To address today’s most pressing adolescent and young adult (AYA) health issues, researchers are increasingly using digital technologies to facilitate interventions. Studies conducted using digital crowdsourcing, mobile health (mHealth) applications, and wearables such as smartwatches may offer unique benefits, including more widespread access to tailored intervention content. However, there is a great deal of variation in the extent to which AYA themselves have a voice in this research, which affects not only a study’s ethical integrity, but also potentially its outcomes. This three-paper dissertation presents a spectrum of approaches to AYA engagement in digital health research, examining the implications of each approach. Collectively, these papers suggest that the genuine and meaningful engagement of AYA in digital health research is a health promotion strategy that may boost the likelihood of intervention relevance, acceptability, and impact for this population.

Vécue comme l’une des plus grandes crises qu’a connue notre génération, la propagation du virus du SIDA est une urgence mondiale sans précédent, notamment en Afrique sub-saharienne où vivent la grande majorité des individus séropositifs. Dans un contexte où aucun vaccin n’existe encore et où les traitements sont onéreux et peu accessibles, les campagnes d’information sur le virus et l’acquisition de connaissances sur les méthodes de prévention, notamment à travers les programmes scolaires, sont cruciaux. La scolarisation est souvent vue comme la solution pour enrayer la propagation du virus et plusieurs études effectuées en Afrique sub-saharienne ont effectivement montré que les individus scolarisés étaient souvent les mieux renseignés sur le VIH/SIDA et son mode de propagation. Au Cameroun, pourtant, la partie de la population qui est la plus touchée par la séropositivité est aussi la plus instruite. C’est sur cet apparent paradoxe que se penche la présente étude. Cette recherche explore les différents facteurs qui sous tendent la relation positive entre le niveau d’instruction et la séropositivité au Cameroun en analysant les données de l’Enquête Démographique et de Santé (EDS) de 2004. Les résultats des analyses bivariées montrent que plus le niveau d’instruction des hommes et des femmes camerounais augmente, mieux ces derniers sont informés sur le VIH et ses modes de transmission. Malgré cet avantage au niveau des connaissances, l’analyse confirme un lien positif entre le niveau d’instruction et la séropositivé fort et statistiquement significatif parmi les femmes camerounaises, mais non significatif chez les hommes. Les résultats des analyses logistiques hiérarchiques suggèrent que c’est une combinaison de facteurs qui explique pourquoi les femmes les plus scolarisées sont aussi les plus touchées par le VIH/SIDA. Le fait qu’elles aient un profil sociodémographique différent (qu’elles soient plus jeunes et plus riches notamment), et qu’elles soient plus urbaines que leurs consœurs moins scolarisées, mais surtout qu’elles aient un temps d’exposition au risque hors union plus long et un nombre de partenaires plus élevés exposent davantage les femmes les plus scolarisées au virus. / Considered the biggest crisis known to our generation, the propagation of the AIDS virus is an unprecedented worldwide emergency, notably in sub-Saharan Africa where the majority of HIV-positive individuals live. In a context where no vaccine exists and where treatments are expensive and difficult to access, information campaigns about the virus and the acquisition of knowledge on prevention, notably through school programs, are essential. Schooling is often seen as the solution to eradicate the propagation of the virus, and studies held in sub-Saharan Africa have actually shown that highest educated individuals are more informed about HIV/AIDS and about its transmission. However, in Cameroon, the most affected part of the population is also the most educated one. This study investigates this apparent paradox. Using the 2004 data from the Demographic and Health Surveys (DHS), this research explores the multiple factors explaining the positive relation between the education level and seropositivity in Cameroon. Result from the bivariate analysis show that the level of knowledge about HIV and its transmission increases with the education level of men and women. In spite of this knowledge advantage, the analysis show a strong, positive and statistically significant link between the education level and seropositivity of women, but this link is not significant with men. The results of the hierarchical logistical analysis suggest that a combination of factor explains why the most educated women are more affected by HIV/AIDS. The fact that those women have a different sociodemographic profile (they are younger and wealthier), and that they live in more urban areas than their less educated counterparts, and especially the fact that they have a longer exposition time to HIV before engaging in a union, as well as an a higher number of sexual partners, increases their exposure to the virus.

