Den ojämlika dödligheten är en studie av främst hjärt–kärldödlighet avseende perioden 1950–2010 i tvillingstäderna Linköping och Norrköping och konsekvenserna av ojämlikhet. Skillnaderna mellan städerna i dödlighet är stora. Under 1970-talet, då jämlikheten stod i focus, minskade dessa. Efterhand som ekonomisk politik och samhällsvärderingar mera anpassades till en global monetaristisk politik ökade också den ojämlika dödligheten mellan städerna. Stora förändringar ägde rum inom respektive stad när det gäller hjärtdödligheten. Miljonprogramområdena i de båda städerna blev relativt sett fattigare och präglades allt mer av flyktinginvandring, samtidigt som städernas centra gentrifierades, inte minst i Linköping. Skillnaderna i dödlighet mellan ytterområdena och centrum ökade under 1990- och 2000-talen. Detta gäller i större utsträckning i Linköping än i Norrköping. Avhandlingen består av tre delar. I licentiatuppsatsen analyseras städernas utveckling från 1950-talet till 2006. Studien gör också ett försök att spåra orsaker till ohälsoskillnader och för tidig död. Artikel 1 handlar om vad som hände med folkhälsan på vägen från ett högindustriellt till ett postindustriellt samhälle. Ett särskilt focus har varit att studera skillnader i hjärtsjuklighet mellan olika stadsdelar i de bägge tvillingstäderna. I artikel 2 analyseras skillnader i hjärt–kärldödlighet på stadsdelsnivå under perioden 1976 till 2010. / Unequal Mortality is primarily a study of coronary heart disease mortality and its consequences during the period 1950–2010 in the twin cities Linköping and Norrköping. The difference in mortality between the two cities was great. During the 1970s, when there was a focus on equality, these differences declined. As economic policies and social values were adapted to a global monetary policy, inequality in mortality between the two cities increased. Large changes took place in the respective cities as far as mortality in coronary heart disease was concerned. In both cities the low cost housing projects became poorer and were increasingly influenced by the influx of refugees, at the same time that the city centres became gentrified, not least in Linköping. The differences in mortality between the out-lying areas and the city centres increased during the 1990s and the first decade of the 21st century. This is true to a greater extent in Linköping than in Norrköping. The dissertation consists of three parts. The licentiate thesis analyses the development of the cities from the 1950s until 2006. The study also attempts to trace the reasons for the differences in health and premature death. Article 1 deals with what happened on the way from a highly industrial to a post-industrial society. It has especially focused on studying the differences in coronary heart disease morbidity among various neighbourhoods in both the twin cities. Article 2 analyses differences in coronary heart disease mortality during the period from 1976 to 2010.

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Introdução: A hanseníase, doença infecciosa crônica, causada pelo bacilo Mycobacterium leprae, tem seu mecanismo de transmissão não totalmente esclarecido. A transmissão ativa pode estar associada a movimentos migratórios, condições sociais ou outras fontes de infecção (como a manutenção do bacilo no ambiente). Objetivos: Descrever o padrão espacial do risco relativo da hanseníase em menores de 15 anos no estado da Bahia; identificar possíveis agrupamentos espaciais e investigar a possível associação entre o risco relativo da hanseníase e fatores socioeconômicos e ambientais. Metodologia: Este estudo ecológico utilizou dados do Sistema de Informação de Agravos de Notificação (SINAN) de 2005 a 2011, do Censo Demográfico do Instituto Brasileiro de Geografia e Estatística de 2010, da Federação das Indústrias do Estado do Rio de Janeiro, Informações Demográficas e Socioeconômicas do Departamento de Informática do SUS, bases cartográficas digitais de dados ambientais do IBGE e bases cartográficas digitais do estado da Bahia e estados vizinhos. Os riscos relativos por município foram padronizados pela covariável gênero. A análise de varredura espacial com o programa SaTScan permitiu verificar a existência de agrupamentos espaciais do tipo alto e/ou baixo. O segundo estágio da análise consistiu em verificar a possível associação entre risco relativo da hanseníase como