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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
11

TAMANHO E DENSIDADE DAS POPULAÇÕES DE Alouatta guariba clamitans CABRERA, 1940 (PRIMATES, ATELIDAE) NO CAMPO DE INSTRUÇÃO DE SANTA MARIA E ÁREAS VIZINHAS / DENSITY AND POPULATION SIZE OF ALOUATTA GUARIBA CLAMITANS CABRERA, 1940 (PRIMATES, ATELIDAE) AT CAMPO DE INSTRUÇÃO DE SANTA MARIA AND SURROUNDING AREAS

Veiga, Joana Beschorner da 28 August 2013 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This dissertation evaluated the age-sex structure, group size and population density of Alouatta guariba clamitans in 40 forest fragments. We also present a Population Viability Analysis for the subspecies. The study was conducted at Campo de Instrução de Santa Maria (CISM), an area of 5,876 ha belonging to the Ministry of Defense (Brazilian Army) and surrounding areas, located in the municipality of Santa Maria (Rio Grande do Sul State, South Brazil). The fieldwork was conducted from March 2012 to February 2013, totaling 58 days and sampling effort of 431 hours. Our data suggest high mortality in the brown howler monkey populations at CISM. The record of low densities, low occupancy rates in fragments and small group size supports our conclusions. Statistical analyzes showed significant differences between the current population parameters and the previously registered. The PVA results suggest the fragment size and adult female survival as the best parameters contributing for the population growth. Yellow fever is an important threat, especially if the incidence of new outbreaks is high. For the long-term persistence of A. g. clamitans at CISM, the minimum viable population must be at least 573 individuals living in a minimum suitable forest area of 516 ha, which is perfectly plausible for the CISM area. In Rio Grande do Sul state there are practically no conservation units, especially in the western range of the distribution of the brown howler monkey and reinforces the important role of CISM in this scenario, although not a conservation unit. Therefore, if the metapopulation dynamics is granted, it is able to ensure regional long-term survival of A. g. clamitans, unless it suffers more intensely other impacts (such as a new yellow fever outbreak) in a near future. / A presente dissertação avaliou a abundância e densidade das populações, o tamanho e a composição sexo-etária de grupos sociais de Alouatta guariba clamitans em 40 fragmentos florestais no município de Santa Maria. Além disso, apresenta uma análise de viabilidade populacional para a subespécie. Este estudo foi conduzido no Campo de Instrução de Santa Maria (CISM), uma área com 5.876 ha pertencente ao Ministério da Defesa (Exército Brasileiro) localizada no município de Santa Maria (Depressão Central do Rio Grande do Sul), e em áreas particulares do seu entorno. Foram realizadas no período de março de 2012 a fevereiro de 2013 doze campanhas de censo, totalizando 58 dias de campo com esforço amostral de 431 horas. Nossos dados sugerem que houve alta mortalidade nas populações de bugios do CISM após o último levantamento populacional, realizado em 2004. Essa conclusão é apoiada principalmente pela constatação de baixas densidades, reduzidas taxas de ocupação dos fragmentos e grupos com tamanho inferior ao encontrado anteriormente na mesma área. As análises estatísticas mostram que os parâmetros populacionais atuais diferem significativamente dos registrados anteriormente. Os resultados da AVP sugerem que o tamanho do fragmento, a sobrevivência e disponibilidade de fêmeas adultas são os parâmetros que melhor contribuem para as tendências de crescimento populacional. A febre amarela é uma ameaça importante, especialmente se a incidência de novos surtos for alta e a atual composição populacional, de acordo com o modelo, não foi capaz de se recuperar adequadamente em 100 anos. Para a persistência de A. g. clamitans no CISM a população mínima viável deve ser de pelo menos 573 indivíduos em uma área >516 ha de habitat adequado. O que é perfeitamente viável para o CISM, uma vez que o fragmento SAR possui uma área de 977,3 ha. Além disso, no Rio Grande do Sul atualmente praticamente inexistem unidades de conservação, especialmente na metade oeste da distribuição do bugio ruivo. Isso ressalta o papel importante do CISM, ainda que não se trate de uma Unidade de Conservação, logo, se assegurada, a dinâmica de metapopulação é capaz de garantir a sobrevivência regional A. g. clamitans em longo prazo, a menos que a mesma venha a sofrer mais intensamente outros impactos (ex: novo surto de febre amarela) em um futuro próximo.
12

