Neighborhoods are composed of physical, social, and cultural environmental factors that influence health and health behaviors. These factors include chronic stressors that are associated with premature mortality. Determining the role of neighborhoods on health is challenging due to individual exposure to multiple types of stressors, and discerning effects of individual stressors from co-occurring neighborhood stressors. This dissertation investigates the role of neighborhood and individual stressors on physical activity, self-rated health, and depressive symptoms in the environmental justice community of Chelsea, Massachusetts. We interview 354 Chelsea residents aged 18 years and older using open- and closed-ended questions that address health-related topics and perceptions of the environment. We use GIS-based methods to map resident-defined neighborhoods and their relation to attributes of the physical environment, and regression models to quantify relationships between neighborhood factors and individual stressors with health outcomes. We also incorporate responses to open-ended interview questions to develop physical activity outcomes. We report positive associations between exposure to neighborhood factors and adverse outcomes. Noise, feeling unsafe, and low social cohesion display positive correlations with poor self-rated health and depressive symptoms. Proximity to resident-preferred parks is positively correlated with physical activity, while knowledge of rape or sexual assault is inversely associated with physical activity. Individual stressors, such as health conditions and disability, are positively associated with all adverse outcomes. Including neighborhood factors and individual stressors in the same model does not change any associations. We conclude that neighborhood factors are independent sources of chronic stress that influence health and health behaviors. In the literature, the outcomes we study are associated with premature mortality. This fact, coupled with the associations we see between our outcomes and neighborhood factors, suggest that aspects of neighborhoods can increase risk for premature mortality. Health could also be improved on an individual level by providing resources to buffer against the negative effects of disability and reported financial problems, such as a sudden loss of income or food insecurity. Environmental policies related to neighborhood conditions should consider the effects of neighborhoods factors on health as a systematic method of improving health.

No description available.

Food insecurity is prevalent in the United States. Although older adults experience food insecurity at lower-than-average rates, this population is vulnerable to the nutrition and health related implications. Food insecurity is tied to both a diminishment of diet quantity and quality, and is associated with incidence of chronic disease, loss of functional status, and quality of life. This survey seeks to fill a gap in research by looking into the prevalence of food insecurity among older adults in Northeast Tennessee, associations between food insecurity and self-rated health, and associations between food insecurity and geographical limitations.

Modelling studies have shown that 1.5 and 3.0 MW wind turbines with blade sweep have an increased annual energy production (AEP) of approximately 5% when compared to straight-blade wind turbines. The objective of the research was to further increase below-rated, variable speed, power capture when using swept-blades. When operating in the variable speed region, the turbine’s torque is proportional to the square of the generator speed, and k is the proportionality constant (T = kΩ 2 ). Initial studies indicated that the value of k needed to be lowered from the original value to increase AEP. This proved to be slightly beneficial for the 3.0 MW turbine but not for the 1.5 MW turbine. The optimal tip speed ratio was too high for both turbines and limited the ability to increase AEP. Original swept-blade chords were designed to fit a linear pattern for manufacturing purposes, but it is believed this is no longer a necessary constraint. The blades were redesigned to have a non-linear chord distribution, which is based on the Betz optimal design method, and the resultant increase in solidity proved to be the solution for slowing down the blades’ rotational speed. The change in chord design proved to be beneficial for both 1.5 and 3.0 MW wind turbines and had immediate, measurable increases to AEP. An effort to further increase AEP was then conducted by using an alternative torque-speed controller, which used a different equation to relate speed and torque. This method only resulted in an increase of AEP for the 1.5 MW turbine. In conclusion, the highest recorded AEP increases from straight-blade values were 6.9% and 8.9% for the 1.5 and 3.0 MW turbines, respectively. The 1.5 MW turbine benefited from the custom controller and redesigned chords, whereas the 3.0 MW turbine only benefited from redesigned chords.

