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No. of bitstreams: 2 Dissertação - Patrícia Pereira de Vasconcelos - 2012.pdf: 1578862 bytes, checksum: 94377135b580d72c62777755a8cc3ef2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-05-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Chronic pain is an unpleasant experience that reaches much of the world's population; however, population studies with the elderly are rare. The aim of this study was to assess chronic pain and self-rated health among community elders. Study population-based cross-sectional, in Goiania, Goias, December/2009 between April 2010 and. For this cut, we excluded those who reached  13 on the MEEM scores, and needed help for the answers. The random sample consisted of 872 participants. Chronic pain was considered as existing for six months or more. Pain intensity was measured by using a numeric scale (0-10: zero=no pain, 1,2,3,4=mild, 5.6=moderate, and strong=7,8,9, and 10=worst pain possible) the location investigated through body diagrams, and self-rated health assessed by the scale of verbal descriptors ("very good", "good," "regular," "bad," "worst"). The project was approved by the CEP/UFG (Protocol 050/2009) and seniors signed the Informed Consent. The data were analyzed using Stata version 8.0 and operated by means of absolute and relative frequency and Confidence Interval (95%). Of the 872 elderly, 460 (52.7%: 95% CI: 49.4% -56.1%) reported chronic pain. By age, the prevalence was 52.4, 53.1 and 53.0%, respectively, among young elderly (60-69 years), elderly (70-79 years) and very elderly (80 or +). Women obtained higher prevalence of chronic pain (60.4%) than men (40.1%), prevailing among the young elderly (57.6/43.4%), elderly (62.8/38.6%) and very elderly (64.5/33.9%). The elderly with chronic pain, 49.8% were young elderly, 33.0% and 17.2% very elderly seniors. The increased representation of women was (71.3%), and 48.8% were young elderly, 32.9% and 18.3% elderly, very elderly. The marriage prevailed among young elderly (46.0%) and elderly (54.1%) and widowed (55.7%), among the very elderly. Income  minimum wage prevailed among the 3 elderly age groups (32.1; 56.4; 50.7%) and education "primary" among young elderly (48.0%), elderly (45.7%) and very elderly (53.9%). The sites of pain were prevalent: MMII (34,5%) and lumbar (29,5%) and 12.6% of seniors reported "worst possible pain," 42.0% "severe pain", 26.0% "moderate" and 19, 4%, "mild". The young elderly (45.2) and seniors (41.3%) reported more pain "strong" and the very old, "severe pain" (33.3%) and "worst pain" (20.3%). Women reported pain "strong" and "worst possible pain" (45.8; 14.1%) more often than men, who reported more pain "mild" and "moderate" (27.1; 32.2 %.) When health was perceived as "very good", "moderate pain" (41.7%) and "mild" (33.3%) prevailed. Those who perceived their health as "good" over reported "mild pain" (33.9%) and when his health was "fair", "bad" and "very bad", the highest frequency of reported pain was "strong" (46.0%), "strong" (56.5%) and "worst possible pain" (60.0%), respectively. The prevalence estimates found are similar to other national studies. Most elderly people suffer from chronic pain of high intensity, which affects the lower limbs and lower back. Population-based studies help us to identify penetration points for planning and implementing strategies that print improving health care in this population. / A dor crônica é uma experiência desagradável que atinge grande parte da população mundial, contudo, estudos populacionais com idosos são raros. O objetivo desse estudo foi analisar a dor crônica e a autopercepção de saúde entre idosos da comunidade. Estudo de base populacional, transversal, em Goiânia, Goiás, entre dezembro/2009 e abril/2010. Para este recorte, foram excluídos aqueles que alcançaram escores 13 no MEEM; e precisaram de ajuda para as respostas. A amostra probabilística constituiu-se de 872 participantes. Dor crônica foi considerada como existente há seis meses ou mais. A intensidade de dor foi medida por meio de escala numérica (0-10: zero=sem dor; 1,2,3,4=leve; 5,6=moderada e 7,8,9=forte; e 10=pior dor possível); a localização investigada por meio de diagramas corporais; e a autopercepção de saúde avaliada por escala de descritores verbais (“muito boa”, “boa”, “regular”, “ruim”, “muito ruim”). O projeto foi aprovado pelo CEP/UFG (Protocolo 050/2009) e os idosos assinaram o TCLE. Os dados foram analisados pelo programa Stata versão 8.0 e explorados por meio de frequência absoluta e relativa e Intervalo de Confiança (95%). Dos 872 idosos, 460 (52,7%: IC 95%: 49,4%-56,1%) referiram dor crônica. Por faixa etária, a prevalência foi de 52,4%; 53,1% e 53,0%, respectivamente, entre jovens idosos (60-69 anos); idosos (70-79 anos); e muito idosos (80 anos ou+). As mulheres alcançaram maior prevalência de dor crônica (60,4%) que os homens (40,1%), prevalecendo entre os jovens idosos (57,6%/43,4%); idosos (62,8%/38,6%) e muito idosos (64,5%/33,9%). Dos idosos com dor crônica, 49,8% eram jovens idosos, 33,0% idosos e 17,2% muito idosos. A maior representação foi pelas mulheres (71,3%), sendo que 48,8% eram jovens idosas, 32,9%, idosas e 18,3%, muito idosas. Os casados prevaleceram entre jovens idosos (46,0%) e idosos (54,1%); e os viúvos (55,7%), entre os muito idosos. A renda  um salário mínimo prevaleceu entre idosos das 3 faixas etárias (32,1%; 56,4%; 50,7%) e escolaridade “primário” entre jovens idosos (48,0%), idosos (45,7%) e muito idosos (53,9%). Os locais de dor prevalentes foram: MMII (34,5%) e região lombar (29,5%); e 12,6% dos idosos referiu “pior dor possível”, 42,0% “dor forte”; 26,0% “moderada” e 19,4%, “leve”. Os jovens idosos (45,2%) e idosos (41,3%) relataram mais dor “forte”; e os muito idosos, “dor forte” (33,3%) e “pior dor” (20,3%). As mulheres relataram dor “forte” e “pior dor possível” (45,8%; 14,1%) com maior frequência que os homens; que relataram mais dor “leve” e “moderada” (27,1%; 32,2%). Quando a saúde foi percebida como “muito boa”, “dor moderada” (41,7%) e “leve” (33,3%) prevaleceram. Aqueles que perceberam sua saúde como “boa” relataram mais “dor leve” (33,9%) e quando a saúde foi “regular”, “ruim” e “muito ruim”, a maior frequência de relatos foi de dor “forte” (46,0%), “forte” (56,5%) e “pior dor possível” (60,0%), respectivamente. As estimativas de prevalência encontradas são semelhantes a outros estudos nacionais. A maioria dos idosos sofre dor crônica, de elevada intensidade, que afeta os MMII e a região lombar, especialmente das mulheres. Estudos de base populacional permitem identificar pontos de penetração para planejamento e implementação de estratégias que imprimam melhoria no cuidado à saúde dessa população.

