Obesity and physical inactivity are major risk factors for numerous chronic diseases, conditions, and early mortality. Healthy body weight and physical activity (PA) are also positively associated with health-related quality of life (HRQL). However, obesity and physical inactivity levels in Canadian youth and adults are high. This thesis comprises five studies exploring the burden of obesity and physical inactivity, focusing on HRQL. The first study assessed PA research productivity in Canada from 1990-2005. Canada produced approximately 5% of global PA research, 50% originating from Ontario, the biomedical and clinical areas accounting for 40% each; however, research in population health and health services was lacking. The second study used data from the Physical Activity Longitudinal Study (PALS), the 22-year follow-up of the 1981 Canada Fitness Survey, to assess PA and obesity tracking from youth to adulthood. Over 80% of overweight/obese youth became overweight/obese adults, while the majority of overweight/obese adults had not been overweight/obese youth; almost all healthy weight adults had been healthy weight youth. PA did not track over 22 years. The third study used the PALS data to examine the long-term effect of youth BMI and PA on adult HRQL (SF-36), using dichotomized outcomes based on Canadian norms. Contrary to expectations, overweight youth were more likely than healthy weight youth to score at/above the norm in adult HRQL, especially in the mental health domains. Youth PA was not associated with adult HRQL. The fourth study used the same data to explore the youth BMI-adult HRQL relationship using continuous outcomes, by sex. Youth BMI was positively associated with mental HRQL in adult females only; no negative impacts emerged. The fifth study used the Canadian Community Health Survey (CCHS) Cycle 3.1 data to investigate the combined association of PA and BMI to HRQL among Canadian adults, including self-rated health, participation/activity limitation, and total disability days, by age and sex. Inactive individuals had increased odds of adverse HRQL, regardless of weight status; underweight, overweight, and obesity were of little consequence for active individuals. Collectively, these results help to better understand the health burdens created by the current epidemics of obesity and physical inactivity in Canadians throughout their lifespans. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2010-12-08 18:00:44.214

The growing prevalence of childhood and adolescent physical inactivity and obesity are major concerns in Canada. Physical activity promoted within schools should be seen as a way to address these problems, since the majority of children receive public schooling. Research highlighting in-school physical activity helps influence school board and public health officials to create a physically active school environment. Consequently, this study has two objectives. The first is to describe the prevalence of in-school physical activity and four dependent variables in a nationwide sample of 9717 students, using data from the Health Behavior in School–aged Children survey. Dependent variables include life satisfaction, self-rated health, academic performance, and out-of-school physical activity. The second objective examines the association between in-school physical activity levels and these dependent variables, while controlling for potential confounders. Using existing data from the 2005/06 Health Behaviour in School-aged Children Survey, a partial proportional odds model form of ordinal logistic regression was fitted in order to investigate the relationship between in-school physical activity and self-rated health, life satisfaction, academic performance, and out-of-school physical activity, while controlling for potential confounders. The results showed a significant positive relationship between in-school physical activity and life satisfaction (OR range: 1.18 – 1.50), in-school physical activity and self-rated health (OR range: 1.10 – 2.86), in-school physical activity and academic performance (OR range: 1.20 – 1.40), and in-school physical activity and out-of-school physical activity (OR range: 1.09 - 6.68). Consequently, it is recommended that school environments which encourage physical activity continue to be promoted, and future studies continue to explore the benefits of in-school physical activity. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-01-21 10:42:29.807

Background  Occupation-focused and occupation-based interventions can potentially promote occupational engagement among community-dwelling older people, but there is limited evidence to identify the most effective and cost-effective interventions. For independent-living older people, there is a lack of evidence to determine if occupation-focused and occupation-based interventions have an effect on their occupational engagement. For older people who need assistance because of bathing disabilities, there is limited evidence of the effects of occupation-focused and occupation-based interventions on their occupational engagement or for reducing or omitting their need for assistance. Finally, there is limited evidence to determine if occupation-focused and occupation-based interventions implemented for community-dwelling older people are cost effective. Aim The aim of this thesis was to evaluate the effects and cost effectiveness of occupation-focused and occupation-based interventions for two groups