The frequently studied concept of social capital has often been related to health, but theconceptualisationand measurement of the conceptisanon-goingdebate. The main aim of this thesis is to study the relationship of four different indicators of social capital; informal social capital, formal social capital, trust towards institutions and trust towards others, with self-rated physical health and self-rated mental health in Iceland in 2009, shortly after a harsh economic crash. Insomnia symptoms will be studied as a possible mediator or moderator in the relationship. Furthermore, longitudinal data on informal social capital will be used to see the causal effect of social capital on health and to see if informal social capital decreased after the economic collapse. Population-based panel data from Iceland in 2007 and 2009 will be used to perform both cross-sectional analysis (n = 3,243) and longitudinal analysis (n = 3,131). The main results are that the four indicators of social capital all relate differently to physical and mental self-rated health, and insomnia symptoms seem to mediate the relationship between social capital and health, especially physical health. Surprisingly, informal social capital did increase during the economic collapse. The panel analysis further suggests that having poor informal social capital has causal effects on poor self-rated mental health when adjusted for symptoms of insomnia, age, gender, family status, education and smoking.

Orientador: Anita Liberalesso Neri / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T19:36:47Z (GMT). No. of bitstreams: 1 White_HarrietJane_M.pdf: 1085400 bytes, checksum: e369eff02a7b34fb4c09790e4f1664ff (MD5) Previous issue date: 2010 / Resumo: Objetivos: investigar relações entre estado nutricional indicado pelo IMC, perda de peso não-intencional, condições funcionais para a alimentação e autoavaliações de saúde bucal e de saúde global em mulheres e homens idosos recrutados na comunidade. Métodos: participaram 689 idosos (470 mulheres; 65 a 90 anos, M = 72,28 + 5,40; renda familiar mensal de < 1 > 10 salários mínimos, M = 4,72 + 5,27), selecionados da amostra probabilística do Estudo FIBRA Campinas. Foram feitas medidas de peso, altura e IMC e aplicadas questões de autorrelato para medida das demais variáveis. Resultados: Vinte e oito por cento pontuaram para obesidade, 14,39% para pré-obesidade e 14,83% para baixo peso; 24,86% tinham perdido peso no ano anterior; 30% da amostra tinham problemas de mastigação; 20% tinham pelo menos 3 problemas funcionais para alimentação; 72,41% pontuaram alto em autoavaliação da saúde bucal, 58,86% em autoavaliação da saúde global. Mais mulheres e mais idosos de 65 a 74 anos pontuaram para obesidade; mais idosos de baixa renda perderam peso e tinham problemas funcionais para a alimentação. Piores condições funcionais para a alimentação e renda inferior a 5 SM mostraram-se fortemente associados com autoavaliações negativas de saúde bucal e de saúde global, sendo esta mais afetada do que a primeira. Conclusão: Autoavaliações negativas de saúde tendem a associar-se com autocuidado deficitário, que pode agravar os problemas de mastigação, deglutição e paladar e as comorbidades provavelmente associadas. A pobreza potencializa esses prejuízos, por relacionar-se com problemas de acesso e de qualidade dos serviços de saúde. / Abstract: Objectives: to investigate the relation between nutritional status indicated by BMI, unintentional weight loss, functional conditions of feeding and self-rated oral health and global health in elderly women and men recruited in the community. Methods: 689 elderly participated (470 women; 65 -90 years old, M = 72,28 + 5,40; familiar monthly income from < 1 > 10 minimum wages, M = 4,72 + 5,27), selected from a random sample of Study FIBRA-Campinas about frailty. It was taken weight measurements, height and BMC and applied questions of self report to measure the rest of the variables. Results: Twenty-eight percent scored for obesity, 14,39% for pre-obesity and 14,83% for low weight; 24,86% had lost weight last year; chewing problems were the most frequent (30% of the samples); 20% had at least 3 functional problems for feeding; 72,41% showed high score of self-rated oral health, 58,86% in global health. More women and elderly from 65 to 74 years old scored obesity; more elderly with low incomes lost weight and had functional problems for feeding. The worst functional conditions for feeding and incomes below 5 minimum salaries were strongly associated with negative self-rated oral health and global health, and the last one being more affected than the first one. Conclusion: Negative self-assessments of health tends to associate to low self-care, that can aggravate chewing problems, taste and swallowing, and the probably comorbidities associated. The poverty powers the damage, because it has relations with access problems and health quality services. / Mestrado / Mestre em Gerontologia

