Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-08-22T18:42:20Z No. of bitstreams: 1 tatianaresendecarvalho.pdf: 1506183 bytes, checksum: b3c7a483a60aa885fc2e59931d92b8b0 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-08-28T13:13:59Z (GMT) No. of bitstreams: 1 tatianaresendecarvalho.pdf: 1506183 bytes, checksum: b3c7a483a60aa885fc2e59931d92b8b0 (MD5) / Made available in DSpace on 2018-08-28T13:13:59Z (GMT). No. of bitstreams: 1 tatianaresendecarvalho.pdf: 1506183 bytes, checksum: b3c7a483a60aa885fc2e59931d92b8b0 (MD5) Previous issue date: 2018-03-21 / Estudo transversal realizado com 340 usuários hipertensos, acompanhados pela Estratégia Saúde da Família do município de São João del-Rei, selecionados a partir do registro das fichas de acompanhamento dos agentes comunitários de saúde, por amostragem aleatória simples. Os objetivos do estudo foram analisar a associação entre letramento funcional em saúde e adesão ao tratamento medicamentoso da HAS; descrever os níveis de letramento funcional em saúde da população de estudo; estimar a prevalência da não adesão ao tratamento medicamentoso da HAS e analisar os fatores associados à não adesão ao tratamento medicamentoso da HAS. A coleta de dados ocorreu entre os meses de junho à setembro de 2017 e foi realizada através de um formulário com questões estruturadas acerca dos fatores socioeconômicos, relacionados ao paciente, à doença, ao tratamento, à equipe e ao serviço de saúde. A avaliação da adesão ao tratamento medicamentoso foi feita através da Escala de Adesão Terapêutica de oito itens de Morisky (MMAS-8) e o nível de letramento funcional em saúde foi medido pelo B-TOFHLA. As análises estatísticas foram feitas utilizando-se o teste qui-quadrado e modelos de regressão de Poisson para estimar as razões de prevalência brutas e ajustadas, os respectivos intervalos de confiança (IC95%) e p-valor. A prevalência de não adesão ao tratamento farmacológico da HAS foi de 24,1% (IC 95%: 19,7 – 28,5). Os fatores associados à não adesão à terapia medicamentosa foram a credibilidade na importância dos medicamentos para o tratamento da HAS, a frequência na tomada dos medicamentos para a doença por dia, a compreensão das orientações e explicações dadas pelos profissionais de saúde e a dificuldade em conversar com os profissionais. Baixo letramento funcional em saúde foi encontrado em 80,2% dos hipertensos entrevistados. A proporção de usuários não aderentes ao tratamento com baixo letramento funcional em saúde foi 77% superior à proporção de usuários não aderentes à terapia medicamentosa com letramento funcional em saúde adequado (RP=1,77; IC95%:0,93 – 3,75). Os resultados mostram que mudanças baseadas na complexidade do regime terapêutico, uma adequada assistência à saúde, baseada nas particularidades de cada indivíduo, levando-se em conta a influência que o mesmo recebe do meio que o cerca podem contribuir para o aumento da adesão ao tratamento medicamentoso da HAS. É possível supor ainda que, identificando-se as limitações apresentadas pelos usuários em relação ao acesso e à compreensão das informações e orientações que lhe são repassadas, a equipe de saúde pode elaborar estratégias que favoreçam o processo de comunicação entre profissionais de saúde e usuários do sistema, compensando assim os baixos níveis de letramento funcional em saúde, fazendo com que as informações e orientações necessárias ao manejo e ao acompanhamento da doença sejam mais facilmente compreendidas pelos usuários. / This is a cross-sectional study performed with 340 hypertensive users who have been monitored by the Family Health Care Service from the city of São João del-Rei. They have been selected based on the follow-up records of the community health agents by simple random sampling. The aim of the study is to analyze the association between Functional Health Literacy and the adherence to the medical treatment for HAS (hypertension); to describe the levels of functional health literacy in the evaluated population; to estimate the predominant non-adherence to the drug treatment for hypertension and to analyze the factors that are connected to the non-adherence to the medical treatment for hypertension. Data collection has happened between June and September 2017 and it was carried out by using a questionnaire with questions about socioeconomic factors related to the patient, to their disease, to their treatment, the team who have assisted them and the health care service itself. The evaluation in order to measure the adherence to the drug treatment was carried out via the 8-item Morisky Medication Adherence Scale (MMAS-8) and the Functional