INTRODUCTION : En milieu urbain, l’amélioration de la sécurité des piétons pose un défi de santé publique. Pour chaque décès attribuable aux collisions routières, il y a des centaines de personnes blessées et, dans les pays riches, la diminution du nombre annuel de piétons décédés s’expliquerait en partie par la diminution de la marche. Les stratégies préventives prédominantes n’interviennent pas sur le volume de circulation automobile, un facteur pourtant fondamental. De plus, les interventions environnementales pour améliorer la sécurité des infrastructures routières se limitent habituellement aux sites comptant le plus grand nombre de décès ou de blessés. Cette thèse vise à décrire la contribution des volumes de circulation automobile, des pratiques locales de marche et de la géométrie des routes au nombre et à la répartition des piétons blessés en milieu urbain, et d’ainsi établir le potentiel d’une approche populationnelle orientée vers la reconfiguration des environnements urbains pour améliorer la sécurité des piétons. MÉTHODE : Le devis est de type descriptif et transversal. Les principales sources de données sont les registres des services ambulanciers d’Urgences-santé (blessés de la route), l’enquête Origine-Destination (volumes de circulation automobile), la Géobase du réseau routier montréalais (géométrie des routes) et le recensement canadien (pratiques locales de marche, position socioéconomique). Les analyses descriptives comprennent la localisation cartographique (coordonnées x,y) de l’ensemble des sites de collision. Des modèles de régression multi-niveaux nichent les intersections dans les secteurs de recensement et dans les arrondissements. RÉSULTATS : Les analyses descriptives démontrent une grande dispersion des sites de collision au sein des quartiers. Les analyses multivariées démontrent les effets significatifs, indépendants du volume de circulation automobile, de la présence d’artère(s) et d’une quatrième branche aux intersections, ainsi que du volume de marche dans le secteur, sur le nombre de piétons blessés aux intersections. L’analyse multi-niveaux démontre une grande variation spatiale de l’effet du volume de circulation automobile. Les facteurs environnementaux expliquent une part substantielle de la variation spatiale du nombre de blessés et du gradient socioéconomique observé. DISCUSSION : La grande dispersion des sites de collision confirme la pertinence d’une approche ne se limitant pas aux sites comptant le plus grand nombre de blessés. Les résultats suggèrent que des stratégies préventives basées sur des approches environnementales et populationnelle pourraient considérablement réduire le nombre de piétons blessés ainsi que les inégalités observées entre les quartiers. / INTRODUCTION: In an urban environment, improving pedestrian safety is a public health challenge. For every death attributable to road injuries, there are hundreds of injured people and, in richer countries, decreases in the number of pedestrian deaths may reflect a reduction of walking as a mode of transportation. The predominant preventive strategies have limited or no effect on traffic volume, which is the most important predictor of the number of pedestrians injured by motor vehicles. Moreover, environmental interventions are usually limited to sites that have had the greatest number of deaths or injuries. The purpose of this thesis is to describe the contribution of environmental factors such as traffic volume, local walking practices and street geometry, on the number and the distribution of pedestrian injuries in an urban setting. METHOD: The design of the study is descriptive and cross-sectional. The main data sources were Urgences-santé ambulance service records (road injuries), the Origin-Destination survey (traffic volume), the Geobase for the Montreal road network (street geometry) and the census of Canada (local walking practices, socioeconomic status). The descriptive analyses included map locations (x, y coordinates) for all collision sites. Multi-level regression models nested intersections in census sectors and in boroughs. RESULTS: The descriptive analyses showed a great deal of dispersion of collision sites within neighbourhoods. The multivariate analyses showed the significant effects, independent of traffic volume, of the presence of an artery and of a fourth leg at the intersection, and of pedestrian volume in the neighbourhood, on the number of pedestrian injuries at intersections. The multi-level analysis showed extensive spatial variation in the effect of traffic volume. This spatial variation in the number of casualties, and the socioeconomic gradient observed, were in large part explained by traffic volume, the presence of an artery and of a fourth leg at the intersection. DISCUSSION: The great dispersion of collision sites supports an approach which is not limited to sites with the highest number of injured pedestrians. This thesis suggests that preventive strategies based on environmental and population approaches could considerably reduce the number of injured pedestrians , as well as road injury inequalities across urban neighbourhoods.

The collapse of the communist regimes in Central and Eastern Europe in 1989-1990 heralded the beginning of an economic transition from central planning to market economies. The subsequent period was marked by malfunctioning of these countries’ social sectors, including their health care systems, raising serious issues of equity. This thesis examines the impact of the transition period and the introduction of social insurance on equity in health care provision in Bulgaria. Equity in health care is investigated with respect to function - i.e. financing (according to ability to pay) and delivery (according to need) - and outcomes - i.e. health status, income inequality and poverty. Differences in health, health care financing and delivery are explored by income, education, ethnic, employment, marital status, age and sex groups. Furthermore, the thesis outlines the impact of health care provision, in particular social insurance, on poverty and health inequalities. The thesis employs empirical analysis based on household data. Its methodology includes concentration and decomposition analysis, and provides new ways of modelling health care financing and delivery, as well as the link between health and health care delivery. The thesis concludes that social insurance does not provide a uniform means of improving equity and that the root cause of the problem lies in the large proportion of out-of-pocket payments and the rather limited size of the health insurance sector. Inequity in health care provision leads to poverty and untreated illness. The data suggests that there are differences between socio-economic groups as regards their likelihood to seek treatment for their ill health, which result in differences in their health status. The social factors that have impacted the most on health are low education and low income.