of community-dwelling older people, independent-living, community-dwelling older people and older people with bathing disabilities. Method Studies I and II were based on an exploratory randomized controlled trial. One hundred and seventy seven persons, 77–82 years, single living, and without need for home help were randomized to a no-intervention control group or to one of three occupational therapy interventions focused on promoting occupational engagement: an individual intervention, an activity group or a discussion group. In study I, effect sizes for leisure engagement and ability to perform activities of daily living (ADL) tasks were estimated for each intervention in relation to the control group to identify the most effective intervention at 3 and 12 months after baseline. In study II, the effects on quality adjusted life years (QALYs) and the total costs for the intervention, social services provided by the municipality and health care were used evaluate cost-effectiveness. Study III was a quasi-experimental clinical trial and included 95 persons, 65+, who had applied for municipality-based home help with bathing. For participants in the intervention group, occupational therapists implemented occupation-focused and occupation-based interventions. No occupational therapy intervention was implemented for those in the control group, but they were allocated home help services if judged to need it based on an assessment by a municipality care manager. Evaluations of ADL ability, self-rated health and allocated home help were implemented at baseline and after 15 weeks. Study IV involved the use of decision-modeling based on a five state Markov model that included levels of dependency in ADLs, place of residency and death. Probabilities for transitions between states in the model, QoL scores and societal costs for each state were derived from previous research. Overall, the model was based on research indicating that more severe levels of dependency reduced QALY scores and increased societal costs. Previous trials have provided evidence that an occupation-focused and occupation-based intervention implemented to reduce bathing disabilities increased the probability of independence of home help. The Markov model was used to evaluate cost-effectiveness over 8 years for an intervention compared to no intervention. Results The results of study I indicated that each intervention had a small positive effect on minimizing a decline in leisure engagement and/or ADL, but no intervention was clearly superior. In study II, the results indicated that the interventions delivered in a group format positively affected self-rated health. The discussion group was the most cost-effective intervention. The results of study III indicated that the intervention had no effect on ADL ability or self-rated health. There was, however, a large difference in the allocation of home help at follow up, indicating that the intervention was effective in reducing dependency on home help for bathing. The results of study IV indicated that compared to no intervention, the intervention resulted in a positive accumulation of QALYs and lower costs for every year during the entire 8 year period. Conclusion This thesis provides evidence to support the implementation of occupation-focused and occupation-based interventions for independent-living, community-dwelling older people in order to reduce their decline in occupational engagement and improve their self-rated health; the interventions also have the potential to be cost effective. This thesis also provides evidence that an occupation-focused and occupation-based intervention implemented for older people with bathing disabilities was effective in promoting independence from home help for bathing. Finally, an occupation-focused and occupation-based intervention that increased the probability of being independent of home help for bathing had a positive impact on the long term accumulation of QALYs and reduced societal costs and, therefore, can be considered very cost effective.

Background and aim: As an experienced paediatric nurse I have recognised that adolescents with persistent chronic childhood diseases fall between two chairs. International studies support this recognition. Norwegian adolescents with juvenile idiopathic arthritis are no exception. Chronic arthritis from childhood might have far-reaching consequences for the growth and development of the child, and for the family and community. The fact that a considerable proportion of children with JIA continue to have active disease and disease residua through adolescence into adulthood underlines the importance of illuminating the situation in a public-health perspective. Through this study I aim at exploring physical and psychosocial health among young adults with JIA in a life-span perspective from childhood and adolescence into adult life. Methods: The thesis has a qualitative and a quantitative approach. Study I had an abductive explorative design. The experiences and perceptions of health-care transition were explored by focus-group interviews with young people with JIA and related health professionals respectively. Qualitative content analysis was utilised. Study II had an abductive explorative design with qualitative interviews to explore young adults’ experiences of living with JIA in a life-span perspective. Qualitative content analysis was utilised. Study III had a longitudinal deductive design. The standardised questionnaires