Health Literacy level was measured by the B-TOFHLA. Statistical analyzes have been performed using the chi-square test and Poisson regression models in order to estimate crude and adjusted prevalence ratios, confidence intervals (IC95%), and p-value. The predominance of non-adherence to the pharmacological treatment for HAS was 24.1% (IC95%: 19.7-28.5). The main factors associated with the non-adherence to the drug therapy were: trustworthiness regarding the importance of drugs for the treatment of HAS, the frequency the user takes the prescribed medicine per day, the understanding of the instructions and explanations given by the health care professionals, and the struggle in talking to the professionals. Low functional health literacy has been found in 80.2% of the hypertensive patients who have been interviewed. The non-adherence ratio among patients with low functional health literacy is 77% higher than the proportion of non-adherence among patients with adequate functional health literacy (PR = 1.77, IC 95%: 0.93-3.75). The results have shown that changes based on the complexity of the therapeutic regime and an adequate health care provision based on the specificities of each individual, taking into account the influence that the patient gets from the environment he comes from can contribute to raise the levels of medication adherence for HAS. It is also possible to assume that, by identifying the patients limitations regarding the access and the overall comprehension of the information and instructions that are passed on to them, it allows the healthcare team to prepare and implement strategies that may favor the communication process between the healthcare professionals and users of the system, thus compensating for the low levels of functional health literacy and making the information and general guidelines that are necessary for the management and follow-up of the disease more easily understood by its users.

Introdução: A comunicação na saúde pública é uma ferramenta de promoção da saúde e acesso à informação. A melhoria da comunicação entre o laboratório clínico e os usuários constitui um direito do usuário do serviço público de saúde e também apresenta potencial para a diminuição de erros de análise provenientes da fase pré-analítica e consequente melhoria da segurança do paciente. Este trabalho teve o objetivo avaliar a adequação da linguagem escrita utilizada na comunicação entre o laboratório clínico e os usuários bem como sua influência da qualidade da fase pré-analítica do processo laboratorial. Materiais e Métodos: Foram analisadas instruções de coleta (IC) da Divisão de Laboratório Clínico (DLC) do Hospital Universitário da USP (HU/USP), de setembro de 2014 a agosto de 2016. Na primeira fase, os parâmetros de linguagem e legibilidade das IC foram avaliados pelos índices Fernández-Huerta (IFH), Flesch-Szigriszt (IFS), utilizando os programas de informática TextMeter® e INFLESZ®. Os textos de IC foram traduzidos para o espanhol e utilizados para validação dos índices IFH e IFS para a língua portuguesa. Na segunda fase, as IC foram reestruturadas e os parâmetros de linguagem e legibilidade foram analisados e comparados com as IC anteriores. O perfil sócio educacional dos usuários e uma lista dos problemas relacionados obtenção de amostras de biológicas foram obtidos na DLC. Resultados: Quanto aos parâmetros de linguagem, o número de linhas por IC, de palavras proparoxítonas e polissilábicas foi similar entre as IC anteriores e novas (p>0,05). Enquanto que o número de termos técnicos e de palavras por frase foi menor, e número de orações subordinadas e coordenadas e ordem inversas das palavras foi maior nas IC novas (p<0,05). O escore do IFH (58,4 ± 8,8) foi menor que o do IFS (62,3 ± 6,8, p=0,019) para 27 IC anteriores, mas não diferiu para as 40 IC novas (p=0,162). Os escores de IFS e IFH das IC novas em português foram similares aos das traduzidas para o espanhol, o que é indicativo de que esses índices são validos para a língua portuguesa. Os índices IFH e IFS de textos didáticos usados para avaliar o grau de escolaridade foram similares para o ensino fundamental (EF) I e II, mas foram menores para os dois últimos anos do ensino médio (EM). O número de IC com índices de legibilidade correspondentes aos textos didáticos destinados ao o 3º ano do EF II (32,7%, n=10) foi menor que o número de IC novas (52,5%, n=21), mas a diferença não foi significativa (p=0,280). Os percentuais de gênero e a cor autodeclarada foram similares entre as duas fases do estudo. Entretanto menos jovens (<34 anos), mais idosos (>50 anos) e mais usuários com EF, EM