OBJETIVO: Analisar o padrão de consumo de medicamentos segundo características demográficas e condições de vida da população de estudo. METODOLOGIA: A pesquisa foi desenvolvida a partir dos dados do projeto Inquérito de Saúde de São Paulo, ISA-SP, estudo transversal com base populacional, que levantou as condições de vida e saúde da população de quatro áreas do Estado de São Paulo. Foi utilizado período recordatório de 3 dias para o uso de medicamentos. A caracterização demográfica da amostra foi feita por meio da idade e sexo, e a sócio-econômica pelas renda familiar e escolaridade do entrevistado e do chefe de família. RESULTADOS: O uso de medicamentos foi declarado por 33,9% e revelou-se maior entre: os grupos de maior idade, o sexo feminino, as famílias com maior escolaridade do chefe, aqueles que se declararam brancos e os que relataram maior renda familiar. Mais de um terço dos que relataram uso de medicamento declarou automedicação, que foi mais freqüente entre jovens e homens. Uma minoria declarou desconhecer o que é “medicamento genérico”. A média da fração da renda familiar gasta com medicamentos foi de 6,2%, e aumentou com a idade, com a menor renda e com a menor escolaridade. CONCLUSÃO: Essa pesquisa revelou diferenças significativas no consumo, na automedicação e no gasto com medicamentos de diferentes sugrupos populacionais. Os trabalhos sobre perfil de consumo de medicamentos podem contribuir para a discussão sobre a problemática de acesso da população às terapias farmacológicas e podem subsidiar políticas públicas que visem promover acesso universal e uso racional dos medicamentos. / OBJECTIVE: To analyze the pattern of medicine use, according to demographic characteristics and life conditions of the population. METHODS: This study was developed with the databank of the project “Health Survey of State of Sao Paulo (ISA-SP)”, a population based household survey transversal study, that studied the life and the health condition of the population of four areas in the State of Sao Paulo. The information about drug consume was collected with a recall period of 3 days. The sample was characterized by the sex and the age, as demographic data, and by the years of study of the subject and the head of the family, and the household income, as socioeconomic data. RESULTS: The drug use was declared by 33,9% of the subjects, which revealed to be higher among the elders, the women, the individuals which the head of the family presented more years of study, among the ones who declared to have white skin, and among the subjects with higher household income. More then one third of the individuals who used drugs reported selfmedication, which was more frequent among the youngsters and the men. A minority declared to ignore what does “generic medicine” means. The average expense with medicines was 6,2% of the household income, which shows to increase with the age, lower hosehold income and less years of study. CONCLUSION: This research revealed significant differences on consume, selfmedication, and expenses with medicines of different population subgroups. Studies about the pattern of drug use can contribute to the discussion of the problematic involving the access of the population to pharmacological therapies and support public policies which aims the rational use and the universal access to the drugs.

Abstract The repair of degenerative mitral valve regurgitation has been shown to be an effective procedure with durable results. The techniques for mitral valve repair are not completely risk-free for late failure, and the identification of factors associated with this increased risk is of clinical relevance as it permits an appropriate selection of patients for whom mitral valve surgery should be offered and by which technique. The European system for cardiac operative risk evaluation score (EuroSCORE) has been used and demonstrated worldwide to be a valid tool for the prediction of immediate postoperative outcome after coronary artery bypass surgery. There are only a few studies which examine its value in heart valve surgery. Mitral valve repair has been shown to be associated with significant improvement in terms of functional capacity, but the late quality of life in these patients has not been adequately assessed, and there is no data on the quality of life of long-term survivors. The study population consisted of two groups of patients operated on at our institution. The first group included 164 patients who underwent isolated or combined mitral valve repair for mitral valve regurgitation during the period 1993 to 2000, while the second group consisted of 207 patients who underwent mitral valve repair (164 patients) or replacement (43 patients) for isolated mitral valve regurgitation during the same time-period. The first study aimed to identify preoperative variables which may have impact on the 30-day postoperative outcome. In the second study, the long-term outcome after mitral valve repair was evaluated in order to identify the risk factors associated with late failures. The third study analyzed quality of life after valve repair and compared it to that of an age- and gender-adjusted Finnish general population. In the fourth study, the validity of EuroSCORE was tested in predicting the immediate and late outcome of patients who had undergone mitral valve repair or replacement for isolated valve regurgitation. Patient age, a history of prior cardiac surgery and NYHA functional class were independent predictors of poor outcome. A residual regurgitation grade of more than one immediately after primary repair and chronic pulmonary disease were independent predictors of mitral valve reoperation. After valve repair, quality of life was similar to the age- and sex-adjusted general Finnish population. Both additive and logistic EuroSCOREs were predictors of the immediate and late outcomes of patients after surgery for mitral valve regurgitation.