of Health Assessment Questionnaire, General Health Questionnaire version 30, and Visual Analogue Scales of pain, fatigue, and illness were utilised to explore physical ability, psychosocial health, pain, fatigue, and illness in a cohort of patients with JIA 18.3 years after symptom-onset. Comparisons with baseline and first follow-up were performed. Data were analysed by descriptive statistics and non parametric tests. Study IV had a cross-sectional deductive design. In addition to the questionnaires utilised in study III, the questionnaire of SF-36 Health Survey and data on education, employment, need of assistive equipment at work, and use of health services the previous year were employed. Comparisons with Norwegian population- based data were performed. Data were analysed by descriptive statistics, and parametric and non parametric tests. Findings: In study I, ability to live a meaningful and responsible adult life seemed to be a common goal. Obstacles for the young people were the nature of the disease, a lack of focus on transition processes, and overprotective parents and health professionals. Obstacles for the health professionals were lack of inter-professional and inter-institutional formal co-operation and agreed practice, and lack of competence on adolescent development and health. Study II demonstrates that living with JIA implies a constant oscillation between struggle and adjustment to an insecure everyday life and an unpredictable life course. This was expressed as bodily experiences of limitation and freedom, interpersonal experiences of being included or set on the sidelines, and intrapersonal perceptions of insecurity and confidence. Of the 55 young adults with JIA in study III, 21 reported physical disability, and 12 reported psychiatric distress within the clinical range. Furthermore, 26 patients reported illness, 27 pain, and 33 fatigue above 10 on the VAS scale (0-100). Significant correlations were found between physical disability, pain, illness and fatigue, and between psychiatric distress, pain, and fatigue. Comparisons from first to second follow-up of the cohort showed no significant changes in physical or psychosocial functioning, pain, or fatigue. In study IV, physical ability and pain were significant predictors of the average variation of physical health while psychiatric distress and female gender were significant predictors of the average variation of mental health. Impaired physical health was associated with low rates of psychiatric distress. As compared to the general Norwegian population, impaired HRQL in the physical domain was found, but not in the mental domain, and a higher level of education, but similar employment rate. Conclusion: The four studies demonstrate complementary findings. Discrepancies between interviews and inquiries indicate that the interviews illuminate a depth and breadth of life with JIA in a life-span perspective that not is possible to unveil solely by standardised inquiries. Although persistent favourable outcomes are found physically and psychosocially from first to second follow-up, young adults with JIA reveal that life with JIA encompasses struggle and adjustment to an insecure life situation physically, psychologically, and socially. / Bakgrunn og mål: Mange års erfaring som pediatrisk sykepleier har vist meg at unge mennesker med kroniske barnesykdommer faller mellom to stoler i overgangen til voksent liv. Internasjonale studier støtter denne erfaringen, og norske ungdommer med juvenil idiopatisk artritt er ikke noe unntak. Kronisk barneleddgikt kan ha vidtrekkende konsekvenser for barnets vekst og utvikling, for familien og samfunnet for øvrig. Det faktum at mange barn fortsetter å ha aktiv sykdom og senvirkninger av sykdommen gjennom ungdomsårene og inn i voksent liv, understreker betydningen av å belyse de unges helse og livssituasjon i et folkehelseperspektiv. Gjennom denne avhandlingen ønsker jeg å undersøke fysisk, psykisk og sosial helse blant unge voksne med barneleddgikt i et livsløpsperspektiv. Metode: Avhandlingen har en kvantitativ og en kvalitativ tilnærming. Studie I hadde en abduktiv eksplorerende design. Gjennom fokusgruppeintervjuer med respektivt unge mennesker med barneleddgikt og helsepersonell innen revmatologi ble opplevelser og erfaringer med overgangen til voksenhelsetjenesten undersøkt. Kvalitativ innholdsanalyse ble benyttet. Studie II hadde også en abduktiv eksplorerende design med kvalitative intervjuer for å utforske livet med barneleddgikt blant unge voksne i et livsløpsperspektiv. Kvalitativ innholdsanalyse ble benyttet også her. Studie III hadde en longitudinell deduktiv design. Standardiserte spørreskjemaer om fysisk funksjon (Health Assessment Questionnaire), psykososial helse (General Health Questionnaire versjon 30), og sykdomsfølelse, smerte og trøtthet (Visual Analogue Scales) ble anvendt for å undersøke selvvurdert helse blant kohorten 18.3 år etter symptomdebut. Sammenligning med baselinestudien og første oppfølging ble gjort. Deskriptiv statistikk og non parametriske tester ble benyttet i dataanalysen. Studie IV var en deduktiv tverrsnittsstudie. I tillegg til spørreskjemaene som ble benyttet i studie III, ble spørreskjemaet SF-36 Health Survey benyttet for å undersøke selvvurdert helserelatert livskvalitet. Data fra telefonintervjuet om utdanning, yrkesaktivitet, behov for hjelpemidler på jobb, og behov for helsetjenester siste året ble inkludert. Sammenligninger ble gjort med norske