Hälsoutveckling i Sverige går framåt, men den självskattade hälsan är låg. Självskattning är ett mått som baseras på individens egen uppfattning av sin hälsa. Hälsa är en subjektiv uppskattning där varje individ har sin syn på upplevelse av hälsa. Autonomi, social gemenskap och begriplighet är olika dimensioner av hälsobegreppet som baseras på patienters upplevelse av hälsa. Många mätinstrument inom sjukvården idag har för avsikt att mäta hälsa genom frånvaro av symtom. Syftet med denna studie var att undersöka hur patienter på en allmänpsykiatrisk öppenvårdsmottagning självskattar sin hälsa utifrån dimensionerna autonomi, social gemenskap och begriplighet. Metoden som användes var en tvärsnittsstudie med kvantitativ ansats. En enkätundersökning utfördes under tre veckor. Resultatet baseras på 49 stycken enkäter. Resultatet visar att autonomidimensionen skattades lägst medelvärde samt att deltagarna skattade högst medelvärde på påståendet ”kan bry mig om andra”. Slutsatsen i denna studie visar att det låga värdet inom dimensionen autonomi kan bero på sjuksköterskornas arbetsklimat och medicinska synsätt. Implikationer i vården som fynden kan medföra kan vara en ökad medvetenhet kring självskattad hälsa både hos patienter och hos sjuksköterskor. / Health development in Sweden is advancing, but the self-rated health is low. Self-assessment is a measure based on the individual's own perception of their health. Health is a subjective estimate where each individual has his views on the experience of health. Autonomy, social community and understandability are different dimensions of the concept of health based on the patients' experience of health. Many measuring devices in healthcare today intends to measure  health by the absence of symptoms. The purpose of this study was to ask how patients in a general psychiatric outpatient clinic self-rate their health on the basis of the dimensions of autonomy, social community and comprehensibility. The method used was a cross-sectional study with quantitative approach. A survey was conducted over three weeks. The result is based on 49 questionnaires. The result shows that the autonomy dimension were estimated lowest average and that the participants estimated highest average on the claim "can care about others." The conclusion of this study is that one reason to low value in the dimension autonomy may depend on the nurses' working environment and medical approaches. Implications of care is that the findings may lead to an increased awareness of self-rated health among both patients and nurses.

The number of persons who are not employed has increased in Sweden since the early 1990s. Unemployment has been found to influence health, especially when unemployment rates are low. The extent to which unemployment affects health when unemployment is high is less clear, and this needs to be further studied. To improve health in the population, the health care system should offer equal access to health care according to need. It is important to study whether the employment status hinders the fulfilment of this goal. This thesis is based on four papers: Paper I and II aimed at analysing self-rated health versus mortality risk in relation to employment status, during one period of low unemployment and one period of high unemployment. Paper III and IV assessed the use of medical health care services and unmet care needs among persons who were unemployed or otherwise not employed. The goal was to analyse what health problems lead people to either seek or abstain from seeking care, and what factors encumber or facilitate this process. The overall results indicate that being unemployed or outside the labour force was associated with an excess risk of poor self-rated health, symptoms of depression, mental and physical exhaustion and mortality. The differences in self-rated health between the unemployed and employed were larger when unemployment levels were high, than when they were low. More groups of the unemployed were also afflicted with poor health when unemployment was high. Thus, poor health among the unemployed seems to be a public health problem during high levels of unemployment. Lack of employment was related to abstaining from seeking care, despite perceiving a need for care, and this was related to psychological symptoms. To deal with the needs of the unemployed and others who are outside the labour force it would be useful to develop and implement interventions within the health care system. These should focus on psychological and psychosocial problems. Future research should analyse how to facilitate health-promoting interventions among persons who are not anchored in the labour market.

<p>Psykometriska egenskaper presenteras från en nyöversatt självskattningsskala för funktionsnedsättning vid social fobi. Liebowitz Self-Rated Disability Scale (LSRDS) avser att undersöka hur ångestproblem kopplade till olika funktionsområden hindrat normal funktion dels de senaste två veckorna och dels när det varit som värst i livet. LSRDS har acceptabel test-retest reliabilitet och god intern konsistens. Den diskriminativa valideten i LSRDS är god i jämförelse mellan normalgrupp och klinisk grupp. I samband med en kognitiv beteendeterapeutisk behandling av åtta individer med social fobi har skalan provats och förefaller fånga förändringar i funktionsförmåga. Skalan föreslås preliminärt som komplement till andra skattningsformulär vid utvärdering av behandling vid social fobi.</p>