Submitted by Jadson Francisco de Jesus SILVA (jadson@uefs.br) on 2018-05-03T21:47:11Z No. of bitstreams: 1 Disserta??o _Roberta.pdf: 3305166 bytes, checksum: a41670e5ec5d0826e0e9c965b8330933 (MD5) / Made available in DSpace on 2018-05-03T21:47:11Z (GMT). No. of bitstreams: 1 Disserta??o _Roberta.pdf: 3305166 bytes, checksum: a41670e5ec5d0826e0e9c965b8330933 (MD5) Previous issue date: 2017-03-10 / Funda??o de Amparo ? Pesquisa do Estado da Bahia - FAPEB / Studies relating to the investigation of the standards of life and health of Quilombola populations are still limited, especially regarding the analysis of the factors associated with the prevalence of injuries and diseases. Aims: Analyzing diseases and injuries which are more prevalent and verifying their association with socioeconomic, environmental factors and health patters in Quilombola communities in Feira de Santana, Bahia, in 2016. Materials and methods: this is a population-based prevalence study carried out with 864 adults quilombolas of both sexes, aged above 18 years, residents in two Quilombolas communities of Feira de Santana, Bahia. A probabilistic sample was used. The data were collected through home visits, having been applied three validated instruments, containing questions related to demographic, socio-economic standards, environmental, health patterns as well as diseases and injuries. Descriptive and bivariate analyses were carried out, whereas a IC80% and p ? 0,20 were considered to verify the association between the exposure and outcome variables. An exploratory factor analysis, from the use of the tetrachoric correlation, in order to identify which diseases and injuries represent the higher prevalence the most. In order to analyze the factors associated with diseases and injuries, it was used the hierarchical logistic regression analysis. Data were analyzed using the statistical package Stata Corportion College Station, United States (STATA), in version 12.0. As a result of this research findings, two scientific papers were written. The first one is a descriptive study, which aimed to trace the epidemiological profile of the living standards and health of Quilombola communities. To achieve the aims of this article, averages of the quantitative variables and absolute and relative frequencies of qualitative variables of each community were estimated as well as the prevalence of injuries and diseases. The second article is an exploratory study, which analysed the social determinants of disease and injuries in Quilombolas communities of Feira de Santana, Bahia. Through the exploratory factor analysis, latent factors were established. In addition, bivariate and multivariate analyses were carried out to test statistically significant association. Results: in the first article, it was found that Quilombola communities of Feira de Santana, Bahia have very similar demographic andsocioeconomic characteristics and both are vulnerable in theirlife and health standards. From 864 respondents, 63,0% were female, married, with an avarage of 42,6 years of age and an average of 7 years of schooling, as well as 73,4% have informal jobs, especially in the roles of farmer labors and agricultors. In relation to environmental vulnerability, it is pointed out that 99,5 percent have no sanitarian system. Among the data on health patterns, it was noted that 67,1% said that they rarely seek for health services. The most prevalent diseases were: Hypertension (22,3%); diseases of bones (15,8%); diseases of sspine (38,4%) parasitic diseases (25,0%). The most prevalent health aggravations were linked to mental health: anxiety (26,7%); phobias (12,3%) and mental disorders (18,4%). In the second article it was found that the factors which responded more to diseases and most prevalent injuriess were related to mental health diseases (48,8%), chronic diseases (39,2%) and diseases of bones and spine (50,0%). Factor 1: mental health injuries it was found that families who do not receive social benefits have 1,43 times higher chance of having some aggravation in mental health. Factor 2: chronic diseases, it was found that individuals who have little consumption of vegetables and fruits show to have possibility of 1,42 times higher chances to develop a chronic disease. Factor 3: diseases of the bones and spine. It was observed that the individuals who are working have 1,44 times greater chance of having bone and spine diseases. For those who receiving social benefits, that possibility raises to 1,93 times of chance to develop spine and bone diseases. The hierarchical logistic regression analysis was performed for the three factors (1-mental health harms, 2-chronic diseases and bone diseases and 3 column). Multivariate analysis on the associated factors of diseases and injuries in the Quilombola communities, with respect to the factor 1 were: receiving social benefits (HR=1,63 CI80%:1,07; 2,50); material used in the construction of the house (HR=3,22; CI80%:1,17; 8,80); disposal of the garbage (HR=1,51 CI80%:1,07; 2,13); have bathroom (HR=2,82; CI80%:1,17; 6,77); self-assessment of health (HR=2,64 CI80%:1,92; 3,65); type of medication: (HR=0,15; CI80%:0,05; 0,45); problems with cavities/canal (HR=1,47 CI80%:1,07; 2,01); age (HR=1,84; CI80%:1,19; 2,84) and sex (HR=0,48 CI80%:0,34; 0,67). In relation to the factor 2, were: material used in the construction of the house (HR=3,18; CI80%:1,09; 9,28); have bathroom (HR=3,69 CI80%:1,36; 10,01); age (HR=1,87; CI80%:1,18; 2,95) and sex (HR=0,47; IC80%:0,32; 0,68). For factor 3, the variables were: years of study (HR=1,77; CI80%:1,20; 2,62); self-assessment of health (HR=1,64; CI80%:1,15; 2,32); type of medication (HR=6,12; CI80%: 2,59; 14,4) and age (HR=1,61; CI80%:1,03; 2,51). Conclusions: scientific evidence was produced about the living standards and health of Quilombola communities of Feira de Santana, Bahia and of social determinants associated with diseases and injuries that reach these populations the most. Thus, it was found that diseases and injuries in Quilombola populations are determined by demographific, socioeconomic, environmental factors and health patterns. It is expected that the results of this study may support further research with this kind of population and that it may contribute to the implementation of specific health and social policies, as well as to carry out intersectoral interventions with loco-regional applicability. / Ainda s?o escassos os estudos referentes ? investiga??o da condi??o de vida e sa?de das popula??es quilombolas, especialmente no que tange ? an?lise dos fatores associados ? preval?ncia de doen?as e agravos. Objetivos: Analisar as doen?as e agravos mais prevalentes e verificar sua associa??o com fatores socioecon?micos, ambientais e das condi??es de sa?de nas comunidades quilombolas do munic?pio de Feira de Santana, Bahia, no ano de 2016. Materiais e M?todos: Trata-se de um estudo de preval?ncia, de base populacional, realizado com 864 adultos quilombolas, de ambos os sexos, com idade acima de 18 anos, residentes nas duas comunidades quilombolas de Feira de Santana, Bahia. Foi utilizada uma amostra probabil?stica. A coleta de dados foi realizada atrav?s de visitas domiciliares, tendo sido aplicados tr?s instrumentos validados, contendo perguntas referentes ?s condi??es demogr?ficas, socioecon?micas, ambientais, das condi??es de sa?de e acerca das doen?as e agravos. Foram feitas an?lises descritivas e bivariadas, considerando um IC80% e p?0,20 para verificar a associa??o entre as vari?veis de exposi??o e de desfecho. Realizou-se uma an?lise fatorial explorat?ria, a partir do emprego da correla??o tetrac?rica, com objetivo de identificar quais as doen?as e agravos mais prevalentes. Para analisar os fatores associados ?s doen?as e agravos, empregou-se a an?lise de regress?o log?stica hierarquizada. Os dados foram analisados utilizando-se o pacote estat?stico Stata Corportion Colege Station, Estados Unidos (STATA), em sua vers?o 12.0. A partir dos achados desta pesquisa, foram elaborados dois artigos cient?ficos. O primeiro artigo corresponde a um estudo descritivo, o qual visou tra?ar o perfil epidemiol?gico das condi??es de vida e sa?de das comunidades quilombolas. Para atingir os objetivos deste artigo, foram estimadas as m?dias das vari?veis quantitativas e as frequ?ncias absolutas e relativas das vari?veis qualitativas, de cada comunidade, assim como foram estimadas a preval?ncia das doen?as e agravos. O segundo artigo se constitui em um estudo explorat?rio, o qual analisou os fatores associados a doen?as e agravos nas comunidades quilombolas de Feira de Santana, Bahia. Mediante a an?lise fatorial explorat?ria, foram estabelecidos os fatores latentes. Al?m disso, foram realizadas an?lises bivariadas e multivariadas para verifica??o de associa??o estatisticamente significante. Resultados: No primeiro artigo, constatou-se que as comunidades quilombolas de Feira de Santana-BA possuem caracter?sticas demogr?ficas e socioecon?micas bem similares, sendo que as duas se encontram vulnerabilizadas em sua condi??o de vida e sa?de. Dos 864 entrevistados, 63,0% s?o do sexo feminino, casados, apresentando uma m?dia de idade de 42,6 anos, e de escolaridade, uma m?dia de 7 anos de estudo, bem como 73,4% realizam trabalhos informais, especialmente nas fun??es de lavrador e agricultor. Em rela??o ? vulnerabilidade ambiental, destaca-se que 99,5% n?o possuem rede de esgoto. Dentre os dados relativos ?s condi??es de sa?de, observou-se que 67,1% disseram raramente procurar os servi?os de sa?de. As doen?as de maior preval?ncia foram: doen?as de ossos (15,8%); hipertens?o arterial (22,3%); doen?as parasit?rias (25,0%); doen?as de coluna (38,4%). Os agravos em sa?de mais prevalentes ligados ? sa?de mental foram: fobias (12,3%); transtornos mentais comuns (18,4%) e ansiedade (26,7%). No segundo artigo verificou-se que, os fatores que mais respondiam ?s doen?as e agravos mais prevalentes estavam relacionados a doen?as cr?nicas (39,2%); agravos em sa?de mental (48,8%) e a doen?as de ossos e coluna (50,0%). Do fator 1: agravos em sa?de mental, verificou-se que fam?lias que n?o recebem benef?cios sociais t?m 43% mais chances de ter algum agravo em sa?de mental. Do fator 2: doen?as cr?nicas, constatou-se que os indiv?duos que fazem pouco consumo de verduras, frutas e legumes apresentam possibilidade de 1,42 mais chances de desenvolver uma doen?a cr?nica. Do fator 3: doen?as dos ossos e de coluna, averiguou-se que sujeitos que est?o trabalhando t?m 1,44 mais chances de ter doen?as de ossos e coluna, e para os que n?o recebem benef?cios sociais, essa possibilidade aumenta para 1,93 vezes. A an?lise de regress?o log?stica hier?rquica foi realizada para os tr?s fatores (1- agravos em sa?de mental, 2- doen?as cr?nicas e 3- doen?as