Made available in DSpace on 2014-08-20T13:58:01Z (GMT). No. of bitstreams: 1 RODRIGO_PEREIRA_DUQUIA_tese.pdf: 673344 bytes, checksum: ae25f96b35c9d6357bf3d184433ebb25 (MD5) Previous issue date: 2006-10-26 / Background: Sunscreen use is important for the prevention of skin cancer, but population-based information about the prevalence and its associated factors are scarce in Brazil. Objective: To evaluate the prevalence and associated factors with sunscreen use among Brazilian adults. Methods: We conducted a cross-sectional population-based study with a representative sample of adults aged 20 years or older living in the urban area of the city of Pelotas, Southern Brazil. We evaluated sunscreen use at the beach, at work, and during outdoor sports, for at least 20 minutes between 10 a.m. and 4 p.m., from December 2004 to March 2005. The outcome measure was dichotomized in subjects who never used sunscreen, and those who used sunscreen, regardless of frequency. Results: Prevalence of sunscreen use at the beach, work, and outdoor sports was 60.8% (CI95% 55.6 - 66.0), 13.7% (CI95% 10.7 - 16.6%), and 30.2% (CI95% 24.1 - 36.3), respectively. At work, the median number of days of exposure was 70 days, while at the beach it was 10 and, for sport it was 16. Females, whites, those with higher educational achievement, and with higher income were more likely to use sunscreen. Limitations: No data on adequacy of sunscreen use was gathered Conclusion: Our data show that the subjects most exposed to sunlight are those that use sunscreen the least. Interventions targeting this group are required, since this is also the population with the lowest socioeconomic level. / Diversos estudos já comprovaram que ficar exposto ao sol acarreta prejuízos para a pele. Pessoas que se protegem do sol têm menor chance de desenvolver câncer de pele. Além disso, a proteção contra os raios solares retarda o aparecimento de rugas e manchas, preservando, desta forma, a pele das pessoas. Apesar deste conhecimento, muitas pessoas preferem expor-se ao sol para ficarem bronzeadas ao invés da preservação de uma pele jovem e saudável. Este assunto tem despertado o interesse de diversos pesquisadores na área da saúde. O médico dermatologista Rodrigo Pereira Duquia realizou uma pesquisa com adultos da cidade de Pelotas para avaliar o comportamento da população com relação à utilização de fotoprotetores (creme protetor solar) durante o verão. O trabalho foi realizado durante os meses de outubro a dezembro de 2005, sendo entrevistadas 3136 pessoas com 20 anos ou mais de idade. Entre os achados mais importantes do estudo destaca-se que 23% dos entrevistados trabalhavam em média 65 dias no verão expostos ao sol, no período das 10:00 às 16:00h, considerado o de maior risco para o desenvolvimento do câncer de pele. Mais preocupante ainda foi o achado de que apenas cerca de 14% dessas pessoas utilizavam fotoprotetor. O estudo também demonstrou que a freqüência do uso do protetor solar foi muito maior na praia. Mais campanhas são necessárias para que a população saiba os malefícios da exposição ao sol e utilize medidas preventivas, como o uso do fotoprotetor, com o objetivo de 106 diminuir as taxas de câncer de pele e retardar o envelhecimento da pele. Atenção especial deve ser dirigida aos trabalhadores expostos ao sol, já que este é o grupo que menos usa o fotoprotetor solar e que permanece maior número de dias exposto ao sol.

