The general objective of this dissertation is to study breast cancer screening and specifically social inequalities by social class and country of origin and its relationship with decreasing mortality. Therefore, four different studies have been done: three with quantitative methodology and one with qualitative. According to the quasi-experimental study, breast cancer mortality decreased in Barcelona before the introduction of the population screening program, but this reduction is more marked after its introduction. According to data from the Spanish National Health Survey in 2006, there are inequalities in the rate of breast cancer screening according to country of origin and social class. According to two studies conducted in Barcelona, immigrant women from low-income countries are less aware, and hence do less, early detection practices, as they have other priorities and perceive more barriers and taboos. Chinese women are the immigrants who present more differences with native women, followed by Maghribian and Philippine women. Place of origin, social class and migration process are key factors in preventive practices. In conclusion, it is necessary to encourage access to preventive screening practices for all women and also to undertake specific actions directed at the most vulnerable groups, taking into account any socio-cultural factors that influence the use of preventive practices. / L’objectiu general d’aquesta tesi és estudiar el cribratge de càncer de mama i en concret les desigualtats socials per classe social i país d’origen, així com la seva relació amb la disminució de la mortalitat. En conseqüència, s’han realitzat quatre estudis diferents: tres de metodologia quantitativa i un de qualitativa. Segons l’estudi quasi-experimental, la mortalitat per càncer de mama a Barcelona disminueix des d’abans de la introducció del programa poblacional de cribatge, però aquesta reducció és més accentuada desprès de la seva introducció. En base a l’Enquesta Nacional de Salut de l’Estat Espanyol de l’any 2006, existeixen desigualtats en la realització de mamografies periòdiques segons país d’origen i classe social. Segons els dos estudis realitzats a Barcelona, les dones immigrades procedents de països de renda baixa coneixen i realitzen menys les pràctiques de detecció precoç, ja que tenen altres prioritats i perceben més barreres i tabús. Les dones xineses són les que presenten més diferències amb les dones autòctones, seguides de les magribines i les filipines. El lloc d’origen, la classe social i el procés migratori són factors claus en les practiques preventives. En conclusió, és necessari afavorir l’accés a les pràctiques preventives a totes les dones i també realitzar accions específiques dirigides als grups més vulnerables sense deixar de tenir en compte els factors socioculturals que influeixen en les pràctiques preventives de les dones.

A mortalidade materna é conhecida como um importante indicador de saúde relacionado à qualidade de vida e ao desenvolvimento de uma população, sendo considerada evitável em 95% dos casos. Apesar dos avanços tecnológicos, a mortalidade materna no nosso meio ainda não alcançou os níveis considerados aceitáveis pela Organização Mundial da Saúde (OMS). Estudo realizado em Porto Alegre, RS, mostrou que há um padrão muito heterogêneo de causas. Tais aspectos instigaram a realização deste estudo, cujos objetivos foram caracterizar a distribuição geográfica da mortalidade materna em Porto Alegre, segundo suas causas, características sócio-demográficas, obstétricas e tipo de serviço de saúde de referência em atenção primária, no período de 1999 a 2008. Foram estudados 96 casos correspondentes à totalidade dos óbitos maternos no período. Os dados foram obtidos no Sistema de Informação de Mortalidade (SIM) e Sistema de Informação sobre Nascidos Vivos (SINASC), complementados por busca em prontuários hospitalares e nos registros do Comitê Municipal de Estudos e Prevenção das Mortes Maternas (CMEPMM). Analisou-se a razão de morte materna (RMM), a RMM proporcional por grupos de causas, cor da pele [branca e não branca (preta, parda e amarela)], escolaridade, faixa etária e variáveis obstétricas O georreferenciamento foi realizado através da identificação do código de logradouros (CDL) dos endereços das declarações de óbito alocadas no território das gerências distritais do município. Os programas utilizados foram: Link Plus, Access e Excel 2003, ArcView Gis 3.2.a e Arc Explorer 2.0. Os resultados mostraram que a mortalidade materna no período foi de 47,84 óbitos/100.000 nascidos vivos (NV), com uma diminuição média de 3% ao ano. Entretanto, algumas causas estão aumentando, como SIDA e doenças clínicas. As principais causas foram as doenças clínicas, SIDA, doenças cardiovasculares (DCV) e a doença hipertensiva da gestação (DIHG). O risco de óbito foi maior para a faixa etária de 35 anos ou mais, para as mulheres com cor de pele não branca e com menor escolaridade, sendo de grande magnitude nas analfabetas. Todas as causas tiveram maior risco de óbito nas não brancas. As causas como aborto, hemorragia, infecção puerperal e SIDA, associadas às condições de maior vulnerabilidade social, foram mais importantes para as mulheres com cor de pele não branca, menor escolaridade e nas que não realizaram pré-natal. O georreferenciamento mostrou que há diferenças no risco de óbito materno, risco de óbito proporcional por tipo de causa (aborto, hemorragia, SIDA), escolaridade e cor de pele, identificando áreas de iniqüidades, mesmo dentro de regiões com melhor colocação no ranking do desenvolvimento humano municipal. Embora a mortalidade materna esteja reduzindo, seu perfil evidencia iniqüidades que necessitam de intervenções, tanto nos determinantes sociais