de ossos e coluna). Na an?lise multivariada os fatores associados ?s doen?as e agravos nas comunidades quilombolas, no que tange ao fator 1 foram: recebimento de benef?cios sociais (OR=1,63 IC80%:1,07; 2,50); material utilizado na constru??o da casa (OR=3,22; IC80%:1,17; 8,80); destino do lixo (OR=1,51 IC80%:1,07; 2,13); ter banheiro (OR=2,82; IC80%:1,17; 6,77); autoavalia??o de sa?de (OR=2,64 IC80%: 1,92; 3,65); tipo de medica??o: (OR=0,15; IC80%:0,05; 0,45); problemas com c?ries/canal (OR=1,47 IC80%:1,07; 2,01); idade (OR=1,84; IC80%:1,19; 2,84) e sexo (OR=0,48 IC80%: 0,34; 0,67). Em rela??o ao fator 2 foram: material utilizado na constru??o da casa (OR=3,18; IC80%:1,09; 9,28); ter banheiro (OR=3,69 IC80%:1,36; 10,01); idade (OR=1,87; IC80%: 1,18; 2,95) e sexo (OR=0,47; IC80%:0,32; 0,68). No fator 3 as vari?veis foram: anos de estudo (OR=1,77; IC80%:1,20; 2,62); autoavalia??o de sa?de (OR=1,64; IC80%:1,15; 2,32); tipo de medica??o (OR=6,12; IC 80%:2,59; 14,4) e idade (OR=1,61; IC80%:1,03; 2,51). Conclus?es: Produziram-se evid?ncias cient?ficas acerca das condi??es de vida e sa?de das comunidades quilombolas do munic?pio de Feira de Santana-BA e dos fatores associados ?s doen?as e agravos que mais atingem essas popula??es. Nesta dire??o, verificou-se que as doen?as e agravos nas popula??es quilombolas s?o determinados por fatores demogr?ficos, socioecon?micos, ambientais e das condi??es de sa?de. Espera-se que os resultados encontrados subsidiem novas pesquisas com essa popula??o e que possam contribuir para a implementa??o de pol?ticas sociais e de sa?de espec?ficas, assim como para a realiza??o de interven??es intersetoriais com aplicabilidade loco-regional.

Objetivos: Este estudo é parte do Projeto Saúde, Bem-estar e Envelhecimento (SABE), com o objetivo de identificar as desigualdades no acesso e uso de serviços de saúde entre idosos no município de São Paulo, Brasil. Métodos: Em 2000, foram entrevistados, 2143 indivíduos com 60 anos ou mais, utilizando-se o questionário padronizado do SABE. A amostra foi obtida em dois estágios, utilizando-se setores censitários com reposição, probabilidade proporcional à população e complementação da amostra de pessoas de 75 anos. Os dados finais foram ponderados, de forma a serem expandidos. Foi mensurado o uso de serviços hospitalares (internações) e ambulatoriais (consultas médicas) nos últimos quatro meses e o não uso de serviços de saúde (mesmo precisando), relacionando-os com fatores de capacidade, necessidade e predisposição (renda total, escolaridade, seguro saúde, morbidade referida, auto-percepção, sexo e idade). Resultados: A proporção dos entrevistados que referiu ter utilizado algum serviço de saúde, nos últimos quatro meses, foi de 4,7 por cento com relação à internação hospitalar e 64, 4 por cento com referência ao atendimento ambulatorial. Dos atendimentos ambulatoriais, 24,7 por cento ocorreu em hospital público e 24,1 por cento em serviço ambulatorial público sendo que nos serviços privados, 14,5 por cento ocorreu em hospital e 33,7 por cento em clínicas. A não utilização foi relacionada à pouca gravidade da doença, qualidade e distância dos serviços e custo. Na regressão logística multivariada, observou-se associação entre a utilização de serviços e sexo, presença de doenças, auto-percepção de saúde, interação da renda e escolaridade e posse de seguro saúde, sendo que a escolaridade isoladamente apresentou efeito inverso. Conclusão: Foram observadas desigualdades no uso e acesso aos serviços de saúde e inadequação do modelo de atenção, indicando necessidade de políticas públicas que levem em conta as especificidades dessa população, facilitem o acesso e possam reduzir essas desigualdades / Objectives: This research is part of a project called Health, Well-being and Aging in Latin America and the Caribbean, “SABE study", and aims to study the inequalities in use and access to health care services among the elderly persons in the Municipality of São Paulo, Brazil. Methods: In 2000, 2.143 individuals aged 60 or older, dwelling in the urban area of São Paulo, were interviewed using census sectors with replacement and probability proportional to population. To achieve the desired number of respondents 75 or older, additional homes close to the selected census sector were used, with weighting of the final results. The use and access to health services were measured for outpatient medical services and hospital admission in the context of the personal characteristics of the subjects, context and need for health care. Results: Considering the elderly who needed healthcare assistance in the four months prior to the interview, 4,7% were hospitalized and 64,4% needed ambulatory care, being 24,7% in public hospitals and 24,1% in public ambulatory health services. As for the private services, this number was 14, 5% for hospitals and 33, 7% for medical clinics. In the multivariate analysis, there is an association between use of health services, sex, diseases, wealth quintiles and health insurance. However, the opposite effect was found for the variable “educational level". Conclusions: The results demonstrate inequalities in use and access to health services and a problematic health care system. Public policies should take into account the different needs of this older population, in order to facilitate access to health care services and reduce inequalities.

