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Obesity and physical inactivity (PI) are major health problems world-wide, and leading contributors to the high incidence of overweight, cardiovascular and metabolic diseases in children both globally and in South Africa in particular. Despite the importance of physical activity (PA), health-related physical fitness (HRPF) and body composition to health, very few studies have investigated the longitudinal relationship between these variables in children. Three articles based on this research were written in which a total of 283 adolescent learners (111 boys and 172 girls) with a mean age of 14.90±0.72 years from the Physical Activity and Health Longitudinal Study (PAHLS) participated. The students’ physical characteristics were measured using the protocol of the International Society for the Advancement of Kinanthropometry (ISAK); the EUROFIT test protocol and International Physical Activity Questionnaire (IPAQ) were used to assess the children’s HRPF and PA levels, respectively. In the first article, the results showed that girls had a slightly higher significant BMI (21.43±4.37 kg/m²) than the boys (20.01±3.71kg/m²) (p=0.002), and were substantially more overweight (32.4%) and fatter (%body fat=26.01±8.51) than the boys (17.1%)). A total of 85 (30%), 78 (27.5%) and 88 (31.1%) of the students had low, moderate and high PA involvement. It was concluded that girls were more overweight and less active than boys. The second article examined the relationships between body composition, health-related fitness and PA. Inverse relationships were found between BMI and the health-related fitness items of SBJ and BAH. Furthermore, BMI negatively associated with SAR and endurance performance, especially in girls. Percentage body fat was negatively related to SBJ, BAH, SAR and endurance performance. The aim of the third article was to evaluate the longitudinal development of HRPF, anthropometry and body composition status among the children. Regression coefficients showed that changes in BMI were inversely associated with those in health-related physical fitness. The changes in %BF were negatively associated with SBJ, BAH and aerobic capacity (VO2max) in the boys and girls. The results also yielded a low significantly positive association between changes in WHtR and SBJ in both genders, while low inverse associations were found between WHtR and BAH in girls, and VO2max in both genders. It is concluded that the incidence of overweight and PI was especially high in girls and excessive fatness negatively affected the girls’ fitness performances. Changes in BMI, % body fat and WHtR were negatively related with the children’s strength and running performances, especially among the girls in which the relative increase in overweight negatively affected their endurance running and static strength performances. In view of the health implications of the findings, it is necessary to create an enabling environment and opportunities to promote physically active lifestyles and develop life-long positive attitudes towards PA among students. Community-based strategies targeted at facilitating sustainable PA intervention programmes in schools are recommended. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014

Obesity and physical inactivity (PI) are major health problems world-wide, and leading contributors to the high incidence of overweight, cardiovascular and metabolic diseases in children both globally and in South Africa in particular. Despite the importance of physical activity (PA), health-related physical fitness (HRPF) and body composition to health, very few studies have investigated the longitudinal relationship between these variables in children. Three articles based on this research were written in which a total of 283 adolescent learners (111 boys and 172 girls) with a mean age of 14.90±0.72 years from the Physical Activity and Health Longitudinal Study (PAHLS) participated. The students’ physical characteristics were measured using the protocol of the International Society for the Advancement of Kinanthropometry (ISAK); the EUROFIT test protocol and International Physical Activity Questionnaire (IPAQ) were used to assess the children’s HRPF and PA levels, respectively. In the first article, the results showed that girls had a slightly higher significant BMI (21.43±4.37 kg/m²) than the boys (20.01±3.71kg/m²) (p=0.002), and were substantially more overweight (32.4%) and fatter (%body fat=26.01±8.51) than the boys (17.1%)). A total of 85 (30%), 78 (27.5%) and 88 (31.1%) of the students had low, moderate and high PA involvement. It was concluded that girls were more overweight and less active than boys. The second article examined the relationships between body composition, health-related fitness and PA. Inverse relationships were found between BMI and the health-related fitness items of SBJ and BAH. Furthermore, BMI negatively associated with SAR and endurance performance, especially in girls. Percentage body fat was negatively related to SBJ, BAH, SAR and endurance performance. The aim of the third article was to evaluate the longitudinal development of HRPF, anthropometry and body composition status among the children. Regression coefficients showed that changes in BMI were inversely associated with those in health-related physical fitness. The changes in %BF were negatively associated with SBJ, BAH and aerobic capacity (VO2max) in the boys and girls. The results also yielded a low significantly positive association between changes in WHtR and SBJ in both genders, while low inverse associations were found between WHtR and BAH in girls, and VO2max in both genders. It is concluded that the incidence of overweight and PI was especially high in girls and excessive fatness negatively affected the girls’ fitness performances. Changes in BMI, % body fat and WHtR were negatively related with the children’s strength and running performances, especially among the girls in which the relative increase in overweight negatively affected their endurance running and static strength performances. In view of the health implications of the findings, it is necessary to create an enabling environment and opportunities to promote physically active lifestyles and develop life-long positive attitudes towards PA among students. Community-based strategies targeted at facilitating sustainable PA intervention programmes in schools are recommended. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014