variável dependente e variáveis socioeconômicas e ambientais como explicativas, através de análises de regressão hierárquica multivariada não espacial e espacial, de acordo com quadro conceitual definido previamente. Resultados: Durante o período de estudo foram notificados 1.674 casos, que representam 7,87% dos casos totais. As taxas em menores de 15 anos, padronizadas por gênero, diminuiu de 0,89/10.000 em 2005 para 0,57 em 2011. A estatística de varredura espacial identificou 4 agrupamentos de risco alto e 6 de risco baixo. No modelo de regressão hierárquica, o risco relativo foi associado positivamente com porcentagem de corpos dágua, Índice de Gini, porcentagem de população urbana, número médio de moradores em domicílios particulares permanentes, e negativamente com o número de residentes nascidos na Bahia. Conclusão: Este estudo mostrou que a hanseníase ainda está ativa no Nordeste do Brasil, principalmente em ambientes urbanos. Embora o risco relativo da hanseníase tenha diminuído, ele ainda permanece muito alto. Migrações de assentamentos rurais para as cidades, bem como mais pessoas vivendo em domicílios e desigualdades sociais são resultados de um processo histórico no nordeste do Brasil, que dão suporte para a continuidade do processo de transmissão da doença. A associação entre o risco relativo da hanseníase e corpos dágua na escala geográfica proposta, indica que a hipótese que associa a M. leprae e ambientes úmidos ainda não pode ser descartada. / Background: Leprosy is a chronic infectious disease caused by the bacillus Mycobacterium leprae. Its mechanism of transmission has not been completely understood. The active transmission may be associated with people migration, social conditions or other sources of infection (such as maintenance of bacilli in the environment). Objectives: To describe the spatial pattern of the relative risk of leprosy in children under 15 years old in the State of Bahia; to identify possible spatial clusters and to investigate the possible association between the relative risk of leprosy with socioeconomic and environmental factors. Methods: This ecological study used data from the Brazilian Disease Notification System (Sistema Nacional de Informação de Agravos de Notificação SINAN) for the studied period of 2005 to 2011; Instituto Brasileiro de Geografia e Estatstica (IBGE 2011), Department of Data and Information Technology (Informações Demográficas e Socioeconômicas do Departamento de Informática do SUS DATASUS, 2010) and the Federation of Industries of the State of Rio de Janeiro FIRJAN (2010), Cartographic base of municipalities in Bahia and surrounding States corresponded to the shape files from the Brazilian Demographic Census. Relative risks were calculated accounting for the respective covariate gender. The spatial scan analysis with SaTScan program allowed to verify the existence of high and/or low spatial clusters. The second stage of the analysis consisted of verifying possible associations between the relative risks of leprosy as a dependent variable, and socio-economic and environmental variables as independent. This was performed using a multivariate regression analysis according to a previously defined conceptual framework. Results: During the study period, 1,674 cases were reported, representing 7.87% of the total cases. Overall rates have decreased from 0.88/10 000 in 2005 to 0.52 in 2011. Spatial scan statistics identified 4 high-risk and 6 low-risk clusters. In the regression model, after allowing for spatial dependence, relative risks were associated with higher percentage of water bodies, higher Gini index, higher percentage of urban population, larger average number of dwellers by permanent residence and smaller percentage of residents born in Bahia. Conclusions: This study showed that leprosy is still active in the Northeast of Brazil, especially in urban environments. Although relative risks of leprosy in Bahia have been decreasing, they remain very high. Migration of rural settlements to the cities, more people living in households and social inequalities are the result of a historical process in northeastern Brazil, that support the continuity of the disease transmission process. The association between relative risks of leprosy and water bodies in the proposed geographic scale indicates that hypothesis linking M. leprae and humid environments cannot be discarded.