Made available in DSpace on 2014-12-17T15:43:48Z (GMT). No. of bitstreams: 1 GenycleaSO_DISSERT.pdf: 2009007 bytes, checksum: 19a6d4fcd41f06f499ef6b4431291aa7 (MD5) Previous issue date: 2012-12-17 / In Brazil, despite the decline in infant mortality in recent decades it still has high rates going against recommended by WHO. Being the largest percentage of infant mortality rate composed of neonatal deaths. Objective: A study was conducted to analyze the spatial distribution of neonatal mortality and its correlation with the biological, socioeconomic and maternal and child health care in the Brazilian states in the period from 2006 to 2010. Method: The study made thematic maps and correlation (LISA) for verification of spatial dependence and multiple linear regression models. Results: Was found that there is no spatial autocorrelation for neonatal mortality in the Brazilian states (R = 0.002, p = 0.48). Most of variables were correlated (r> 0.3, p <0.05) with neonatal mortality, forming clusters in the North and Northeast, with the highest rates of teenage mothers, low household income per capita, lower prenatal appointments and beds of Neonatal Intensive Care Unit. The number of Neonatal UCI beds remained independent effect after regression analysis. Conclusion: The study concludes that regional inequalities in living conditions and especially the access to maternal and child health services contribute to the unequal distribution of neonatal mortality in Brazil / No Brasil, apesar do decl?nio da mortalidade infantil nas ?ltimas d?cadas esta ainda possui altas taxas indo de encontro ao preconizado pela OMS. Sendo o maior percentual da taxa de mortalidade infantil composto pelos ?bitos neonatais. Objetivo: Realizou-se um estudo para analisar a distribui??o espacial da mortalidade neonatal e sua correla??o com os fatores biol?gicos, socioecon?micos e de aten??o ? sa?de materno-infantil nos estados brasileiros, no per?odo de 2006 a 2010. Desenho: ecol?gico, utilizando os estados brasileiros e o Distrito Federal como unidades de an?lise. M?todo: Foram constru?dos mapas tem?ticos e de correla??o (LISA) para verifica??o de depend?ncia espacial e modelos de regress?o linear m?ltipla. Resultados: Verificou-se que n?o h? autocorrela??o espacial para mortalidade neonatal nos estados brasileiros (I =0,002; p=0,48). A maioria das vari?veis estavam correlacionadas (r >0,3, p<0,05) com a mortalidade neonatal, formando clusters em estados do Norte e Nordeste, com maiores taxas de m?es adolescentes, renda domiciliar per capta baixa, menor realiza??o de consultas de pr?-natal e de leitos de UTI Neonatal. O n?mero de leitos de UTI Neonatal manteve efeito independente ap?s a an?lise de regress?o. Conclus?o: As desigualdades regionais das condi??es de vida e principalmente de acesso aos servi?os de sa?de materno-infantil contribuem para a distribui??o desigual da mortalidade neonatal no Brasil

Made available in DSpace on 2016-04-29T14:16:46Z (GMT). No. of bitstreams: 1 Nathalie Jacinta Rodrigues de Oliveira Py.pdf: 1071074 bytes, checksum: 13862fca79bbb6cfa67df01abeb5b819 (MD5) Previous issue date: 2015-12-02 / Goals: The goal of the study is an analyze of the implantation of health care public polities for mammography access in the Oiapoque river frontier between France and Brazil where there is several social inequalities in health care. Justifications: The interest to this subject has two influences: The work realized at the coordination of the Regional Cancer Network of French Guiana in collaboration with health care professionals, a social worker and a psychologist in the support to patients and their dose relatives. The knowledge of the frontier zone with the richness of the population and the challenges they take up in the everyday life by living far away from the main cities. Hypotheses: Two questions will be analyzed to answer the main problematic: Are the social determinants on health care for the frontier population regarded for the implantation of polities for breast cancer detection access? Which are the strategies of the public powers, institutional actors and the professionals to facilitate the access to mammography for the frontier population? Teorico-metodological aspects: The analyze of the social inequalities on health care influence will be based on the economist Amartya Sen theory on the link between social inequalities and individual freedom. A documental research and interviews of professionals working on the frontier had been realized to understand the specific context of the region, the brazilian and french health care system, the organization of the breast cancer detection for the frontier population. Results: We can conclude that the territorial inequalities has most impact on the access of mammographyfor the women living on frontier. The inequalities needs a coordination of the public action to realized the structural modifications, and also local actions promoting more interaction between professionals and population / Objetivos: Este trabalho tem como objetivo analisar a implementação das políticas publicas de saúde para o acesso à mamografia na região da fronteira fluvial do rio Oiapoque entre a França e o Brasil que apresenta varias situações de desigualdades sociais de saúde. Justificativa: O interesse por essa problemática teve duas influências: O trabalho realizado na coordenação da Rede regional do câncer da Guiana Francesa, em colaboração com os profissionais de saúde, uma assistente social e uma psicóloga no atendimento aos pacientes e familiares. O conhecimento de uma região de fronteira rica pela diversidade de sua população e dos desafios que enfrentam no seu quotidiano pelo distanciamento com as cidades principais. Duas questões foram contempladas para responder à problemática principal: Os determinantes sociais de saúde da população da região fronteiriça estão sendo contemplados na implementação das políticas de acesso à detecção do câncer de mama? Quais são as estratégias propostas pelos poderes públicos, os atores institucionais, os profissionais para facilitar o acesso à mamografia para a população da fronteira? Aspectos teórico-metodológicos: A análise da influência das desigualdades sociais de saúde no acesso a mamografia foi realizada com base na teoria do economista Amartya Sen sobre a relação entre as desigualdades sociais e a liberdade dos indivíduos. Uma pesquisa documental e entrevistas com profissionais da fronteira foram realizadas para entender o contexto específico da região, os sistemas de saúde brasileiros e francês e a organização da detecção do câncer de mama para a população fronteiriça. Resultados obtidos: Pudemos concluir que as desigualdades territoriais são maior impacto na falta de participação ao exame de as que tem detecção do câncer de mama das mulheres de vivem na fronteira. Essas desigualdades requerem uma ação pública coordenada para realizar mudanças estruturais "e de organização dos serviços públicos, mais também ações localizadas, promovendo maior interação entre os profissionais e a população