normdata. Deskriptiv statistikk, parametriske og non parametriske tester ble benyttet i dataanalysen. Funn: Studie I viste at det å være i stand til å leve et meningsfylt og ansvarsbevisst voksenliv var et felles mål. Hindringer for de unge viste seg å være sykdommens natur, manglende fokus på overgangsprosessen, og overbeskyttende foreldre og helsepersonell. Hindringer blant helsepersonell var mangel på formelt samarbeid og omforent praksis på tvers av profesjoner og institusjoner, og mangel på kompetanse om ungdoms helse og utvikling. Studie II viste at livet med barneleddgikt innebærer en konstant veksling mellom kamp og tilpasning til et usikkert dagligliv og et uforutsigbart livsløp. Dette kom til uttrykk i erfaringer om kroppslige begrensninger eller frihet, interpersonlige opplevelser av å bli inkludert eller satt til side, og intrapersonlige opplevelser av usikkerhet eller trygghet. Blant de 55 unge voksne med barneleddgikt i studie III rapporterte 21 fysiske funksjonshemninger og 12 psykiatrisk distress. Videre rapporterte 26 pasienter sykdomsfølelse, 27 smerter, og 33 trøtthet med en skåring på 10 eller mer på VAS-skalaene (0-100). Signifikante korrelasjoner ble funnet mellom fysisk funksjonshemning, smerter, sykdomsfølelse og trøtthet, og mellom psykiatrisk distress, smerter og trøtthet. Sammenligninger fra første til andre oppfølging av kohorten viste ingen signifikante endringer i fysisk eller psykisk funksjonsevne, smerter eller trøtthet. Studie IV viste at fysisk funksjons-hemning og smerter var signifikante prediktorer for den gjennomsnittlige variasjonen i fysisk helse, mens psykiatrisk distress og kvinnelig kjønn var signifikante prediktorer for den gjennomsnittlige variasjonen i mental helse. Sviktende fysisk helse var ikke assosiert med psykiatrisk distress. Sammenlignet med norske normdata fant vi sviktende helserelatert livskvalitet i det fysiske domene, men ikke i det mentale domene, og høyere utdanningsnivå, men ingen forskjell i yrkesaktivitet. Konklusjon: Funnene fra de fire delstudiene kompletterer hverandre. Diskrepansen mellom funnene fra intervjuene og spørreskjemaene belyser en bredde og dybde i opplevelsene avlivet med barneleddgikt som det ikke er mulig å avdekke bare gjennom bruk av standardiserte spørreskjemaer. Selv om funnene viser vedvarende positive utfall av sykdommen både fysisk og psykososialt fra første til andre oppfølging, viser unge mennesker med barneleddgikt at livet innebærer kamp og tilpasning til en usikker livssituasjon fysisk, psykisk og sosialt.

Bakgrund: Minoritetsgrupper, inklusive invandrargrupper, tenderar att skatta sin hälsa sämre i jämförelse med majoriteten. Syfte: Det övergripande syftet med föreliggande avhandling var att beskriva, analysera, jämföra och fördjupa förståelsen för äldre finlandssvenskars hälsa i form av upplevd och självskattad hälsa återspeglad ur ett livsloppsperspektiv. Upplevd hälsa studerades kvalitativt bland äldre finlandssvenskar i Finland och bland äldre finlandssvenskar i Sverige och som återflyttare till Finland (delstudierna I, IV). Självskattad hälsa studerades kvantitativt bland äldre finlandssvenskar i Finland (delstudie II), samt bland äldre finlandssvenskar i Sverige jämfört med äldre finskspråkiga i Sverige (delstudie III). Migration (III, IV) och åldrandet (I, II, IV) återspeglade sig i äldres hälsa. Metod: Urvalen erhölls från Befolkningsregistet i Finland samt Statistiska Centralbyrån i Sverige. Studiegrupperna bestod av totalt n=982 personer. Data insamlades genom strukturerad muntlig och inbandad intervju, halvstrukturerad inbandad intervju, strukturerat intervjuformulär samt postad enkät. Data analyserades genom hermeneutisk ansats med kärnberättelser, tematisk kvalitativ innehållsanalys, kumulativ multipel regressionsanalys samt Chi2-test. Resultat: Äldres upplevda hälsa tog sig uttryck genom personligheten, fysisk hälsa, sociala relationer och samhället. Över hälften skattade sin hälsa som god. Hälsa skattades som bättre ju mindre mediciner man behövde, ingen värk/smärta, bättre funktionsförmåga, bättre livslust och bättre ekonomi. Äldre finlandssvenskar i Sverige skattade sin hälsa som bättre jämfört med finskspråkiga i Sverige. Migration hade medfört svårigheter i samband med flyttningen till Sverige och arbetslivet i Sverige. Återflyttningen kunde försvåras av ohälsa och åldrandet. Åldrandet medförde en anpassning till att sätta egen hälsa och nuläge i perspektiv. Resultaten visade att äldre kan bidra med kunskaper om friskfaktorer. Konklusion: Ur ett folkhälsovetenskapligt hälsofrämjande perspektiv är det av relevans att lyfta fram minoritetsgrupper ur ett resursperspektiv. Det är centralt att beakta att det kan förekomma skillnader i hälsa mellan minoriteter, inom minoriteter och inom etniska minoriteter. Sociala och kulturella skillnader kan inverka på hur äldre skattar sin hälsa. Äldre i minoritet kan vara mera sårbara på grund av ohälsa, migration och kön / Background: Minority groups, including immigrants, generally tend to report lower self-rated health than the majority. Aims: The overall object of the dissertation was to describe, analyze and compare the self-rated health of older Finland-Swedes, and deepen the understanding of their experience of health in a life-course perspective. The experience of health was qualitatively studied among older Finland-Swedes in Finland, Finland-Swedes in Sweden and after re-migration in Finland (parts I, IV). Self-rated health was quantitatively studied