Introduction : L'arrêt cardiaque (AC) est considéré comme un problème majeur de santé publique. Prévenir les arrêts cardiaques, les décès consécutifs et optimiser leur prise en charge sont les objectifs partagés à la fois par les professionnels de l’urgence et les décideurs des politiques de santé publique. A l’heure de la territorialisation prenant en compte les besoins des populations, très peu d’études ont été consacrées aux variations d’incidence induites par la localisation géographique des arrêts cardiaques et les caractéristiques socio-économiques des patients. L’objectif de cette thèse est d'identifier, à partir des données du registre national des arrêts cardiaques RéAC, dans les trois départements de la petite couronne d’Ile-de-France, des clusters de communes présentant une incidence élevée ou faible en matière d’arrêt cardiaque, puis de les caractériser à partir des facteurs socio-économiques qui peuvent leur être associés. Matériel et Méthodes : Nous avons étudié les données d’arrêt cardiaque des trois départements d’Ile-de-France composant la petite couronne francilienne. Nous avons ainsi travaillé sur un ensemble de 123 communes. Les données relatives aux arrêts cardiaques ont été extraites du registre français des arrêts cardiaques RéAC. Des données socioéconomiques ont été collectées pour chacune de ces communes auprès de l’Institut National de la Statistique et des Etudes Economiques (INSEE). En termes de méthodes, nous avons eu recours à une double approche sur le plan statistique, combinant des méthodes bayésiennes afin d’étudier les variations géographiques d'incidence des arrêts cardiaques et des statistiques de scan en vue d’identifier des clusters de communes selon le niveau d’incidence des arrêts cardiaques. Enfin, nous avons caractérisé et comparé ces clusters de communes selon des facteurs socioéconomiques. Résultats : Nous avons inclus 3.414 arrêts cardiaques sur une période de deux ans, entre août 2013 et août 2015. De fortes variations géographiques - significatives - ont été observées parmi 123 municipalités : 34 présentaient un risque d'incidence élevé et 37 présentaient un risque faible. Les statistiques de scan ont permis d’identifier 7 clusters significatifs sur le plan de l’incidence des arrêts cardiaques, dont 3 clusters à faible incidence (le risque relatif variait de 0,23 à 0,54) et 4 clusters à forte incidence (avec un risque relatif de 1,43 à 2). Les clusters de municipalités ayant une incidence élevée d'AC se caractérisent par un statut socioéconomique inférieur à celui des autres (clusters d'incidence d’arrêt cardiaque faible ou normale). L'analyse a montré des relations statistiquement significatives entre les facteurs de défaveur sociale et une incidence élevée. Discussion : L’analyse des taux d’incidence standardisés et lissés dans la zone de la petite couronne parisienne révèle l’existence d’une forte hétérogénéité en termes d’incidence des arrêts cardiaques. L’utilisation des statistiques de scan nous a permis d’identifier 7 clusters significatifs, dont 4 de sur-incidence et 3 de sous-incidence. Ces résultats, les premiers en France sur cette thématique, confirment ceux déjà existants dans la littérature internationale montrant une hétérogénéité spatiale de l'incidence de l'arrêt cardiaque et l’importance de certains facteurs socio-économiques. Enfin, le recours aux statistiques de scan, différente des méthodes généralement utilisées, permet de mettre en évidence l'existence de zones à haut risque d’arrêt cardiaque [...] / Cardiac arrest (CA) is considered a major public health problem. Preventing cardiac arrest and subsequent deaths and optimizing their management are objectives shared by both emergency professionals and public health policy makers. At a time when territorialization is taking into account the needs of populations, very few studies have been devoted to the variations in incidence induced by the geographical location of cardiac arrests and the socio-economic characteristics of patients. The objective of this thesis is to identify, based on data from the national register of cardiac arrests RéAC, in the three departments of the inner suburbs of Ile-de-France, clusters of municipalities with a high or low incidence of cardiac arrest, and then to characterize them based on the socio-economic factors that can be associated with them. Equipment and Methods: We studied cardiac arrest data from the three departments of Ile-de-France that make up the inner suburbs of the Paris region. We have worked on a total of 123 municipalities. Data on cardiac arrests were extracted from the French register of cardiac arrests RéAC. Socio-economic data were collected for each of these municipalities from the Institut National de la Statistique et des Etudes Economiques (INSEE). In terms of methods, we used a statistically twofold approach, combining Bayesian methods to study geographical variations in the incidence of cardiac arrest and CT statistics to identify clusters of communes according to the incidence level of cardiac arrest. Finally, we characterized and compared these clusters of municipalities according to socio-economic factors.