<p>Functional impairment is increasingly prevalent among middle-aged and older adults, with 2 in 5 adults over the age of 65 having some form of disability, the majority being limitations on mobility. Many older adults are able to maintain functional capacity well into later life, but the factors that contribute to high levels of function and the mechanisms by which they operate are unclear, although prior work has demonstrated the importance of social relationships for health. Guided by principles from the life course perspective and perspectives on social connectedness, this dissertation examined the role of social connectedness across the life course as a predictor of functional capacity in adulthood. I used existing longitudinal data from the national Midlife in the United States (MIDUS) study to pursue three central aims.</p> <p><br></p> <p>First, Paper 1 compared theoretical and data-driven approaches to classifying life course relationships, including multiple dimensions of social connectedness at different time points across the life course. Results showed that the data-driven approach (i.e., latent profile analysis) was a stronger predictor of functional limitations than the theoretical approach and revealed relationship trajectories consistent with life course cumulative processes. Second, using the profiles obtained from Paper 1, Paper 2 probed the association between life-course social connectedness and functional limitations by examining the potential mediating role of candidate biological and behavioral mechanisms, and moderation by socioeconomic status (SES). Paper 2 findings suggested that observed differences in later-life functional limitations based on life-course social connectedness can be at least partially explained by physical activity, but do not vary by SES. Contrary to hypotheses, inflammation was not a significant mediator. Third, Paper 3 used monozygotic twin data and within-family analyses to sharpen the focus on potential causal associations between life-course social connectedness and adult functional status. Results suggested that the association is likely driven by genetic and/or shared environmental influences. </p> <p><br></p> <p>Taken together, these results add to our understanding of social connectedness and health and address important gaps in the literature. These findings are used to generate theory- and intervention-relevant insights into the successful maintenance of health, independence, and function across the lifespan.</p>

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L'adolescence est une période cruciale dans le développement, la consolidation et parfois le déclin de certaines habitudes de vie. Durant cette période, l'activité physique tend à diminuer avec l'âge, en particulier chez les filles. Fillactive est un organisme qui offre des services qui aident les écoles canadiennes à mettre en oeuvre des interventions d'activité physique spécifiquement dédiées aux adolescentes. Les objectifs de cette étude étaient d’évaluer les changements dans la pratique d’activité physique et les habitudes de vie (temps sédentaire, durée du sommeil et habitudes alimentaires) des participantes du programme Fillactive et de déterminer si ces changements variaient en fonction du respect des Directives canadiennes en matière de mouvement sur 24 heures et des recommandations du Guide alimentaire canadien à l'inscription. Lors de l’inscription et à la fin de l’année scolaire, 73 participantes ont répondu à un questionnaire en ligne. Les participantes ont rapporté une augmentation du nombre de journées actives et une diminution de la consommation quotidienne de sucreries à la fin du programme. Des analyses de sous-groupes ont révélé des changements plus importants chez celles qui ne rencontraient pas les recommandations canadiennes à l’inscription. Celles-ci ont augmenté de façon significative leur nombre de journées actives et leur consommation de légumes et de fruits, et ont diminué leur temps d’écran. Les résultats indiquent que la participation à Fillactive a le potentiel d’améliorer plusieurs habitudes de vie liées à la santé chez les adolescentes. D’autres études s’avèrent nécessaires afin d’explorer les effets de programmes d’interventions en activité physique chez les adolescentes. / Adolescence is a crucial time in the development, maintenance and sometimes the decline of different lifestyle habits. During adolescence, physical activity typically decreases with age, particularly in girls. FitSpirit is an organizaton that offers services that help Canadian schools implement physical activity interventions for adolescent girls. The objectives of this study were to evaluate changes in participants’ physical activity levels and lifestyle habits (sedentary time, sleep duration and eating habits) and to assess whether these changes varied on adherence to the Canadian 24-Hour Movement Guidelines and Canada’s Food Guide recommendations at enrollment. At the time of FitSpirit registration and at the end of school year, 73 participants answered online questionnaire. The participants reported improvements, with an increase in the number of days with physical activity and a decrease in daily consumption of sweets. Subgroup analyzes revealed greatest changes in those who did not adhere to the Canadian recommendations at enrollment. These participants significantly increased their number of days with physical activity and their consumption of fruits and vegetables, and decreased their screen time. The results indicate that participation in FitSpirit has the potential to improve several health behaviors among adolescent girls. More research is needed to explore the effects of physical activity intervention programs among adolescent girls.

