Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2008. / Title from PDF title page (viewed on July 12, 2010). Includes bibliographical references (p. 131-148).

Over the past 20 years there has been a clear shift in Peru’s mortality profile towards non-communicable diseases. As part of this transition, childhood overweight and obesity (O&O) has become a growing public health concern. In order to address this challenge, context-specific information is needed concerning prevalence, associated factors and culturally appropriate interventions. To this end, I conducted a mixed methods study using a socio-ecological framework to investigate childhood overweight and obesity in Peru. This study found a prevalence of 19.2% overweight and 8.6% obesity among children aged seven to eight in a pro-poor cohort in Peru. Factors associated with being overweight in this cohort included: a high socioeconomic status, living in metropolitan Lima, an O&O mother, being male and being an only child or having only one sibling. The quantitative analysis highlighted the prevalence in O&O in this population and revealed a number of relationships explored in more depth via interviews and focus group discussions. The qualitative component of this research explored these associations amongst a sub-sample of children, parents and teachers in three distinct geographical regions in Peru. My qualitative research showed that parents, teachers and children are aware of the health implications of childhood overweight and obesity and that they have a sophisticated understanding of the many factors that influence its aetiology. Participants also had many suggestions for ways to address this issue in their community. This information was complemented by a systematic review and meta-analysis of the evidence of childhood O&O interventions that took place in Latin America published between 1990 and 2011. A combination of diet, physical activity and pharmaceutical strategies have shown modest effect on BMI reduction in O&O children, but more evidence is needed for effective population-level prevention strategies. The findings highlight the need for comprehensive, multi-level interventions. Notable intervention components include: kiosco reform, junk food taxation, creation of recreational space and enhancement of school-based physical activity programmes. To accomplish this, communities need to be mobilised and work together with school administration, municipal and national government.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 10, 2009). Includes bibliographical references (p. 71-78).

Introduction: Population is demographically aging and proportion of older adults in the society increases. Also the number of sick persons raises, and the high consumption of drugs and polypharmacotherapy in old age are global problems. The definition of polypharmacotherapy is not uniform. Most commonly it is defined as the use of 5 or more drugs simultaneously. In the scientific literature we also see the term "excessive polypharmacotherapy". This is defined as the use of 10 or more drugs simultaneously. Polymorbidity, irrational indications, wrong diagnostics of drug-related problems, but also changes in pharmacokinetics and pharmacodynamics common in the old age contribute to polypharmacotherapy. It is important that pharmacotherapy in the old age must be simple, effective and safe. Methods: Using the electronic database PubMed, all studies on the subject "Polypharmacotherapy in Old Age" published in 2005-2015 were reviewed. The data were summarized in tables. Studies that included causal factors (predictors) of polypharmacotherapy were also evaluated. The most frequently prescribed drugs in geriatric patients with polypharmacotherapy were recorded in a separate table. Results: In this diploma thesis, the prevalence of polypharmacotherapy was compared from 81 studies. We found that the...

The home is supposed to provide support and safety for children but can also be the place where children suffer abuse and other adverse treatment by their parents. Violence against children in homes has been banned in Sweden for more than 30 years but it is still a considerable problem in the society and a threat to public health. The overall aim of this thesis was to create comprehensive knowledge of the phenomenon Child Physical Abuse (CPA) in Sweden after the ban on corporal punishment. The focus has been on examining the characteristics of cases reported to the police as well as self-reported CPA, prevalence of CPA and finally associations between CPA and health-problems/risk-taking behaviors among adolescents. Two samples are used in this thesis. The first comprises cases reported to the police during 11 years (n=142) in a Swedish police-district and the second is a population-based youth survey of the total number of pupils in three different school grades (13, 15 and 17 years old) in Södermanland County, Sweden. Cases of severe abuse constituted 14 % of the total number of cases reported to the police. The main difference between the group of severe cases and the remaining was the higher occurrence of convictions in court in the severe cases and the pattern of reporting to the police. The severe cases were reported by agencies to a greater degree than minor cases. Cases of severe abuse were characterized by an accumulation of risk factors in different areas as perpetrator factors, stress- and strain factors, factors of insufficient social network and finally child-related factors. In the cross-sectional study a prevalence of 15 % was found for self-reported CPA (n=8 494). There were associations between risk factors in different areas and abuse and there was a dos-response relationship between risks and reported abuse. It was shown that children who reported parental intimate-partner violence were at considerably higher risk for CPA than other children and that only 7 % of the children exposed to violence had disclosed this to authorities. The study of associations between health and risk-taking behaviors, were performed among the 15 and 17 years old pupils (n=5 933). Associations with health-problems and risk-taking behaviors were shown and the associations became stronger when the pupils reported repeated abuse. Finally there was a cumulative effect of multiple abuse in the form of being exposed to child physical abuse plus other types of abuse (parental intimate partner violence, bullying and being forced to engage in sexual acts) and the associations increased with the number of concurrent abuse.