La question des infections sexuellement transmissibles (IST) en Afrique a longtemps été négligée par des chercheurs africains spécialistes en sciences sociales, en raison notamment du tabou qui entoure la sexualité dans ce continent. Toutefois, les dernières décennies ont donné lieu à plusieurs recherches menées principalement par les Européens africanistes sur ces pathologies grâce à l’émergence de la pandémie actuelle du Sida. La plupart des travaux réalisés sont axés sur les facteurs de risque, les mécanismes de diffusion, les croyances et les attitudes populaires face à ces maladies, les politiques de lutte, etc. Mais les études historiques consacrées aux IST sont très rares. Celles qui existent ont surtout mis en évidence la dimension démographique axée sur le problème de la dénatalité en laissant dans l’ombre le contexte socio-historique et les conditions socio-épidémiologiques de propagation de ces affections. Au moment où le Sida fait des ravages dans le monde et tout particulièrement en Afrique subsaharienne, l’intérêt d’une réflexion historique sur les IST au Congo n’est plus à démontrer. Contrairement à une affirmation classiquement admise dans la littérature, selon laquelle la lutte contre les IST au sein de la population congolaise fut un franc succès pour les autorités coloniales surtout après la Deuxième Guerre mondiale, cette thèse montre plutôt l’augmentation de la prévalence des IST dans le temps. Les archives inédites et l’analyse des données révèlent que cette progression continue est la conséquence de l'urbanisation accélerée et de la monétarisation de la société et de la sexualité entraînant des modes de vie propres à la société coloniale urbaine. Les villes issues de ce processus deviendront non seulement des espaces d’acculturation et de modernité, mais aussi des lieux d’expansion de ces maladies. Le développement de la prostitution et la multiplicité des partenaires sexuels, à travers les unions plus libres et momentanées, sont les principaux facteurs explicatifs de cette observation. On présente généralement de manière panégyrique l’oeuvre sanitaire coloniale de la Belgique au Congo comme ‘‘modèle’’. Pourtant, aucune étude n’a déjà été menée pour examiner, de manière chiffrée, les aspets liés aux différences de santé entre les Congolais et les Blancs. Cette dissertation vient combler les lacunes existantes dans ce domaine. De ce point de vue, il en résulte de fortes inégalités et des déséquilibres persistants de santé entre ces deux types de populations. Les Congolais beaucoup plus nombreux, socialement défavorisés, ne bénéficient que d’une situation peu ou moins favorable ; tandis que les Blancs, socialement plus favorisés, bénéficient en général d’une meilleure situation sanitaire. Plusieurs indicateurs élaborés dans ce travail sont révélateurs de cette réalité coloniale, en termes d’équipements sanitaires, d’accès et d’utilisation de soins et d’état de santé différencié./ The issue of sexually transmitted infections (STI) in Africa has long been neglected by researchers African social scientists, particularly because of the taboo surrounding sexuality in Africa. However, recent decades have resulted in several research conducted mainly by the European Africanists on these diseases through the emergence of the current pandemic of AIDS. Most of studies are focused on risk factors, distribution mechanisms, the popular attitudes about these infections, control policies... But historical studies on STI are seldom examined. Those that exist are mainly concerning the demographic dimension focuses on the problem of declining birth, leaving the socio-historical and socio-epidemiological spread of such diseases. While AIDS is ravaging the world and especially in sub-Saharan Africa, one thing to mention is that the interest of historical reflection on STI in the Congo is obvious. Contrary to an assertion conventionally accepted in the literature, that the fight against gonorrhea and syphilis among the Congolese population was a success for the colonial authorities, especially after the Second World War, our thesis shows rather the increasing prevalence of STI. The archives and analysis of data indicates this continued progress is the result of special conditions of industrialization and urbanization colonial that make people vulnerable. Cities from this historical process will not only areas of acculturation and modernity, but also places for expansion of these diseases. The development of prostitution and multiple sexual partners through free and temporary unions are the main factors explaining this observation. It has generally praises how the actions of Belgian colonial health in the Congo as 'model'. However, no study has been conducted to establish or to compare quantitatively the health status between Blacks (Congolese) and Withes (Europeans in majority). This essay shows the social health inequalities among these two populations. The Congolese many in number, but more socially disadvantaged have only less favorable conditions to health. While the white people, socially privileged, generally have better health status. Several indicators developed in this study are revealing of the colonial reality in terms of sanitation, access and use of care and health status differential.

