INTRODUÇÃO: A rinossinusite crônica (RSC) é uma doença comum na população, com documentada repercussão na qualidade de vida e com alto custo direto em saúde pública que engloba consultas médicas, exames complementares e radiológicos, internações hospitalares, cirurgias e tratamento medicamentoso. Apresenta também custos indiretos como diminuição da produtividade no trabalho e absenteísmo. Os dados epidemiológicos sobre rinossinusite crônica são escassos; e as definições de rinossinusite crônica estabelecidas, as metodologias das pesquisas e as taxas de respostas diferem muito entre si. A pesquisa epidemiológica da RSC é importante para avaliar sua distribuição, analisar seus fatores de risco e fornecer dados para promoção de políticas de saúde pública, entretanto não existem dados epidemiológicos sobre a prevalência desta doença em nossa população. MÉTODO: Foi realizado um inquérito transversal de base populacional (survey) com plano de amostragem complexo realizado em dois estágios: setor censitário e domicílio. Entrevistas foram conduzidas pessoalmente, através de entrevistadores treinados, em 2003 indivíduos com idade de 12 anos ou mais, residentes da cidade de São Paulo. O questionário incluiu o diagnóstico de rinossinusite crônica segundo os critérios epidemiológicos estabelecido pelo EP3OS. Dados demográficos, diagnóstico médico autorreferido de doenças respiratórias (asma, sinusite, rinite), tabagismo, renda familiar, nível educacional e características do domicílio também foram incluídas. RESULTADOS: A taxa de resposta total foi de 87,8%. A idade média foi de 39,8 anos (DP= 21, 12-92), 45,33% do sexo masculino. A prevalência da rinossinusite crônica na cidade de São Paulo foi de 5,51% (IC 95%=3,99-7,58). Não existiu uma diferença estatisticamente significativa na prevalência segundo o sexo. Foi encontrada uma associação estatisticamente significativa do diagnóstico de RSC com o diagnóstico de asma (OR=3.88), de rinite (OR=5,02) e com o subgrupo de baixa renda (OR=2,28) As prevalências de RSC segundo o estado tabágico (p=0,43), consumo tabágico em anos.maço (p=0,26) e tabagismo passivo intradomiciliar (p=0,18) não apresentaram uma diferença estatisticamente significativa. CONCLUSÃO: A prevalência estimada de RSC na população da cidade de São Paulo é de 5,51% (aproximadamente 500.000 indivíduos). Foi encontrada associação com rinite, asma e com o subgrupo de baixa renda. Não houve associação com tabagismo / INTRODUCTION: Chronic rhinosinusitis (CRS) is a common disease with proven repercussions on quality of life and a high burden of direct costs to public health, which included physician visits, laboratory tests and medical imaging, hospital admissions, surgical intervention, and medical treatment. It also carries indirect costs, such as decreased productivity in the workplace and absenteeism. Epidemiological data on CRS are scarce, and the established definitions of CRS, study methods, and response rates vary widely. Epidemiological research into CRS is important to assess its distribution, analyze its risk factors, and provide data to subsidize public health policies; however, there are no epidemiological data on the prevalence of this disease in our population. METHOD: This was a cross-sectional population-based survey with a complex cluster sampling plan carried out in two stages: census sector and household. Interviews of 2,003 individuals, aged 12 years or older and living in the city of São Paulo, were conducted face-to-face by trained investigators. The questionnaire included diagnosis of CRS according to the epidemiological criteria established by EP3OS. Demographic data, a self-reported history of physician-diagnosed respiratory diseases (asthma, sinusitis, rhinitis), smoking, family income, educational attainment, and household characteristics were also included. RESULTS: The overall response rate was 87.8%. The mean age was 39.8 years (SD = 21 years; range = 12-92), and 45.33% were male. The prevalence of CRS in the city of São Paulo was 5.51% (95%CI = 3.99-7.58). There was no statistically significant difference in prevalence between the sexes. Statistically significant associations were found between diagnosis of CRS and diagnosis of asthma (OR=3.88), of rhinitis (OR=5.02), and belonging to the low-income subgroup (OR=2.28) The prevalences of CRS according to smoking status (p=0.43), tobacco intake in pack years (p=0.26) or exposure to passive smoking in the household (p=0.18) did not exhibit a statistically significant difference. CONCLUSION: The estimated population-wide prevalence of CRS in the city of São Paulo is 5.51% (approximately 500,000 individuals). Associations were found with rhinitis, asthma, and low income. There was no association with smoking