Made available in DSpace on 2016-04-25T16:44:29Z (GMT). No. of bitstreams: 1 Wilton Moises Modro.pdf: 1762868 bytes, checksum: 37683595c1b75e15b2ac5d6da474f7ac (MD5) Previous issue date: 2012-06-05 / The purpose of this study was to analyze if the main financial indicators, value metrics and economic factors are relevant to explaining the performance of common shares return of the three largest Brazilian banks, Banco do Brasil, Banco Itau and Banco Bradesco, during the period between 2001 and 2010. Such rationale begins with the assumption, based on the modern theory of finance, that certain factors may contribute to the explanation of stock return behavior. Accordingly, were selected the top accounting indicators and value metrics exposed in the studies and in finance literature and, additionally, the top economic factors that could be related to stock return. Considering the growing importance of the Brazilian banking sector and the lack of studies focused on companies in this sector, it was decided to apply the selected indicators and metrics to these key Brazilian banks, which together accounted, at the end of 2010, for about half of the performance of the banking sector in the country. Through an empirical-descriptive study, based on documentary research, having the financial statements and the stock market performance of the three selected banks as the main sources of data, it was verified which independent variables showed positive correlation and explanatory power on the stock return of the following period of these banks. The results obtained by correlation analysis and multiple regressions, applied to the accumulated variation of common shares return and the 26 (twenty six) independent variables studied, showed the price-to-earnings ratio (P/E) as the main explanatory variable statistically significant to common shares return, with r2 of 77.7% (Banco do Brasil), 69.8% (Banco Itaú) and 64.3% (Banco Bradesco). Other variables with significant explanatory power, although smaller, were the index of operational efficiency (16.5%) for Banco Itau and the ratio loans/deposits (7.6%) and inflation (6.7%) for Banco Bradesco. These results demonstrate the importance of the P/E ratio, which shows the investors expectation about the generation of future cash flows by companies and, therefore, it is expected to be associated with stock returns. Some limitations of this study, however, should be taken into consideration, especially regarding the use of accounting data, the events occurred during the period of analysis (accounting changes, mergers and acquisitions, subprime crisis, etc..), and the calculations and results of value metrics, since several studies indicate value metrics, specifically the EVA®, as more closely related to the return or the market price of the shares / O objetivo deste estudo foi analisar se os principais indicadores contábeis, métricas de valor e fatores econômicos são relevantes para a explicação do desempenho do retorno das ações ordinárias dos três maiores bancos brasileiros, Banco do Brasil, Banco Itaú e Banco Bradesco, no período entre 2001 e 2010. Tal objetivo parte do pressuposto, fundamentado na teoria moderna de finanças, de que certos fatores podem contribuir para a explicação do comportamento do retorno das ações. Nesse sentido, foram selecionados os principais indicadores contábeis e métricas de valor expostos nos estudos e na literatura de finanças e, além destes, os principais fatores econômicos que podem ter relação com o retorno das ações. Tendo em vista a crescente relevância do setor bancário brasileiro e a escassez de estudos voltados para empresas desse setor, optou-se por aplicar os indicadores e métricas selecionados, aos principais bancos brasileiros, os quais responderam em conjunto, no final de 2010, por cerca de metade do desempenho do setor bancário no país. Por meio de um estudo empírico-descritivo, baseado em pesquisa documental, sendo as principais fontes de dados as demonstrações contábeis e o desempenho bursátil dos três bancos selecionados, verificou-se quais variáveis independentes apresentaram correlação positiva e poder explicativo sobre o retorno das ações ordinárias do período seguinte, desses bancos. Os resultados obtidos pelas análises de correlação e regressão múltiplas, aplicadas sobre a variação acumulada do retorno das ações ordinárias e das 26 (vinte e seis) variáveis independentes pesquisadas, indicaram o índice preço/lucro (P/L) como principal variável explicativa estatisticamente significante do retorno das ações ordinárias, com r2 de 77,7% (Banco do Brasil), 69,8% (Banco Itaú) e 64,3% (Banco Bradesco). Outras variáveis que apresentaram relevante poder explicativo, embora