Made available in DSpace on 2015-07-15T13:31:37Z (GMT). No. of bitstreams: 1 Noelia Caires.pdf: 604827 bytes, checksum: e0ebadd0ce9042e9aac1c6bb994674f2 (MD5) Previous issue date: 2005-02-25 / The obesity is considered, nowadays, serious problem in the public health, it has been constituted as a risk factor for chronic disease in the modern society, as mellitus diabetes, high levels of cholesterol, heart diseases and some kinds of cancer. In order to contribute for the knowledge of prevailing of the overweight and the obesity and its factors of risk, in Feira de Santana city, it has been evaluated a significative sample of the employees of Feira de Santana State University (number of 435 persons 73,2%). We use a questionnaire applied during the interview were identified biological variables (gender, age, birth ability, familiar history of obesity, presence of diseases related to obesity); socioeconomic variables (education and family income) and socio-behavioral (marital status, food habits, practice of physical activity, smoking and consumption of alcoholic drinks).Overweight and obesity were defined through the body mass index (BMI) adapting the established criteria by WHO (1997): values between 25 and 29,9 kg\m2 for overweight and the same values or bigger of 30kg/m2 for obesity. The measure of the abdominal circumference was used to evaluate the risks of heart diseases, adopting the suggested values by Latin American Consensus of obesity (1998): high risk ≥ 94 cm in men and ≥80 in women; very high risk ≥ 102 cm in men and ≥ 88cm in women. In the descriptive analysis were included all the individuals, and in the exploratory analysis were excluded the individuals with low weight (number of 18). Among the 435 participants of the study, the prevailation of overweight and obesity was 31,15% and 10,34% respectively. Among men, these prevailations were of 34,55% and 10,81% ; and among the women of 30,66% and 10,10% respectively. Using the X2 test, it has been observed age, birth condition, family history, daily frequency of food, and kind of physical activity are the variables which show differences in the distribution of weight. For a multivariate analysis it has been made a model using multiple regression with the following variables: age, family history of obesity, birth condition, individuals with and without mates, education, income, practice, duration and frequency of physical activity, number of meals, the use of alcoholic drinks, smoking. It has been done three analyses, the first with men and women; the second only with men and the third only with women. The BMI presented a positive association with family history in all the analyses; the same occurred with income among men and women. In relation to the education the BMI decreases in the answer to the increasing of the level of education only with women. An inverse association occurred with smoking among men and women, and among men isolated. The obtained results point to the necessity of the measures aiming for the control and the prevention of obesity by the official health institutions. / A obesidade ? considerada, atualmente, grave problema de sa?de p?blica, constituindo-se em fator de risco para doen?as cr?nicas freq?entes na sociedade moderna, como diabetes melitus, dislipidemias, doen?as cardiovasculares e certos tipos de c?ncer. Objetivando contribuir para o conhecimento da preval?ncia do sobrepeso e da obesidade e seus fatores de risco, na cidade de Feira de Santana, foi avaliada amostra significativa dos funcion?rios da Universidade Estadual (n=435 -73,2%). Atrav?s de question?rio aplicado em entrevista foram identificadas vari?veis biol?gicas (g?nero, idade, paridade, hist?ria familiar de obesidade, presen?a de doen?as relacionadas ? obesidade); socioecon?micas (escolaridade e renda familiar) e sociocomportamentais (estado civil, h?bitos alimentares, pr?tica de atividade f?sica, tabagismo e consumo de bebidas alco?licas). Sobrepeso e obesidade foram definidos atrav?s do ?ndice de Massa Corp?rea (IMC) adotando os crit?rios definidos pela OMS (1997): valores entre 25 e 29,9 kg/m2 para sobrepeso e valores iguais ou maiores de 30 kg/m2 para obesidade. Medida da circunfer?ncia abdominal foi utilizada para avalia??o