The prevalence of respiratory symptoms indicative of asthma in children from Latin America has been largely ignored. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), 17 centers in 9 different Latin American countries participated in the study, and data from 52,549 written questionnaires (WQ) in children aged 13-14 years and from 36,264 WQ in 6-7 year olds are described here. In children aged 13-14 years, the prevalence of asthma ever ranged from 5.5-28%, and the prevalence of wheezing in the last 12 months from 6.6-27%. In children aged 6-7 years, the prevalence of asthma ever ranged from 4.1-26.9%, and the prevalence of wheezing in the last 12 months ranged from 8.6-32.1%. The lower prevalence in centers with higher levels of atmospheric pollution suggests that chronic inhalation of polluted air in children does not contribute to asthma. Furthermore, the high figures for asthma in a region with a high level of gastrointestinal parasite infestation, and a high burden of acute respiratory infections occurring early in life, suggest that these factors, considered as protective in other regions, do not have the same effect in this region. The present study indicates that the prevalence of asthma and related symptoms in Latin America is as high and variable as described in industrialized or developed regions of the world. / Revisión por pares

Objetivo. Avaliar o perfil de saúde, o acesso aos serviços de saúde e as condições de vida dos deficientes em áreas do Estado de São Paulo. Metodologia. A pesquisa utilizou os dados de um Inquérito Multicêntrico de Saúde no Estado de São Paulo em 2002 e de outro, realizado na capital em 2003. Os entrevistados que referiram deficiências foram a população estudada segundo as variáveis que compõem o banco de dados. Os dados foram digitados em Epi-Data e analisados em SPSS e STATA. Resultados. A prevalência de alguma deficiência foi de 143,2 por mil; deficiência visual (DV), 63,21 por mil; deficiência auditiva (DA), 43,01 por mil e a deficiência física (DF) de 11,06 por mil. Os acidentes de trabalho foram a segunda causa de DA em homens; os acidentes de trânsito foram a segunda causa das DF nos homens. As prevalências das deficiências aumentaram com a idade; foram maiores nas mulheres e nas pessoas com menos de 3 anos de escolaridade. A prevalência de DA e DF foi maior entre os homens. Entre os deficientes a prevalência de algumas doenças crônicas foi maior que entre os não-deficientes. Houve mais morbidades nos 15 dias anteriores à entrevista entre os DV e DA quando comparados com os não-deficientes. Entre os DV, 18,94% necessitavam de assistência médica regular; entre os DA, 15,38%; entre os DF, 57,16%. A principal causa das deficiências foi a doença. Mais DF relataram uma ou mais internações e menor uso de serviços odontológicos. Menor prevalência de exame das mamas entre DA e DF e de exames de próstata entre os DF e maior consumo de remédios entre os DV e DF, comparados com não-deficientes. Conclusão. As deficiências aumentaram com a idade, foram mais prevalentes em mulheres e em pessoas com menor escolaridade, sendo sua principal causa, as doenças. A DV foi a mais prevalente das três deficiências. A DA e a DF foram mais prevalentes nos homens. Entre os DV e os DA houve mais morbidades nos 15 dias anteriores à entrevista. Houve mais doenças crônicas entre os deficientes do que entre os não-deficientes. Os DF foram os mais necessitados de assistência médica periódica. O consumo de medicamentos maior entre os DV e DF. Políticas de saúde específicas devem ser ampliadas e outras criadas para atender as necessidades de saúde dos deficientes. / Objective. Evaluate health profile, access health services patterns and life conditions of the handicapped in some areas of the State of São Paulo. Methodology. The research used data from the Multicenter Survey Health in the State of São Paulo, 2002, and from another study carried through in São Paulo city, in 2003. The interviewed that had answered positively to disability were the target population studied according to the variables of the data bank. These data were typed in Epi Data and analyzed in SPSS and STATA. Results. The prevalence for any disability found was 143.2 for a thousand; visual disability (VD) 63.21 for a thousand; hearing disability (HD) 43.01 for a thousand and physical disability (PD) 11.06 for a thousand. The work accidents were the second cause of HD in men; the traffic accidents were the second major cause of PD in men. The prevalence of disability increases with the age; it was bigger in women and in the people who have less than 3 years of instruction. In all three groups of disability studied, the prevalence to the handicapped in some chronic diseases was grater comparing to the not-disability ones. Among VD, 18.94% needed regular medical assistance; among the HD, 15.38%; among PD, 57.16%. The main cause of all disabilities was the disease itself. More PD had told one or more hospitalization and minor use of odontological services. Lesser prevalence of breast examination between HD and PD, and prostate examination among the PD; and bigger drug consumption compared with the not-disability. Conclusion. The disabilities increased according to the age, were more prevalent in women and people with lesser years of study, being the diseases its main cause. The VD was the most prevalent comparing to the other three disabilities. The HD and the PD had been more prevalent among men. Among VD and HD had been found more morbidity in the 15 days before the interview. There was more chronic illness among handicapped comparing to the not handicapped. The PD were the most needed in terms of regular medical assistance. Specific health politics must be extended and others created in order to taking care of handicapped health necessities.