La santé des enfants demeure une question prioritaire en Afrique sub-saharienne. Les disparités en matière de mortalité entre pays et au sein des pays persistent et se sont fortement accrues durant la dernière décennie. En dépit de solides arguments théoriques voulant que les variables contextuelles soient des déterminants importants de la santé des enfants, ces facteurs, et particulièrement les influences du contexte local, ont été étudiées beaucoup moins souvent que les caractéristiques individuelles. L'objectif principal de la présente thèse est d’identifier les déterminants individuels et contextuels associés à la mortalité des enfants de moins de 5 ans en Afrique sub-saharienne. L’analyse systématique est basée sur les données les plus récentes des enquêtes démographiques et de santé (DHS/EDS). Deux questions spécifiques sont examinées dans cette thèse. La première évalue la mesure dans la quelle le contexte local affecte la mortalité infanto-juvénile, net des caractéristiques individuelles. La seconde question est consacrée à l’examen de l’effet du faible poids à la naissance sur le risque de décès avant 5 ans. Par rapport à la première question, les analyses multi-niveaux confirment pour plusieurs pays étudiés l’importance simultanée de l’environnement familial et du contexte local de résidence dans l’explication des différences de mortalité infanto-juvénile. Toutefois, par comparaison au contexte familial, l’ampleur de l’effet de l’environnement local paraît assez modeste. Il apparaît donc que le contexte familial reste un puissant déterminant de la mortalité des enfants de moins de 5 ans en Afrique sub-saharienne. Les résultats indiquent en outre que certains attributs du contexte local de résidence influencent le risque de décès des enfants avant 5 ans, au-delà des facteurs individuels dans plusieurs pays. Cette thèse confirme l’effet contextuel de l’éducation sur la mortalité des enfants. Cet effet s’ajoute, dans certains pays, à l'effet positif du niveau individuel d’éducation de la mère sur la survie de l'enfant. Les résultats montrent aussi que le degré d’homogénéité ethnique de la localité influence fortement la probabilité de mourir avant 5 ans dans certains pays. Globalement, les résultats de cette thèse suggèrent que le défi de réduire la mortalité des enfants va au-delà des stratégies visant uniquement les facteurs individuels, et nécessite une meilleure compréhension de l’influence des facteurs contextuels. Par rapport à la deuxième question, les résultats montrent également que les facteurs individuels restent aussi très importants dans l’explication des différences de mortalité des enfants dans plusieurs pays étudiés. Nos résultats indiquent que les différences de mortalité selon le poids à la naissance sont significatives dans tous les pays inclus dans l’analyse. Les enfants nés avec un faible poids (moins de 2500 grammes) courent presque 2 à 4 fois plus de risques de mourir au cours des cinq premières années de vie que les enfants de poids normal, même après correction pour l’hétérogénéité non observée. Ce résultat suggère qu’en plus des mesures visant à réduire la pauvreté et les inégalités de revenus, la réduction de l’incidence du faible poids à la naissance pourrait apporter une contribution majeure aux Objectifs du Millénaire pour le développement; spécialement comme une stratégie efficace pour réduire le niveau de mortalité parmi les enfants de moins de cinq ans. / Child health remains a priority area for health policy in sub-Saharan Africa. Disparities in child mortality between and within countries have persisted and widened considerably during the last few decades. While researchers have devoted considerable attention to the impact of individual-level factors on child mortality, less is known about how community characteristics and institutions affect health outcomes for children, even though they have a prominent role in theoretical models. The aim of this thesis is to identify individual and contextual effects of child mortality by using data from the latest round of Demographic Health Surveys for all countries in sub-Saharan Africa. Two sets of questions are addressed in this research. First, we evaluate the impact of contextual factors on the risk of dying before age 5 net of the effect of individual factors. The results indicate that some attributes of the community influence the mortality risks of children, over and above the intermediate factors included in this investigation. For instance, in half of the countries under study a 1% increase in the proportion of children fully immunized in the community is associated with a decrease of 17-79% in the odds of dying before age 5. The proportion of women in the community completing secondary school also significantly increases child survival. This effect is, in some countries, in addition to the positive individual-level effect of the child’s own mother being educated. Net of individual and household characteristics, higher community-level ethnic homogeneity is associated with decreased odds of dying before age 5 in some countries. Overall, the results of this study therefore suggest that the challenge to reduce under-five mortality goes beyond addressing individual factors, and requires a better understanding of contextual factors. Second, the study exploits recent national survey data for nine countries in sub-Saharan Africa to investigate the association of LBW and mortality not only in infancy but also during childhood, using a standardized methodology to adjust missing birth weight data from household surveys while accounting for unobserved family-level factors (genetic or behavioral) that may modify the relationship between birth weight and under-five-years mortality. We find evidence of the impact of birth weight on the risk of dying not only in infancy but also during childhood, which remains strong and significant in all countries even after controlling for potential confounding factors. The main policy implication of our findings is that reducing the incidence of LBW may be an important prevention strategy to combating child mortality in sub-Saharan Africa countries.