dos riscos de comorbidades, adotando valores sugeridos pelo Consenso Latino Americano de Obesidade (1998): risco elevado ≥ 94 cm no homem e ≥ 80 cm na mulher e risco muito elevado ≥ 102 cm no homem e ≥ 88 cm na mulher. Na an?lise descritiva foram inclu?dos todos os indiv?duos, e na an?lise explorat?ria, foram exclu?dos os indiv?duos com baixo peso (n=18). Dentre os 435 participantes do estudo, a preval?ncia de sobrepeso e obesidade foi de 31,95% e 10,34%, respectivamente. Entre os homens, estas preval?ncias foram de 34,46% e 10,81% e entre as mulheres de 30,66% e 10,10%, respectivamente. Utilizando o teste de Qui-quadrado, foi observado que idade, paridade, hist?ria familiar, freq??ncia di?ria da alimenta??o e tipo de atividade f?sica s?o as vari?veis que apontaram diferen?as na distribui??o do peso. Para an?lise multivariada, foi constru?do modelo utilizando a regress?o m?ltipla com as seguintes vari?veis: idade, hist?ria familiar de obesidade, paridade, indiv?duos com e sem companheiros, escolaridade, renda, a pr?tica, a dura??o e a freq??ncia da atividade f?sica, n?mero de refei??es, uso e quantidades de bebidas alco?licas, tabagismo. Foram realizadas tr?s an?lises, uma com homens e mulheres, outra apenas com homens e outra apenas com mulheres. O IMC apresentou associa??o positiva com a hist?ria familiar em todas as an?lises; o mesmo ocorreu com a renda entre homens e mulheres. Em rela??o ? escolaridade, o IMC diminui em resposta ? eleva??o do n?vel de escolaridade apenas entre as mulheres. Associa??o inversa ocorreu com o tabagismo entre homens e mulheres e entre os homens, isoladamente. Os resultados obtidos apontam para a necessidade de medidas objetivando o controle e a preven??o da obesidade por parte dos ?rg?os de sa?de.

Made available in DSpace on 2014-07-29T15:26:24Z (GMT). No. of bitstreams: 1 Tese Carmen.pdf: 1118244 bytes, checksum: 4d66a35abfcfbb9e9d2f1d1dc4fb4c02 (MD5) Previous issue date: 2009-04-02 / Hepatitis C virus (HCV) infection is an important problem of public health. Drug users (DU) constitute a group of frequent exposure to HCV and little is known about this infection in DU in Brazil. This study aimed to investigate the seroepidemiological and molecular profile of HCV infection among drug users in Central Brazil. A total of 691 DU, being 102 injection drug users (IDU) and 589 noninjecting drug users (NIDU), were interviewed and blood samples collected in 26 treatment drug centers in Campo Grande-MS and Goiânia-GO. Blood samples (sera) were tested for antibodies to HCV (anti-HCV). Anti-HCV-positive samples were submitted to HCV RNA detection by polymerase chain reaction (PCR) with primers complementary to the 5 NC and NS5B regions of viral genome and genotyped by LiPA and direct nucleotide sequencing followed by phylogenetic analysis, respectively. The anti-HCV prevalence was 6.9% (95% CI: 5.2-9.2). The study population reported a low known regarding HCV transmission ways, such as parenteral (20.8-30.5%), sexual (31,7%) and vertical (20%) of HCV. Multivariate analysis of risk factors revealed that age > 40 years, route (injecting) and duration of drug use and blood transfusion were associated with HCV infection. HCV RNA was detected in 85.4% of the anti-HCV-positive samples. Thirty-three samples were of genotype 1 by the LiPA, subtypes 1a (63.4%) and 1b (17.1%), and eight samples (19.5%) were of genotype 3, subtype 3a. The phylogenetic analysis of the NS5B region showed that 17 (68%), 5 (20%) and 3 (12%) samples were of subtypes 1a, 3a and 1b, respectively. This study shows a high HCV infection prevalence and the predominance of subtype 1a among drug users in Central Brazil. Also, the injecting drug use was the risk factor most strongly associated with this infection. In addition, the study population reported a low known regarding HCV transmission ways. Thus, preventive measures are needed to control this infection in illicit drug users / A infecção pelo vírus da hepatite C (HCV) é um importante problema de saúde pública. Os usuários de drogas (UD) constituem um grupo com freqüente exposição ao HCV e, pouco se conhece sobre essa infecção em UD no Brasil. Este estudo teve como objetivo investigar o perfil soroepidemiológico e molecular da