Introdução: A deficiência auditiva em idosos é decorrente do processo fisiológico do envelhecimento que ocorre de forma individual e pode ser agravada por fatores como exposição a ruídos, medicamentos, doenças e estresse. As limitações decorrentes deste déficit podem ser minimizadas evitando consequências como isolamento e frustração no idoso. A deficiência auditiva referida representa um importante instrumento para obtenção de indicadores de prevalência desta deficiência que ainda são escassos em âmbito nacional, regional e local. Objetivos: Descrever a prevalência da deficiência auditiva referida e seu impacto nas condições de saúde de idosos do município de São Paulo. Métodos: Os dados são provenientes do Inquérito de Saúde do Município de São Paulo (ISA-Capital), um estudo transversal de base populacional (n=3357) com a população não-institucionalizada e residente em área urbana do município de São Paulo. Analisou-se o subgrupo dos idosos (n=872). Foram utilizados os testes de associação do 2 e a análise de regressão de Poisson univariada. Resultados: A prevalência da deficiência auditiva referida pelos idosos foi 11,2 por cento e apesar do predomínio do sexo feminino na população estudada (60,3 por cento), esta prevalência foi quase duas vezes maior nos homens quando comparados às mulheres (p=0,006). Os homens que referiram deficiência auditiva apresentaram um diferencial na utilização de serviços de saúde, participavam mais dos programas de prevenção ao câncer de próstata (RP: 1,252 - p=0,015). A maior parte dos idosos com deficiência auditiva relatou não ter dificuldades em atividades de lazer (74,5 por cento), não necessitar de ajuda nas atividades de rotina (88,6 por cento), nem de assistência, seja médico-hospitalar ou para tratamentos de reabilitação (63,3 por cento) em decorrência deste déficit. Conclusão: A alta prevalência de deficiência auditiva referida pelos idosos, principalmente no sexo masculino, remete à relevância deste problema para a saúde pública, já que se observou desconhecimento dos idosos quanto a questões relativas a esta deficiência, assim como ações de prevenção, tratamento e reabilitação decorrentes da mesma. A utilização deste tipo de indicador em estudos de base populacional poderia representar a criação de dados para determinação da extensão da carga global e regional desta deficiência no processo do envelhecimento / Introduction: Hearing loss in the elderly is due to the physiological process of aging that occur individually and it may be aggravated by several factors such as noise exposure, medications, illnesses and stress. Limitations resulting from this deficit can be minimized by avoiding consequences such as isolation and frustration in the elderly. Self report hearing loss that is an important tool to obtain indicators of prevalence of disability and that are scarce at the national, regional and local levels. Objectives: To describe the prevalence of hearing loss and its impact on health conditions of elderly people in São Paulo, Brazil. Methods: Data are from the Survey of Health of São Paulo (ISA-Capital), a population-based cross-sectional study (n = 3357) with the non-institutionalized population residing in urban area of São Paulo. We analyzed the subgroup of elderly (n = 872). We used the 2 test of association and analysis of univariate Poisson regression. Results: The prevalence of hearing loss in elderly patients was 11.2 per cent and despite the preponderance of females in the population studied (60.3 per cent), the prevalence was higher in men than women (p = 0.006). Men who reported hearing loss had a differential use of health services, participated in more programs to prevent cancer of the prostate (RP: 1.252 - p = 0.015). Most elderly people with hearing impairment reported no difficulties in leisure activities (74.5 per cent) did not need help in routine activities (88.6 per cent), or assistance, whether medical or hospital treatment rehabilitation (63.3 per cent) as a result of this deficit. Conclusion: The high prevalence of self reported hearing loss, especially in the male sex, is relevant from the health public perspective, because the lack of knowledge the elderly regarding issues related to this deficiency as well as prevention, treatment and rehabilitation resulting from the same. The use of this type of indicator in population-based studies could represent the generation of data to determine the extent of global and regional burden of this deficiency in the aging process

