.7 per thousand inhabitants for men versus 1.4 per thousand inhabitants for women in 2012) (Manuscript 3). We also found a decrease in the proportion of children who are actively commuting to school between 1997 and 2012 (Manuscript 4). The epidemiological scenario of active commuting in Brazil is the result of a historical dispute for the right to the city, with repercussions for human mobility transition and people\'s health and quality of life, as can be seen in the case of São Paulo (Manuscript 5). Building a more inclusive São Paulo, with shorter distances and more walking and cycling, would lead to substantial reductions of total and sedentary commuting time, without reducing active commuting time (Manuscript 6). It would also result in improvements for peoples health, particularly due to the increasing physical activity and decreasing air pollution (Manuscript 7). Conclusions: Active commuting in Brazil shows marked regional and socioeconomic contrasts. Overall, this practice has decreased, which should contribute negatively to the health of Brazilians. The promotion of more inclusive and compact cities, favoring active travel, can help reverse this worrying trend.

Submitted by ARIANE ELOIZA GUILHERME POLISAITIS (arianeguilher@yahoo.com.br) on 2018-06-11T22:27:09Z No. of bitstreams: 1 TA.Ariane.Polisaitis.VF.pdf: 1312666 bytes, checksum: a089481fbc3ae68c14cd62d10abc93f9 (MD5) / Approved for entry into archive by Simone de Andrade Lopes Pires (simone.lopes@fgv.br) on 2018-06-11T23:17:12Z (GMT) No. of bitstreams: 1 TA.Ariane.Polisaitis.VF.pdf: 1312666 bytes, checksum: a089481fbc3ae68c14cd62d10abc93f9 (MD5) / Approved for entry into archive by Isabele Garcia (isabele.garcia@fgv.br) on 2018-06-12T19:46:55Z (GMT) No. of bitstreams: 1 TA.Ariane.Polisaitis.VF.pdf: 1312666 bytes, checksum: a089481fbc3ae68c14cd62d10abc93f9 (MD5) / Made available in DSpace on 2018-06-12T19:46:55Z (GMT). No. of bitstreams: 1 TA.Ariane.Polisaitis.VF.pdf: 1312666 bytes, checksum: a089481fbc3ae68c14cd62d10abc93f9 (MD5) Previous issue date: 2018-06-11 / O rápido crescimento da população idosa portadora de doenças crônicas e degenerativas e a pressão por redução de custos nos hospitais por parte das fontes pagadoras têm demandado a necessidade de serviços de longo prazo por serem menos onerosos. Com o envelhecimento populacional as necessidades de saúde tendem a se tornar mais crônicas e complexas. É necessário alinhar os sistemas de saúde às necessidades das populações que, cada vez mais, exigirão mudanças no enfoque dos cuidados clínicos e assistenciais. O objetivo deste trabalho aplicado é identificar como são classificadas no Brasil as Instituições de Longa Permanência para Idosos e as Clínicas de Retaguarda. Realizado estudo exploratório e descritivo no site do Departamento de Informática do SUS (DATASUS), para consultar a Classificação Nacional de Atividades Econômicas (CNAE), e no site do Instituto Brasileiro de Geografia e Estatística (IBGE), para consulta do Cadastro Nacional de Estabelecimento de Saúde (CNES). Também foi analisada uma base de dados coletada no ano 2017, contendo registros de internação de pacientes de dois prestadores de serviços da região metropolitana de São Paulo, sendo uma Instituição de Longa Permanência para Idosos e uma Clínica de Retaguarda. A pesquisa identificou a falta de padrão na classificação do CNAE e no cadastramento CNES, dificultando o levantamento dos dados do total de estabelecimentos, e total de leitos de retaguarda e ILPIs. No que tange as políticas de saúde, considera-se frente ao atual cenário brasileiro, uma omissão do Estado, que até o presente momento não atualizou os cuidados continuados prestados em instituições de longa permanência para idosos no Brasil. Os idosos admitidos na ILPI para o serviço de curta permanência ficaram internados em média 49 dias. Do total de admissões na ILPI, 65% dos idosos receberam alta para seu domicilio. Os pacientes atendidos na Clínica de Retaguarda permaneceram em média 53 dias, e 76% dos pacientes receberam alta para seu domicílio. O Brasil tem um grande potencial para evoluir em um sistema de saúde que integre o Pre-Acute Care, o Acute Care e o Post-Acute Care, sendo assim possível a configuração de uma rede de cuidados. / The fast growth of the elderly population with chronic and degenerative diseases and underwrites influencing hospitals to reduce their costs have demanded the use of long-term services considering they are less expensive. Health requirements tend to become more chronic and complex due to population aging. Health systems need to be aligned with population demands, which will increasingly require changes in clinical care and assist approaches. This work aims to identify how Long-Term Care Facilities (LTCFs) for the elderly and Nursing Homes are classified in Brazil. An exploratory and descriptive study has been carried out on the SUS Department of Informatics website in order to browse the National Classification of Economic Activities (CNAE), and also on the Brazilian Institute of Geography and Statistics website in order to browse the National Registry of Establishment of Health (CNES). A database collected in 2017 has also been reviewed. It contains patient hospitalization records from two different service providers in the metropolitan region of São Paulo, the first one is a Long-Term Care Facility and the second one is a Nursing Home. This research has identified the lack of standardization in the classification of CNAE and in the CNES registration process, making it difficult to collect data about the amount of establishments, and amount of beds in Nursing Homes and LTCFs. With regard to health policies in the current Brazilian scenario it is considered a government’s omission, since long-term care provided in Brazilian LTCFs has not been updated up to the present moment. The elderly people admitted to the LTCF for the short-term care service were hospitalized for an average of 49 days. 65% of the total admissions to the LTCF were discharged to return to their home. Patients treated at the Nursing Home remained on an average of 53 days, and 76% of the patients were discharged to return to their home. Brazil has a great potential to build up a health system to integrate Pre-Acute Care, Acute Care and Post-Acute Care, thus enabling the configuration of a care network.

Having a chronic illness may feel alienating, yet examination of the literature shows limited research on social connectedness and health. In order to contribute to the understanding of this impact of illness, I examined perceived levels of social connectedness in persons with chronic diseases (CD), functional somatic syndromes (FSS) and medically unexplained symptoms (MUS). A major focus of this study was to investigate the association of social connectedness with depression, anxiety, and general health in patients with ongoing symptoms of illness. Data collection was obtained through the use of four online surveys collectively known as VOICE (Verification of Coping, Illness and Experience). For the purposes of this study, five measures were used: the Social Connectedness Scale, Short Form Health Survey (SF-36), Patient Health Questionnaire depression scale (PHQ-8), Hopkins Symptoms Checklist (HSCL) and the Social Impact Scale. Participants were recruited through announcements via online message boards and support groups, as well as through the distribution of brochures in local medical practices. A total of 148 participants (80% female) completed all four surveys. Results indicated that the chronic illness groups did not significantly differ in social connectedness, although there was some indication that the FSS group felt more social isolation. Regression analyses indicated that, while accounting for socio-cultural and health factors, social connectedness was the strongest predictor of depression (β = - .43, p < .001), anxiety (β = -.48, p < .001) and general health (β = .34, p < .001) in chronically ill persons. The independent and robust relationship of social connectedness with psychological and physical health in individuals with chronic illness suggests that this is an important factor deserving of future research with important clinical applications.