Made available in DSpace on 2011-05-04T12:42:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / O vínculo longitudinal pode ser definido como ‘relação terapêutica entre paciente e profissionais da equipe de Atenção Primária em Saúde (APS) ao longo do tempo, que se traduz na utilização da unidade básica de saúde (UBS) como fonte regular de cuidado para os vários episódios de doença e cuidados preventivos. O vínculo longitudinal contribui para diagnósticos e tratamentos mais precisos, diminuição dos custos da atenção e maior satisfação do paciente. O presente estudo teve por objetivo investigar o atendimento a tal atributo na experimentação de diferentes modelos assistenciais organizativos da APS no contexto do SUS. O estudo, que está estruturado em três artigos/capítulos, teve início com a identificação do vínculo longitudinal como característica central da APS. Revisão conceitual possibilitou definir o termo, identificar três dimensões para análise do atributo (identificação da UBS como fonte regular de cuidados; relação interpessoal entre profissional e paciente; e continuidade informacional), e construir roteiro para investigar o vínculo longitudinal no âmbito da APS municipal. Revisão bibliográfica sobre os modelos assistenciais no Brasil identificou propostas atuais com experiências consolidadas de estruturação da APS. Esses municípios/modelos foram: Camaragibe – que aderiu à Estratégia Saúde da Família; e Belo Horizonte – que segue os princípios orientadores do modelo Em Defesa da Vida/Acolhimento, embora tenha aderido à Estratégia Saúde da Família posteriormente. A presença de elementos favorecedores do vínculo longitudinal na abordagem teórica desses modelos foi averiguada, bem como a reprodução desses elementos nas concepções vigentes no âmbito da gestão da APS municipal. A terceira parte da tese consiste em estudos de caso, com trabalho de campo nesses dois municípios. A investigação teve por base as três dimensões identificadas para o atributo; e a atenção aos portadores de hipertensão arterial foi utilizada como condição traçadora. As fontes de dados contemplaram três âmbitos: gestão do sistema, prática profissional e ponto de vista do usuário. As estratégias de coleta de dados foram: entrevista semi-estruturada com os profissionais, revisão de amostra de prontuários e aplicação de inquérito em amostra de usuários, além de análise de documentos e de dados secundários. Os resultados apontam para a existência de fatores que ainda dificultam o atendimento do vínculo longitudinal como: busca de outras unidades de saúde para atendimento de rotina, rotatividade do profissional médico, e problemas de completude e suficiência dos registros em saúde. Por outro lado há avanços, como: o reconhecimento da interferência de fatores socioeconômicos no processo de adoecimento dos indivíduos, e a presença de vínculo entre usuários e profissionais da equipe de APS. Belo Horizonte apresentou melhor desempenho na primeira e na terceira dimensão; Camaragibe, na segunda. Aspectos relativos à estruturação da rede de serviços, valorizados pelo modelo Em Defesa da Vida/Acolhimento, mas também proporcionados pelas condições socioeconômicas locais, favoreciam o vínculo longitudinal no que refere à identificação da UBS como fonte regular de cuidado e à continuidade da informação para o acompanhamento do paciente em Belo Horizonte; enquanto que limitações estruturais da rede de serviços, presentes em Camaragibe, podem estar relacionadas com a busca de outras unidades de saúde em concomitância com a UBS para o tratamento de rotina. A realização do estudo aponta para a pertinência de se avaliar o vínculo longitudinal no âmbito da APS. / The longitudinal relationship can be described as a ‘therapeutic relationship between patient and Primary Health Care (PHC) staff over time, expressed as use of the basic health care center (Unidade Básica de Saúde, UBS) as the regular source of care for the various episodes of disease and for preventive care’. A longitudinal relationship contributes towards more accurate diagnoses and treatments, lower health care costs and greater patient satisfaction. The purpose of this study was to investigate this attribute in the experimentation with different PHC organization models in Brazil’s national health system, the Sistema Único de Saúde (SUS). The study, which is divided into threepapers/chapters, began by identifying the longitudinal relationship as a key characteristic of PHC. By conceptual review it was possible to define the term, to identify three dimensions for analysis of the attribute (identification of the UBS as the regular source of care; the interpersonal relationship between health care professional and patient; and informational continuity) and to construct an investigational path for researching the longitudinal relationship in municipal PHC. A bibliographical review of health care models in Brazil identified current setups with established experience in structuring PHC. These municipalities/models were Camaragibe, which applied Brazil’s Family Health Strategy, and Belo Horizonte, which followed the guiding principles of the Em Defesa da Vida/Acolhimento (in defence of life/humane reception) model, although it later adhered to the Family Health Strategy. The models’ theoretical approaches were examined for elements likely to favour the longitudinal relationship, and whether such elements were reproduced in conceptions current in the municipal PHC managements. The third part of the thesis comprises case studies involving field work in these two municipalities. The research was based on the three dimensions identified for the attribute; and care for arterial hypertension patients was used as the tracer condition. The data sources covered three areas: system management, professional practice and user point of view. The data collection strategies employed were semi-structured interviews of health professionals, review of a patient record sample and application of questionnaires to a user sample, as well as documentary and secondary data analysis. The results point to factors that continue to hinder longitudinal relationships, such as: patients seeking other health units for routine care, turnover of doctors, and problems of incomplete and inadequate medical records. On the other hand, there have been advances, such as the recognition that socioeconomic factors affect the individual process of falling ill, and bonding between PHC users and staff. Belo Horizonte performed better in the first and third dimensions; and Camaragibe, in the second. In Belo Horizonte, aspects of service network structure valorised by the Em Defesa da Vida/Acolhimento model, but also afforded by local socioeconomic conditions, favoured the longitudinal relationship with regard to identification of the UBS as the regular source of care and to informational continuity in patient follow-up. Meanwhile, structural constraints in Camaragibe’s service network may be related to patients’ attending other health care units in parallel to the UBS for routine treatment. The study signals the relevance of evaluating the longitudinal bond in PHC.