Introdução: O câncer do colo do útero é uma das neoplasias malignas mais frequentes, particularmente nos países em desenvolvimento e, sobretudo nos grupos com maior vulnerabilidade social. As estimativas de incidência e mortalidade tendem para a redução, porém em ritmo lento. Vários são os fatores de risco identificados, no entanto, apresenta um dos mais altos potenciais de prevenção e cura. A estratégia utilizada para a detecção precoce é o exame de Papanicolaou. Inquéritos de base populacional representam oportunidades únicas para a obtenção de informações que possibilitam avanço no conhecimento das condições de vida e saúde da população e para a formulação e avaliação de políticas sociais de saúde. Objetivo: Analisar a realização do exame de Papanicolaou segundo variáveis socioeconômicas, demográficas, de estilo de vida, estado de saúde e o uso de serviços de saúde das mulheres com 20 anos ou mais de idade, residentes no município de São Paulo, Brasil. Métodos: Estudo transversal de base populacional, com dados obtidos através do Inquérito de Saúde no Município de São Paulo ISA Capital, 2008, em amostra composta por 1.236 mulheres com 20 anos ou mais. Considerou-se a prevalência do exame realizado nos últimos 3 anos que antecederam à entrevista. Para as análises estatísticas foi utilizado o módulo survey do programa Stata 10.0. O modelo de regressão de Poisson foi aplicado para verificar associações mais precisas da realização do exame com as variáveis estudadas. A confidencialidade foi garantida. Resultados: As associações estatisticamente significantes encontradas foram: idade (20 a 29 anos), ser casada ou ter companheiros, escolaridade (12 anos), tabagismo (exfumantes), mulheres que possuíam exame clínico das mamas e plano de saúde. O Sistema Único de Saúde foi responsável por 39,2 por cento dos exames de Papanicolaou realizados. O motivo referido para a não realização do exame mais frequente foi não era necessário/sou saudável. Discussão: Ao considerar a realização do exame conforme recomendada pelo Ministério da Saúde, seria esperada cobertura de Papanicolaou superior à observada. Em termos de condições socioeconômicas, as associações com renda e atividade remunerada não permaneceram no modelo final, sugerindo equidade social na realização do exame. Entretanto, os serviços de saúde devem criar estratégias que ampliem o acesso às populações mais vulneráveis proporcionando maior conhecimento e envolvimento da população na incorporação das práticas preventivas do câncer do colo do útero, oferecendo um atendimento de maior qualidade a todas as mulheres, sobretudo, as SUS dependentes. Considerações Finais: Para o êxito do programa de rastreamento, deve-se priorizar a capacitação dos profissionais de saúde, a qualidade dos exames, a garantia do seguimento e tratamento dos casos e o estabelecimento de intervenções mais humanizadas e equitativas na utilização dos serviços de saúde do SUS / Introduction: Cervical cancer is one of the most frequent malignancies, particularly in developing countries and especially in groups with higher social vulnerability. Estimates of incidence and mortality tend to decrease but at a slow pace. Several risk factors are identifies, however, shows one of the highest potential for prevent and cure. The strategy used for early detection is the Pap smear. Population-based surveys represent unique opportunities to obtain information to enable an advance in knowledge of living conditions and population health and for the formulation and evaluation of welfare policies. Objective: To analyze the performance of Pap smears according to socioeconomic variables, demographic, lifestyle, health status and use of health services for women aged 20 or older, residing in São Paulo, Brazil. Methods: Cross-sectional population-based data obtained from the Survey of Health in São Paulo - ISA Capital, 2008, in a sample of 1,236 women aged 20 years or more. We considered the prevalence of the examination in the last three years prior to the interview. For statistical analysis we used the survey module in Stata 10.0. The Poisson regression model was applied to assess associations more precise examination carried out with the variables. Confidentiality was guaranteed. Results: Statistically significant associations were found: age (20 to 29 years old), be married or have partners, education ( 12 years), smoking (former smokers), women who had a clinical breast exam and health plan. The Unified National Health System was responsible for 39,2 per cent of the reported Pap smears. The most frequent reported reason for not undergoing the test was \"not necessary / I\'m healthy.\" Discussion: When considering the test as recommended by the Ministry of Health, Pap smear coverage would be expected higher than that observed. In terms of socioeconomic conditions, the association with income and remunerated activity did not remain in the final model, suggesting an social equity in the exam. However, health services should develop strategies to increase access to vulnerable populations by providing greater knowledge and involvement of the population in the incorporation of preventive practices of cancer of the cervix, providing a higher quality care to all women, mainly the SUS dependent. Final considerations: For the success of the screening program, one should prioritize the training of health professionals, the quality of examinations, ensuring the monitoring and treatment of cases, and the establishment of more humane and equitable interventions at use of SUS´s health services