Wohnstandortwahl in ländlichen Räumen

Harms, Bettina, Trunec, Katrin 23 December 2010 (has links)
In vier ländlichen Gemeinden Sachsens wurden die Bewohner zu ihrem Umzugsverhalten befragt. Mehr als ein Drittel der befragten Zuzügler stammt aus den Nachbargemeinden oder anderen Ortsteilen der eigenen Gemeinde. Knapp die Hälfte kam aus anderen Teilen Sachsens. Nur 14 Prozent zogen von außerhalb des Freistaats zu. Ausschlaggebend für den Zuzug sind zumeist familiäre oder persönliche Gründe. Dazu gehören die Zuzüge zum Lebenspartner oder den Kindern und Familiengründungen. Auch der Wunsch nach einem eigenen Heim wird häufig genannt. Berufliche Gründe für den Zuzug sind selten. Sie spielen dafür als Wegzugsgrund eine große Rolle. Dörfliche Ortsteile werden insbesondere von jungen Familien gewählt, um sich ihren Wunsch nach Wohneigentum zu erfüllen. Menschen, die die Nähe zu Einkaufsmöglichkeiten, ärztlicher Versorgung oder die ÖPNV-Anbindungen suchen, entscheiden sich häufiger für die Kleinstädte. Gefragt wurde auch nach der Zufriedenheit der Zugezogenen mit ihrem neuen Wohnstandort und nach Verbesserungen und Verschlechterungen der Lebensbedingungen. Die Studie legt so Stärken und Schwächen ländlicher Wohnstandorte offen und gibt Hinweise zur Steigerung der Zuzugsattraktivität von ländlichen Städten und Dörfern.
13

Uso de serviços de saúde em São Paulo: ecologia do cuidado em saúde / Utilization of healthcare services in São Paulo: ecology of care