This paper describes a community coalition-university partnership to address health needs in an underserved US-Mexico border, community. For approximately 15 years, this coalition engaged in community-based participatory research with community organizations, state/local health departments, and the state's only accredited college of public health. Notable efforts include the systematic collection of health-relevant data 12 years apart and data that spawned numerous health promotion activities. The latter includes specific evidence-based chronic disease-preventive interventions, including one that is now disseminated and replicated in Latino communities in the US and Mexico, and policy-level changes. Survey data to evaluate changes in a range of health problems and needs, with a specific focus on those related to diabetes and access to healthcare issues-identified early on in the coalition as critical health problems affecting the community-are presented. Next steps for this community and lessons learned that may be applicable to other communities are discussed.

Master of Public Health - MPH / Background:Theoutcomeofpregnanciesinmanyinstancesislargelypredicatedon availabilityofSkilledBirthAttendants(SBAs).Despitethisphenomenon,illiteracyand financialdisadvantagehavebeenvariouslycitedastwinfactorspromotingtheinterest andpatronageofTraditionalBirthAttendants(TBAs)bywomenfolk.Itistherefore expected thatwomenhavingtertiarylevelofeducationandpossessing adequate economic resources would naturally prefer to use the SBAs.However,these http://etd.uwc.ac.za/ 9 observationshavenotsignificantlyreflected therealityin thechoiceofmaternal healthcareprovidersinNigeriaandthecityofLagosinparticular.Yet,accessto maternalservicesoftheSBAshasbeenwidelyacceptedasoneoftheleadingwaysof loweringmaternalmortality.Therefore,inordertoimprovethepatronageofSBAsand correspondinglylowermaternaldeathrates,itbecomesimperativetounderstandthe rationalebehindthepreferencefortheTBAs’usebywomenwhoarenotordinarily expectedtodosobyvirtueoftheirhighlevelofeducationandgoodfinancialcapacity. Aim:Theaim ofthisstudywastoexploreandunderstandtheexperiences,perception and beliefsystems influencing well-educated,middle income women and their reasoningfortheuseofTraditionalBirthAttendantsratherthanSkilledBirthAttendants fordeliveryservicesinLagos,Nigeria. Methodology:ThisisaqualitativestudyconductedinAlimoshoLocalGovernmentArea ofLagosinNigeria.Tenwomenwithtertiarylevelofeducationandbelongingtomiddle incomeeconomiccategorieswereenrolledasparticipants.Inaddition,itinvolved3 FocusGroupDiscussionscomprising7TraditionalBirthAttendantspergroup. Results:Behaviouraland attitudinalshortcomings by the SBAs;misconceptions regardingsurgicaldeliverybywomen;bureaucraticdelaysandbottlenecksexperienced attheSBAs’centres;thebeliefbythewomenthatpregnancyisasacredandspiritual eventwhichonlytheTBAshaveabilitytomanage;women’sconfidenceintheTBAsas havingbettercapacitytomanagecertaincoexistingmedicalconditionsinpregnancy; andmisinformationonmanagementmodalitiesforcertainconditionslikeinfertilityand fibroidallcombinetoinfluencepreferenceforutilizationofTBAsbywell-educated, middleincomewomeninthestudyarea.