Introdução: as doenças crônicas não transmissíveis (DCNT) são reconhecidamente um problema de saúde pública, uma vez que têm gerado elevado número de óbitos, perda de qualidade de vida, podendo levar a incapacidades. Dentre as DCNT que mais acometem as populações adulta e idosa, destacam-se a hipertensão arterial (HA) e o diabetes mellitus (DM). O monitoramento das prevalências destas DCNT é de extrema importância para a vigilância, assim como o conhecimento de suas tendências e práticas de controle. Objetivo: estudar a evolução das prevalências de hipertensão arterial e diabetes mellitus, bem como as medidas de controle para essas doenças em indivíduos adultos e idosos (20 anos e mais) residentes no Município de São Paulo, nos anos de 2003, 2008 e 2015. Metodologia: foram utilizados dados dos Inquéritos de Saúde no Município de São Paulo (ISA-Capital) nos anos de 2003, 2008 e 2015, estudos transversais de base populacional. Todas as análises foram realizadas no programa estatístico Stata 14.0, por meio do módulo survey, que permite considerar variáveis de um plano de amostragem complexo. Foram realizados três estudos: 1) evolução das prevalências de HA e DM e suas medidas de controle; 2) uso de serviços de saúde para controle da HA e do DM; 3) potencialidades do ISA-Capital e sua contribuição para a gestão em saúde local. Resultados: (artigo 1) entre as pessoas de 20 a 59 anos, diferenças estatisticamente significativas foram observadas para as prevalências de: hipertensão (2003-2015) e dieta alimentar (ambos períodos). Entre as pessoas de 60 anos e mais: diabetes (2003-2015) e medicamento oral para controlar a diabetes (ambos períodos); hipertensão (2003-2015), dieta alimentar e medicamento oral para controlar a hipertensão (2003-2008). (artigo 2) observou-se aumento significativo no percentual de pessoas que referiu ir ao serviço de saúde de rotina por causa do DM no período 2003-2015. Em 2015, maior uso de serviços de saúde de rotina para controle da HA foi observado entre os idosos e as pessoas que referiram possuir plano de saúde. No caso do DM, houve associação entre o uso de serviços de baixa escolaridade. Ser idoso diminui o risco de não ir ao serviço de saúde para a controle da HA, enquanto ser do sexo masculino e não possuir plano de saúde aumentam este risco significativamente. (artigo 3) diferenças estatisticamente significativas no período 2003-2015 foram observadas para os indicadores: morbidade referida, passando de 27,9% (IC95%:24,1-32,1) em 2003 para 19,2% (IC95%:17,6-20,9) em 2015; e procura por serviços de saúde, de 13,2% (IC95%:10,59-15,9) em 2003 para 18,7% (IC95%:17,1-20,3) no ano de 2015. Foram encontradas diferenças significativas nas análises dos três indicadores segundo as CRS no ano de 2015: menor autorrelato de morbidade referida e procura por serviços de saúde na região sul em relação às regiões norte, sudeste e leste; considerando se o serviço procurado era SUS, maior autorrelato foi observado nas regiões norte, sul e leste em relação às regiões centro-oeste e sudeste. Conclusão: os inquéritos de saúde constituem importante base para o monitoramento e vigilância das condições de saúde, em especial, as doenças crônicas não transmissíveis e seus fatores de risco e proteção. A concepção de uma estratégia eficaz de vigilância e monitoramento de DCNT demanda investimentos em todas as esferas de gestão, mas é no nível local que se estabelece uma linha de base para avaliações mais precisas e particularizadas. Compreender as informações provenientes de inquéritos de saúde locais de modo a traduzi-las em práticas e políticas destinadas aos usuários dos sistemas de saúde é indispensável para o desenvolvimento do SUS. / Introduction: noncommunicable chronic diseases (NCDs) are recognized public health problems, since they have been generating a high number of deaths, loss of life quality, and may lead to disabilities. Among the NCDs that most affect the adult and elderly populations, the most prominent are arterial hypertension (AH) and diabetes mellitus (DM). Monitoring the prevalences of these NCDs is very important for surveillance, as well as enlighten their trends and control measures. Objective: to study the evolution of arterial hypertension and diabetes mellitus prevalences, likewise the control measures for these diseases in adults and elderly individuals (20 years and over) living in the Municipality of São Paulo in 2003, 2008 and 2015. Methods: data regarding adults who participated in the Health Surveys conducted in the Municipality of Sao Paulo in 2003, 2008 and 2015, which were cross-sectional studies, were analyzed. Data analysis was performed using the statistical software Stata 14.0 and the