Alves, Demian de Oliveira e 08 October 2018 (has links)
Introdução: A análise do uso de serviços de saúde é fundamental para o planejamento sanitário e tem grande contribuição dos inquéritos de saúde de base populacional, com destaque ao ISA CAPITAL, no Município de São Paulo (MSP). Os inquéritos provem informações privilegiadas para a compreensão das mudanças epidemiológicas e organização dos serviços de saúde, principalmente quando se reconhece o posicionamento da Atenção Primária à Saúde (APS) como eixo central organizador do sistema. A expansão da Estratégia de Saúde da Família (ESF), no Sistema Único de Saúde (SUS) nos estado e município de São Paulo, devido às terceirizações da gestão da saúde, por meio de Organizações Sociais de Saúde (OSS), evidencia, neste sentido, o fundamental papel regulatório do Estado. Objetivo: Descrever o uso de serviços de saúde no município de São Paulo e analisar os fatores associados. Método: Foram utilizados dados do ISA CAPITAL 2015, inquérito de saúde de base populacional, de corte transversal, com amostra representativa do Município de São Paulo (MSP). A análise foi realizada em função dos indicadores de utilização dos serviços e sua tipologia foi apresentada em quadro de prevalências de eventos por 1.000 pessoas por mês e comparada com estudos de \"Ecologia do cuidado\". A análise estatística consistiu em modelos de regressão logística multivariados para avaliar fatores associados ao desfecho de utilização de algum serviço de saúde nos 30 dias anteriores a entrevistas e estratificado por faixa etária. Resultados: Os fatores sociodemográficos estudados, sexo, faixa etária, situação conjugal, raça ou cor de pele, escolaridade, situação de trabalho e posse de plano de saúde são associados à prevalência de doenças crônicas, e apenas raça ou cor de pele não estiveram também associados à autoavaliação de saúde. O uso de serviços de saúde nos últimos 30 dias foi de 31,4%, sendo os serviços mais utilizados consultórios ou clínicas e UBS. O tipo de serviço utilizado foi associado à posse de plano de saúde e ao tipo de atendimento e há uma tendência de utilização do tipo de serviço habitual. A tipologia de uso de serviços de saúde no MSP teve diferenças constatadas com outros países e cidades por influência da organização do sistema de saúde e fatores socioculturais. Foi associado ao uso de serviços de saúde: sexo feminino, ser idoso, posse de plano de saúde, autoavaliação da saúde como \'ruim\' e possuir alguma doença crônica, em concordância com achados da literatura. Na estratificação por faixa etária o único fator que persiste em todas as faixas estudadas foi possuir alguma doença crônica. Conclusões: O fortalecimento do SUS no MSP com a aposta na APS, como organizadora do sistema, precisa considerar a coexistência de serviços públicos e privados, bem como a alta prevalência de doenças crônicas. Tais fatores determinam diferentes tipologias de uso de serviços de saúde e, portanto, devem ser levados em consideração para o planejamento em saúde em geral, para os marcos regulatórios das OSS e para a distribuição de serviços. / Introduction: The analysis of health services utilization is fundamental for health planning and for this, has great contribution of population-based health surveys, with emphasis in the city of São Paulo on the ISA-CAPITAL study. Population-based surveys provide privileged information for understanding the epidemiological changes and organization of health services, especially when the Primary Health Care (PHC) is recognized as the organizing axis of the system. The expansion of the Family Health Strategy (FHS), in the Unified Health System (UHS) in the state and municipality of São Paulo occurred by outsourcing the management of health services through Social Health Organizations (SHO) and in this context is prominent the regulatory role of the State. Objective: To describe the use of health services in the city of São Paulo and to analyze the associated factors. Method: Data was provided from ISA CAPITAL 2015, a population-based health survey representative of the municipality of São Paulo. The descriptive analysis was performed according to the indicators of service utilization and its typology was presented in a table of prevalence of events per 1000 people per month and compared with studies of \"Ecology of Care\". Statistical analysis consisted of multivariate logistic regression models to evaluate factors associated with the outcome of use of any health service in the 30 days prior to interviews and stratified by age group. Results: The sociodemographic factors studied, gender, age, marital status, race or color of skin, schooling, work situation and health insurance coverage are associated with the prevalence of chronic diseases and only race or skin color was not associated health self-assessment. The use of health services in the last 30 days was 31.4%, with the most used services being clinics and primary care centers. The type of service used was associated with health plan ownership and type of care and there is a tendency to search for the usual type of service. The typology of the use of health services in São Paulo has had differences with other countries and cities due to the influence of the organization of the health system and socio-cultural factors. It was associated with the use of health services: female sex, being elderly, coverage of health insurance, poor self-rated health and chronic illness, in agreement with findings from the literature. In stratification by age group the only factor that persists in all the studied groups was chronic diseases. Conclusions: The strengthening of UHS in São Paulo with focus on PHC as the organizing axis of the health system needs to consider the coexistence of public and private services and the high prevalence of chronic diseases. These factors determine different typologies of health services utilization and therefore should be considered for SHO regulatory frameworks and for the distribution of health services.
14

Uso de serviços de saúde em São Paulo: ecologia do cuidado em saúde / Utilization of healthcare services in São Paulo: ecology of care