The study comprehensively analysed the impact of primary prevention services for reproductive health in the environment within which the adolescents grow towards life skills ecquisition and positive behavior patterning. The availability, accessibility and the effectiveness of adolescents' accompaniment in Soshanguve Township by certain caregivers were assessed. Unstructured observations, review of documents, questionnaire and semi-structured interviews were used for data collection. The results revealed the least support by parents and churches to accompany the adolescents and the inaccessibility of specialised center to the disadvantaged. The continued lack of knowledge and life-skills perpetuated the onset of reproductive problems. The lack of programmes to equip care providers on how to improve communication during care provision was a major setback. There is a great need for the erection of special care centers for adolescents. / Health Studies / M.A. (Nursing Science)

INTRODUÇÃO: A rinossinusite crônica (RSC) é uma doença comum na população, com documentada repercussão na qualidade de vida e com alto custo direto em saúde pública que engloba consultas médicas, exames complementares e radiológicos, internações hospitalares, cirurgias e tratamento medicamentoso. Apresenta também custos indiretos como diminuição da produtividade no trabalho e absenteísmo. Os dados epidemiológicos sobre rinossinusite crônica são escassos; e as definições de rinossinusite crônica estabelecidas, as metodologias das pesquisas e as taxas de respostas diferem muito entre si. A pesquisa epidemiológica da RSC é importante para avaliar sua distribuição, analisar seus fatores de risco e fornecer dados para promoção de políticas de saúde pública, entretanto não existem dados epidemiológicos sobre a prevalência desta doença em nossa população. MÉTODO: Foi realizado um inquérito transversal de base populacional (survey) com plano de amostragem complexo realizado em dois estágios: setor censitário e domicílio. Entrevistas foram conduzidas pessoalmente, através de entrevistadores treinados, em 2003 indivíduos com idade de 12 anos ou mais, residentes da cidade de São Paulo. O questionário incluiu o diagnóstico de rinossinusite crônica segundo os critérios epidemiológicos estabelecido pelo EP3OS. Dados demográficos, diagnóstico médico autorreferido de doenças respiratórias (asma, sinusite, rinite), tabagismo, renda familiar, nível educacional e características do domicílio também foram incluídas. RESULTADOS: A taxa de resposta total foi de 87,8%. A idade média foi de 39,8 anos (DP= 21, 12-92), 45,33% do sexo masculino. A prevalência da rinossinusite crônica na cidade de São Paulo foi de 5,51% (IC 95%=3,99-7,58). Não existiu uma diferença estatisticamente significativa na prevalência segundo o sexo. Foi encontrada uma associação estatisticamente significativa do diagnóstico de RSC com o diagnóstico de asma (OR=3.88), de rinite (OR=5,02) e com o subgrupo de baixa renda (OR=2,28) As prevalências de RSC segundo o estado tabágico (p=0,43), consumo tabágico em anos.maço (p=0,26) e tabagismo passivo intradomiciliar (p=0,18) não apresentaram uma diferença estatisticamente significativa. CONCLUSÃO: A prevalência estimada de RSC na população da cidade de São Paulo é de 5,51% (aproximadamente 500.000 indivíduos). Foi encontrada associação com rinite, asma e com o subgrupo de baixa renda. Não houve associação com tabagismo / INTRODUCTION: Chronic rhinosinusitis (CRS) is a common disease with proven repercussions on quality of life and a high burden of direct costs to public health, which included physician visits, laboratory tests and medical imaging, hospital admissions, surgical intervention, and medical treatment. It also carries indirect costs, such as decreased productivity in the workplace and absenteeism. Epidemiological data on CRS are scarce, and the established definitions of CRS, study methods, and response rates vary widely. Epidemiological research into CRS is important to assess its distribution, analyze its risk factors, and provide data to subsidize public health policies; however, there are no epidemiological data on the prevalence of this disease in our population. METHOD: This was a cross-sectional population-based survey with a complex cluster sampling plan carried out in two stages: census sector and household. Interviews of 2,003 individuals, aged 12 years or older and living in the city of São Paulo, were conducted face-to-face by trained investigators. The questionnaire included diagnosis of CRS according to the epidemiological criteria established by EP3OS. Demographic data, a self-reported history of physician-diagnosed respiratory diseases (asthma, sinusitis, rhinitis), smoking, family income, educational attainment, and household characteristics were also included. RESULTS: The overall response rate was 87.8%. The mean age was 39.8 years (SD = 21 years; range = 12-92), and 45.33% were male. The prevalence of CRS in the city of São Paulo was 5.51% (95%CI = 3.99-7.58). There was no statistically significant difference in prevalence between the sexes. Statistically significant associations were found between diagnosis of CRS and diagnosis of asthma (OR=3.88), of rhinitis (OR=5.02), and belonging to the low-income subgroup (OR=2.28) The prevalences of CRS according to smoking status (p=0.43), tobacco intake in pack years (p=0.26) or exposure to passive smoking in the household (p=0.18) did not exhibit a statistically significant difference. CONCLUSION: The estimated population-wide prevalence of CRS in the city of São Paulo is 5.51% (approximately 500,000 individuals). Associations were found with rhinitis, asthma, and low income. There was no association with smoking