among older Finland-Swedes in Finland (part II), and among older Finland-Swedes in Sweden compared to older Finnish-speakers in Sweden (part III). Migration (parts III, IV) and ageing (parts I, II, IV) were reflected in the health of older persons. Methods: The sample was obtained from the Population Register Centre of Finland and Statistics Sweden. The target groups consisted of 982 persons. The data was collected in structured oral and taped interviews, semi-structured taped interviews, structured interview forms, and postal enquiries. The data were analyzed through a hermeneutic approach with core narratives, thematic qualitative content analysis, cumulative multiple regression analysis, and chi-square test. Results: The experiential health of older persons manifested itself in personality, physical health, social relations, and society. More than a half of the respondents rated their health as good. Better health was reported with less medicine, no pain/suffering, better functional capacity, more zest for life, and better financial position. Older Finland-Swedes in Sweden reported better health than the Finnish-speaking respondents in Sweden. Migration had caused difficulties in connection with the move to Sweden and with working life in Sweden. Ill-health and ageing could cause problems with remigration. Ageing involved an adjustment in setting own health and the present in perspective. The results showed that older persons could contribute knowledge about health factors. Conclusions: From the perspective of public health science and health promotion, it is relevant to present minority groups from the vantage point of resources. It is essential to realize that there can be health differences between minorities, within minorities, and among ethnic minorities. Social and cultural variations can affect the way older persons evaluate their health. Older persons in minorities can be more vulnerable owing to ill-health, migration and gender.

Aim of the study: To get better insights into the profile of body composition, the prevalence of overweight and obesity in school children aged 11, 13 and 15 years old and to analyze relationship of overweight and obesity with some behavioral and social health factors in Lithuania. Objectives: To establish the prevalence of overweight and obesity in school-age children (11, 13 and 15 years old) in Lithuania. To describe the distribution of obesity and overweight by age, gender, nationality, family affluence, living place and household groups of school age children. To establish the statistical relationship of obesity and overweight with nutritional habits and physical activity and to analyze the relation of overweight and obesity with self-rated health and self body image. Methods: In this master’s research work the selected primary source of existing research raw data from the HBSC questionnaire survey 2009/10 was used. The author of the master’s thesis has provided his own contribution by selecting the research topic, formulating the research questions, identifying the questionnaire items relevant to the topic and also conducting statistical analysis, interpretation of data. The analysis of the data (3338 questionnaires of 11, 13 and 15 year old school children were analyzed) was calculated in percentages, averages. IBM SPSS Statistics 20.0 and MS Excel 2007 were applied for calculations and visual presentation of the results. The significance level when p<0.05 was... [to full text] / Tyrimo tikslas: Ištirti 11, 13 ir 15 metų amžiaus Lietuvos moksleivių kūno sudėjimą, antsvorio ir nutukimo paplitimą bei išanalizuoti jų sąsajas su kai kuriais elgsenos ir socialiniai sveikatos veiksniais. Uždaviniai: Nustatyti antsvorio ir nutukimo paplitimą tarp mokyklinio amžiaus (11, 13 ir 15 metų) vaikų Lietuvoje. Aprašyti mokinių antsvorio ir nutukimo pasiskirstymą pagal amžių, lytį, tautybę, šeimos pragyvenimo lygį, gyvenamąją vietą, šeimyninę sudėtį. Nustatyti antsvorio ir nutukimo statistines sąsajas su mitybos ypatumais ir fiziniu aktyvumu bei išanalizuoti sąryšį su savo sveikatos vertinimu bei savo kūno įvaizdžio suvokimu. Metodai: Duomenys šiam magistriniam tiriamajam darbui buvo paimti iš 2009/10 metų HBSC anketinio tyrimo. Magistro tezių autorius pats pasirinko tyrimo temą, suformulavo tyrimo klausimus, atrinko su tema susijusius anketos klausimus, atliko statistinę duomenų analizę ir interpretaciją. Išanalizuotos 3338 11, 13 ir 15 metų amžiaus moksleivių anketos, rezultatai pateikti procentais, vidurkiai. Statistiniams skaičiavimams naudotas IBM SPSS Statistics 20.0 paketas, grafinis rezultatų pateikimas atliktas MS Excel 2007 pagalba. Reikšmingumo lygmuo, kai p<0,05, buvo laikomas kaip statistiškai reikšmingas. Rezultatai: 10,8% 11, 13 ir 15 metų amžiaus Lietuvos moksleivių turėjo antsvorį, 1,6% iš jų nustatytas nutukimas. Be to, procentai mažėja didėjant amžiui. Statistiškai reikšmingai (p<0,05) antsvorio ir nutukimo paplitimas buvo didesnis tarp berniukų (16... [toliau žr. visą tekstą]