quanto na qualidade da assistência à saúde. / Maternal mortality is known as a major health indicator related to quality of life and to population development, and it is considered avoidable in 95% of cases. Despite technological advances, maternal mortality in our country has not reached levels considered acceptable by the World Health Organization (WHO). A previous study in Porto Alegre, RS, showed a very heterogeneous pattern of causes. These aspects led to the present study, whose aims were to characterize the spatial distribution of maternal mortality in Porto Alegre according to sociodemographic and obstetrical causes and type of reference health services in primary care, during the period from 1999 to 2008. Ninety-six cases were studied, corresponding to the total number of maternal deaths between 1999 and 2008. The data were obtained from the SIM and SINASC systems, and complemented by looking at hospital charts and the records of the Municipal Committee of Studies and Prevention of Maternal Deaths (CMEPMM). Analyses were performed according to the maternal mortality ratio (MMR), proportional MMR according to groups of causes, skin color [white or nonwhite (black, brown and yellow)] schooling and age group, and some obstetrical variables. Georeferencing was performed by identifying street codes (código de logradouros –CDL) of territorialization areas of the municipal management districts. The programs used were Link Plus, Access and Excel 2003, ArcView Gis 3.2.a and Arc Explorer 2.0. The data showed that maternal mortality in Porto Alegre, was 47.84 deaths/100,000 live births (LB), and presented a mean reduction of 3% a year. However, some causes are increasing, such as AIDS and clinical diseases. The main causes were clinical diseases, AIDS, cardiovascular diseases (CVD), and hypertensive disorders of pregnancy (HDP). The risk of death was higher for the age group of 35 years or over, non-white skin color, less schooling, and higher in illiterate women. All causes presented a higher risk of death in non-white skin color. Causes such as abortion, hemorrhage, puerperal infection and AIDS, associated with greater social vulnerability, were more important for non-white women with less schooling and those who did not receive antenatal care. Geographic distribution allowed observing that there are differences in the risk of maternal death, risk of death proportional to type of cause (abortion, hemorrhage, AIDS), level of schooling, skin color, identifying areas of iniquity even within regions better placed in the ranking of municipal human development.. Although maternal deaths have been diminishing their profile shows iniquities that require intervention, both in social determinants and in improving the quality of health care.

A mortalidade materna é conhecida como um importante indicador de saúde relacionado à qualidade de vida e ao desenvolvimento de uma população, sendo considerada evitável em 95% dos casos. Apesar dos avanços tecnológicos, a mortalidade materna no nosso meio ainda não alcançou os níveis considerados aceitáveis pela Organização Mundial da Saúde (OMS). Estudo realizado em Porto Alegre, RS, mostrou que há um padrão muito heterogêneo de causas. Tais aspectos instigaram a realização deste estudo, cujos objetivos foram caracterizar a distribuição geográfica da mortalidade materna em Porto Alegre, segundo suas causas, características sócio-demográficas, obstétricas e tipo de serviço de saúde de referência em atenção primária, no período de 1999 a 2008. Foram estudados 96 casos correspondentes à totalidade dos óbitos maternos no período. Os dados foram obtidos no Sistema de Informação de Mortalidade (SIM) e Sistema de Informação sobre Nascidos Vivos (SINASC), complementados por busca em prontuários hospitalares e nos registros do Comitê Municipal de Estudos e Prevenção das Mortes Maternas (CMEPMM). Analisou-se a razão de morte materna (RMM), a RMM proporcional por grupos de causas, cor da pele [branca e não branca (preta, parda e amarela)], escolaridade, faixa etária e variáveis obstétricas O georreferenciamento foi realizado através da identificação do código de logradouros (CDL) dos endereços das declarações de óbito alocadas no território das gerências distritais do município. Os programas utilizados foram: Link Plus, Access e Excel 2003, ArcView Gis 3.2.a e Arc Explorer 2.0. Os resultados mostraram que a mortalidade materna no período foi de 47,84 óbitos/100.000 nascidos vivos (NV), com uma diminuição média de 3% ao ano. Entretanto, algumas causas estão aumentando, como SIDA e doenças clínicas. As principais causas foram as doenças clínicas, SIDA, doenças cardiovasculares (DCV) e a doença hipertensiva da gestação (DIHG). O risco de óbito foi maior para a faixa etária de 35 anos ou mais, para as mulheres com cor de pele não branca e com menor escolaridade, sendo de grande magnitude nas analfabetas. Todas as causas tiveram maior risco de óbito nas não brancas. As causas como aborto, hemorragia, infecção puerperal e SIDA, associadas às condições de maior vulnerabilidade social, foram mais importantes para as mulheres com cor de pele não branca, menor escolaridade e nas que não realizaram pré-natal. O georreferenciamento mostrou que há diferenças no risco de óbito materno, risco de óbito proporcional por tipo de causa (aborto, hemorragia, SIDA), escolaridade e cor de pele, identificando áreas de iniqüidades, mesmo dentro de regiões com melhor colocação no ranking do desenvolvimento humano municipal. Embora a mortalidade materna esteja reduzindo, seu perfil evidencia iniqüidades que necessitam de intervenções, tanto nos determinantes sociais quanto na qualidade da assistência à saúde. / Maternal mortality is known as a major health indicator related to quality