e ensino superior completo foram atendidos, na segunda fase do estudo (p<0,05). Foram identificadas mais falhas de orientação na primeira fase (n=11) que na segunda (n=22) mas sem diferença significativa (p=1,000). Conclusão: Os parâmetros de linguagem e legibilidade melhoraram após a reestruturação das novas IC. A análise de legibilidade contribui para a comunicação do laboratório clinico com os usuários e pode influenciar positivamente a qualidade da fase pré-analítica do processo laboratorial. / Introduction: Communication in public health is a tool to promote health and access to information. The improvement of communication between the clinical laboratory and the users constitutes a right of the public health service user and it is presents potential for the reduction of analytical errors from the pre-analytic phase and consequent improvement of patient safety. This work aimed to evaluate the adequacy of the written language used in the communication between the clinical laboratory and the users as well as its influence on the quality of the pre-analytical phase of the laboratory process. Materials and Methods: Collection instruction leaflet (CIL) from the Clinical Laboratory Division (DLC) of the University Hospital of USP (HU/USP) were analyzed from September 2014 to August 2016. In the first phase, the language and readability parameters of the CIL were evaluated by the Fernández-Huerta indexes (IFH), Flesch-Szigriszt (IFS), using the TextMeter® and INFLESZ® software programs. CIL texts were translated into Spanish and used for validation of the IFH and IFS indexes for Portuguese language. In the second phase, the CIL were restructured and the language and readability parameters were analyzed and compared with the previous CIL. The socioeconomic profile of the users and a list of problems related to obtaining biological samples were obtained in the DLC. Results: Regarding the language parameters, the number of lines per CIL and the proparoxytone and polysyllabic words was similar between the previous and new CIL (p> 0.05). While the number of technical terms and words per sentence were smaller, and number of subordinate and coordinated sentences and inverse order of words was higher in the new CIL (p<0.05). The IFH score (58.4 ± 8.8) was lower than the IFS score (62.3 ± 6.8, p = 0.019) for 27 previous CIL, but did not differ for the 40 new CIL (p = 0.162). The IFS and IFI scores of the new CIL in Portuguese were similar to those translated into Spanish, which is indicative of the fact that these indices are valid for the Portuguese language. The IFH and IFS indexes for didactic texts used to assess the educational level were similar for elementary education (EF) I and II, but were lower for the last two years of secondary education (MS). The number of CIL with readability indexes corresponding to the didactic texts for the 3th year of EF II (32.7%, n=10) was lower than the number of new CIL (52.5%, n=21), but the difference was not significant (p=0.280). The percentages of gender and self-reported color were similar between the two phases of the study. However, young adults people (<34 years), older people (>50 years) and more users with EF, MS and complete higher education were attended in the second phase of the study (p<0.05). More guiding failures were identified in the first phase (n=11) than in the second (n=22) but no significant difference (p=1,000). Conclusion: The language and readability parameters improved after the restructuring of the new CIL. The readability analysis contributes to the communication of the clinical laboratory with the users and can positively influence the quality of the pre-analytical phase of the laboratory process.

The aim of this thesis is to find out how the future teachers adopt a stance on health and if they are ready to pass the information on health issues of their pupils. Currently reveals how faculty of education prepares future teachers in terms of health issues and his support. The theoretical part devote to teacher's personality, general health issue, but also specifically teacher's health, the determinants of health, the issue of health literacy and burnout. The practical part is focused on research of personal attitudes of future teachers towards health and their awareness in this direction. The outcome of this work is to propose an elective subject, whose inclusion in the program of study at faculties of education can give students the opportunity to obtain the necessary information relating to health in relation to the development of health literacy among students in their future teaching profession.

Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. To counteract this, attention tends to focus around access (equality) of services. Yet access may not equate with the meaningfulness (equity) of services for women from different socioeconomic backgrounds. Without understanding equity we are not in a position to plan appropriate and equitable care. This study aimed to determine pregnant women's perceptions of the current antenatal provision and to determine if women from the extremes of socioeconomic background perceived their antenatal care differently. Longitudinal interviews were undertaken with multiple, comparative antenatal case studies between January 2007 and April 2009. Cases were primigravida women from ‘least deprived’ (n=9) and ‘most deprived’ (n=12) geographical areas as identified by the Scottish Index of Multiple Deprivation (SIMD 2006). The data were analysed using case study replication analysis. Analysis of categorical data from the sample groups indicated they were less diverse than might have been expected in terms of age and education. However in the key variables of housing tenure, potential income and socioeconomic status based on area of residence, the groups were indicative of the SIMD target populations. The preliminary analysis showed that the sample groups considered the initial General Practitioner contact to be less than adequate and the subsequent utility of antenatal education to be based on self perceived relevance. The substantive analysis showed little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups but perception of care differed. A key difference concerned the level of ‘engagement’ (defined as personalisation and active involvement in care, power and relationships and health literacy). Using these concepts, engagement was present in most of the ‘least deprived’ group and almost none of the ‘most deprived’ group. In comparison with women from affluent areas, more deprived women described less evidence of: personal connection to their own care; shared decision making; and perceived value in relation to the written educational aspects of antenatal care. In terms of the preliminary analysis, the results suggest that utility of educational material may need to be reviewed to ensure it is relevant to specific needs. Without this relevance, key information may be missed. The substantive analysis suggests that for women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing quality of antenatal services. The lack of engagement perceived by those who are most deprived suggests that equity of service has yet to be attained for those who are most in need. Future research needs to be directed to the potential reasons that may undermine equity and engagement in women from lower socioeconomic areas.

Alzheimer's Disease (AD) prevalence is 47 million in the world, 160,000 in Sweden. AD will increase by 70% in 50 years. AD cost is $7.9 trillion dollars in medicine and healthcare costs annually. Modifiable risk factors need to be mapped. Objective: Explore the relationship between sleep disorders and AD. Method: Searching PubMed and ScienceDirect for a literature review with 20 articles that were quality-reviewed. Result: Sleep-related factors that increase the risk of AD 1) Sleep disorders, sleep disturbed breathing, sleep apnea and insomnia. 2) The influence on cognitive ability, learning and memory showed correlation with sleep parameters. Sleep longer than 9 hours or less than 7 hours, daily naps longer than one hour were associated with increased AD risk 3) Other diseases and interfering factors, depression, cognitive impairment. Carriers of the APOE4-e4 gene with depression or cognitive impairment. IL-1b, a marker for inflammation, increases the risk of sleep disorders. People with clinician-verified depression and APOE-e4 were associated with a very high risk of AD, people with APOE-e4 and sleep disorders were associated with a high risk of AD. Symptoms of poor sleep that may be a sign of mechanisms are inflammation and tau / Ab accumulation as a sign of neurodegeneration. Conclusion: Sleep disorders, sleep parameters, disturbed REM sleep and genes are important for AD incidence. Programs to improve health literacy, control and treatment of sleep disorders and depression, limitation of risk factors, training in risk factors and sleep interventions. Interdisciplinary AD research needs to address the problem through transdisciplinary collaboration. / Prevalensen för Alzheimers sjukdom (AD) är 47 miljoner i världen varav 160 000 i Sverige. Antalet personer med AD kommer att öka med 70 % om 50 år. Kostnaderna för AD är 7900 miljarder dollar i medicin och vårdkostnader årligen. Påverkbara riskfaktorer kan därför behöva kartläggas. Syfte: Att kartlägga kunskapsläget kring och samband mellan sömnstörningar och AD. Metod: Sökning i PubMed och ScienceDirekt för en litteraturöversikt med 20 artiklar som kvalitetsgranskades och analyserades. Resultat: Sömnrelaterade faktorer som ökar risken för AD 1) Sömnsjukdomar, sömnrelaterad andningsstörning, sömnapné och insomni 2) Sömnpåverkan, fragmenterad sömn, otillräcklig sömnkvalitet, otillräcklig REM sömnslängd och ”REM latency”. Påverkan på kognitiv förmåga, inlärning och minne visade samband med sömnparametrar. Sömn längre än 9 timmar eller kortare än 7 timmar, dagliga tupplurar längre än en timme var associerat med ökad AD risk 3) Andra sjukdomar