Demian de Oliveira e Alves 08 October 2018 (has links)
Introdução: A análise do uso de serviços de saúde é fundamental para o planejamento sanitário e tem grande contribuição dos inquéritos de saúde de base populacional, com destaque ao ISA CAPITAL, no Município de São Paulo (MSP). Os inquéritos provem informações privilegiadas para a compreensão das mudanças epidemiológicas e organização dos serviços de saúde, principalmente quando se reconhece o posicionamento da Atenção Primária à Saúde (APS) como eixo central organizador do sistema. A expansão da Estratégia de Saúde da Família (ESF), no Sistema Único de Saúde (SUS) nos estado e município de São Paulo, devido às terceirizações da gestão da saúde, por meio de Organizações Sociais de Saúde (OSS), evidencia, neste sentido, o fundamental papel regulatório do Estado. Objetivo: Descrever o uso de serviços de saúde no município de São Paulo e analisar os fatores associados. Método: Foram utilizados dados do ISA CAPITAL 2015, inquérito de saúde de base populacional, de corte transversal, com amostra representativa do Município de São Paulo (MSP). A análise foi realizada em função dos indicadores de utilização dos serviços e sua tipologia foi apresentada em quadro de prevalências de eventos por 1.000 pessoas por mês e comparada com estudos de \"Ecologia do cuidado\". A análise estatística consistiu em modelos de regressão logística multivariados para avaliar fatores associados ao desfecho de utilização de algum serviço de saúde nos 30 dias anteriores a entrevistas e estratificado por faixa etária. Resultados: Os fatores sociodemográficos estudados, sexo, faixa etária, situação conjugal, raça ou cor de pele, escolaridade, situação de trabalho e posse de plano de saúde são associados à prevalência de doenças crônicas, e apenas raça ou cor de pele não estiveram também associados à autoavaliação de saúde. O uso de serviços de saúde nos últimos 30 dias foi de 31,4%, sendo os serviços mais utilizados consultórios ou clínicas e UBS. O tipo de serviço utilizado foi associado à posse de plano de saúde e ao tipo de atendimento e há uma tendência de utilização do tipo de serviço habitual. A tipologia de uso de serviços de saúde no MSP teve diferenças constatadas com outros países e cidades por influência da organização do sistema de saúde e fatores socioculturais. Foi associado ao uso de serviços de saúde: sexo feminino, ser idoso, posse de plano de saúde, autoavaliação da saúde como \'ruim\' e possuir alguma doença crônica, em concordância com achados da literatura. Na estratificação por faixa etária o único fator que persiste em todas as faixas estudadas foi possuir alguma doença crônica. Conclusões: O fortalecimento do SUS no MSP com a aposta na APS, como organizadora do sistema, precisa considerar a coexistência de serviços públicos e privados, bem como a alta prevalência de doenças crônicas. Tais fatores determinam diferentes tipologias de uso de serviços de saúde e, portanto, devem ser levados em consideração para o planejamento em saúde em geral, para os marcos regulatórios das OSS e para a distribuição de serviços. / Introduction: The analysis of health services utilization is fundamental for health planning and for this, has great contribution of population-based health surveys, with emphasis in the city of São Paulo on the ISA-CAPITAL study. Population-based surveys provide privileged information for understanding the epidemiological changes and organization of health services, especially when the Primary Health Care (PHC) is recognized as the organizing axis of the system. The expansion of the Family Health Strategy (FHS), in the Unified Health System (UHS) in the state and municipality of São Paulo occurred by outsourcing the management of health services through Social Health Organizations (SHO) and in this context is prominent the regulatory role of the State. Objective: To describe the use of health services in the city of São Paulo and to analyze the associated factors. Method: Data was provided from ISA CAPITAL 2015, a population-based health survey representative of the municipality of São Paulo. The descriptive analysis was performed according to the indicators of service utilization and its typology was presented in a table of prevalence of events per 1000 people per month and compared with studies of \"Ecology of Care\". Statistical analysis consisted of multivariate logistic regression models to evaluate factors associated with the outcome of use of any health service in the 30 days prior to interviews and stratified by age group. Results: The sociodemographic factors studied, gender, age, marital status, race or color of skin, schooling, work situation and health insurance coverage are associated with the prevalence of chronic diseases and only race or skin color was not associated health self-assessment. The use of health services in the last 30 days was 31.4%, with the most used services being clinics and primary care centers. The type of service used was associated with health plan ownership and type of care and there is a tendency to search for the usual type of service. The typology of the use of health services in São Paulo has had differences with other countries and cities due to the influence of the organization of the health system and socio-cultural factors. It was associated with the use of health services: female sex, being elderly, coverage of health insurance, poor self-rated health and chronic illness, in agreement with findings from the literature. In stratification by age group the only factor that persists in all the studied groups was chronic diseases. Conclusions: The strengthening of UHS in São Paulo with focus on PHC as the organizing axis of the health system needs to consider the coexistence of public and private services and the high prevalence of chronic diseases. These factors determine different typologies of health services utilization and therefore should be considered for SHO regulatory frameworks and for the distribution of health services.
15