of life and to population development, and it is considered avoidable in 95% of cases. Despite technological advances, maternal mortality in our country has not reached levels considered acceptable by the World Health Organization (WHO). A previous study in Porto Alegre, RS, showed a very heterogeneous pattern of causes. These aspects led to the present study, whose aims were to characterize the spatial distribution of maternal mortality in Porto Alegre according to sociodemographic and obstetrical causes and type of reference health services in primary care, during the period from 1999 to 2008. Ninety-six cases were studied, corresponding to the total number of maternal deaths between 1999 and 2008. The data were obtained from the SIM and SINASC systems, and complemented by looking at hospital charts and the records of the Municipal Committee of Studies and Prevention of Maternal Deaths (CMEPMM). Analyses were performed according to the maternal mortality ratio (MMR), proportional MMR according to groups of causes, skin color [white or nonwhite (black, brown and yellow)] schooling and age group, and some obstetrical variables. Georeferencing was performed by identifying street codes (código de logradouros –CDL) of territorialization areas of the municipal management districts. The programs used were Link Plus, Access and Excel 2003, ArcView Gis 3.2.a and Arc Explorer 2.0. The data showed that maternal mortality in Porto Alegre, was 47.84 deaths/100,000 live births (LB), and presented a mean reduction of 3% a year. However, some causes are increasing, such as AIDS and clinical diseases. The main causes were clinical diseases, AIDS, cardiovascular diseases (CVD), and hypertensive disorders of pregnancy (HDP). The risk of death was higher for the age group of 35 years or over, non-white skin color, less schooling, and higher in illiterate women. All causes presented a higher risk of death in non-white skin color. Causes such as abortion, hemorrhage, puerperal infection and AIDS, associated with greater social vulnerability, were more important for non-white women with less schooling and those who did not receive antenatal care. Geographic distribution allowed observing that there are differences in the risk of maternal death, risk of death proportional to type of cause (abortion, hemorrhage, AIDS), level of schooling, skin color, identifying areas of iniquity even within regions better placed in the ranking of municipal human development.. Although maternal deaths have been diminishing their profile shows iniquities that require intervention, both in social determinants and in improving the quality of health care.

Ojämlikhet i hälsa kan bero på flertalet orsaker, exempelvis graden av delaktighet och inflytande i samhället. En grupp som vanligen isoleras från samhället är flyktingar, vars anpassning till det nya landet kan vara påfrestande samtidigt som de drabbas av psykiska, fysiska och sociala svårigheter. Av den anledningen krävs interventioner i syfte att underlätta integrationsprocessen samt skapa förutsättningar för en tillfredsställande och hälsosam tillvaro i det nya samhället. Studiens syfte var att undersöka genomförarnas uppfattningar av arbetet med integrationssatsningen för flyktingpojkar på Salaortens Ryttarförening. En kvalitativ metod användes för att besvara syftet och data samlades in genom semistrukturerade intervjuer där sex personer som arbetat med integrationssatsningen deltog. Insamlad data analyserades genom en manifest kvalitativ innehållsanalys. Resultatet visade att integrationssatsningen genererat flertalet positiva effekter gällande flyktingarnas mående. Det upplevdes finnas goda möjligheter kopplade till integration av flyktingar genom hästar och stallmiljö. Dessa möjligheter berörde inte enbart ökade förutsättningar för hälsa hos flyktingar, utan kunde även kopplas till en utveckling hos andra ungdomar och medlemmar i föreningen. Studien tyder på att hästar och stallmiljö torde kunna stödja integrationsprocessen hos flyktingar på liknande sätt som lagsporter, samtidigt som stallets unika miljö bringar ytterligare fördelar i form av exempelvis trygghet och vänskapligt stöd från hästen. / Inequalities in health can be due to several reasons, including the degree of involvement and influence in the society. One group of people commonly isolated from society is refugees, whose adaption to the new country can be stressful. Meanwhile, they often suffer from psychological, physical and social difficulties. Therefore, interventions to facilitate the integration process and creating conditions to a satisfying and healthy life in the new society are required. The purpose of this study was to investigate the implementers perceptions of working with the refugee integration projects implemented by Salaortens Ryttarförening. A qualitative method was used to answer the purpose, and data was collected by the use of six semi structured interviews. The collected data was analyzed with a manifest qualitative content analysis. Results showed that the refugee integration project had generated several positive effects related to the wellbeing of the refugees. It was perceived that good possibilities related to integration could be achieved through interaction with horses and being in a stable. These possibilities did not only affect the refugees through improved health conditions, but also affected the adolescents, and other members of Salaortens Ryttarförening. The study indicates that involvement with horses and the the environment regarding stables should support the integration process regarding refugees, similar to team sports. Meanwhile the unique environment of the stable can bring further benefits like a sense of security and friendly support from the horse.