menor, foram o índice de eficiência operacional (16,5%) para o Banco Itaú e o índice empréstimos/depósitos (7,6%) e inflação (6,7%) para o Banco Bradesco. Tais resultados demonstram a importância do índice P/L, o qual evidencia a expectativa dos investidores quanto à geração de fluxos de caixa futuros pelas empresas e, portanto, espera-se que esteja associado ao retorno das ações. Algumas limitações deste estudo, entretanto, devem ser consideradas, principalmente em relação ao uso dos dados contábeis, aos eventos ocorridos no período da análise (mudanças contábeis, fusões e aquisições, crise do subprime, etc.) e aos cálculos e resultados das métricas de valor, já que diversos estudos indicam as métricas de valor, mais especificamente o EVA®, como mais fortemente relacionadas ao retorno ou ao preço de mercado das ações

Magister Public Health - MPH (Public Health) / The prevalence of diabetes in Africa has been on the increase. A prevalence of 1%- 10% has been reported by different authors in different regions in Nigeria. The International Diabetes Federation estimates that 1.9% of Nigerians are diabetic and most of them have complications at the time of diagnosis. Laboratory measurement of Glycosylated hemoglobin (HbA1c) is the method of choice for monitoring glycaemic control but due to its cost and limited availability, most developing countries use fasting plasma glucose (FPG) measurement (which is less reliable) to assess glycaemic control. Most diabetic patients in Nigeria have poor glycaemic control and several factors have been implicated especially socio-economic, behavioral and treatment-related factors. Understanding the reasons for poor glycaemic control is essential in order to reduce the rate of diabetes complications.

Introduction: Obesity development is one of the most obvious - and at the same time, one of the most neglected - public health problems (WHO, 2018). Objective: The primary purpose was to investigate the understanding of the factors behind childhood obesity in a limited group of participants living in three areas in Viña del Mar, Chile; Reñaca Alto, Santa Inés and Center. The secondary purpose of the study was to elucidate the perception of the authorities' health-promoting efforts among participants in different socio-economic groups in these areas. The two main research questions were: What are the views of the residents of Viña del Mar about the factors behind childhood obesity? What are the opinions of residents of Viña del Mar about measures to counteract the problem? Method: The study is a cross-sectional survey (n = 63) and the data were collected and analysed using SPSS statistical program and an Excel program. The results are presented through descriptive statistics, in the form of tables. Results: The survey was answered by 63 persons, representing 63 families, consisting of a total of 231 persons, divided into 156 adults and 75 children. The results show that 15% of the participants do not know the severity of child obesity. Furthermore, 88% of the participants perceive that the household economy is the main significant risk factor for child obesity, followed by a high consumption of sugar and sugar-containing products. In addition, participants perceive that it is possible to influence the childhood obesity epidemic and 84% of participants feel that the family can have a positive influence on childhood obesity, but more tools are needed in the form of knowledge and support. The results show that only 10% of the participants think that the authorities are making a considerable effort, while 49% (n = 25) think that they are not doing enough. Behaviour-changing measures show a better result in population groups with a high SEP (Socio Economic Position) than in those with a low, since the former are more influenced by the information. However, a multidisciplinary holistic perspective is needed on health promotion work. If the SES gap (Socio Economic Status) is reduced and SEP equated, more people can get advice and be given the opportunity to have a healthy lifestyle. Socioeconomic factors affect the risk of childhood obesity in particular in economic transition processes. If SEP and SES, both individually and socially, change from poor to rich, child obesity in society increases and Chile is an example of this phenomenon. The health promotion efforts in the country are multifaceted and innovative in many ways and there are many actors working with these. However, the question is how effective the efforts are when the work is done in many different forms and often without being anchored to one another. Finally, prevention efforts should be developed and implemented in collaboration with the target groups.