INTRODUCTION : En milieu urbain, l’amélioration de la sécurité des piétons pose un défi de santé publique. Pour chaque décès attribuable aux collisions routières, il y a des centaines de personnes blessées et, dans les pays riches, la diminution du nombre annuel de piétons décédés s’expliquerait en partie par la diminution de la marche. Les stratégies préventives prédominantes n’interviennent pas sur le volume de circulation automobile, un facteur pourtant fondamental. De plus, les interventions environnementales pour améliorer la sécurité des infrastructures routières se limitent habituellement aux sites comptant le plus grand nombre de décès ou de blessés. Cette thèse vise à décrire la contribution des volumes de circulation automobile, des pratiques locales de marche et de la géométrie des routes au nombre et à la répartition des piétons blessés en milieu urbain, et d’ainsi établir le potentiel d’une approche populationnelle orientée vers la reconfiguration des environnements urbains pour améliorer la sécurité des piétons. MÉTHODE : Le devis est de type descriptif et transversal. Les principales sources de données sont les registres des services ambulanciers d’Urgences-santé (blessés de la route), l’enquête Origine-Destination (volumes de circulation automobile), la Géobase du réseau routier montréalais (géométrie des routes) et le recensement canadien (pratiques locales de marche, position socioéconomique). Les analyses descriptives comprennent la localisation cartographique (coordonnées x,y) de l’ensemble des sites de collision. Des modèles de régression multi-niveaux nichent les intersections dans les secteurs de recensement et dans les arrondissements. RÉSULTATS : Les analyses descriptives démontrent une grande dispersion des sites de collision au sein des quartiers. Les analyses multivariées démontrent les effets significatifs, indépendants du volume de circulation automobile, de la présence d’artère(s) et d’une quatrième branche aux intersections, ainsi que du volume de marche dans le secteur, sur le nombre de piétons blessés aux intersections. L’analyse multi-niveaux démontre une grande variation spatiale de l’effet du volume de circulation automobile. Les facteurs environnementaux expliquent une part substantielle de la variation spatiale du nombre de blessés et du gradient socioéconomique observé. DISCUSSION : La grande dispersion des sites de collision confirme la pertinence d’une approche ne se limitant pas aux sites comptant le plus grand nombre de blessés. Les résultats suggèrent que des stratégies préventives basées sur des approches environnementales et populationnelle pourraient considérablement réduire le nombre de piétons blessés ainsi que les inégalités observées entre les quartiers. / INTRODUCTION: In an urban environment, improving pedestrian safety is a public health challenge. For every death attributable to road injuries, there are hundreds of injured people and, in richer countries, decreases in the number of pedestrian deaths may reflect a reduction of walking as a mode of transportation. The predominant preventive strategies have limited or no effect on traffic volume, which is the most important predictor of the number of pedestrians injured by motor vehicles. Moreover, environmental interventions are usually limited to sites that have had the greatest number of deaths or injuries. The purpose of this thesis is to describe the contribution of environmental factors such as traffic volume, local walking practices and street geometry, on the number and the distribution of pedestrian injuries in an urban setting. METHOD: The design of the study is descriptive and cross-sectional. The main data sources were Urgences-santé ambulance service records (road injuries), the Origin-Destination survey (traffic volume), the Geobase for the Montreal road network (street geometry) and the census of Canada (local walking practices, socioeconomic status). The descriptive analyses included map locations (x, y coordinates) for all collision sites. Multi-level regression models nested intersections in census sectors and in boroughs. RESULTS: The descriptive analyses showed a great deal of dispersion of collision sites within neighbourhoods. The multivariate analyses showed the significant effects, independent of traffic volume, of the presence of an artery and of a fourth leg at the intersection, and of pedestrian volume in the neighbourhood, on the number of pedestrian injuries at intersections. The multi-level analysis showed extensive spatial variation in the effect of traffic volume. This spatial variation in the number of casualties, and the socioeconomic gradient observed, were in large part explained by traffic volume, the presence of an artery and of a fourth leg at the intersection. DISCUSSION: The great dispersion of collision sites supports an approach which is not limited to sites with the highest number of injured pedestrians. This thesis suggests that preventive strategies based on environmental and population approaches could considerably reduce the number of injured pedestrians , as well as road injury inequalities across urban neighbourhoods.

