Thesis (Ph. D.)--University of Rhode Island, 2004. / Typescript. Includes bibliographical references (leaves v. 2, 389-428).

Diss. (sammanfattning) Umeå : Univ., 2006. / Härtill 6 uppsatser.

Bakgrund: Diabetes typ 2 är en utav de vanligaste folksjukdomarna både i Sverige och globalt. Sjukdomen uppmärksammas långt efter att personen drabbats. Därmed har också diabetes typ 2 ökat senaste decennierna vilket i sin tur kan leda till svåra komplikationer och förtidig död. Till grund ligger ohälsosamma levnadsvanor relaterat till utveckling av diagnosen vilket globala organisationer och svenska myndigheter strävar efter att förebygga. Vid diabetes typ 2 kan utveckling av kunskap om egenvård samt livsstilsförändringar behöva genomföras för att främja hälsa. Utifrån det ökade antalet av individer som utvecklar sjukdomen samt vikten av livsstilsförändringar utforskas personers upplevelser av dessa förändringar.  Syfte: Syftet var att belysa hur personer med diabetes typ 2 upplever information om- samt genomförandet av livsstilsförändringar.           Metod: En kvalitativ litteraturöversikt baserat på elva originalartiklar från åtta länder i fyra världsdelar.            Resultat: Fyra övergripande teman identifierades; Information, Självhantering, Känslor och Stöd. Varje tema delades sedan in i 13 kategorier. Även om upplevelserna varierade i hög grad upplevde en majoritet av personerna med diabetes typ 2 svårigheter att förändra sina levnadsvanor samt att förstå informationen. Två bifynd i arbetet var socio-ekonomiska begränsningar och stöd utifrån, vilka beskrevs som viktigt samtidigt som det kunde ha en negativ inverkan på personernas självhantering av sjukdomen.                 Slutsats: Individanpassad information och inkludering av familjen i möten med vården är viktigt för att främja egenvårdsarbetet för personer med diabetes typ 2. Med tanke på att upplevelserna varierar finns behov av fortsatt forskning av enskilda individer med diabetes typ 2. / Background:  Type 2 diabetes is one of the most common endemic diseases in Sweden and a global health problem. The disease may be diagnosed several years after onset and that is one reason why type 2 diabetes has increased during the past decades. This in turn could lead to severe complications and even a premature death. Unhealthy eating habits and a lack of regular physical exercise are the primary causes in relation to the development of the diagnosis. Something both global organizations and Swedish authorities strive to prevent. A person diagnosed with type 2 diabetes faces big challenges. Lifestyle changes are often advised, and it is important to develop and acknowledge the need for self-care to promote health. Based on the increased number of individuals who develop the disease, and the importance of lifestyle changes, persons’ experiences of these adjustments are investigated.                        Purpose: The purpose was to highlight how persons with type 2 diabetes experience information about- and the procedure of changing their lifestyle.                      Method: A qualitative review based on eleven qualitative original articles from eight countries in four continents.             Result: Four general themes were identified; Information, Self-management, Feelings and Support. The themes were thereafter divided into 13 categories. Even if the experiences differed, the majority of persons with type 2 diabetes experienced difficulties changing their living habits and to understand the information. Two incidental findings in this review were socio-economic limitations and support from others, which were both described as important and simultaneously could have a negative impact on self-management. Conclusion: Individualized information and including family in healthcare meetings is important to promote self-care work for persons with type 2 diabetes. Considering the variation of experiences, further research on individuals with type 2 diabetes is still necessary.