The primary purpose of this project was to investigate some relationships between workload and employee wellbeing. The necessary first stage was to formulate a theoretical framework � the JobLoad Model � to support a comprehensive and detailed investigation of the main factors that contribute to a job's workload. Building on the ergonomics concept of �workload�, this Model incorporates task- and job-level factors that have been identified within the research literatures of physical and cognitive ergonomics as important; additional constructs were added to take account of additional factors shown to be relevant to employee wellbeing, drawing on evidence from occupational health and organizational psychology literatures. Using this framework, available questionnaire-based measurement instruments for assessing workload and employee wellbeing were reviewed, new items were developed as required, and the JobLoad Index (JLI) was developed. The JLI was used to collect data from public servants in two different workplaces, with participation rates of 63% and 73% respectively. Relationships were determined between major task, job and organisational environment factors, self-perceived performance adequacy, and various aspects of employee wellbeing including job satisfaction, physical discomfort and psychological fatigue, stress and arousal. For a sub-sample of participants in one of the two workplaces, levels of adrenaline, noradrenaline and cortisol were also measured from 24-hour urine collections. The factors measured by the JLI accounted for a very substantial proportion of variance in these various dimensions of work-related wellbeing. The results provide potentially very useful insights into the relative influences of a wide range of work- and job-related variables on people's perceived abilities to cope with their job demands, and on several aspects of their wellbeing. Further, the importance of measuring multiple dimensions of wellbeing, and differentiating their separate sets of work-related determinants, was well demonstrated. Finally, and perhaps most significantly, this study has identified the powerful role that self-perceived performance plays as an intervening variable between job demands and people's work-related wellbeing.

Introdução. Capital social é definido como as características das associações e cooperações humanas que podem ter efeito na saúde. Estudos realizados na última década apontam para uma associação positiva entre maior capital social e melhores indicadores de saúde. Entretanto, algumas características da vizinhança de residência podem atuar como mediadores dessa associação, um tema ainda pouco analisado na literatura científica. Estudos nessa área podem ajudar a melhor entender o efeito do capital social em uma sociedade com altos índices de desigualdade e violência, como é o caso da brasileira. Objetivo. Analisar se as características da vizinhança atuam como mediadores da associação entre o capital social e a autopercepção de saúde. Metodologia. Foram usados os dados da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). O ELSA-Brasil é uma coorte multicêntrica, composta por 15.105 funcionários públicos, ativos e aposentados, de ambos os sexos e com idades entre 35-74 anos vinculados a seis diferentes instituições de ensino e pesquisa brasileiras. As variáveis independentes de interesse foram os domínios de apoio social e de prestígio e educação e de coesão social de vizinhança individual, todos analisados no nível individual. Para a análise dos efeitos da vizinhança foram considerados apenas os indivíduos residentes no mesmo endereço há pelo menos cinco anos. As características de vizinhança estudadas foram: ambiente para atividade física, disponibilidade de alimentos saudáveis, segurança, violência percebida e vitimização. Modelos regressão logísticos foram sequencialmente ajustados para cada uma das características de vizinhança de interesse. Resultados. Os modelos apontam para uma associação consistente entre indicadores mais elevados de apoio e coesão social de vizinhança e melhor autopercepção de saúde, mesmo após o ajuste pelas características do local de residência. Por outro lado, a dimensão referente a prestigio e educação não apresentou uma associação significativa com a situação de saúde em nenhum dos modelos. O apoio social apresentou, na maioria dos modelos, um odds ratio (OR) de 0,81 (95 por cento , IC: 0,69-0,95) em indivíduos com apoio social moderado e OR de 0,62 (95 por cento , IC: 0,52-0,74) em indivíduos com apoio social elevado, mesmo após o controle pelas características da vizinhança. A coesão social da vizinhança também não apresentou modificação em seus efeitos e manteve para a maioria dos modelos um OR de 0,76 (95 por cento , IC: 0,67 0,85) para os indivíduos com coesão social moderada e OR de 0,82 (95 por cento , IC: 0,72 0,93) para os indivíduos com coesão social elevada. Apesar de todas as características de vizinhança terem apresentado associação significativa com a autopercepção de saúde, nenhuma causou modificação significante na associação entre os domínios de capital social e autopercepção de saúde. Conclusão. As características de vizinhança não alteraram significativamente a associação entre capital social e autopercepção de saúde, o que aponta para um efeito do capital social na saúde independentemente das características do local de residência. Entretanto, novos estudos são necessários para que os detalhes dos mecanismos envolvidos, principalmente em relação à possibilidade de causalidade reversa e ao tempo de exposição à vizinhança, sejam plenamente elucidados / Introduction. Social capital can be defined as the characteristics of human associations and cooperation that may have an effect on people\'s health. Studies conducted in the last decade point to a positive association between higher social capital and better health indicators. However, some characteristics of the neighborhood in which people live can