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

Scholars have long theorized that religious contexts provide health-promoting social integration and regulation. A growing body of literature has documented associations between individual religiosity and health as well as macro–micro linkages between religious contexts, religious participation, and individual health. Using unique data on individuals and county contexts in the United States, this study offers new insight by using multilevel analysis to examine meso–micro relationships between religion and health. We assess whether and how the relationship between individual religiosity and health depends on communal religious contexts. In highly religious contexts, religious individuals are less likely to have poor health, while nonreligious individuals are markedly more likely to have poor health. In less religious contexts, religious and nonreligious individuals report similar levels of health. Consequently, the health gap between religious and nonreligious individuals is largest in religiously devout contexts, primarily due to the negative effects on nonreligious individuals’ health in religious contexts.

<p>This cross-sectional study investigated the use of health benefits in relation to the self-rated health of employees at two medium-sized industrial enterprises in Hälsingland. The method used to investigate this was through a self-designed questionnaire consisting 19 questions about health, lifestyle and health benefits at the workplace. A total of 100 questionnaires were distributed in the two companies, hence 50 surveys at each workplace. The response rate was measured to 88 % and 74 %, which means a loss of 6 persons and 13 persons. The results showed that Company nr 1 offers its employees a health benefits consisting of free access to gym in the company premises after working hours and financial contributions to training-cards. These benefits are used regularly by 29% of respondents. Company nr 2 currently offered no health benefits for their employees. The results also showed that 66% of the respondents at Company nr 1 rated their physical health as <em>Excellent</em> or <em>Good</em> and 79% consider their mental health as <em>Excellent</em> or <em>Good</em>. At Company nr 2, 65 % of the participants responded that they consider their physical health as Excellent or Good and 84% consider their mental health as <em>Excellent</em> or <em>Good</em>. The study also found that more than half of the participants in the two companies had a BMI (Body Mass Index) greater than 26. The conclusion from this is that the health benefits offered at Company nr 1 is used sparingly and that more than half of the participants at both companies consider their physical and mental health as <em>Excellent</em> or <em>Good</em>.</p>

<p>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. </p><p>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. </p><p>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.