A presente dissertação trata do tema das desigualdades sociais em saúde, tendo como objetivo principal investigar os efeitos da ação do Estado sobre as condições de saúde da população. Adotou-se como delineamento de pesquisa o quase experimental de natureza quantitativa para buscar o objetivo proposto. Foram utilizadas técnicas de estatística descritiva e inferencial, e como unidade de análise as regiões de saúde brasileiras, caracterizando um estudo ecológico. A abordagem é hipotética dedutiva, tendo como hipótese central a expectativa de que quanto maior o nível de intervenção do Estado na área da saúde (gasto, oferta de estrutura e profissionais e cobertura do Sistema Único de Saúde - SUS), controlando por outros fatores determinantes sociais da saúde, menores são as chances de a região estar na categoria Taxa de Mortalidade Infantil (TMI) alta vis-à-vis não estar na categoria TMI alta. Como objetivos específicos buscou-se descrever o cenário da desigualdade social em saúde no Brasil, quanto às relações entre condição de saúde e fatores socioeconômicos e geográficos das regiões de saúde e caracterizar como o Estado intervém na área da saúde no que se refere ao gasto público em saúde, oferta de estrutura e profissionais do SUS e cobertura de algumas ações e serviços do SUS entre as regiões de saúde no Brasil. Dentre os resultados encontrados destaca-se a demonstração com evidências empíricas da magnitude das diferenças que existem entre as regiões de saúde tanto em termos de determinantes socioeconômicos da saúde, quanto do provimento de ações e serviços de saúde pelo Estado. Foram constatadas tendências na ação do Estado que favorecem territórios do ponto de vista social e de localização geográfica, com exceção da distribuição do indicador de Cobertura de Atenção Básica. Os resultados apontaram que a hipótese principal foi confirmada parcialmente. Pode-se afirmar que o nível de ação do Estado tem efeito de diminuição nas chances da região estar classificada com TMI alta estatisticamente significativo, a depender dos demais fatores determinantes da saúde considerados. A única variável que mede ação do Estado com efeito significativo (p<0,01) em todos modelos ajustados foi a Proporção de Nascidos Vivos com 7 ou mais consultas pré-natal. Salienta-se nos resultados o efeito substancial e significativo da variável socioeconômica na determinação nas chances de a região de saúde ser classificada com TMI alta ou não, corroborando com a literatura da área. Por fim, pode-se refletir sobre a identificação dos efeitos cumulativos das desigualdades, as regiões de saúde com menor nível de renda dispõem em geral de menos ações e serviços de saúde ofertados pelo Estado. Ao mesmo tempo, as conclusões apontam que a ação do Estado tem potencialidade para incidir sobre as desigualdades em saúde. / This dissertation addresses the issue of social inequalities in health. The main objective was to investigate the effects of State action on health conditions. The research design was based on a quasi-experimental and quantitative approach. Descriptive and inferential statistical techniques were used, and the unit of analysis was the health regions, characterizing this research as an ecological study. The main hypothesis was that the higher the level of State intervention in health, controlling for other determinants, the lower the chances of the region being in the category of high Infant Mortality Rate (IMR) vis-à-vis not being in the high IMR category. The specific objectives were to describe the scenario of social inequality in health in Brazil, based on the relationship between health condition and socioeconomic and geographical factors; and to characterize how the State intervenes in the health area considering public expenditure in health, structure availability, access to professionals and coverage of some actions and services of the Unified Health System. Among the results, this study highlighted with empirical evidence the magnitude of the differences between the health regions, both in terms of socioeconomic determinants of health, and of the provision of health services and actions by the State. It was found that there were trends in State action in favor of territories from a social and geographical point of view, with the exception of the distribution of the indicator of Primary Care Coverage. The results indicated that the main hypothesis was partially confirmed. It can be affirmed that the level of action of the State has a decreasing effect on the chances of the region being classified as having a high IMR that is statistically significant, depending on the other health determinants considered. The only variable that measures State action with a significant effect (p <0.01) in all adjusted models was the proportion of live births with seven or more prenatal consultations. The results show the substantial and significant effect of the socioeconomic variable on the determination of the health region's chances of being classified as having a high IMR, corroborating the literature. Finally, it is possible to reflect on the identification of the cumulative effects of inequalities; the regions with a lower level of income generally have fewer actions and health services offered by the State. At the same time, the conclusions point out that State action has the potential to influence health inequalities.