Atskleidus kaimo vietovių ekonominio konkurencingumo ir vietos gyventojų verslumo ryšį ir išnagrinėjus vietos gyventojų verslumo plėtojimo svarba siekiant stiprinti kaimo vietovių ekonominį konkurencingumą pateiktos vietos gyventojų verslumo plėtojimo galimybės ir geroji patirtis. / Disclosed in the rural areas of economic competitiveness and entrepreneurship in local access and examined the development of local entrepreneurship is key to strengthening the economic competitiveness of rural areas. Submitted by local entrepreneurial development opportunities and best practices.

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The number of older persons is growing at a shocking rate. In spite of this reality, the South African health care sector does not prioritise older persons, causing their health to be poorly managed. Not only does poor health management affect the health of the older person, but also economic factors. This causes a high burden on the public health sector of South Africa, with specific reference to the Primary Health Care (PHC) clinics. PHC clinics in this country are not only overcrowded due to staff shortages, but also owing to the rapidly ageing population and the large number of younger persons affected by the high unemployment rate of South Africa. The above-mentioned factors keep the professional nurses in the clinic from spending time on proper physical examinations and provision of health education to older persons. This causes older persons to lack knowledge regarding self-care, potentially leading to unintentional self-neglect, which decreases their quality of life. Studies conducted on older persons concluded that the older person wants to be involved in health promotion, but needs the necessary knowledge to take care of him- or herself. Therefore, the researcher's overarching aim with this study was to develop guidelines to facilitate self-care amongst older persons. Such guidelines aim at constituting an indirect approach to promote the health of the older person. Health education on self-care should be conducted in self-care support groups, since community experience teaches that some older persons in the community do not apply self-care skills learned without some form of support. The aim with these guidelines is to decrease unintentional self-neglect by empowering the older person to make autonomous decisions regarding self-care, in order to increase quality of life. RESEARCH AIM AND OBJECTIVES In order to reach the overarching aim of this study, which comprises the development of guidelines to facilitate self-care amongst the older persons in the Potchefstroom district, the study firstly includes a literature review to understand self-care and related constructs from a theoretical perspective. Secondly, the Appraisal of self-care agency scale-A (ASA-A) and Exercise of self-care agency scale (ESCA) were used as questionnaires to assess the self-care of the selected older persons. Lastly, after determining the self-care of the older persons, the study investigates the relationship between these two questionnaires through correlational analysis. RESEARCH DESIGN A quantitative, descriptive, correlational and contextual design was used in this study to .reach the overarching aim and respective objectives. RESEARCH METHOD The researcher firstly conducted a literature review to understand self-care and related constructs. Thereafter the researcher employed two structured questionnaires, the ASA-A and ESCA, were employed to collect data. The questionnaires were developed to measure self-care (self-care is determined by measuring the self-care agency). These questionnaires were based on Dorothea OrenYs self-care deficit theory of nursing, the same theory that this research study is based on. Minor adaptations were made to both the questionnaires prior to administration to the predominantly Setswana-speaking older population. The study formed part of the larger Multinational Prospective Urban and Rural Epidemiological study (PURE-SA study - ethical approval number 04M10). All the older persons identified in the peri-urban population of the PURE-SA study living in the Potchefstroom district and who were willing to participate were included in the sample. Trained fieldworkers assisted the researcher in data collection. Of the 198 older persons, 192 participated, accumulating to a 98% response rate. Lastly the researcher correlated the ASA-A and ESCA to determine their relationship as an added benefit to this research study. RESULTS The findings indicate that although the studied older population was of a lower socio-economic status with a lower literacy level, their overall self-care was relatively good. Seven self-care deficits were identified namely time management skills affecting self-care, energy deficit affecting self-care, sleep deprivation, lack of knowledge and ability to acquire knowledge with regard to health and self-care, lack of a rest, exercise and self-care programme, self-care deficit caused by physical deterioration and, lastly, the lack of performance of activities to prevent/decrease self-care deficits. These identified self-care deficits supported the development of guidelines to facilitate self-care amongst older persons, together with Menon's psychological health empowerment model, as well as an in-depth literature review on self-care and related constructs to understand self-care from a theoretical perspective. Furthermore, the study compared the ASA-A and ESCA questionnaires to determine the relationship between these questionnaires. The two questionnaires had a very good correlation with each other, conclusion that either of these two questionnaires could be used to measure self-care of a population. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010.