Background: The challenge of research in resource-poor settings remains a profound concern and is closely linked to African social development. Work of this thesis spans the end of apartheid and first decade of the democratic era in South Africa, along with emergence of the HIV/AIDS pandemic. It also covers the founding decade of the INDEPTH Network. Aims: Through appraising health and population research in a rural southern African sub-district over the past decade, to evaluate the utility of health and socio-demographic surveillance in rural African settings for: • capturing the dynamics of health, population and social transitions • supporting a mix of research designs, and • contributing to policy and programme development and evaluation. To extend this appraisal by examining the multi-site opportunities offered by the INDEPTH Network. Methods: Work was sited in the Agincourt sub-district, a heavily populated border area of rural north-eastern South Africa. Health and socio-demographic surveillance, introduced in 1992, involved prospective follow-up of the entire sub-district population of 70,000 people (including some 30% Mozambican immigrants) who lived in 11,700 households and 21 villages. Annual census rounds systematically updated household membership and recorded all vital events (births, deaths and migrations) since the previous census. A maternity history was asked of women of reproductive age and a verbal autopsy carried out on all deaths registered. The resulting ‘data and research platform’ – a core feature of all INDEPTH field sites – provided data for computation of trends in vital events and supported an extensive interdisciplinary project portfolio. The population under surveillance can be disaggregated into cohorts selected by age, sex or other criteria. Analyses are possible at multiple levels (individual, family/household or neighborhood) and can include socioeconomic factors. Findings: The Agincourt community experienced a serious worsening of mortality among most age-sex groups, rapidly declining fertility to near replacement level, and changing patterns of labour migration. This resulted in major changes in population structure and household composition. The rising burden of chronic disease involved both chronic infectious illness (HIV/AIDS and tuberculosis) and non-communicable disorders (such as stroke and related vascular disease). The burden of illness requiring chronic care increased disproportionately to that needing acute care. Potential contributions of field sites based on health and socio-demographic surveillance to local and national health policy are considerable yet remain underexploited. Interpretation: Rural South and southern Africa is in the midst of multiple, interrelated transitions with implications for health, social and development sectors. Health and socio-demographic surveillance systems are effective research instruments that can capture the rapidly-changing dynamics of health and social transitions in developing settings. Similarly, they can support a range of observational and intervention study designs including policy evaluations. The INDEPTH Network should boost much-needed comparative research; yet singly, and as a group, many of these sites have yet to fulfil their undoubted potential.