Actuellement les gynécologues sont en France les professionnels de santé les plus impliqués dans le dépistage des cancers gynécologiques, mais les généralistes, qui voient l’ensemble de la population, sont les mieux placés pour dispenser des soins préventifs à tous et de façon équitable.Ce travail visait à comprendre la variabilité des pratiques de dépistage des cancers gynécologiques (par le frottis cervico-utérin et la mammographie) chez les femmes consultant en médecine générale, en fonction notamment de la position sociale des patientes et de l’organisation du cabinet de leur médecin.Il s’intègre dans une étude menée en 2005-06 sur les principaux soins préventifs destinés aux adultes des deux sexes. Sur une période de deux semaines, toutes les patientes de 50 à 69 ans de 59 généralistes franciliens tirés au sort (taux de participation des généralistes : 39 %) ont été incluses au fil des consultations. Les données ont été recueillies auprès des patients par téléphone et auprès des médecins en face-à-face à leur cabinet. L’essentiel des analyses a été réalisé avec des modèles logistiques mixtes à intercept aléatoire pour tenir compte de la structure hiérarchique des données.Au total, 66,7 % des patients éligibles (n=4106) ont participé à l’étude, sans différence selon le sexe des patients.Même parmi des femmes utilisant le système de santé, on observe des inégalités sociales, mais uniquement concernant le frottis (n=858). Un gradient de dépistage défavorable au bas de la hiérarchie sociale existe pour la profession (indice relatif d’inégalité = 2,3), le niveau d’études (IRI = 2,0) et les revenus (IRI = 3,0). L’analyse des contributions à ces gradients de diverses dimensions de la position sociale (logement, quartier, richesse du foyer, statut vis-à-vis de l’emploi, relations sociales et assurance santé) montre que la richesse du foyer, les caractéristiques du quartier et le type d’assurance santé expliquent entre 20 et 60 % de ces inégalités.L’investissement des généralistes dans le dépistage semble restreint comme en témoignent les taux de renseignement d’une date de dernier frottis ou de dernière mammographie dans les dossiers médicaux (23 % pour le cancer du col utérin et 38 pour le cancer du sein). Les praticiens semblent mieux renseigner les dossiers des patientes du bas de la hiérarchie professionnelle et les dossiers des femmes dont ils savent qu’elles ne sont pas suivies par un gynécologue.L’organisation des consultations apparaît centrale dans notre enquête. La participation des patients à l’étude était meilleure parmi les médecins proposant des consultations sur rendez-vous (OR = 2,12 pour les patients hommes et 3,38 pour les femmes). Cette organisation jouerait aussi sur les pratiques de soins : les médecins ayant des consultations plus courtes s’impliquent moins dans le dépistage du cancer du sein (n=898, OR = 0,65). Ces aspects organisationnels permettent d’expliquer environ un quart de la variabilité des pratiques entre les médecins.Ces résultats devraient inciter les généralistes à investir davantage les dépistages des cancers gynécologiques et peut-être à opérer des changements organisationnels. Ce travail, au croisement de la recherche en médecine générale et de l’épidémiologie sociale, a fait émerger une réflexion sur l’analyse de données provenant de patients suivis sur le long cours par des professionnels de santé. Il ouvre aussi des perspectives sur la mise en place d’interventions pour réduire les inégalités sociales observées dans les patientèles. / Currently gynecologists are the healthcare professionals most involved in screening for gynecologic cancers in France, but general practitioners, who see the entire population, are best placed to provide preventive care equitably and to all.The aim of this work was to understand the variability in practices of screening for gynecologic cancers (by Pap smears and mammography) among women seeing general practitioners, especially as a function of the patient's social position and the organization of their doctor's office.It was included as part of a study conducted in 2005-06 of the principal types of preventive care for adults of both sexes. Over a two-week period, this study included all consecutive patients aged 50-69 years seen by 59 randomly drawn general practitioners in the Paris metropolitan region (participation rate of general practitioners: 39%). Data were collected from the patients by telephone and from the physicians in face-to-face interviews in their office. Most of the analyses were performed with mixed logistic models with a random intercept to take the hierarchical structural of the data into account.Overall, 66.7% of the eligible patients (n=4106) participated in the study; this rate did not differ by sex.Social inequalities were observed even among women who use the health-care system, but only for the Pap smear (n=858). A gradient with screening lowest at the bottom of the social hierarchy was observed for occupation (relative index of inequality = 2.3), educational level (RII = 2.0), and income (RII = 3.0). Analysis of the contributions to these gradients of diverse dimensions of social position (housing, neighborhood, household wealth, employment status, social relations, and health insurance) showed that household wealth, neighborhood characteristics, and type of health insurance explain between 20 and 60% of these inequalities.General practitioners' investment in screening seems limited, as shown by the rates of information in the medical files about the date of the last Pap smear (23%) or the last mammography (38%). Physicians appear to keep this information better for women at the bottom of the occupational hierarchy and women whom they know are not seeing a gynecologist.The organization of doctors' consultations appeared central in our survey. Patient participation in this study was best among the physicians who offered appointments for consultations (OR = 2.12 for male patients and 3.38 for the women). This organization also appeared to play a role in care practices: physicians with shorter consultations were less involved in screening for breast cancer (n=898, OR = 0.65). These organizational aspects explained approximately a quarter of the variability of practices between physicians.These results should encourage general practitioners to spend more time in screening for gynecologic cancers and perhaps to modify the organization of their practice. This study, at the intersection between research in general practice and in social epidemiology, leads to a discussion about the different strategies for analysis of data from patients followed over the long-term by healthcare professionals. It also opens up perspectives for interventions to reduce social inequalities in patient lists.