O envelhecimento populacional e as alterações socioestruturais recentes no contexto brasileiro tem aumentado a probabilidade de que os cuidados prestados a idosos doentes ou dependentes sejam assumidos por indivíduos também idosos. As particularidades da sobrecarga experimentada por idosos são pouco descritas pela literatura de pesquisa gerontológica, carecendo, ainda, de modelos explicativos. O presente estudo buscou testar um modelo teórico-empírico de associações explicativas de sobrecarga subjetiva de idosos cuidadores considerando sexo, idade, intensidade da ajuda prestada, comprometimento cognitivo do idoso receptor do cuidado e autoavaliação de saúde. Trata-se de um estudo de corte transversal desenvolvido a partir dos dados de um estudo maior do Programa de Pós-Graduação em Gerontologia da Faculdade de Ciências Médicas da Unicamp Bem-estar psicológico de idosos que cuidam de outros idosos no contexto da família que envolveu idosos com 60 anos ou mais, que prestam cuidados a familiares também idosos dependentes no contexto domiciliar. Foram selecionadas variáveis de caracterização sociodemográficas e econômica da amostra, da intensidade da ajuda prestada em atividades básicas e instrumentais de vida diária, do comprometimento cognitivo do idoso cuidado por meio da aplicação do Clinical Dementia Rating Scale Sum of boxes, de autoavaliação geral da saúde e da Escala de Sobrecarga de Zarit. O modelo explicativo proposto foi testado por meio da análise de equações estruturais via Path analysis com auxílio do programa estatístico SAS System for Windows (Statistical Analysis System), versão 9.2. A amostra foi composta por 138 idosos, em sua maioria mulheres (76%), cônjuges (64%), prestando cuidado, em média, há 4,4 anos (±4,1) e auxiliando em sete tarefas (±3,6). Resultados da Path analysis revelaram caminhos associativos entre o sexo e a sobrecarga mediados pelo comprometimento cognitivo do idoso receptor de cuidados e autoavaliação de saúde do cuidador. Houve associações entre sexo e intensidade da ajuda prestada mediadas pelo comprometimento cognitivo do idoso receptor de cuidados. O modelo resultante sugere que a sobrecarga de idosos cuidadores não é produto direto da intensidade da ajuda e do comprometimento cognitivo e que a autopercepção de saúde pode influenciar seus efeitos. Reproduz as concepções presentes em modelos psicológicos de adaptação ao estresse ressaltando a centralidade da saúde como recurso importante para o cuidador idoso / The ageing population and recent socio-structural changes in Brazil have increased the likelihood that the care to the elderly will be provided by another elderly individual. The burden specificities experienced by older caregivers are little described in the gerontological literature, therefore lacking explanatory models. The present study aims to test a theoretical-empirical model of explanatory associations of subjective burden of older caregivers considering variables as sex, age, aid intensity provided, cognitive impairments of the recipient of care and self-rate health. This is a cross-sectional study based on data from a larger study entitled \"Psychological well-being of the elderly who care for other elderly in the family context\", consisting of individuals aged 60 and over who provide care to family members at the home. Sociodemographic and economic variables of the sample, the intensity of the assistance given in basic and instrumental activities of daily living, were selected from the cognitive impaired of the elderly care through the application of the Clinical Dementia Rating Scale - Sum of boxes, of general health self-assessment and the Zarit Burden Scale. The proposed explanatory model was tested through the analysis of structural equations via Path analysis. The sample consisted of 138 elderly people, mostly women (76%), spouses (64%), with average time of care 4.4 years (± 4.1) and seven tasks (± 3.6). Results from Path analysis shows associative paths between sex and overload mediated by cognitive impairments of elderly care recipient and self-rated health. There were associations between sex and intensity of aid provided mediated by the cognitive impairment of the elderly care recipient. Although it explains little of the variability, the model suggests that the caregiver burden is not a direct product of the cognitive impairment of the recipient of care and that self-rated health can influence its effects. It replicates conceptions presented in different psychological models of adaptation to stress emphasizing the centrality of health as an important resource for older caregivers