infecção pelo HCV em usuários de drogas ilícitas no Brasil Central. Um total de 691 UD, sendo 102 injetáveis (UDI) e 589 não injetáveis (UDNI), foi entrevistado e amostras sanguíneas coletadas em 26 centros de tratamento de uso de drogas situados em Campo Grande-MS e Goiânia-GO. As amostras sanguíneas (soros) foram testadas para a detecção de anticorpos para o HCV (anti-HCV). As amostras anti-HCV positivas foram submetidas à detecção do RNA-HCV pela reação em cadeia da polimerase (PCR) com iniciadores complementares às regiões 5 NC e NS5B do genoma viral e, genotipadas pelo LiPA e por seqüenciamento direto, seguido de análise filogenética, respectivamente. A prevalência para anti-HCV foi 6,9% (IC 95%: 5,2-9,2). A população estudada apresentou conhecimento limitado sobre as formas de transmissão parenteral (20,8-30,5%), sexual (31,7%) e vertical (20%) do HCV. A análise multivariada de fatores de risco revelou que idade > 40 anos, via (injetável) e tempo de uso de drogas e transfusão de sangue foram associados à infecção pelo HCV. O RNA viral foi detectado em 85,4% das amostras anti-HCV positivas. Trinta e três amostras foram do genótipo 1 pelo LiPA, subtipos 1a (63,4%) e 1b (17,1%), e oito (19,5%) do genótipo 3, subtipo 3a. A análise filogenética da região NS5B mostrou que 17 (68%), 5 (20%) e 3 (12%) amostras foram dos subtipos 1a, 3a e 1b, respectivamente. Este estudo mostra uma prevalência elevada da infecção e do subtipo 1a do HCV em usuários de drogas no Brasil Central, bem como o uso injetável de drogas como principal fator de risco para essa infecção. Além disso, evidenciou conhecimento limitado da população estudada sobre as formas de transmissão do HCV. Assim, medidas preventivas são necessárias para o controle dessa infecção em usuários de drogas ilícitas

Made available in DSpace on 2016-12-23T13:56:04Z (GMT). No. of bitstreams: 1 ninive_final.pdf: 1453037 bytes, checksum: c8d3a56f599241459c53b0ea48a6904e (MD5) Previous issue date: 2008-11-27 / Objectives: To determine the frequency of hepatitis B markers and risk factors associated with HBV infection in young women living in Vitória, ES where routine vaccination for newborns and adolescents started in 1993 and 2000, respectively. Methods: A population based survey performed in young women (18 to 29 years old) attending Family Health Program, samplied in three health regions of Vitória in 2006. Structured interviews were administered and blood sample collected to test for markers of HBV infection (HBsAg, anti-HBc and anti-HBs). Associations between anti-HBc and risk behavior or demographs and clinic variables associations were tested using chi-square test. Odds Ratio and confidence intervals were calculated to estimate the association between the infection and potential risk factors. Multivariate logistic regression was used to assess factors independently associated with anti-HBc. Results: Of 1,200 selected women, 1,029 were enrolled (85.75%). Median age was 23 (interquartile range 20, 26) years and 93, 2% had more than four years of schooling. Forty-three women [4.2% (CI= 95% 2.97% - 5.43%)] were anti-HBc positive, and 9 [0.9% (CI= 95% 0.4%-1.6%)] HBsAg. There were 466 [45.3% (CI=95% 42.2% - 48.4%)] anti-HBs positive tests, 427 of them were anti-HBc and HBsAg negatives. Prevalence of anti-HBs positive with anti-HBc and HBsAg negatives reflects vaccine coverage of 43.7%. Family income of up to 4-times the minimum month salary was the only variable independently and significantly associated with anti-HBc [OR =2,6 (IC95% 1,06-6,29)]. Conclusions: These data show low prevalence of exposure to hepatitis B virus and its more frequent risk factors. Only income was associated with being positive for having been exposed to HBV. Besides income, it was not detected other risk factors to virus B infection in this population, what can suggest a lack of infected women profile. It is necessary to increase the vaccination to other age groups and perform in routine HBsAg in antenatal care, as protection measures to vertical transmission of HBV. / Objetivo: Determinar a freqüência dos marcadores para hepatite B e os fatores de risco associados com a infecção pelo vírus B em mulheres jovens residentes em Vitória, ES onde a vacinação de