Objetivos: Este estudo é parte do Projeto Saúde, Bem-estar e Envelhecimento (SABE), com o objetivo de identificar as desigualdades no acesso e uso de serviços de saúde entre idosos no município de São Paulo, Brasil. Métodos: Em 2000, foram entrevistados, 2143 indivíduos com 60 anos ou mais, utilizando-se o questionário padronizado do SABE. A amostra foi obtida em dois estágios, utilizando-se setores censitários com reposição, probabilidade proporcional à população e complementação da amostra de pessoas de 75 anos. Os dados finais foram ponderados, de forma a serem expandidos. Foi mensurado o uso de serviços hospitalares (internações) e ambulatoriais (consultas médicas) nos últimos quatro meses e o não uso de serviços de saúde (mesmo precisando), relacionando-os com fatores de capacidade, necessidade e predisposição (renda total, escolaridade, seguro saúde, morbidade referida, auto-percepção, sexo e idade). Resultados: A proporção dos entrevistados que referiu ter utilizado algum serviço de saúde, nos últimos quatro meses, foi de 4,7 por cento com relação à internação hospitalar e 64, 4 por cento com referência ao atendimento ambulatorial. Dos atendimentos ambulatoriais, 24,7 por cento ocorreu em hospital público e 24,1 por cento em serviço ambulatorial público sendo que nos serviços privados, 14,5 por cento ocorreu em hospital e 33,7 por cento em clínicas. A não utilização foi relacionada à pouca gravidade da doença, qualidade e distância dos serviços e custo. Na regressão logística multivariada, observou-se associação entre a utilização de serviços e sexo, presença de doenças, auto-percepção de saúde, interação da renda e escolaridade e posse de seguro saúde, sendo que a escolaridade isoladamente apresentou efeito inverso. Conclusão: Foram observadas desigualdades no uso e acesso aos serviços de saúde e inadequação do modelo de atenção, indicando necessidade de políticas públicas que levem em conta as especificidades dessa população, facilitem o acesso e possam reduzir essas desigualdades / Objectives: This research is part of a project called Health, Well-being and Aging in Latin America and the Caribbean, “SABE study”, and aims to study the inequalities in use and access to health care services among the elderly persons in the Municipality of São Paulo, Brazil. Methods: In 2000, 2.143 individuals aged 60 or older, dwelling in the urban area of São Paulo, were interviewed using census sectors with replacement and probability proportional to population. To achieve the desired number of respondents 75 or older, additional homes close to the selected census sector were used, with weighting of the final results. The use and access to health services were measured for outpatient medical services and hospital admission in the context of the personal characteristics of the subjects, context and need for health care. Results: Considering the elderly who needed healthcare assistance in the four months prior to the interview, 4,7% were hospitalized and 64,4% needed ambulatory care, being 24,7% in public hospitals and 24,1% in public ambulatory health services. As for the private services, this number was 14, 5% for hospitals and 33, 7% for medical clinics. In the multivariate analysis, there is an association between use of health services, sex, diseases, wealth quintiles and health insurance. However, the opposite effect was found for the variable “educational level”. Conclusions: The results demonstrate inequalities in use and access to health services and a problematic health care system. Public policies should take into account the different needs of this older population, in order to facilitate access to health care services and reduce inequalities.

Kvinnor rapporterar sämre självskattad hälsa än män och utlandsföddas psykiska välmående är sämre än svenskföddas. Delaktighet och inflytande har visats vara starkt sammankopplat med hälsa och det är därför viktigt med ett effektivt integrationsarbete för att skapa delaktighet och inflytande i det svenska samhället. Syftet med denna undersökning var att undersöka upplevelser och erfarenheter av integrationen i Sverige bland utlandsfödda kvinnor utifrån ett folkhälsoperspektiv. För att besvara syftet har en kvalitativ ansats använts och fem semistrukturerade intervjuer med utlandsfödda kvinnor i olika åldrar över 18 år genomfördes. Insamlade intervjudata analyserades genom en manifest innehållsanalys. I resultatet framkom att sociala nätverk, språk och arbete är tre viktiga aspekter för att integreras i det svenska samhället. Rädsla och ovilja inför nya kulturer kan förhindra individers möjligheter till att integreras samt att kulturkrockar kan försvåra integrationen. Det framkom även att det bör finnas ett tvärsektoriellt arbete mellan samhällsaktörer och att lättillgänglig information kan nås, för en lättare förståelse för kulturen i det nya landet. Slutsatsen är att det finns olika aspekter som utlandsfödda kvinnor upplever påverkar deras möjlighet till integration: upplevelser, underlättande faktorer och hinder för integration. Framtida beslutsfattare bör ha dessa i åtanke vid utformning av styrning och policy för integration. / Women self-report worse health than men, and people born in a foreign country report lower psychological well-being than Swedish born people. Participation and influence within society directly correlate with health, therefore it is important to integrate people into society so that they can participate and gain influence. The purpose of this study is, using a public health perspective, to examine foreign born women’s relations and experiences of integration in Sweden. A qualitative approach was used to answer the purpose. Five semi-structured interviews have been conducted in Stockholm, Västerås and Gävle with foreign born women of 18 years and older. The collected interview data was analyzed using manifest content analysis. The results showed that social-networks, language, and occupation are three important aspects that contribute to successful integration. Fear and unwillingness to assimilate to different cultures in a new country can increase the difficulty of integration. To ease integration, the participants believed that a multi-sectoral approach is necessary, stakeholders in integration need to work together. The women further described that more information and transparency in information from stakeholders will increase their ability to successfully integrate into a new country. The conclusions are that there are three main aspects that foreign born women believe influence their possibility to integration: experiences, possibilities and obstacles. Future policy makers should regard these important aspects when presenting policies for integration.