act as mediators of this association, an area not yet analyzed in the scientific literature. Studies that analyze this association can help to improve the understanding of the effect of social capital in a society with high levels of inequality and violence, as is the Brazilian society. Objective. The aim of this thesis is to analyze whether neighborhood characteristics act as mediators of the association between social capital and self-perception of health. Methodology. Baseline data (2008-2010) from the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) was analyzed. ELSA-Brasil is a multi-center cohort of 15,105 active and retired civil servants of both sexes aged between 35-74 years linked to six different Brazilian teaching and research institutions. The multiple variables were the domains of social support, prestige and education and social cohesion of individual neighborhood, all analyzed at the individual level. For the analysis of neighborhood effects, only individuals residing at the same postal address for at least five years were included. The neighborhood characteristics studied were: physical activity environment, availability of healthy foods, safety, perceived violence and victimization. Logistic regression models were sequentially adjusted for each of the neighborhood characteristics of interest. Results. The models point to a consistent association between both higher support indicators and social neighborhood cohesion with better health status, even after adjusting for neighborhood characteristics. On the other hand, the dimension of prestige and education did not present a significant association with health situation in any of the models. Social support presented an odds ratio (OR) of 0.81 (95 per cent , CI: 0.69-0.95) for individuals with moderate social support and an OR of 0.62 (95 per cent CI, CI: 0.52-0.74) for individuals with high social support, even after controlling for neighborhood characteristics. Neighborhood social cohesion also did not presented modifications in its effects and remained stable in most OR models: 0.76 (95 per cent CI 0.67-0.85) for individuals with moderate social cohesion and 0,82 (95 per cent , CI: 0.72-0.93) for individuals with high social cohesion. Although all neighborhood characteristics presented a significant association with self-perception of health, none caused a change in the association between social capital domains and self- perception of health. Conclusions. The results indicate that neighborhood characteristics did not significantly alter the association between social capital and self-perception of health, which points to an effect of social capital on health regardless of neighborhood characteristics. However, new studies are needed in order to fully elucidate the details of the mechanisms involved, especially in relation to reverse causation and exposure time within a neighborhood

Globally, psychological health problems are currently among the most serious public health challenges. Adolescent girls suffer from internalizing problems, such as somatic symptoms and mental health problems, at higher rates than in decades. By age 15, over 50 % of all girls experience multiple health complaints more than once a week and one in five girls reports fair or poor health. The overall aim of this study was to investigate the effects of and experiences with an after-school dance intervention for adolescent girls with internalizing problems. The intervention comprised dance that focused on resources twice weekly for 8 months. Specifically, this thesis aimed to: I) investigate the effects on self-rated health (SRH), adherence and over-all experience; II) evaluate the effects on somatic symptoms, emotional distress and use of medication; III) explore the experiences of those participating in the intervention; and IV) assess the cost-effectiveness. A total of 112 girls aged 13 to 18 years were included in a randomized controlled trial. The dance intervention group comprised 59 girls, and the control group 53. In paper I, the dance group showed increased SRH scores compared to the control group (p = .02). Girls in the intervention group showed high adherence and a positive overall experience. In paper II, the dance group exhibited a decrease in somatic symptoms (p = .021), emotional distress (p = .023) and use of medication (p = .020) compared to the control group. In paper III, a strategic sample of 24 girls was interviewed. Qualitative content analysis was performed, and five generic categories emerged. Two were “An Oasis from Stress” and “Supportive Togetherness”, which was shown to represent the fundamental basis and setting of the intervention. The main category, participants’ central experience, was understood as “Finding embodied self-trust that opens new doors”. Paper IV revealed that, due to decreased number of visits to the school nurse and an increase in health related quality of life; the intervention was considered to be cost-effective (combined with the usual school health services). In summary, the results of this thesis show that this dance intervention for adolescent girls with internalizing problems generated positive health effects and proved to be cost-effective. For this target group, a non-judgmental environment and supportive togetherness proved to be of importance for participation. The results of this study may provide practical information for school health care staff and caregivers in designing future interventions.