Background Teenage pregnancy is a public and global health concern that remains a substantial challenge in Low-income countries, particularly the densely populated countries, including Rwanda. The factors that contribute to teenage pregnancies are broad, with the most common are socioeconomic factors. The study aims to investigate the association of socioeconomic, demographic factors of teenagepregnancy in Rwanda. Methods This study uses a cross-sectional study of Demographic and Health Survey data from the national Representative of Rwanda Demographic and Health Survey done between 2014 and 2015. Our study Analysis used a weighted data sample of adolescents aged 19-24 years. Bivariate descriptive and logistic regression was used to examine the associated factors of Teenage Pregnancy. Results Descriptive bivariate analysis exhibit place of residence, wealth index and education attainment variables are statistically significant. Multivariate analysis found positive association with teenage pregnancy after adding all variables to control potential confounders in bivariate logistic regression. For example, education attainment (no education and primary); Religion (Protestant and Adventist); wealth index (poor and middle) teenager’s women and girls who lived in the eastern region were associated with pregnancy among women who were Below 20 years old. Conclusion There is a substantial increase in teenage pregnancy in Rwanda. The study results demonstrate that potential factors (economic status and education attainment) are more likely to correlate to teenage pregnancy in Rwanda. Socioeconomic and demographics factors should be strongly considered when designing policies to address teenage pregnancy in Rwanda. / <p>Thesis presentation of Socio-economic factors associated with teenage pregnancy in Rwanda: A secondary analysisof Rwanda Demographic and Health Survey data from 2014-2015 by Kalisa Francois</p>

Background: Internal migration, a consequence of the demographic transition towards urbanization driven by globalization, represents a particular public health challenge. Change in residence from one sociocultural geographic context to another, with not only economic implications, but also changes in women’s long-established relationships of family interdependence, influences gender relations and can influence Intimate Partner Violence (IPV) against women. Different migratory trajectories may be related to IPV. The aim of this study was to identify the association between internal migration and physical and/or sexual violence against women in the last 12 months. Methods: A secondary analytical cross-sectional analysis of the publicly accessible 2015–2017 Demographic and Family Health Survey (DHS) was performed. The outcome variable was reported physical and/or sexual violence inflicted by the partner (IPV) during the last 12 months. Exposure variable was internal migration, operationalized from three questions: current place of residence, principal place of residence before 12 years of age and number of years of residence in the current place. Migrants were classified as those who reported having lived for 5 years or more in the current location and were categorized as rural-rural migrants, urban-urban migrants, urban–rural migrants and rural–urban migrants, recent migrants and nonmigrants those who resided in the same place all their lives. To identify the association between internal migration and physical violence, a generalized linear model (GLM) of the family and the log Poisson link log option was used, and the results are presented as prevalence ratios (PRs). A crude model and a model adjusted for confounding variables were performed. Results: Rural–urban migrant women had a 15.0% higher probability of experiencing IPV than nonmigrant women (PRa 1.15, 95% CI 1.03–1.29, p = 0.015), while the probability of experiencing IPV in the last 12 months for urban–rural, rural-rural,urban-urban migrantand recent migrant women was not significantly different from that of nonmigrant women. Conclusion: Rural–urban migration among women of childbearing age is a factor associated with a higher probability of IPV in the last 12 months. The identification of women with this rural–urban migration pattern could help prioritize those that may experience a greater probability of physical and/or sexual violence in Peru, it must be studied if this pattern is the same in other countries. / Revisión por pares

No description available.

<p>Background</p> <p>Adults with cerebral palsy (CP) may have special health care considerations related to an increased prevalence of risk factors for chronic diseases. In particular, disability-related sedentary time may increase the risk of cardiovascular disease and the related major adverse cardiovascular events (MACE) in this population.</p> <p>Methods</p> <p>Part I: A systematic review of major databases, trial registries, and conference abstracts identified randomized trials and observational studies exploring the prevalence and evaluating the prevention of MACE and risk factors for MACE in adults with CP. Title and abstract, data extraction, and quality of reporting assessment were completed in duplicate.</p> <p>Part II: A secondary analysis of Canadian census data evaluated the crude and adjusted risk of stroke in adults with CP and compared the crude risk with other Canadian adults with spinal cord injury, acquired brain injury, and epilepsy. All risks were reported as an odds ratio (OR) with 95% confidence intervals.</p> <p>Results</p> <p>Part I: 2281 unique articles were screened to provide 10 cross-sectional studies. No studies evaluated any interventions for MACE or risk factors for MACE. The most common risk factor studied was obesity. Two studies showed an increased in death due to circulatory diseases.</p> <p>Part II: Crude risk of stroke to CP was OR=12.5 (12.2-12.9). Mediation effects or multicollinearity was not observed. The adjusted risk of stroke was OR=7.9 (1.8-34.2). Elevated crude risk of stroke was also noted in patients with acquired brain injury (OR=16.2 [16.0-16.5]), spinal cord injury (OR=6.1 [6.0-6.3]), and epilepsy (OR=6.2 [6.0-6.3]).</p> <p>Conclusions</p> <p>This thesis provides a preliminary overview of the risk of MACE in adults with CP and hypothesis generating evidence for further research in this population. A prospective cohort study is urgently needed assess the implications of these findings. Adults with CP should minimize exposure to modifiable risk factors as much as possible.</p> / Master of Science (MSc)