Made available in DSpace on 2014-12-17T15:43:51Z (GMT). No. of bitstreams: 1 JanmilleVS_DISSERT.pdf: 924305 bytes, checksum: f63a120cee4f02a246910cfb885de7a3 (MD5) Previous issue date: 2012-12-07 / Despite the improvement of Brazilian s living conditions in recent decades, this improvement occurred in a polarized way between groups of better social position. Then, there is still a health inequity?s panorama in Brazil which encompasses the oral health state. This panorama instigated the attainment of this ecological study that aimed to evaluate the relationship of socioeconomic conditions, and public health policies with oral health status in Brazilian capitals. Thus, we performed factor analysis and linear regression using oral health indicators collected from SB Brasil 2010, of socioeconomic conditions from Brazilian Census 2010 and related to water?s supply fluoridation from SISAGUA. Factor analysis with indicators of living conditions revealed two common factors, economic deprivation and socio-sanitary condition. Economic deprivation showed statistically significant positive correlation with DMFT 12 years (p= 0,03) and mean missing teeth (p = 0,002) and negative correlation with caries-free population (p=0,012). Socio-sanitary negatively correlated with DMFT (p <0,0001) and a positive correlation with caries-free population (p = 0.002). Fluoridated water had a significant association with DMFT (p <0,0001), mean missing teeth (p <0,0001) and caries free population (p <0.0001). Multiple linear regression analysis for the DMFT of capital was estimated by socio-sanitary condition and fluoridation, adjusted by economic deprivation, whereas the model for the mean missing teeth was estimated only by fluoridation and economic deprivation, and finally the model the rate for the population free of caries in Brazilian capitals was estimated by economic and socio-sanitary status adjusted fluoridated water supply. Therefore, factors related to living conditions and public policies are intrinsically linked to tooth decay issues. Thus, actions, beyond dental care assistance, must be development to impact positively in social and economic conditions, especially, between the most vulnerable populations / Apesar da melhoria das condi??es de vida dos brasileiros nas ?ltimas d?cadas, esta ocorreu de forma polarizada entre grupos de melhor posi??o social. Assim, persiste um panorama de iniquidades em sa?de no Brasil que abrange, inclusive, a situa??o de sa?de bucal. Tal panorama instigou a realiza??o deste estudo ecol?gico que visou avaliar a rela??o das condi??es socioecon?micas (SE), bem como de pol?ticas de sa?de p?blica com as condi??es de sa?de bucal nas capitais brasileiras. Para tanto, foram realizadas an?lise fatorial e de regress?o linear utilizando indicadores de sa?de bucal coletados do SB Brasil 2010, de condi??es socioecon?micas do Censo Brasileiro 2010 e relativos ? fluoreta??o das ?guas de abastecimento do Sisagua. A An?lise fatorial com os indicadores de condi??es de vida revelou dois fatores comuns; depriva??o econ?mica e condi??o s?cio-sanit?ria. Depriva??o econ?mica apresentou correla??o positiva estatisticamente significativa com o CPO-D 12 anos (p=0,03) e m?dia de dentes perdidos (p=0,002) e correla??o negativa com popula??o livre de c?rie (p=0,012). Condi??o s?cio-sanit?ria mostrou correla??o negativa com CPO-D (p<0,0001) e correla??o positiva com popula??o livre de c?rie (p=0,002). ?gua de abastecimento fluoretada teve associa??o significativa com CPO-D (p<0,0001), m?dia de dentes perdidos (p<0,0001) e popula??o livre de c?rie (p<0,0001). An?lise de regress?o linear m?ltipla para o CPO-D das capitais foi estimado pelas condi??es s?cio-sanit?rias e fluoreta??o, ajustado pela depriva??o econ?mica; enquanto que o modelo para a m?dia de dentes perdidos foi estimado apenas pela fluoreta??o e depriva??o econ?mica, e por fim, o modelo para a taxa da popula??o livre de c?rie nas capitais brasileiras foi estimado pela condi??o econ?mica e s?cio-sanit?ria ajustadas pelo abastecimento de ?gua fluoretada. Portanto, quest?es relativas ?s condi??es de vida e ?s pol?ticas p?blicas est?o intrinsecamente associadas ? c?rie dent?ria. Assim, ? preciso desenvolver a??es, para al?m da assist?ncia odontol?gica, para impactar positivamente nas condi??es econ?micas e sociais, sobretudo, das popula??es mais vulner?veis