Abstract Becoming involved in war is an experience that has the potential to shape later-life health. The aim of the present study was to explore Finnish Second World War veterans’ health status and the determinants of self-rated health (SRH) and functional capacity, especially the ability to walk, and to identify risk factors and their combinations that predict late-life mortality among veterans. The study population comprised Finnish Second World War veterans who participated in the Veteran 1992 and Veteran 2004 Project surveys. In 1992, a postal questionnaire was sent to all 242,720 war veterans living in Finland. The follow-up survey, the Veteran 2004 Project, was conducted with a randomized sample of veterans who participated in the Veteran 1992 Project. The total number of participants in the baseline survey was 177,989 men and 48,745 women, and in the follow-up survey, 4,348 men and 651 women. The response rate was high in both surveys: 93% in 1992 and 87% in 2004. All analyses were conducted separately for men without disability, men with disability and women. In a cross-sectional study, SRH and functional capacity was found to be better among 80–84-year-old Finnish war veterans in 2004 compared with 1992, although the prevalence of many diseases increased during the follow-up. Among the 4,999 veterans who participated in both surveys, the majority rated their health as improved or unchanged during the follow-up. Walking difficulties and cardiovascular (CVD), musculoskeletal and neurological diseases were found to be predictors of declined SRH. When exploring functional capacity among veterans, neurological and musculoskeletal diseases, but especially walking difficulties, predicted veterans’ future functional impairment as many as 12 years in advance, and worsening of these conditions was associated with impaired activities of daily living. During an average 9.9-year follow-up, walking difficulties alone or together with multimorbidity and/or with a third risk factor was the most important risk factor for total and for CVD mortality among all veteran groups. In conclusion, the majority of veterans rated their SRH as improved or unchanged during the follow-up. The importance of walking difficulties as a determinant of SRH and functional capacity and as a predictor of mortality was confirmed. / Tiivistelmä Tutkimuksen tarkoituksena oli arvioida suomalaisten toisen maailmansodan veteraanien terveydentilaa ja tutkia, mitkä tekijät vaikuttavat veteraanien itsearvioituun terveyteen ja toimintakykyyn (erityisesti kävelykykyyn) sekä tunnistaa ne riskitekijät ja tekijäyhdistelmät, jotka ennustavat kuolleisuutta. Tutkimuspopulaationa käytettiin Veteraaniprojekti 1992 ja Veteraaniprojekti 2004 -tutkimuksiin osallistuneita veteraaneja. Vuonna 1992 kysely lähetettiin postitse jokaiselle Suomessa tuolloin asuneelle 242 720 veteraanille. Seurantatutkimukseen valittiin 5 750 veteraanin satunnaisotos vuoden 1992 tutkimukseen osallistuneista. Veteraaniprojekti 1992 -tutkimukseen osallistui 177 989 miestä ja 48 745 naista ja seurantatutkimukseen 4 348 miestä ja 651 naista. Osallistumisprosentti oli 93 % (1992) ja 87 % (2004). Analyysit tehtiin erikseen veteraanimiehille joilla ei ollut invaliditeettia, invalidimiehille ja naisille. Poikkileikkaustutkimuksessa tarkasteltiin 80–84-vuotiaiden veteraanien terveyttä ja toimintakykyä vuosina 1992 ja 2004. Vuonna 2004 veteraanit arvioivat terveytensä ja toimintakykynsä paremmiksi kuin samanikäiset veteraanit vuonna 1992, vaikka monet sairaudet yleistyivät seuranta-aikana. Suurin osa molempiin kyselyihin vastanneista 4 999 veteraanista arvioi terveytensä joko parantuneen tai pysyneen ennallaan seuranta-aikana. Veteraanien kokemat kävelyvaikeudet, sydän- ja verisuonisairaudet, tuki-ja liikuntaelinsairaudet sekä neurologiset sairaudet ennustivat itsearvioidun terveyden heikkenemistä. Sydän- ja verisuonisairauksia lukuun ottamatta edellä mainitut tekijät ennustivat myös toimintakyvyn laskua jopa 12 vuotta etukäteen. Myös kävelykyvyn heikkeneminen ja sairauksien paheneminen seuranta-aikana ennustivat toimintakyvyn laskua. Kävelyvaikeudet joko yksin tai yhdessä multimorbiditeetin ja/tai jonkin kolmannen riskitekijän kanssa oli tärkein sekä kokonaiskuolleisuutta että sydän- ja verisuonitautikuolleisuutta ennustava tekijä kaikissa veteraaniryhmissä keskimäärin 9,9 vuoden seuranta-aikana. Yhteenvetona voidaan todeta, että enemmistö tutkimukseen osallistuneista veteraaneista arvioi terveytensä joko parantuneen tai pysyneen ennallaan seuranta-aikana. Koetut kävelyvaikeudet ovat erittäin tärkeä itsearvioitua terveyttä, toimintakykyä ja kuolleisuutta ennustava tekijä.