survey module, which takes into consideration the effects of complex sampling. Three studies were carried out: 1) evolution of AH and DM prevalences and their control measures; 2) health services utilization to control AH and DM; 3) potential of ISA-Capital and its contribution to local health management. Results: (paper 1) among people aged 20 to 59, statistically significant differences were observed for the prevalence of: hypertension (2003-2015) and diet (both periods). Among people aged 60 and over: diabetes (2003-2015) and oral medication to control diabetes (both periods); hypertension (2003-2015), diet and oral medication to control hypertension (2003-2008). (paper 2) there was a significant increase in the prevalence of people who reported routine health services utilization to control DM in the period 2003-2015. For 2015, an increased routine health services utilization to control AH was observed among the elderly and those who self-reported having health insurance. For those who reported DM, an association between health services utilization and low schooling was found. Being elderly reduces the risk of not going to the health services to control AH, while being male and not having a health insurance increase this risk significantly. (paper 3) statistically significant differences in the period 2003-2015 were observed for the indicators: self-reported morbidity, from 27.9% (95% CI: 24.1-32.1) in 2003 to 19.2% (95% CI: 17.6-20.9) in 2015; and demand for health services, from 13.2% (CI95%: 10.59-15.9) in 2003 to 18.7% (CI95%: 17.1-20.3) in 2015. There were significant differences in the analysis of the three indicators according to the health region coordination in 2015: lower self-reported morbidity and demand for health services in the south region compared to north, southeast and east regions; considering that the service sought was from the Unified Health System, the highest self-report was observed in the north, south and east regions in relation to the central-west and southeast regions. Conclusions: health surveys are an important basis for the monitoring and surveillance of health conditions, especially NCDs and their risk and protective factors. An effective NCD surveillance and monitoring strategy requires investment in all management scopes, but it is at the local level that a baseline is established for more precise and particularized assessments. Understanding information from local health surveys in order to translate them into practices and policies aimed to health systems users is crucial for the development of the Unified Health System.

This thesis has three main research aims. First the development of a questionnaire to measure HRQOL of ICU patients. Second, to examine a model of HRQOL proposed to assist with the development of the questionnaire. Third, to examine the HRQOL outcomes of patient after hospital discharge. The proposed model is based on a review of conceptual issues related to Quality of Life (QOL), Health Status and HRQOL. After a content analysis of a broad range of definitions of QOL, Health Status and HRQOL, QOL was defined as a dynamic attitude, continually being modified by experience. It is a function of the cognitive and affective appraisals of the discrepancies between domain specific perceptions and expectations. HRQOL was defined as an individuals cognitive and affective response to, or the QOL associated with, their health status. Health status was seen to consist of two health dimensions, physical and psychological health, with each dimension being composed of a number of component measures assessed subjectively. The developed questionnaire, the Sydney Quality of Life (SQOL) had good construct validity, based on substantial correspondence between qualitative and quantitative data, and internal consistency data (factor analysis and Cronbach's alpha). It had good concurrent validity in relation to the Sickness Impact Profile. The second order factor analysis of the SQOL suggested that health status may consist of three dimensions, physical health, positive mental health and negative mental health. The HRQOL model when formally examined, using Structural Equation Modelling (using LISREL), was not supported. However, exploratory modelling supported the separation of mental health into positive and negative components. The structure of HRQOL was different for patients than for the community from which they came. Patients QOL was determined largely by positive mental and physical health, whereas community members QOL was largely determined by negative mental health. Sixty three percent of patients at 12 months after discharge had significantly worse physical and functional health, lower satisfaction with their lives, lower positive affect and poorer QOL. Overall, mental health adapts rapidly to the impact of serious physical ill health and hospitalisation. Implications for clinical practice are examined.