L’hémophilie est une maladie héréditaire incurable qui ralentit la coagulation sanguine. Le plan de traitement vise à prévenir les saignements pouvant se produire dans les articulations, puisque ceux-ci peuvent causer des dommages à long terme dans les structures internes. Le traitement consiste en l’administration régulière et continue d’injections de concentré de facteur de coagulation. Le plan de traitement inclut aussi des indications sur les activités physiques sécuritaires et celles à éviter pour les patients atteints de la maladie. Peu de recherches psychosociales ont été conduites en hémophilie à ce jour. L’objectif de cette thèse, composée de 5 articles, était de déterminer les facteurs sociocognitifs susceptibles d’influencer l’adhésion aux recommandations chez les enfants et les adolescents atteints d’hémophilie et de proposer des pistes d’intervention. Pour ce faire, nous nous sommes appuyés sur trois modèles théoriques qui apportent, en complémentarité, un éclairage sur des aspects centraux de l’adhésion. Dans le premier article, nous avons traduit en français un instrument de mesure de l’adhésion au traitement par injection et nous avons fourni les données psychométriques préliminaires de l’instrument. Les données ont appuyé son utilisation auprès des jeunes patients, ce qui nous a permis de l’utiliser dans la thèse. Dans le deuxième article, nous avons utilisé la théorie du comportement planifié pour comprendre comment les jeunes se positionnent face aux recommandations de l’équipe médicale en ce qui a trait au traitement par injection et à l’activité physique. Pour cela, nous avons mesuré leur attitude, leur perception de contrôle comportemental, la norme sociale subjective et le comportement passé. Nous avons évalué si ces facteurs étaient liés à l’intention de suivre les recommandations. Les résultats ont indiqué que ces facteurs expliquaient une grande proportion de la variance de l’intention de suivre les recommandations sur l’activité physique, surtout pour celles dites « à risque ». Ayant constaté une bonne adhésion au traitement par injection chez les participants et une adhésion plus faible en ce qui a trait à l’activité physique, nous avons décidé de nous concentrer sur l’activité physique pour la suite. Dans le troisième article, nous avons utilisé le modèle du sens commun pour comprendre comment les patients se représentent leur maladie et si ces représentations pouvaient avoir un impact sur leur pratique d’activé physique. Les perceptions étaient plus négatives pour les domaines suivants : les conséquences de la maladie, le nombre de symptômes et l’impact émotionnel. Lorsque nous avons classé les participants selon leur profil d’activité physique, le sous-groupe « adhésion faible », c’est-à-dire celui qui suivait moins et avait moins l’intention de suivre les recommandations, avait significativement plus de préoccupations par rapport à la maladie et percevait plus de symptômes en moyenne. Le quatrième article souligne l’intérêt du modèle du soutien à l’autonomie de la théorie de l’autodétermination dans l’intervention en hémophilie et consiste en une adaptation pratique de ce modèle aux enjeux spécifiques de la maladie. Le cinquième article porte sur un livret d’information que nous avons développé utilisant la théorie de l’autodétermination. Nous avons utilisé des méthodes quantitatives et qualitatives pour évaluer la réception du livret chez les parents et pour apporter des modifications à celui-ci. / Hemophilia is an incurable bleeding disorder that slows the blood clotting process. The treatment plan aims to prevent bleeding episodes that occur in the joints, since repeated bleeding episodes can cause long-term damage to internal structures. The treatment plan consists of regular infusions of the missing clotting factor and specific recommendations as to which physical activities are safe and which are to be avoided. The objective of this thesis, composed of 5 articles, was to determine the socio-cognitive factors likely to influence the adherence of children and adolescents to the recommendations of the treatment plan, and to suggest avenues for intervention. To do this, we relied on three theoretical models which, together, shed light on the central aspects of adherence: the perspective of young patients on the medical recommendations, their perceptions of the illness and, finally, avenues of intervention to promote better adherence in those young patients in the long-term. In the first article, we translated to French an instrument that measured adherence to the infusion therapy, and we provided the preliminary psychometric data of the instrument. The data supported the use of the instrument with young patients, which allowed us to use it in the thesis. In the second article, we used the theory of planned behavior to understand how young people perceive the recommendations concerning infusion treatment and physical activity. For this, we measured their attitude towards the behavior, their perception of behavioral control, the subjective social norm and past behavior. We assessed whether these factors were related to the intention to follow the recommendations. The results indicated that these factors explain a large proportion of the variance in intention to follow physical activity recommendations, especially for those at risk of causing bleeding. As adherence to injection therapy was high in our sample while adherence to physical activity recommendations was lower and more variable among participants, we decided to focus on the latter for the next articles. In the third article, we wanted to understand how patients view their illness and whether illness perceptions could have an impact on their physical activity practice. For this we used the common-sense model. Perceptions were more negative for the following areas: the consequences of hemophilia, the number of symptoms and the emotional impact. When we ranked participants according to their physical activity profile, the subgroup that followed the recommendations less iv closely and had a lower intention of following the recommendations had significantly more concerns and perceived more symptoms. The fourth article highlights the interest of the autonomy support model in hemophilia intervention and consists of a practical adaptation of this model to the specific challenges of the illness. The fifth article is about the development of an information booklet that we created using the concepts of this theory. We used quantitative and qualitative methods to assess the parents’ acceptability of the booklet and modified the booklet according to their suggestions.