Introduction. La notion d'" embodiment " propose que chaque humain est à la fois un être social ainsi que biologique, intégrant le monde dans lequel il/elle vit. Nous faisons l'hypothèse que la position socioéconomique pendant l'enfance peut être biologiquement incorporée, conduisant à la production des inégalités sociales de santé entre les sous-groupes de population. La charge allostatique (CA) est un concept qui tente de capturer l'usure physiologique globale du corps liée à l'activation répétée des mécanismes physiologiques compensatoires en cas d'exposition à des stress chroniques. La CA pourrait permettre une meilleure compréhension des voies biologiques qui jouent un rôle potentiel dans la construction du gradient social de santé des adultes. Objectif. Pour explorer l'hypothèse d'incorporation biologique, nous avons examiné les voies de médiation entre les adversités psychosociales et la position socioéconomique précoces et la CA à 44 ans. Nous avons également confronté l'indice de CA à une mesure multidimensionnelle de santé latente à 50 ans. Méthodes. Les données sont issues de la cohorte Britannique de naissance de 1958 (n=18 000). La CA a été construite avec les données de l'enquête biomédicale conduite à 44 ans, comme une mesure physiologique synthétique, multi-système, à l'aide de 14 biomarqueurs représentant les systèmes neuroendocrinien, métabolique, immunitaire / inflammatoire et cardiorespiratoire. Résultats. L'ensemble de nos résultats suggèrent que la CA pourrait être un indice approprié pour capturer partiellement la dimension biologique des processus d'embodiment. Discussion. Comprendre comment l'environnement affecte notre santé en se " glissant sous la peau " et pénétrant dans les cellules, les organes et les systèmes physiologiques de notre corps est un principe clé dans la recherche en santé publique. Promouvoir le recueil de marqueurs biologiques dans des grandes études prospectives et représentatives est crucial pour continuer la recherche sur ce sujet. Les études de réplication pourraient faire partie des futures perspectives de recherche, pour comparer entre populations avec des contextes culturels différents pour observer si un index de CA peut être considéré comme "universel ". / Introduction. The notion of embodiment proposes that every human being is both a social and a biological organism that incorporates the world in which (s)he lives. It has been hypothesized that early life socioeconomic position (SEP) can be biologically embedded, potentially leading to the production of health inequalities across population groups. Allostatic load (AL) is a concept that intends to capture the overall physiological wear-and-tear of the body triggered by the repeated activation of compensatory physiological mechanisms as a response to chronic stress. AL could allow a better understanding of the potential biological pathways playing a role in the construction of the social gradient in adult health. Objective. To explore the biological embedding hypothesis, we examined the mediating pathways between early SEP and early adverse psychosocial experiences and higher AL at 44 years. We also confronted an AL index with a latent multidimensional and integrative measure of health status at 50y. Methods. Data are from the 1958 British birth cohort (n=18 000) follow-up to age 50. AL was operationalized using data from the biomedical survey collected at age 44 on 14 parameters representing the neuroendocrine, metabolic, immune-inflammatory and cardiovascular systems. Results. Overall, our results suggest that AL could be a suitable index to partially capture the biological dimensions of embodiment processes. Discussion. Understanding how human environments affect our health by 'getting under the skin' and penetrating the cells, organs and physiological systems of our bodies is a key tenet in public health research. Promoting the collection of biological markers in large representative and prospective studies is crucial to continue to investigate on this topic. Replication studies could be part of the future research perspectives, to compare with other cultural context and to observe if an AL index can be 'universal'.