Background: Self-rated health (SRH) is among the most frequently assessed health perceptions in epidemiological research. While the predominant focus has been the predictive relevance of SRH, there is increasing interest in understanding the nature of SRH. Recently a conceptual interpretation of SRH was proposed. Purpose: To assess the tenability of the recently proposed distinctions of self-rated health, as a spontaneous assessment of overall health, or as an enduring self-concept, or both, and to determine the significance of mental well-being, physical and social health for SRH. Methods: A cohort of individuals undergoing total joint replacement (TJR) for hip or knee osteoarthritis (OA) was followed over 6 months of recovery. Participants (n=449) completed (pre-surgery, 3 and 6 months post-surgery) measures associated with physical health: pain, physical function, sports/recreation, fatigue; mental well-being: anxiety, depression; and social health: social participation, passive/active recreation, community access. Using structural equation modeling, confirmatory factor analyses (CFA) investigated 3 latent health variables, and the responsiveness of SRH to current and changing health status, as well as its predictive significance for future health status was investigated. Results: CFA analyses confirmed relationships between observed health measures and hypothesized latent health dimensions. SRH was responsive to current and changing mental well-being. The effects of physical and social health were mediated through mental well-being. SRH was a strong predictor of future SRH and future health status. Conclusion: SRH displayed features of both an enduring self-concept and spontaneous assessment of health status; evidence is provided that both operate simultaneously. While aspects of physical health have always been perceived as the major determinants of SRH, these findings indicate that mental and social health explain much of the relationship between physical health and SRH. These results are particularly unexpected since this is a sample of individuals undergoing TJR surgery, for which pain and restricted physical function are primary indicators. Since SRH is a significant predictor of health status, TJR outcomes, health care utilization and mortality, this study suggests that health research and care, treatment and management modalities should consider a broad range of health dimensions, not only physical aspects of health, and SRH.

A single-item measure of self-rated mental health (SRMH) asks respondents to rate their mental health on a 5-point scale from ‘excellent’ to ‘poor’. SRMH is being used increasingly in research and on population health surveys. However, little is known about this item, as there are no literature reviews and few formal validation studies. The aim of this study is to understand what SRMH measures by conducting the first known systematic review of SRMH literature, followed by analysis of the Canadian Community Health Survey (CCHS 1.2). Results of the systematic review reveal SRMH has relationships with mental health scales, mental disorders, self-rated health, health problems, service utilization, and service satisfaction. Analysis of CCHS 1.2 data finds SRMH is associated with psychiatric diagnoses, distress, physical health, and sociodemographic characteristics. Both studies conclude SRMH is measuring mental health and more; however, there needs to be more research to understand the specifics of these relationships.

A single-item measure of self-rated mental health (SRMH) asks respondents to rate their mental health on a 5-point scale from ‘excellent’ to ‘poor’. SRMH is being used increasingly in research and on population health surveys. However, little is known about this item, as there are no literature reviews and few formal validation studies. The aim of this study is to understand what SRMH measures by conducting the first known systematic review of SRMH literature, followed by analysis of the Canadian Community Health Survey (CCHS 1.2). Results of the systematic review reveal SRMH has relationships with mental health scales, mental disorders, self-rated health, health problems, service utilization, and service satisfaction. Analysis of CCHS 1.2 data finds SRMH is associated with psychiatric diagnoses, distress, physical health, and sociodemographic characteristics. Both studies conclude SRMH is measuring mental health and more; however, there needs to be more research to understand the specifics of these relationships.

Background: Self-rated health (SRH) is among the most frequently assessed health perceptions in epidemiological research. While the predominant focus has been the predictive relevance of SRH, there is increasing interest in understanding the nature of SRH. Recently a conceptual interpretation of SRH was proposed. Purpose: To assess the tenability of the recently proposed distinctions of self-rated health, as a spontaneous assessment of overall health, or as an enduring self-concept, or both, and to determine the significance of mental well-being, physical and social health for SRH. Methods: A cohort of individuals undergoing total joint replacement (TJR) for hip or knee osteoarthritis (OA) was followed over 6 months of recovery. Participants (n=449) completed (pre-surgery, 3 and 6 months post-surgery) measures associated with physical health: pain, physical function, sports/recreation, fatigue; mental well-being: anxiety, depression; and social health: social participation, passive/active recreation, community access. Using structural equation modeling, confirmatory factor analyses (CFA) investigated 3 latent health variables, and the responsiveness of SRH to current and changing health status, as well as its predictive significance for future health status was investigated. Results: CFA analyses confirmed relationships between observed health measures and hypothesized latent health dimensions. SRH was responsive to current and changing mental well-being. The effects of physical and social health were mediated through mental well-being. SRH was a strong predictor of future SRH and future health status. Conclusion: SRH displayed features of both an enduring self-concept and spontaneous assessment of health status; evidence is provided that both operate simultaneously. While aspects of physical health have always been perceived as the major determinants of SRH, these findings indicate that mental and social health explain much of the relationship between physical health and SRH. These results are particularly unexpected since this is a sample of individuals undergoing TJR surgery, for which pain and restricted physical function are primary indicators. Since SRH is a significant predictor of health status, TJR outcomes, health care utilization and mortality, this study suggests that health research and care, treatment and management modalities should consider a broad range of health dimensions, not only physical aspects of health, and SRH.