The Detection of Amazonian Manatees (Trichechus inunguis) Using Side-Scan Sonar and the Effect of Oil Activities on Their Habitats in Eastern Ecuador

Brice, Caitlin E. 01 May 2014 (has links)
Substantial hunting pressure and habitat destruction caused by oil extraction has critically endangered the Amazonian manatee in Ecuador. The current population status is unknown because an effective method to observe them in the wild has yet to be developed. This study explored whether the Amazonian manatee persists or has been extirpated in the eastern Ecuadorian Amazon utilizing side-scan sonar to increase odds of detection. Spatial differences in probability of detection were quantified if manatees were observed. The level of chemical contamination was determined and compared spatially and temporally against historical data. Data were collected using opportunistic transect surveys and grab sampling of surface water in Yasuni National Park, Lagartococha, and Cuyabeno Wildlife Reserve. Surveys confirmed that the manatee population is extant. Manatees were encountered more often in Cuyabeno Wildlife Reserve than in Lagartococha and Yasuni. Side-scan sonar detected more manatees than previously reported in 1996-1999. Side-scan sonar is a viable method for detection of manatees in the Ecuadorian Amazon system and resulted in greater detection as a function of effort. All future population studies should incorporate side-scan sonar. Lead, arsenic, mercury, polynuclear aromatic hydrocarbons [PAHs], and volatile organic compounds [VOCs] were not detected in the waters of the study region. High total petroleum hydrocarbon [TPH] levels were measured in 7 samples from Yasuni National Park. The concentrations of TPH were higher in Yasuni National Park than in Lagartococha and Cuyabeno. TPHs were detected only in the study region with a recent oil spill; there was no evidence that TPHs were higher near oil production wells and pipelines. The concentrations of TPH were significantly different than those measured in 1998 (z =3.01710, p=0.0026). A dedicated study should be performed to develop a protocol for monitoring persistent oil contaminants in the Ecuadorian Amazon and determine their sink.
16

A life course approach to measuring socioeconomic position in population surveillance and its role in determining health status.

Chittleborough, Catherine R. January 2009 (has links)
Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring changes in socioeconomic inequities in health over time. A life course approach in epidemiology considers the long-term effects of physical and social exposures during gestation, childhood, adolescence, and later adult life on health. Previous studies provide evidence that socioeconomic factors at different stages of the life course influence current health status. Measures of SEP during early life to supplement existing indicators of current SEP are required to more adequately explain the contribution of socioeconomic factors to health status and monitor health inequities. The aim of this thesis was to examine how a life course perspective could enhance the monitoring of SEP in chronic disease and risk factor surveillance systems. The thesis reviewed indicators of early life SEP used in previous research, determined indicators of early life SEP that may be useful in South Australian surveillance systems, and examined the association of SEP over the life course and self-rated health in adulthood across different population groups to demonstrate that inclusion of indicators of early life SEP in surveillance systems could allow health inequities to be monitored among socially mobile and stable groups. A variety of indicators, such as parents’ education level and occupation, and financial circumstances and living conditions during childhood, have been used in different study designs in many countries. Indicators of early life SEP used to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations, need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating. Retrospective recall of various indicators of early life SEP was examined in a telephone survey of a representative South Australian sample of adults. The highest proportions of missing data were observed for maternal grandfather’s occupation, and mother’s and father’s highest education level. Family structure, housing tenure, and family financial situation when the respondent was aged ten, and mother and father’s main occupation had lower item non-response. Respondents with missing data on early life SEP indicators were disadvantaged in terms of current SEP compared to those who provided this information. The differential response to early life SEP questions according to current circumstances has implications for chronic disease surveillance examining the life course impact of socioeconomic disadvantage. While face-to-face surveys are considered the gold standard of interviewing techniques, computer-assisted telephone interviewing is often preferred for cost and convenience. Recall of father’s and mother’s highest education level in the telephone survey was compared to that obtained in a face-to-face interview survey. The proportion of respondents who provided information about their father’s and mother’s highest education level was significantly higher in the face-to-face interview than in the telephone interview. Survey mode, however, did not influence the finding that respondents with missing data for parents’ education were more likely to be socioeconomically disadvantaged. Alternative indicators of early life SEP, such as material and financial circumstances, are likely to be more appropriate than parents’ education for life course analyses of health inequities using surveillance data. Questions about family financial situation and housing tenure during childhood and adulthood asked in the cross-sectional telephone survey were used to examine the association of SEP over the life course with self-rated health in adulthood. Disadvantaged SEP during both childhood and adulthood and upward social mobility in financial situation were associated with a reduced prevalence of excellent or very good health, although this relationship varied across gender, rurality, and country of birth groups. Trend data from a chronic disease and risk factor surveillance system indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health. The surveillance system, however, does not currently contain any measures of early life SEP. Overlaying the social mobility variables on the surveillance data indicated how inequities in health could be differentiated in greater detail if early life SEP was measured in addition to current SEP. Inclusion of life course SEP measures in surveillance will enable monitoring of health inequities trends among socially mobile and stable groups. Life course measures are an innovative way to supplement other SEP indicators in surveillance systems. Considerable information can be gained with the addition of a few questions. This will provide further insight into the determinants of health and illness and enable improved monitoring of the effects of policies and interventions on health inequities and intergenerational disadvantage. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1367190 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2009
17