A tendência de globalização dos ensaios clínicos, observada nos últimos anos, trouxe à tona questões antes não discutidas como a continuidade do tratamento com os medicamentos em investigação, após a conclusão da pesquisa. A inclusão de países em desenvolvimento nesses estudos traz consigo a preocupação com a vulnerabilidade dos participantes da pesquisa. No Brasil, há cerca de cinco anos, os Comitês de Ética em Pesquisa, CEP, e, particularmente, a Comissão Nacional de Ética em Pesquisa, CONEP, passaram a solicitar a manutenção do fornecimento do(s) medicamento(s) do estudo após sua finalização. Embora baseada nos principais documentos éticos que norteiam a pesquisa clínica, essa solicitação apresenta dificuldades práticas para implantação, principalmente no caso de doenças crônicas. O objetivo deste trabalho foi identificar as questões envolvidas na continuidade do fornecimento de medicamentos após a conclusão de ensaio clínico e analisar a perspectiva de atores que compõem o cenário da pesquisa clínica nacional. Questionários e respectivos Termos de Consentimento Livre e Esclarecidos, TCLE, foram enviados por correioeletrônico, entre outubro de 2009 e janeiro de 2010, a membros de CEPs (todos os CEPs credenciados pela CONEP naquela data), pesquisadores (em duas áreas terapêuticas, HIV/AIDS e Diabetes mellitus) e patrocinadores. Aos pesquisadores foi solicitado que aplicassem o questionário a seus pacientes de pesquisa. A taxa de resposta dos CEPs foi de 20,7% (124 responderam, de 599 questionários enviados), 20% para os pesquisadores (58 de 290) e 45,3% para os patrocinadores (24 de 53). Cinquenta e quatro pacientes convidados por seus médicos responderam. Com relação à informação contida no TCLE, o item menos informado é relativo a como obter o medicamento após o estudo, para todos os grupos pesquisados. Com relação à motivação dos pacientes ao participar de uma pesquisa, 96,2% dos pacientes responderam como \"muito importante\", na decisão, a busca de melhores cuidados médicos e atenção à própria saúde, e 94,2% o fato de colaborar para o desenvolvimento da ciência (altruísmo). Entretanto, os demais grupos entrevistados não pensam da mesma forma: para eles, a maior motivação dos pacientes, ao participar de pesquisas clínicas, é a busca de melhores cuidados médicos e atenção à sua saúde, seguido da busca pelo acesso a alternativas de tratamento para sua doença. Ao serem perguntados sobre quem deveria receber o medicamento em investigação após o estudo, os pacientes responderam que todas as pessoas deveriam receber o medicamento após o estudo (60,4%); entre os pesquisadores, a maior parte (43,1%) respondeu que o medicamento deveria ser fornecido às pessoas participantes do estudo e 39,7% deles responderam que o medicamento deveria ser fornecido às pessoas que se beneficiariam do medicamento em estudo. Já os representantes de CEP concordaram com os pacientes que todas as pessoas deveriam receber o medicamento, mas em proporção bem menor (35,3%). Os patrocinadores opinaram que o medicamento do estudo deveria ser fornecido aos participantes da pesquisa que dele se beneficiariam (50%). Houve consenso entre os grupos em que, havendo a continuidade do tratamento, este deveria ser fornecido pelo patrocinador e de forma gratuita. Ao responder a questão relativa a quanto tempo deveria o medicamento ser fornecido, pesquisadores e patrocinadores consideraram que o medicamento deveria ser fornecido até estar disponível na rede pública, enquanto que os membros de CEP, opinaram que isso deveria acontecer durante o período que o paciente fosse beneficiado. Os pacientes responderam que o benefício deveria ser mantido pela vida toda. Devido às várias limitações deste estudo (representatividade da amostra, população restrita a usuários da Internet), seus resultados podem não ser generalizados, mas podem contribuir para a discussão do tema, ao analisar os pontos de vista de vários atores do cenário da pesquisa clínica nacional. / The recent trend of globalization of clinical trials, observed in the last years, raised some non-previously discussed issues, such as the continuity of treatment after the conclusion of the study. The inclusion of developing countries in these trials brings together the concern with the participants\' vulnerability. In Brazil, about 5 years ago, the Ethics Committees (EC) and the National Commission of Ethics in Research (so called CONEP) started requiring the access to study medication after the trial ends. Even being based on the main documents related to ethics and research, some practical issues make this requirement difficult to implement, mainly in the arena of chronic diseases. The goal of this research was to identify the questions related to continuing the supply of the investigational medicine and analyze the perspective of all stakeholders involved in clinical research. Questionnaires and informed consents were sent through e-mail, between Oct 2009 and Jan 2010, to EC members (all ECs mentioned at CONEP site at that moment), clinical investigators (in two therapeutical areas, HIV/AIDS and Diabetes) and sponsors. We also asked the clinical investigators to submit the questionnaire (in paper) to their patients who already participated in clinical research. The response rate in each group was: 20.7% in EC members\' group (599 questionnaires sent, 124 replied), 20% in clinical investigators\' group (58 of 290) and 45.3% in sponsors\' group (24 of 53). Fifty four patients answered the questionnaire through their doctors. Regarding to the information displaced in the informed consent, the item less informed, according to all groups, was related to how to obtain the study medication after the conclusion of the trial. Concerning the motivation of patients which made them accept to participate in a clinical trial, 96.2% of patients answered as \"very important\" to obtain better health care and attention and 94.2% mentioned also as \"very important\" the possibility to collaborate with the progress of the science (altruism). However, among the other groups, the responses were different: for them, the major motivation for the patients would be to have access to better health care and attention (similar to patients) and search for access to treatment alternatives for their diseases. When asked to