Thesis--University of Oklahoma. / Includes bibliographical references (leaves 76-82).

Vécue comme l’une des plus grandes crises qu’a connue notre génération, la propagation du virus du SIDA est une urgence mondiale sans précédent, notamment en Afrique sub-saharienne où vivent la grande majorité des individus séropositifs. Dans un contexte où aucun vaccin n’existe encore et où les traitements sont onéreux et peu accessibles, les campagnes d’information sur le virus et l’acquisition de connaissances sur les méthodes de prévention, notamment à travers les programmes scolaires, sont cruciaux. La scolarisation est souvent vue comme la solution pour enrayer la propagation du virus et plusieurs études effectuées en Afrique sub-saharienne ont effectivement montré que les individus scolarisés étaient souvent les mieux renseignés sur le VIH/SIDA et son mode de propagation. Au Cameroun, pourtant, la partie de la population qui est la plus touchée par la séropositivité est aussi la plus instruite. C’est sur cet apparent paradoxe que se penche la présente étude. Cette recherche explore les différents facteurs qui sous tendent la relation positive entre le niveau d’instruction et la séropositivité au Cameroun en analysant les données de l’Enquête Démographique et de Santé (EDS) de 2004. Les résultats des analyses bivariées montrent que plus le niveau d’instruction des hommes et des femmes camerounais augmente, mieux ces derniers sont informés sur le VIH et ses modes de transmission. Malgré cet avantage au niveau des connaissances, l’analyse confirme un lien positif entre le niveau d’instruction et la séropositivé fort et statistiquement significatif parmi les femmes camerounaises, mais non significatif chez les hommes. Les résultats des analyses logistiques hiérarchiques suggèrent que c’est une combinaison de facteurs qui explique pourquoi les femmes les plus scolarisées sont aussi les plus touchées par le VIH/SIDA. Le fait qu’elles aient un profil sociodémographique différent (qu’elles soient plus jeunes et plus riches notamment), et qu’elles soient plus urbaines que leurs consœurs moins scolarisées, mais surtout qu’elles aient un temps d’exposition au risque hors union plus long et un nombre de partenaires plus élevés exposent davantage les femmes les plus scolarisées au virus. / Considered the biggest crisis known to our generation, the propagation of the AIDS virus is an unprecedented worldwide emergency, notably in sub-Saharan Africa where the majority of HIV-positive individuals live. In a context where no vaccine exists and where treatments are expensive and difficult to access, information campaigns about the virus and the acquisition of knowledge on prevention, notably through school programs, are essential. Schooling is often seen as the solution to eradicate the propagation of the virus, and studies held in sub-Saharan Africa have actually shown that highest educated individuals are more informed about HIV/AIDS and about its transmission. However, in Cameroon, the most affected part of the population is also the most educated one. This study investigates this apparent paradox. Using the 2004 data from the Demographic and Health Surveys (DHS), this research explores the multiple factors explaining the positive relation between the education level and seropositivity in Cameroon. Result from the bivariate analysis show that the level of knowledge about HIV and its transmission increases with the education level of men and women. In spite of this knowledge advantage, the analysis show a strong, positive and statistically significant link between the education level and seropositivity of women, but this link is not significant with men. The results of the hierarchical logistical analysis suggest that a combination of factor explains why the most educated women are more affected by HIV/AIDS. The fact that those women have a different sociodemographic profile (they are younger and wealthier), and that they live in more urban areas than their less educated counterparts, and especially the fact that they have a longer exposition time to HIV before engaging in a union, as well as an a higher number of sexual partners, increases their exposure to the virus.