och samverkande faktorer, depression, kognitiv påverkan. Bärare av APOE4-e4 genen som hade depression eller kognitiv nedsättning. IL-1b, en markör för inflammation ger större risk för sömnstörningar. Personer med kliniskt etablerad depression och APOE-e4 associerades med mycket hög risk för AD, personer med APOE-e4 och sömnstörningar associerades hög risk för AD. Symptom vid sämre sömn som kan vara tecken på mekanismer är inflammation samt tau/Ab ansamling som tecken på neurodegeneration. Slutsats: Sömnstörningar, störd REM sömn och gener har betydelse för AD incidens. Program med hälsoinformation för att öka hälsolitteracitet behövs samt kontroll och behandling av sömnstörningar, depression och begränsning av riskfaktorer, utbildning i riskfaktorer och sömninterventioner. Tvärvetenskaplig AD forskning behöver hantera problemet genom ämnesövergripande samverkan.

Cardiovascular disease (CVD) is responsible for 25% of the annual deaths in the United States and represents a major public health burden, as patients often require screening and lifestyle changes related to multiple risk factors such as high blood pressure and high cholesterol. The purpose of this quantitative correlational study was to determine if there was a statistically significant association between high blood pressure and high cholesterol awareness (prevention and management) and cardiovascular health outcomes (angina pectoris, coronary heart disease, and heart attack). The theoretical framework that guided this study was the health belief model. Data from adults over the age of 18 from the 2017 National Health and Nutrition Examination Survey dataset were used for this study. Logistic regression was used to analyze data. Results showed no statistically significant association between high blood pressure awareness (prevention and management) and cardiovascular health outcome (angina pectoris, coronary heart disease, and heart attack) based on race, age, level of education, and acculturation. There was also no statistically significant association between high cholesterol awareness (prevention and management) and cardiovascular health outcome (angina pectoris, coronary heart disease, and heart attack) based on race, age, level of education, and acculturation. This study may contribute to positive social change through an increase in individuals' level of awareness of their medical condition, which could lead to a reduction in the burden of cardiovascular disease.

An important challenge for physical education teachers is to find strategies for the implementation of health education in the school subject physical education and health (PEH). The overall aim of this thesis has been to develop and explore the implementation of a pedagogical, practice based teaching-learning model in PEH. Focus of the study has been to promote students' understanding of health with aerobic condition, and its impact on health, as the specific object of learn-ing. The concept of Health Literacy has pervaded the entire project, both in the design of the model and in the analysis of students' description of their experi-ence and knowledge development. One upper secondary school class (n=32) was chosen for this action-based study. The implementation of the pedagogical model was designed as a student task-oriented interactive model. The educational outcomes of the model derived from tests and questionnaires were examined analyzed with statistics and con-tent analyses, as presented in article I and with phenomenographic analyses of student reports presented in article II. In focus for the analysis was how the object of learning, the phenomenon that the students encountered were de-scribed, experienced, conceptualized and understood. The design of the model supported an active processing of knowledge and stu-dents' ability of critical self-reflection within the framework of health literacy. To better integrate health in physical education, we need to both broaden stu-dents' way of questioning, and challenge their ways of constructing knowledge in (physical) health. / Forskningslinjen Utbildning

This diploma thesis deals with the topic of health literacy level in the Czech population and its association with sociodemographic and lifestyle factors. The aim was to describe this association in the stages of health information processing, which are the stages of finding, understanding, judging and application of health information. The data from the Czech modification of the HLS-EU survey from 2014 was used. Lower level of health literacy was associated with older age, lower level of education, as well as lower self-assessed social status at all stages of health information processing. Lower self- assessed health condition was also associated with lower level of health literacy, especially in the phases of understanding and application of health information. Regarding the lifestyle factors, the association was determined in case of physical activity, most notably in the phases of understanding and application of health information. The association was also determined in the case of body mass index, but only in phases understanding and judging. Differences in health literacy levels between smoking categories as well as between gender were not been determined. Regarding the difference between phases of health information processing, the judging of health information seems to be the most risk.