Submitted by Miriam Lucas (miriam.lucas@unioeste.br) on 2018-05-14T16:57:50Z No. of bitstreams: 2 Viviane_Cristina_Trevisol_2017.pdf: 2227807 bytes, checksum: 65ae68288069f1d5b7639b9aa66b5685 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-05-14T16:57:51Z (GMT). No. of bitstreams: 2 Viviane_Cristina_Trevisol_2017.pdf: 2227807 bytes, checksum: 65ae68288069f1d5b7639b9aa66b5685 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-06-20 / Developing countries experience different levels of epidemiological transition in which infectious and parasitic diseases are replaced by chronic-degenerative and anthropogenic diseases as the main cause of mortality in the population. In Brazil, due mainly to socioeconomic, health and regional differences, the epidemiological transition does not occur homogeneously in the national territory. The objective of this work was to analyze the spatial distribution of cases of hepatitis A and death due ischemic heart diseases in Foz do Iguaçu-Pr and its demographic and socioeconomic determinants and thus allowing the reflection about the epidemiological transition that occur in a Brazilian border municipality. The mean incidence rates of hepatitis A and specific mortality due to ischemic heart diseases (IHD) in Foz do Iguaçu-PR, from 2010 to 2015, were used, considering the census tracts of the municipality as analysis unit. The data were obtained from the Epidemiology Sector of the city of Foz do Iguaçu-PR. The georeferencing of hepatitis A cases and IHD deaths were performed using the QGIS program, version 2.16. The spatial data exploratory analysis was performed through the Global Moran analysis, Local Indicator of Spatial Association (LISA) analysis and Global Moran Bivariate analysis, using the GeoDa program, version 1.6.7. As results, a significant positive spatial autocorrelation (p = 0.001) was detected when the census tracts were analyzed according to the hepatitis A incidence rate and the specific mortality rate by IHD. The incidence rate of hepatitis A presented a mean of 9.48 cases/100,000 inhabitants and the specific mortality rate due to IHD, referring to the period, presented an average of 29.4 deaths/100,000 inhabitants. Through the LISA analysis, four high-high clusters were identified considering the incidence of hepatitis A and were distributed in the North, South and East districts of the municipality, while for IHD mortality, seven high-high clusters were identified, distributed in the Eastern, West, South and North, but in comparison to the clusters referring to the incidence of hepatitis A, these census tracts had a different geographic location. In the Moran Global bivariate analysis, variables related to a lower socioeconomic 9 and sanitary conditions showed a positive correlation with high rates of hepatitis A incidence, while variables related to a higher socioeconomic and sanitary pattern had a positive correlation with high specific mortality rates for DIC. The data of the present study indicate that Foz do Iguaçu presents urban areas whose conditions favor the transmission and maintenance of high rates of hepatitis A, coexisting with urban areas where better socioeconomic and sanitary conditions prevail where ischemic heart diseases predominate, suggesting that the municipality is still in a prolonged and polarized phase of the epidemiological transition. / Os países em desenvolvimento vivenciam níveis diferentes de transição epidemiológica nos quais as doenças infecciosas e parasitárias são substituídas por doenças crônico-degenerativas e antropogênicas como principal causa de mortalidade da população. No Brasil, devido principalmente às diferenças socioeconômicas, sanitárias e regionais, a transição epidemiológica não ocorre de maneira homogênea no território nacional. O objetivo deste trabalho foi analisar a distribuição espacial dos casos de hepatite a e óbitos por doenças isquêmicas do coração em Foz do Iguaçu e dos seus determinantes demográficos e socioeconômicos e assim permitir a reflexão a respeito da transição epidemiológica em um município brasileiro de fronteira. Utilizaram-se as taxas médias de incidência de hepatite A e de mortalidade específica por doenças isquêmicas do coração (DIC) em Foz do Iguaçu-PR, no período de 2010 a 2015, considerando-se os setores censitários do município como unidade de análise. Os dados foram obtidos no Setor de Epidemiologia do município de Foz do Iguaçu-PR. O georreferenciamento dos casos de hepatite A e óbitos por DIC foram realizadas utilizando-se o programa QGIS, versão 2.16. A análise exploratória de dados espaciais foi realizada por meio da análise de Moran Global, análise de Indicador Local de Associação Espacial e análise de Moran Global Bivariado, utilizando-se o programa GeoDa, versão 1.6.7. Como resultados obtidos, constatou-se que os setores censitários quando analisados segundo a taxa de incidência de hepatite A e a taxa de mortalidade específica por DIC apresentaram autocorrelação espacial positiva significativa (p=0, 001). A taxa de incidência de hepatite A apresentou média foi de 9,48 casos/100.000 habitantes e a taxa de mortalidade específica por DIC (TME), referente ao período, apresentou média de 29,4 óbitos/100.000 habitantes. Por meio da análise LISA identificou-se quatro agrupamentos Alto-Alto para incidência de hepatite A distribuídos nos distritos Norte, Sul e Leste do município, enquanto que para a mortalidade por DIC, foram identificados sete agrupamentos Alto-Alto, distribuídos nos distritos Leste, Oeste, Sul e Norte, mas que comparativamente com os agrupamentos 7 referentes à incidência de hepatite A, predominantemente, esses setores censitários apresentaram localização geográfica distinta. Na análise de Moran Global bivariada, variáveis relacionadas com um padrão socioeconômico e sanitário mais baixo apresentaram correlação positiva com altas taxas de incidência de hepatite A, enquanto que, variáveis relacionadas com um padrão socioeconômico mais alto apresentaram correlação positiva com altas taxas de mortalidade específica por DIC. Os dados do presente estudo indicam que o município de Foz do Iguaçu apresenta bolsões urbanos cujas condições favorecem a transmissão e manutenção de altas taxas de hepatite A, coexistindo com bolsões urbanos onde predominam melhores condições socioeconômicas e sanitárias onde predominam as doenças isquêmicas do coração, sugerindo que o município ainda se encontra em uma fase prolongada e polarizada da transição epidemiológica. Palavras