Reliable und valide Informationen zur Häufigkeit und zu Korrelaten von Depression in der Allgemeinbevölkerung sind eine Voraussetzung für eine wissenschaftlich fundierte Gesundheitsversorgung und für Präventionsmaßnahmen. Die Vielfalt an Definitionen und die klinische Heterogenität von „Depression“ stellt eine Herausforderung für das Gesundheitsmonitoring und für die epidemiologische Forschung dar. Dies spiegelt sich in der Vielzahl an Depressionsmaßen wider. Daran anknüpfend ist das Ziel dieser kumulativen Dissertation, die Häufigkeiten und soziodemographischen und gesundheitsbezogenen Korrelate – mit einem Schwerpunkt auf der somatischen Komorbidität – eines breiten Spektrums etablierter Depressionsmaße in der erwachsenen Allgemeinbevölkerung in Deutschland zu untersuchen: von aktueller psychischer Belastung, depressiver Symptomatik und einem depressiven Syndrom über eine selbstberichtete ärztliche Depressionsdiagnose bis hin zu einer klinischen Major Depression. Datenbasis für die vier Originalarbeiten der Dissertation sind die bundesweit repräsentativen Querschnittstudien „Gesundheit in Deutschland aktuell“ (GEDA, 18 Jahre und älter) und die „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1, 19-79 Jahre) mit dem Modul Psychische Gesundheit (DEGS1-MH) des Robert Koch-Instituts (RKI). In Kapitel 1 werden Forschungshintergrund, Fragestellungen und Methoden der vier Originalarbeiten zusammengefasst und die Ergebnisse dargestellt. Es ergeben sich hohe Prävalenzen auf Basis aller Depressionsmaße. Zugleich wird deutlich, dass die jeweiligen Maße zu unterschiedlichen Prävalenzschätzungen führen und dass es nur moderate Schnittmengen der jeweils identifizierten Fallgruppen gibt. Weiterhin zeigt sich eine weitgehende, jedoch keine vollständige Übereinstimmung in assoziierten soziodemographischen und gesundheitsbezogenen Korrelaten. Dies betrifft auch die Assoziation mit chronischen somatischen Erkrankungen, für die sich teilweise unterschiedliche Muster zwischen den untersuchten Depressionsmaßen und zwischen den Altersgruppen zeigen. Es folgen eine synthetisierende Ergebnisdiskussion und die Ableitung von Implikationen für die epidemiologische Forschung, das Gesundheitsmonitoring und die klinische Praxis. Kapitel 2 enthält die vier Originalarbeiten der Dissertation.

Introduction: In Timor-Leste, anemia affects approximately 21% of reproductive age of women. The established risk factor for anemia is poor nutritional status, but recently solid fuel use in the household has emerged as a possible risk factors. The association between solid fuel and anemia has been studied in children and pregnant women, but there hasn’t been a study conducted to find the association among all reproductive age women from 15-49 years old. Aim: The objective of this study is to determine if use of solid fuels (charcoal, wood, and straw/shrubs/grass) compared to cleaner fuels (electricity, LPG. natural gas, biogas, and kerosene) associated with the increasing of the prevalence of anemia among reproductive age women (15-49 years old) in Timor-Leste. Methods: This study used data from the Timor-Leste Demographic Health Survey (TLDHS) 2009-2010. The data used was based on the individual level within household from 13 districts in Timor-Leste. Bivariable logistic regression analysis was performed to assess associations between each independent variable (type of fuels, age group, BMI group, residence, wealth index, education level and smoking behavior) and the outcome variable (anemia) and mutlivariable logistic regression model was also performed with significant covariates. Results: The association based on the type of fuels showed that the odds ratio for anemia in women using solid fuels was 1.73 (OR: 95% CI: 1.49 - 2.01) compared to the women using cleaner fuels. After adjustment for other covariates, the odds ratio for anemia in women that use solid fuels was 1.43 (95% CI: 1.29-1.64) compared to women using cleaner fuels. Discussion: Based on our study population, this study found that reproductive age women 15-49 years old in Timor-Leste who used solid fuel as a source of energy for cooking or heating activities in the household were at higher risk for anemia.