This thesis investigates approaches to public health in the Czech Republic and compares them to approaches in Norway. The theoretical part outlines key concepts in the field of health, public health, health policy and prevention and explores their diverse interpretation on the level of professional discourse. The empirical part provides a comparative analysis of the development and current state of health systems in both countries, health status of their populations, a general comparison of the approaches to prevention and health policy, as well as an analysis of a concrete example - fight against smoking as a major health risk factor. The aim of the thesis is not only to compare approaches to public health in both countries, but also to understand the complex relationships between the compared cases and the context. Based on this analysis, examples of good practice are identified, and recommendations are formulated which could stimulate further research or serve as a basis for the development of new health policies, prevention programs and campaigns. key words: health, public health, prevention, health policy, health system, health literacy, comparative analysis

Kroniskt sjuka tar idag flera beslut om hur de på egen hand ska behandla sin sjukdom, genommediciner, kost och träning. Tidigare forskning visar att det finns ett samband mellan kronisktsjuka och låg hälsolitteracitet. Definitionen av hälsolitteracitet är förmågan att tolka text,dokument och nummer som står i samband med varandra, samt förmågan att fungera isjukvården (Baker, 2006). Personer med kroniska sjukdomar har sämre kunskap om sittsjukdomstillstånd och tillgängliga behandlingar, vilket leder till sämre hälsoutkomster.Kroniskt sjuka har god tillgänglighet att utföra medicinska mätningar i hemmet, vilket ledertill en mer förståelse för sin egna sjukdom och bättre hälsoutkomst. Omfattande mängderlångtidsdata sparas idag inom vården, vilket har gjort data mer komplex. För att kunna tolkaoch förstå datan behövs det ett sätt att visualisera hälsodata på, så att det kan omvandlas tillinsikter och ny kunskap. Ett område som skulle kunna möta utmaningarna inom visualiseringav hälsodata är spelvisualisering. Syftet med studien var att undersöka om kunskap omvisualisering som tidigare enbart används i speldesign kan placeras på hälsodata och såledesstötta hälsolitteraciteten hos kroniskt sjuka. Studien har tillämpat en designforskingsansats,där designriktlinjer för visualisering inom spel implementerades i en prototyp, för att kunnaidentifiera hur hälsodata lämpligast kan visualiseras. Studien resulterade i fem designförslagför hur hälsodata kan visualiseras för att stötta hälsolitteracitet. / Today, chronically ill make several decisions about how to treat their medical condition through medication, diet and exercise. Previous research shows that there is a connection between chronical illness and low health literacy. The definition of health literacy is the ability to interpret text, document and numeracy that are interrelated, as well as the ability to function in the health care system (Baker, 2006). People with a chronical illness have inferior knowledge about their health and available treatments, leading to poor health outcomes. Chronically ill people have good accessibility to perform medical measurements at home, which leads to a greater understanding of their own illness, and better health outcomes. Large amounts of long-term healthdata is today stored in the health care system, which has made the data more complex. To be able to interpret and understand this data there is a need to visualize health data in a way that it can be transformed into insights and new knowledge. One area that could possibly meet the challenges of visualizing health data is game visualization. The purpose of the study was to investigate if common game visualization patterns can be effectively applied to health dataand thus support the health literacy of people with a chronicall illness. This was accomplished through a design research approach, where design guidelines for visualization in games were implemented in a prototype. It was done to identify how health datacan best be visualized. The study resulted in five design suggestions for how health data can be visualized to support health literacy.