whom should be given the study medication after the trial, the patients answered that all patients should receive it (60.4%); for the clinical investigators, 43.1% believe that the medication should be given to the participants of the study and 39.7% to the subjects who participated and benefited from the study treatment. The EC members agreed (but to a lesser degree, 35.3%) with the patients that all individuals with the disease should receive the medication after the trial. For 50% of the sponsors, the study medication should be assured to the participants who had benefit from the treatment. In the case of need of access extension after the trial, a consensus could be observed among all groups, concerning to whom should provide the medication (the sponsor) and how (completely free). One question addressed the issue of how long the treatment should be assured after the trial: clinical investigators and sponsors replied that the medication should be kept until be available in the public health sector; the EC members thought it should be furnished while the patient keeps the benefit. The patients answered that the benefit should be assured for all life. Due to the several limitations of this research (such as the sample representativeness, population restrict to internet users), their results can\'t be generalized; however, the data can contribute to the discussion of this very complex topic through analyzing the views of the several stakeholders of the scenario of clinical research in Brazil.

O bullying escolar é um importante problema de saúde pública que vem sendo extensivamente estudado em países de alta renda. Nos países de baixa e média renda, características individuais e contextuais associadas ao bullying são pouco conhecidas. A presente tese é composta por três estudos. O estudo 1 objetivou realizar revisão sistemática sobre fatores contextuais associados ao bullying escolar. A busca utilizou as bases de dados MEDLINE, PsychInfo, Web of Knowledge e SciELO. Trinta e um estudos foram incluídos. Resultados sugerem associação entre maior desigualdade de renda em classes, escolas e países e maior risco de bullying. A relação entre tamanho da classe e da escola com bullying foi inconclusiva; escolas sem normas anti-bullying, com menor apoio e pior gestão da classe pelo professor tiveram maior risco de bullying. O estudo 2 visou identificar características individuais e contextuais associadas ao bullying verbal na escola, entre adolescentes brasileiros. Utilizou-se dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2009, com estudantes do 9º ano escolar. Realizou-se modelos de regressão logística multinível para identificar associações com variáveis de três níveis (indivíduo, escolas, cidades). A prevalência de bullying verbal em adolescentes brasileiros foi 14,2%. Somente 1,8% e 0,3% da variância do bullying verbal ocorreu nos níveis de escola e capital, respectivamente. Nenhuma característica das cidades se associou ao bullying. Escolas privadas apresentaram mais bullying que escolas públicas. Desigualdade de renda não se associou ao bullying. Meninos, os mais jovens, os que não moravam com pai e mãe, os expostos à violência doméstica, os com baixo peso ou sobrepeso sofreram mais bullying. O estudo 3 objetivou identificar padrões de comportamento relacionados a saúde, incluindo bullying, entre adolescentes brasileiros. Utilizou-se dados da segunda edição da PeNSE, coletados em 2012. Realizou-se análise fatorial exploratória e confirmatória, além de regressão linear para descrever características socio-demográficas associadas a cada padrão. Identificou-se três padrões de comportamento: o padrão \"comportamento problema\", compreendeu comportamento agressivo (incluindo bullying), consumo de álcool, cigarro e drogas e sexo não seguro; o padrão \"comprometedor da saúde\" incluiu indicadores de alimentação não saudável e comportamento sedentário; e o padrão \"promotor da saúde\" incluiu indicadores de alimentação saudável e atividade física. Os padrões \"comportamento problema\" e \"comprometedor da saúde\" se associaram aos mais velhos e aos residentes em regiões mais desenvolvidas, sendo o primeiro associado a escolas públicas e ao sexo masculino, enquanto o segundo ao sexo feminino. O padrão \"promotor da saúde\" se associou ao sexo masculino e aqueles com mães com maior nível educacional. Concluiuse que contextos de desigualdade parecem mais propícios à ocorrência de bullying de acordo com a revisão. Entretanto, dados do Brasil não corroboram essa hipótese para bullying verbal. Ambiente escolar com adoção de regras anti-bullying e professores mais solidários devem ser estimulados. As características das escolas e cidades estudadas explicaram pouco o bullying verbal. Características individuais sugerem sub-grupos de maior risco, podendo subsidiar políticas anti-bullying. Perpetrar bullying compôs o padrão de \"comportamento problema\", indicando que as intervenções devem ser mais amplas e direcionadas a múltiplos comportamentos / School bullying is an important public health problem, which has been extensively studied among high-income countries. In low- middle-income countries, there is a lack of information about associations between both individual-level and contextual-level characteristics with bullying. The aim of Study 1 was to carry out a systematic review of contextual factors associated with school bullying. Searches were performed in MEDLINE, PsychInfo, Web of Knowledge and SciELO. 