<p>Globally, injury is a major public health problem. The extent of the problem varies considerably by demographic subgroups, regions and national income. The overall objective of this thesis is to examine the relationship between injury mortality and economic development, and to discuss its role in the changing patterns of mortality as described in health transition theory.</p><p>By cross-sectional analysis between cause-specific injury-related mortality and income per capita, studies included in this thesis indicated that while unintentional injury mortality (UIM) and homicide rates correlated negatively with GNP per capita for total populations with varying patterns for age-specific mortality, suicide rates increased slightly by nations’ income per capita, especially among women. In age- and cause-specific injury mortality differentials between low-income, middle-income and high-income countries, ageing and injury interplay mutually with regard to health transition; declining rates in child UIM by income level contributes to the ageing process, while increasing UIM among the elderly, in combination with ageing populations boosts the absolute number of injury deaths in this segment.</p><p>Between the income-based country groups, both cross-sectional and longitudinal analyses show that injury mortality for all three major causes (i.e. unintentional injury, suicide and homicide) first increase and then decrease with rising income per capita, following an inverted U-shaped curve.</p><p>These results illustrate that injury is not a homogeneous public health phenomenon from a health transition perspective. While child unintentional mortality clearly agrees with ‘diseases of poverty’, unintentional injury in the elderly agrees with ‘diseases of affluence’. Patterns for homicide and suicide are more complex and uncertain. Generally, the strength and direction of injury mortality by economic development vary considerably by age, sex and type of injury.</p><p>Further research on causations, mechanisms, broader indicators and data quality, as well as theoretical developments on health transition taking new findings and parallel frameworks into account, is needed to fully understand the complex relationship between economic development and injury mortality.</p>

Determinants of circulatory system diseases among the Czech population Abstract The determinants of circulatory system diseases are very well known, modifiable risk factors and factors widely spread among populations are in focus for the public health research. The aim of this thesis is a quantification of main cardiovascular risk factors in the Czech population using the survival analysis and HAPIEE cohort data. The epidemiologic situation, trends in the Czech population health including "the cardiovascular revolution" is discussed in the first part of the thesis. Among the Czech population high prevalence of many risk factors were found. The education had the strongest impact on cardiovascular health from sociodemographic characteristics. The negative effect of smoking, prevalence of high blood pressure, prevalence of diabetes and physical inactivity was confirmed. On the other hand the impact of obesity, binge drinking and high blood cholesterol level was not significant among the Czech population. The population approach in cardiovascular epidemiology and cardiovascular health promotion as well are discussed in the last chapter. Keywords: diseases of the circulatory system, mortality, health transition, cardiovascular health, risk factors, survival analysis, health promotion

Globally, injury is a major public health problem. The extent of the problem varies considerably by demographic subgroups, regions and national income. The overall objective of this thesis is to examine the relationship between injury mortality and economic development, and to discuss its role in the changing patterns of mortality as described in health transition theory. By cross-sectional analysis between cause-specific injury-related mortality and income per capita, studies included in this thesis indicated that while unintentional injury mortality (UIM) and homicide rates correlated negatively with GNP per capita for total populations with varying patterns for age-specific mortality, suicide rates increased slightly by nations’ income per capita, especially among women. In age- and cause-specific injury mortality differentials between low-income, middle-income and high-income countries, ageing and injury interplay mutually with regard to health transition; declining rates in child UIM by income level contributes to the ageing process, while increasing UIM among the elderly, in combination with ageing populations boosts the absolute number of injury deaths in this segment. Between the income-based country groups, both cross-sectional and longitudinal analyses show that injury mortality for all three major causes (i.e. unintentional injury, suicide and homicide) first increase and then decrease with rising income per capita, following an inverted U-shaped curve. These results illustrate that injury is not a homogeneous public health phenomenon from a health transition perspective. While child unintentional mortality clearly agrees with ‘diseases of poverty’, unintentional injury in the elderly agrees with ‘diseases of affluence’. Patterns for homicide and suicide are more complex and uncertain. Generally, the strength and direction of injury mortality by economic development vary considerably by age, sex and type of injury. Further research on causations, mechanisms, broader indicators and data quality, as well as theoretical developments on health transition taking new findings and parallel frameworks into account, is needed to fully understand the complex relationship between economic development and injury mortality.