rotina em recém-nascidos e em adolescentes foi iniciada em 1993 e 2000, respectivamente. Métodos: Estudo populacional, por amostragem, realizado em três regiões de saúde de Vitória, entre mulheres jovens (18 a 29 anos), atendidas pelo Programa de Saúde da Família em 2006. Entrevistas estruturadas, contendo perguntas fechadas, foram aplicadas e uma amostra de sangue foi coletada e analisada para os marcadores da infecção pela hepatite B (HBsAg, anti-HBc e anti-HBs). Associação entre a presença do anti-HBc total e o comportamento de risco ou variáveis demográficas e clínicas foram testadas através de testes de qui-quadrado. Odds Ratio e intervalos de confiança foram calculados para estimar o grau de associação entre a infecção e os potenciais fatores de risco. Análise multivariada de regressão logística foi utilizada para identificar variáveis independentemente associadas com a presença do anti-HBc. Resultados: De 1.200 mulheres selecionadas, 1.029 (85,8%) participaram do estudo. A mediana de idade foi 23 anos (distância interquartil 20-26 anos) e 93,2% tinham mais de quatro anos de escolaridade. Quarenta e três mulheres [4,2% (IC= 95% 2,97% - 5,43%)] apresentaram anti-HBc total positivo e nove [0,9% (IC= 95% 0,4%- 1,6%)] HBsAg positivo. Foram encontrados 466 [45,3% (IC=95% 42,2% - 48,4%)] testes anti-HBs positivos, dos quais 427 mulheres eram anti-HBc e HBsAg negativos. A prevalência do anti-HBs positivo, com anti-HBc e HBsAg negativos reflete a cobertura vacinal que foi de 43,7%. A única variável significativamente associada com anti-HBc positivo foi renda mensal de até 4 salários mínimos [OR=2,6 (IC95% 1,06-6,29)]. Conclusão: Os dados mostram baixa prevalência da exposição ao vírus B e seus fatores de risco mais conhecidos. Além da renda, não se detectou outros fatores de risco significativos para a aquisição do vírus nessa população, o que sugere não haver um perfil para a mulher infectada. Faz-se necessário ampliar a cobertura vacinal às faixas etárias mais altas, e realizar rotineiramente HBsAg no pré-natal, como medidas de proteção à transmissão vertical do VHB.

Die Arbeit gibt einen methodenkritischen Überblick über die in Deutschland vorliegenden Ergebnisse zur Prävalenz sowie Risikofaktoren von Substanzmißbrauch und -abhängigkeit (SMA). Es wird gezeigt, daß die vorliegenden epidemiologischen Studien unvollständig und methodisch unbefriedigend sind. Vor allem die fehlende Erfassung spezifischer diagnostischer Kriterien zur Ableitung klinisch relevanter Mißbrauchs- und Abhängigkeitsstörungen erschwert eine Interpretation der Ergebnisse der vorliegenden Repräsentativerhebungen. Diese geben zwar aussagekräftige populationsbezogene Informationen über die Häufigkeit und Verteilungsmuster von legalen und illegalen Substanzen, klinisch relevante Beurteilungsaspekte wie z.B. zu Schweregrad, Toleranz und Abstinenzproblemen sowie zu Einstieg und Verlauf der "Sucht"-Problematik fehlen jedoch vollständig. Dies trifft auch für Untersuchungen zu Risikofaktoren zu. Als ein durchgängiger Mangel wird ferner die Erfassungsmethodologie angesehen, die sich bislang fast ausschließlich auf Fragebögen oder Interviews stützt, über deren Reliabilität und Validität nur unzureichende psychometrische Daten vorliegen. / A critical review of prevalence and risk factor studies of substance abuse and dependence in Germany is presented. It is shown that currently available epidemiological data are incomplete due to the failure of instruments to allow for a detailed assessment of specific substance use disorders. The neglect of diagnostic criteria for clinically significant abuse and dependence disorders makes it especially difficult to draw conclusions about the results of representative surveys. Although the give clear population-related information about frequency and distribution patterns of legal and illegal substancees, relevant clinical data regarding aspects such as severity, tolerance, problems of abstinence, onset and course of abuse and dependence are completely lacking. This is also true of studies on risk factors. An additional problem is diagnostic assessment based almost exclusively on questionnaires and interviews whose reliability and validity have not been sufficiently established.