A life course approach to measuring socioeconomic position in population surveillance and its role in determining health status.

Chittleborough, Catherine R. January 2009 (has links)
Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring changes in socioeconomic inequities in health over time. A life course approach in epidemiology considers the long-term effects of physical and social exposures during gestation, childhood, adolescence, and later adult life on health. Previous studies provide evidence that socioeconomic factors at different stages of the life course influence current health status. Measures of SEP during early life to supplement existing indicators of current SEP are required to more adequately explain the contribution of socioeconomic factors to health status and monitor health inequities. The aim of this thesis was to examine how a life course perspective could enhance the monitoring of SEP in chronic disease and risk factor surveillance systems. The thesis reviewed indicators of early life SEP used in previous research, determined indicators of early life SEP that may be useful in South Australian surveillance systems, and examined the association of SEP over the life course and self-rated health in adulthood across different population groups to demonstrate that inclusion of indicators of early life SEP in surveillance systems could allow health inequities to be monitored among socially mobile and stable groups. A variety of indicators, such as parents’ education level and occupation, and financial circumstances and living conditions during childhood, have been used in different study designs in many countries. Indicators of early life SEP used to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations, need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating. Retrospective recall of various indicators of early life SEP was examined in a telephone survey of a representative South Australian sample of adults. The highest proportions of missing data were observed for maternal grandfather’s occupation, and mother’s and father’s highest education level. Family structure, housing tenure, and family financial situation when the respondent was aged ten, and mother and father’s main occupation had lower item non-response. Respondents with missing data on early life SEP indicators were disadvantaged in terms of current SEP compared to those who provided this information. The differential response to early life SEP questions according to current circumstances has implications for chronic disease surveillance examining the life course impact of socioeconomic disadvantage. While face-to-face surveys are considered the gold standard of interviewing techniques, computer-assisted telephone interviewing is often preferred for cost and convenience. Recall of father’s and mother’s highest education level in the telephone survey was compared to that obtained in a face-to-face interview survey. The proportion of respondents who provided information about their father’s and mother’s highest education level was significantly higher in the face-to-face interview than in the telephone interview. Survey mode, however, did not influence the finding that respondents with missing data for parents’ education were more likely to be socioeconomically disadvantaged. Alternative indicators of early life SEP, such as material and financial circumstances, are likely to be more appropriate than parents’ education for life course analyses of health inequities using surveillance data. Questions about family financial situation and housing tenure during childhood and adulthood asked in the cross-sectional telephone survey were used to examine the association of SEP over the life course with self-rated health in adulthood. Disadvantaged SEP during both childhood and adulthood and upward social mobility in financial situation were associated with a reduced prevalence of excellent or very good health, although this relationship varied across gender, rurality, and country of birth groups. Trend data from a chronic disease and risk factor surveillance system indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health. The surveillance system, however, does not currently contain any measures of early life SEP. Overlaying the social mobility variables on the surveillance data indicated how inequities in health could be differentiated in greater detail if early life SEP was measured in addition to current SEP. Inclusion of life course SEP measures in surveillance will enable monitoring of health inequities trends among socially mobile and stable groups. Life course measures are an innovative way to supplement other SEP indicators in surveillance systems. Considerable information can be gained with the addition of a few questions. This will provide further insight into the determinants of health and illness and enable improved monitoring of the effects of policies and interventions on health inequities and intergenerational disadvantage. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1367190 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2009
18