31 studies were included. Results suggested that greater income inequality in schools, classes and countries is associated with increased risk of bullying. The influence of class and school size on bullying was inconclusive; schools without anti-bullying rules, with less support and poorer classroom management by the teacher had a higher risk of bullying. The aim of study 2 was to identify individual and contextual characteristics associated with verbal bullying, among Brazilian adolescents. We used data from the National Survey of School Health (PeNSE 2009) on students in 9th grade. We performed multilevel logistic regression models to identify associations with variables from three levels (individual, school, city). The prevalence of verbal bullying among Brazilian adolescents was 14.2%. Only 1.8% and 0.3% of the bullying variance occurred at school and capital levels, respectively. No city characteristic was associated with bullying. Private schools showed more bullying than public. Income inequality was not associated with bullying in Brazil. Boys, those of younger age, those not living with both parents, those exposed to domestic violence, those underweight or overweight suffered more bullying. The aim of Study 3 was to identify health-related behavior patterns, including bullying, among Brazilian adolescents. We used data from the second edition of PeNSE, carried out in 2012. We conducted exploratory and confirmatory factor analysis to identify behavior patterns, and linear regression models to describe sociodemographic characteristics associated with each pattern. We identified three behavior patterns; the problem-behavior pattern, which comprised aggressive behavior (including bullying), alcohol drinking, smoking, drugs use and unsafe sex; the health-compromising pattern, which included unhealthy diet indicators and sedentary behavior; and the health-enhancing pattern, which included healthy diet indicators and physical activity. The problembehavior and health-compromising patterns were associated with older age and from more developed regions. The former was associated with male gender and attending public school, while the latter was associated with female gender and more educated mothers. The health-enhancing pattern was associated with male gender and more educated mothers. In conclusion, the review suggested that bullying is more likely to occur in unequal contexts, but we could not confirm this hypothesis for verbal bullying in the Brazilian setting. Schools should be encouraged to adopt anti-bullying rules and to train teachers in bullying prevention. Among Brazilian adolescents the school and city variables explained litle of verbal bullying victimization. Individual characteristics indicated high risk sub-groups, which could be used to support anti-bullying policies. Bullying perpetration comprised part of the problem behavior pattern, suggesting that interventions should be more broaden

Les maladies chroniques (dont les maladies cardio-vasculaires (MCV)) constituent dans la majorité des pays en Europe voire dans le monde, une des principales causes de mortalité et de morbidité. En Belgique, ces pathologies sont responsables de 37% des décès (33% des décès chez les hommes et 40% chez les femmes) .<p><p>Les études épidémiologiques ont montré que certaines populations sont plus susceptibles que d’autres de développer ou de décéder des maladies cardio-vasculaires (1). Pendant longtemps, l’Europe a été caractérisée par des écarts importants de mortalité cardio-vasculaire entre le Nord, plus à risque, et le Sud. Ces différences entre populations s’expliquent par des facteurs génétiques, environnementaux, sociaux et culturels. <p><p>Parmi les facteurs culturels et environnementaux, des travaux scientifiques montrent, depuis plusieurs dizaines d’années, que l’alimentation et l’état nutritionnel participent de façon essentielle au développement et à l’expression clinique des maladies dans l’ensemble des pays industrialisés. Un équilibre nutritionnel, une consommation alimentaire variée, avec une répartition satisfaisante des quantités ingérées permettent de préserver un bon état de santé. <p><p>Les études épidémiologiques interethniques ont joué un rôle important dans l’avancée de la recherche de ces facteurs. Les études d’observation révèlent que lorsque des sujets d’un groupe ethnique particulier changent d’environnement, leur statut physique change au contact du nouvel environnement et diffère généralement de ceux restés dans le pays d’origine. La comparaison des taux de mortalité et de morbidité des immigrés de longue date aux taux observés dans le pays d’origine permet d’étudier la contribution des facteurs génétiques et environnementaux dans les variations de morbidité et de mortalité.<p><p>Les différences de morbidité et de mortalité entre ethnies ont été largement documentées pour les immigrés hispaniques, africains et sud-asiatiques en Amérique du Nord et en Grande Bretagne. Ces études ont montré que le profil de santé des immigrés est influencé tant par l’environnement du pays de naissance que par celui du pays d’accueil. L’influence de ces deux environnements peut donner lieu à 3 modèles de morbidité et de mortalité :la sous-mortalité (principalement observée parmi les immigrés de première génération issus de pays moins développés), la convergence (mortalité ou morbidité égale. Ce modèle concerne essentiellement les immigrés de seconde génération) et le dépassement (sur-mortalité ou sur-morbidité). <p><p>La santé des immigrés en Belgique est mal connue et peu étudiée. Dans la majorité des statistiques sanitaires comme dans les recherches épidémiologiques, les critères de nationalité et de naissance soit n'apparaissent pas du tout, soit ne font l'objet d'aucune analyse. L'occultation de ces variables a cependant pour conséquence de laisser dans l'ombre des indications précieuses pour la mise en œuvre de politiques de santé publique. <p><p>Bien que d’un intérêt évident en épidémiologie, les études interethniques posent un certain nombre de problèmes méthodologiques. Difficile à traiter, cette question n'en demeure pas moins essentielle à penser. <p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Tuberculosis (TB) has become a serious South African health problem because it is the most common opportunistic disease that leads to death in people with HIV/AIDS. Due to the airborne nature of the disease it can easily be spread to anyone including healthy people. A lack of compliance to treatment by TB patients explains why prevalence rates of the