L’hypothèse traitée dans les travaux internationaux récents est celle d’un effet médiateur de la perspective temporelle entre insertions sociales et comportements de santé, en faisant ainsi un objet d’étude central dans l’analyse et la prévention des inégalités sociales de santé. L’arrêt du tabagisme, pris comme modèle d’addiction, constitue une situation exemplaire pour analyser les freins à la mise en œuvre de comportements de santé chez les publics en situation de précarité. Le sevrage, comme d’autres comportements de réduction et/ou d’arrêt de consommation de substances addictives ne peut s’opérer sans une gestion du temps et de la temporalité du sevrage, mais cette gestion est profondément impactée par la nature de la relation que l’individu entretient avec le temps. Ce croisement des temps est considéré dans cette recherche comme déterminant dans les possibilités d’édification et de maintien des changements cognitifs et comportementaux engagés par le sevrage. L’objectif de cette recherche est donc d’introduire les avancées récentes de la recherche en psychologie sociale sur le temps dans l’étude de la démarche de sevrage tabagique et plus particulièrement celle de publics en situation de précarité. Elle tente plus généralement de comprendre et de modéliser comment, et dans quelle mesure, la précarité et le rapport au temps peuvent influencer les résultats du sevrage tabagique. L’objectif final est de développer l’intégration des dimensions temporelles dans l’étude des mécanismes du sevrage tabagique, mais aussi plus largement d’accroître les connaissances des déterminants psychosociaux de la réussite du sevrage et ainsi d’optimiser la prise en charge des populations en situation de précarité. / Recent international works deal with the hypothesis of a mediation effect of time perspective in the link between social insertions and health behaviours, making it a key factor in the analysis and prevention of social inequalities in health.Smoking cessation, as a model of addiction, constitutes an exemplary situation to analyze the impediments in health behaviours implementation in socially deprived populations. Stopping tobacco, as well as other behaviours of reduction and/or cessation of addictive substances cannot operate without time management and the temporality of cessation, but this management is deeply impacted by one’s relationship with time. This crossing of times is considered in this research as a determinant in the possibilities to edify or maintain behavioural and cognitive changes needed by the cessation.The aim of this research is to introduce recent advances of time in social psychology in the field of smoking cessation and more precisely in socially deprived populations. It more generally attempts to understand and modelize how, and to what extent, precariousness and time perspective may influence the results of smoking cessation. The final goal is to develop the integration of temporal dimensions in the study of smoking cessation mechanisms, and to increase the knowledge about psychosocial determinants of success in order to optimize the care of socially deprived populations.

Le terme d’infanticide recouvre des homicides divers, souvent appréhendés de manière indifférenciée. Parmi eux, le néonaticide désigne le meurtre d’un nouveau-né dans les vingt-quatre heures qui suivent sa naissance. Dans les pays connaissant une forte diffusion de la contraception et de l’accès à l’avortement, cette conduite – anciennement associée à un mode de régulation des naissances – est devenue marginale. Cette recherche propose une approche sociologique de la pratique du néonaticide fondée sur ses mises en récits par la justice et par les auteures elles-mêmes en France (2005-2015). L’enquête a permis de conduire des séries d’entretiens approfondis avec cinq femmes jugées pour ces faits et d’observer cinq procès en cour d’assises. Ces matériaux ont été complétés par des entretiens avec des avocat·e·s et magistrat·e·s, des dossiers judiciaires et un corpus d’articles de presse portant sur 75 affaires jugées sur la même période. Les récits judiciaires dévoilent la prégnance d’une approche essentialiste de la maternité et de la procréation qui pèse sur les efforts de mise en intelligibilité déployés par les professionnel·le·s. L’analyse des parcours de ces femmes, de leurs processus de socialisation, de leurs situations conjugales et familiales et de leurs ressources, permet d’identifier les obstacles rencontrés pour mettre en œuvre une contraception efficace ou accéder à l’IVG. En appréhendant le néonaticide comme l’ultime moyen d’éviter une naissance jugée catastrophique, cette étude s’éloigne de la lecture individualisante imposée par le traitement judiciaire et documente l’agentivité reproductive des femmes. / The term infanticide covers diverse realities too long understood in an undifferentiated way. Among them, neonaticide refers to the murder of a newborn within twenty-four hours of birth. In countries with a high access to contraception and abortion, this behavior – formerly associated with birth control – has become marginal. This research proposes a sociological approach to the practice of neonaticide based on its narratives by the courtrooms and by the authors themselves in France (2005-2015). The investigation led to a series of in-depth interviews with five women prosecuted for these acts and to observe five trials in criminal courts. These materials were supplemented by interviews with lawyers and magistrates, court files and a corpus of press articles covering 75 cases judged over the same period. Courtrooms narratives reveal the essentialist approach to motherhood and procreation, which weighs on the intelligibility efforts made by professionals. The analysis of women's life stories, their socialization processes, their intimate partner and family situations and their resources, makes it possible to identify the obstacles encountered in implementing effective contraception or accessing abortion. By apprehending neonaticide as the ultimate means to avoid a birth deemed catastrophic, this study moves away from the individualizing interpretation imposed by the judicial treatment and documents the reproductive agency of women.