A life course approach to measuring socioeconomic position in population surveillance and its role in determining health status.

Chittleborough, Catherine R. January 2009 (has links)
Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring changes in socioeconomic inequities in health over time. A life course approach in epidemiology considers the long-term effects of physical and social exposures during gestation, childhood, adolescence, and later adult life on health. Previous studies provide evidence that socioeconomic factors at different stages of the life course influence current health status. Measures of SEP during early life to supplement existing indicators of current SEP are required to more adequately explain the contribution of socioeconomic factors to health status and monitor health inequities. The aim of this thesis was to examine how a life course perspective could enhance the monitoring of SEP in chronic disease and risk factor surveillance systems. The thesis reviewed indicators of early life SEP used in previous research, determined indicators of early life SEP that may be useful in South Australian surveillance systems, and examined the association of SEP over the life course and self-rated health in adulthood across different population groups to demonstrate that inclusion of indicators of early life SEP in surveillance systems could allow health inequities to be monitored among socially mobile and stable groups. A variety of indicators, such as parents’ education level and occupation, and financial circumstances and living conditions during childhood, have been used in different study designs in many countries. Indicators of early life SEP used to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations, need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating. Retrospective recall of various indicators of early life SEP was examined in a telephone survey of a representative South Australian sample of adults. The highest proportions of missing data were observed for maternal grandfather’s occupation, and mother’s and father’s highest education level. Family structure, housing tenure, and family financial situation when the respondent was aged ten, and mother and father’s main occupation had lower item non-response. Respondents with missing data on early life SEP indicators were disadvantaged in terms of current SEP compared to those who provided this information. The differential response to early life SEP questions according to current circumstances has implications for chronic disease surveillance examining the life course impact of socioeconomic disadvantage. While face-to-face surveys are considered the gold standard of interviewing techniques, computer-assisted telephone interviewing is often preferred for cost and convenience. Recall of father’s and mother’s highest education level in the telephone survey was compared to that obtained in a face-to-face interview survey. The proportion of respondents who provided information about their father’s and mother’s highest education level was significantly higher in the face-to-face interview than in the telephone interview. Survey mode, however, did not influence the finding that respondents with missing data for parents’ education were more likely to be socioeconomically disadvantaged. Alternative indicators of early life SEP, such as material and financial circumstances, are likely to be more appropriate than parents’ education for life course analyses of health inequities using surveillance data. Questions about family financial situation and housing tenure during childhood and adulthood asked in the cross-sectional telephone survey were used to examine the association of SEP over the life course with self-rated health in adulthood. Disadvantaged SEP during both childhood and adulthood and upward social mobility in financial situation were associated with a reduced prevalence of excellent or very good health, although this relationship varied across gender, rurality, and country of birth groups. Trend data from a chronic disease and risk factor surveillance system indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health. The surveillance system, however, does not currently contain any measures of early life SEP. Overlaying the social mobility variables on the surveillance data indicated how inequities in health could be differentiated in greater detail if early life SEP was measured in addition to current SEP. Inclusion of life course SEP measures in surveillance will enable monitoring of health inequities trends among socially mobile and stable groups. Life course measures are an innovative way to supplement other SEP indicators in surveillance systems. Considerable information can be gained with the addition of a few questions. This will provide further insight into the determinants of health and illness and enable improved monitoring of the effects of policies and interventions on health inequities and intergenerational disadvantage. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1367190 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2009

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