disease are high and why there is an emergence of drug resistant strains such as XDR-TB and MDR-TB. Information on existing knowledge, attitudes and perceptions regarding TB can provide a crucial foundation for the development of educational programmes and interventions aimed at reducing the further spread of the disease. This study aimed at understanding the knowledge, attitudes and perceptions towards TB and relating these to the current prevalence of HIV/AIDS. A face-to-face interview survey was conducted among adult Grahamstown East residents (n=1020). The Health Belief Model (Rosenstock et al., 1994) and Bandura’s (1986) Social Cognitive Theory formed the theoretical framework of the data collection and analysis. The data generated from the field work was first descriptively analysed providing frequency tables. Thereafter cross tabulations were calculated for relevant items using independent variables, namely gender, level of education, and experience of dealing with TB. The results of the study show that, in general, knowledge concerning TB was sufficient to provide a foundation for the adoption of healthier behaviours in the female respondents. Few of the respondents reported feeling personally susceptible although the majority of the respondents acknowledged the severity of the disease. The cues to action lacked the influence to persuade people to adopt positive health related behaviours. The perceived benefits of adopting preventative behaviour were not very influential in the adoption of healthier behavioural changes in the respondents. Disease stigma regarding the dual association of TB and HIV/AIDS was the main barrier for the adoption of healthier behavioural attitudes. Perceived self-efficacy in preventative behaviours was generally low in the less educated respondents. Recommendations regarding areas for future research and change interventions are provided.

Chapter 1: The Impact of Culture on the Second-Generation Immigrants’ Level of Trust in Canada Trust is one of the main elements of social capital; it determines the extent to which an individual cooperates with others. In this chapter, I assess whether cultural factors influence the level of trust in the population of second-generation immigrants in Canada. This paper is related to two strands of empirical literature. The first analyses the determinants of trust and the second studies the cultural transmission of values, attitudes and beliefs. I follow closely the literature on the cultural transmission and use an epidemiological approach to assess whether trust of second-generation immigrants is affected by their cultural heritage. This approach consists of comparing information about the outcomes of second-generation immigrants with that of the country of origin of their ancestry. We apply this approach using the Ethnic Diversity Survey (EDS), the World Value Survey (WVS) and the European Value Survey (EVS). Estimation results show that the average level of trust in the countries of origin of the ancestors of the second-generation immigrants has a strong significant impact on their level of trust. Thus, individual whose country of ancestry displays a high level of trust, tend to have a high level of trust. This provides evidence that individuals’ level of trust is not only explained by their personal experiences, characteristics, and the environment in which they live; but also by the culture in their country of ancestry. This means that culture does matter! I find that the results remain robust even if certain key countries are omitted or a different data set is used. Chapter 2: Decomposing Health Achievement and Socioeconomic Health Inequalities in Presence of Multiple Categorical Information This chapter presents a decomposition of the health achievement and the socioeconomic health inequality indices by multiple categorical variables and by regions. I adopt Makdissi and Yazbeck's (2014) counting approach to deal with the ordinal nature of the data of the United States National Health Interview Survey 2010. The findings suggest that the attributes that contribute the most to the deviation from perfect health in the United States are: anxiety, depression and exhaustion. Also, I find that the attributes that contribute the most to the total socioeconomic health inequality are ambulation, depression and pain. The regional decomposition results suggest that, if the aversion to socioeconomic health inequality is high enough, socioeconomic health inequalities between regions are the main contributors to the total socioeconomic health inequality in the United States. Chapter 3: Accounting for Freedom and Economic Resources in the Assessment of Changes in Women Poverty in Sub-Saharan Africa This chapter assesses the importance of freedom in women’s wellbeing in twelve Sub-Saharan Africa countries by using data from Demographic Health Surveys. This paper presents a poverty comparison by using the stochastic dominance approach and relies on the economic resources and freedom as the two aspects of wellbeing which evokes the multidimensionality of poverty. This study is related to the following three pieces of literature: the sequential stochastic dominance, the multidimensional poverty, the Sen’s capability approach which is based on freedom. This paper is built on Makdissi et al. (2014) but differs from it in a number of respects. First, it focuses on poverty instead of welfare. Secondly, it applies the Shapley decomposition to determine the contributions of the economic resource distribution and the incidence of the threat of domestic violence to poverty changes over time. Consistent with previous work on the importance of freedom, I find that more freedom, i.e. less threat of domestic violence, affects women’s wellbeing positively since it decreases women’s poverty. The results indicate that women’s wellbeing has improved in Burkina Faso, Ghana, Kenya, Lesotho, Madagascar, Malawi, Rwanda, Senegal, and Zimbabwe and deteriorated in Ethiopia, Nigeria and Tanzania.