Rationale: Vital registration is lacking in developing settings where health and development problems are most pressing. Policy-makers confront an “information paradox”: the critical need for information on which to base priorities and monitor progress, and the profound shortage of such information. Aims: To better understand the dynamics of mortality transition in rural South Africa over a decade of profound socio-political change coupled with emerging HIV/AIDS. Thereby to inform health and development programming, policy formulation, and the research agenda; and contribute to debate on the nature of the ‘health transition’. Methods: The Agincourt health and demographic surveillance system is based on continuous monitoring of the Agincourt sub-district population in rural north-east South Africa. This involves annual recording of all vital events, specifically deaths, births and migrations in 11,700 households comprising some 70,000 persons. A “verbal autopsy” is conducted on every death, and special modules provide additional data. Key findings: A major health transition has occurred over the past decade, with marked changes in population structure and rapidly escalating mortality particularly among children and younger adults. A quadruple burden of disease is evident with persisting infectious disease and malnutrition in children, emerging non-communicable disease in the middle-aged and older, high levels of violence in an apparently peaceful community, and rapidly escalating HIV/AIDS and tuberculosis. There is evidence of sex differences and socio-economic differentials in mortality; vulnerable sub-groups include the children of Mozambican immigrants and recently returned labour migrants. Implications: With respect to health transition, empirical data demonstrate a marked “counter transition” with mortality increasing in children and young adults; “epidemiologic polarization” is evident with the most vulnerable experiencing a higher mortality burden; and a “protracted transition” is reflected in the co-existence of persisting infectious disease and malnutrition, emerging HIV/AIDS, and increasing chronic non-communicable disease. With respect to health policy and practice there is urgent need to: strengthen HIV/AIDS prevention, treatment and care; offer effective long-term care to control the rising burden of chronic illness and related risk; maintain and improve maternal and child health services; and address differential access to care. This poses a substantial challenge to a severely stretched health system.

Demographic and epidemiological change has resulted globally in changes in population and individual health, which, in turn, have resulted in changing care needs. Demographic change in South Africa, mainly through a confluence of declining fertility rates and pre-AIDS increases in life expectancy, has produced an ageing population that is expected to continue ageing for at least the next 10 to 15 years. Currently, South Africa’s older population (60 years+) has a much higher annual average percent growth rate than the total population. Having more older persons than ever before implies increased prevalence of frailty, chronic disease and disability through a tendency of declining physical, mental and cognitive functional capacities—hence meaning a larger demand for care. The changing age structure of a population is commonly associated with changes in health, disease and cause of death patterns. Recent research indicates an intensive, quadruple burden of disease, with the major addition of HIV/AIDS to persistent pre-transitional conditions, non-communicable conditions, and high rates of injuries—implying an extensive and diverse need for care. While demographic and epidemiological change have led to an increased demand for care, health system change, shortages in formal public health care delivery, and the spiralling costs of private care have led to decreased availability of formal care. Care-requiring persons therefore may need to rely increasingly on ‘informal care’, defined here as ‘care provided at home to another person who, because of frailty disability or ill-health, cannot manage on his/her own’. Research on informal care in developed nations is well-established and extensive, but has received very little attention in South Africa where it is not clear how many and who it is that are informal carers. The thesis study has hence been conducted to contribute to the limited research in the field of informal care, aiming to establish the national extent of informal care, and to present a demographic and socio-economic profile of informal carers. A multi-stage stratified area cluster probability sample of 2704 persons was drawn from free-living adults in a nationally-representative household survey in 2000. Field data were collected during 2611 individual face-to-face interviews. Basic univariate and logistic regression analyses were conducted. Of the adult population, 27% were found to be informal carers. Significant prevalence differences were found regarding sex, population group, geographic residence, education, employment status, and income. Adjusting for selected demographic characteristics, the significance status and levels of some relationships changed. It is concluded that informal caregiving is widespread in South Africa. While demographic and epidemiological evidence suggest that the reliance on informal carers is expected to increase, many informal carers are struggling to shoulder the physical, mental and financial burden. A national strategy to focus on informal carers is recommended, to raise awareness about their essential role and value in the health care system; to recognize their contributions to population and individual health; to comprehensively support them; and to assess their needs and concerns through ongoing research. / Dissertation (MA (Demography))--University of Pretoria, 2006. / Sociology / unrestricted