In der Behandlung der zervikalen Dystonie wird die Therapie mit Botulinumtoxin (BTX) erfolgreich angewendet. Neben dieser Therapie werden von Patienten oft alternative Therapien (CAM [Complementary and Alternative Medicine]) angesprochen und ausprobiert. Diese Studie geht der Frage nach, wie häufig CAM-Therapien genutzt werden, wie deren Wirkung bewertet wird und ob es Prädiktoren für die Therapiewahl gibt. Zur Datenerhebung wurden 265 Fragebögen von zwei Patientengruppen ausgewertet. Gruppe 1 (n=101) bestand aus Patienten der Botulinumtoxinsprechstunde des Universitätsklinikums Leipzig und der Paracelsus Klinik Zwickau. Gruppe 2 (n=165) wurde aus Mitgliedern des Selbsthilfeverbandes Bundesverband-Torticollis e.V. rekrutiert. Bei 86% der Patienten wurde die Therapie mit BTX angewendet. Von den Therapiemöglichkeiten der CAM wurden am häufigsten physikalische Therapien (Massagen n=171) genannt. Am besten bewertet wurden jedoch, neben der BTX-Therapie, spezielle physiotherapeutische sowie psychotherapeutische Verfahren. Die CAM-Therapien wurden häufig in Kombination mit der BTX-Therapie angewendet und von Patienten, deren Erkrankung einen langen chronischen Verlauf vorwies (>10 Jahre). Als Prädiktoren für die Wahl einer CAM-Therapie zeigten sich eine Zugehörigkeit zur Gruppe 2, aufgetretene Nebenwirkungen im Rahmen der BTX-Therapie, männliches Geschlecht und erhöhter Stress bei den Erkrankten. Außerdem fand sich ein signifikanter Unterschied zu einem höheren Bildungsabschnitt und Arbeit in gehobeneren Berufsgruppen bei Patienten, die vermehrt CAM Therapie anwenden. Zusammenfassend wurden CAM-Therapien, neben der Behandlung mit BTX, häufig von den Befragten angewendet. Hohe Zufriedenheitswerte erzielte eine Kombination mit physiotherapeutischen Verfahren oder Psychotherapie. Die Wahl von CAM-Therapien ist von der Erkrankungsdauer, Bildungslage und finanziellen Ressourcen abhängig.:1 EINLEITUNG 5 2 STAND DER FORSCHUNG 6 2.1 Definitionen 6 2.2 Epidemiologie 7 2.3 Pathologie 8 2.4 Klinisches Bild 11 2.5 Therapie 13 3 FRAGESTELLUNG UND HYPOTHESEN 24 4 STICHPROBE UND METHODE 25 4.1 Stichprobe 25 4.2 Erhebungsinstrument 26 4.3 Statistische Auswertung 28 5 ERGEBNISSE 30 5.1 Soziodemographische Daten 30 5.2 Krankheitsbezogene Merkmale 33 5.3 Therapie 35 5.4 Prädiktoren für die Therapiewahl 42 6 DISKUSSION 45 6.1 Das Patientenkollektiv 45 6.2 Diskussion der Botulinum-Toxin-Therapie 47 6.3 Diskussion der alternative Therapien 48 6.4 Diskussion der Prädiktoren für die Therapiewahl 54 6.5 Kritik 58 6.6 Schlussfolgerungen und Empfehlungen 59 7 ZUSAMMENFASSUNG 61 8 LITERATURVERZEICHNIS 64 9 ANLAGEN 72 9.1 Tabellen- und Abbildungsverzeichnis 9.2 Fragebogen 9.3 Erklärung der eigenständigen Abfassung der Arbeit 9.4 Curriculum Vitae 9.5 Veröffentlichungen und Vorträge 9.6 Danksagung