CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / EvidÃncias mostram que indivÃduos com piores condiÃÃes de saÃde sÃo os mais pobres, com menos escolaridade e piores condiÃÃes de vida. A UtilizaÃÃo dos ServiÃos de SaÃde (USS), determinante social intermediÃrio, pode interferir na saÃde dos indivÃduos. No entanto, a busca dos serviÃos de saÃde depende das caracterÃsticas pessoais, dos recursos disponÃveis e da percepÃÃo da necessidade de saÃde segundo o Modelo Comportamental de USS proposto por Andersen. O objetivo do trabalho foi identificar os fatores associados à USS entre crianÃas de 5 a 9 anos na zona urbana do municÃpio de Sobral-CE. O estudo foi um recorte da pesquisa de base populacional âEstudo das condiÃÃes de saÃde, educaÃÃo e qualidade de vida das crianÃas de 5 a 9 anos da zona urbana do municÃpio de Sobral-CEâ. Foram realizadas entrevistas domiciliares com 3.274 crianÃas, em 1999/2000. As variÃveis dependentes foram a USS nas unidades de saÃde da famÃlia (PSF), nos hospitais e nos consultÃrios particulares e conveniados aos planos de saÃde, nos Ãltimos 30 dias e de forma regular. Apenas 558 (17,0%) das crianÃas utilizaram os serviÃos de saÃde nos Ãltimos 30 dias. Quando perguntado o tipo de serviÃo utilizado habitualmente, o PSF foi o mais referido (79,1%), seguido do hospital (13,5%) e dos serviÃos por convÃnio ou particulares (3,4%). Em torno de 116 crianÃas, 3,5% da amostra, eram levadas a outros serviÃos como farmÃcias, rezadeiras, madrinhas, avÃs, entre outros. Os fatores associados à USS no Ãltimo mÃs foram: a ocorrÃncia de problemas de saÃde (OR=3,9); a utilizaÃÃo regular do PSF (OR=1,8); a coleta do lixo, direta e indireta (OR=1,3 e 1,9) e a localizaÃÃo da residÃncia na sede do municÃpio (OR=1,5). Os fatores associados à utilizaÃÃo regular do PSF foram: escolaridade materna e condiÃÃes econÃmicas menores, morar na sede dos distritos e prÃximo ao PSF, realizar consulta sempre ou Ãs vezes no mesmo dia da procura, ser cadastrado no PSF e nÃo ter plano de saÃde. Associados ao hospital foram: escolaridade materna e condiÃÃes econÃmicas maiores, morar na sede do municÃpio e distante do PSF, melhores condiÃÃes de escoadouro de dejetos, realizar consulta sempre no mesmo dia da procura, nÃo ser cadastrado no PSF e nÃo possuir plano de saÃde. Associados aos consultÃrios particulares/conveniados foram: escolaridade materna e condiÃÃes econÃmicas maiores, nÃo ser cadastrado no PSF e possuir cobertura de plano de saÃde. Os resultados mostraram que a USS no municÃpio de Sobral-Ce praticamente nÃo mostrou desigualdade no acesso entre a faixa etÃria estudadas. Atribui-se a implantaÃÃo da EstratÃgia SaÃde da FamÃlia que alcanÃou os grupos populacionais mais vulnerÃveis e historicamente excluÃdos da atenÃÃo à saÃde. / Evidence shows that individuals with worse health conditions are poorer, less educated and poorer living conditions. The Health Services Use (HSU), a social determinant intermediary, can interfere with the health of individuals. However, the pursuit of health services depends on personal characteristics, available resources and the perceived need for health according to the Behavioral Model of HSU proposed by Andersen. The objective was to identify factors associated with HSU among children 5 to 9 years in the urban area of Sobral, CE. The present study was part of a research population-based "Study of the health, education and quality of life for children 5-9 years of the urban area of Sobral-CE". Home interviews were conducted with 3,274 children in 1999/2000. The dependent variables were the HSU in family health units (PSF), in hospitals and private clinics and insured health plans in the last 30 days and regularly. Only 558 (17.0%) children used health services in the last 30 days. When asked what type of service commonly used, the PSF was the most frequently mentioned (79.1%), followed by hospital (13.5%) and services by private agreement or (3.4%). Around 116 children, 3.5% of the sample were taken to other services such as pharmacies, mourners, godmothers, grandmothers, and others. Factors associated with HSU in the last month were: the occurrence of health problems (OR = 3.9), regular use of the PSF (OR = 1.8), garbage collection, direct and indirect (OR = 1.3 and 1.9) and location of residence in the town (OR = 1.5). Factors associated with regular use of the PSF were maternal education and lower economic conditions, living in the headquarters district and close to the PSF, conduct consultation always or sometimes the same day seeking to be registered with the PSF and not have health insurance. Associated with the hospital were: maternal education and higher economic conditions, living in the town and away from the PSF, better outlet for waste, carry out consultation on the same day of demand, not registered in the PSF and do not have health insurance. Associated with private offices / insured were maternal education and higher economic conditions, the PSF is not registered and has health plan coverage. The results showed that the HSU in Sobral-CE showed almost no inequality in access between the age group studied. Is attributed to the implementation of the Family Health Strategy which reached the most vulnerable populations and historically excluded from health care.

A tuberculose (TB) ainda se destaca como uma emergência global, apresentando elevada magnitude, transcendência e vulnerabilidade. Assim, objetivou-se investigar os determinantes das internações por tuberculose e sua distribuição espacial e tendência temporal. Estudo ecológico, cujos dados primários foram obtidos a partir de entrevistas com os profissionais da saúde da Atenção Primária à Saúde (APS) no ano de 2014 e os dados secundários das internações por TB entre 2006 e 2015 registrados no Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS). Além disso, recorreu-se ao Índice Paulista de Vulnerabilidade Social - versão 2010 para mensurar a vulnerabilidade social nos territórios. Procedeu-se inicialmente às análises dos dados por meio da estatística descritiva, realizadas no Statistica 12.0. Para análise espacial realizou-se a geocodificação das internações no TerraView versão 4.2.2. Considerou-se como unidades de análise as 46 áreas de abrangência da APS, classificadas segundo suas modalidades. Estimou-se a taxa bruta e bayesiana empírica das internações evitáveis por TB, sendo suavizada pelo Método Bayesiano Empírico. Recorreu-se, ainda, à regressão linear múltipla pelo método dos mínimos quadrados e à regressão espacial para verificar a relação de dependência espacial das internações evitáveis por TB com a capacidade da APS de coordenar as Redes de Atenção à Saúde (RAS) e ao Índice de Vulnerabilidade Social. Mapas coropléticos foram construídos no ArcGis 10.2. Das 46 unidades de APS, apenas cinco foram classificadas na condição regular para coordenar as RAS. Em relação aos atributos, nenhuma das áreas foi classificada na condição insatisfatória e apenas uma, na condição ótima. Na modelagem espacial, não se observaram atributos que fossem significativamente relacionados às internações evitáveis por TB. Foram identificados 265 casos de internações evitáveis por TB. As taxas variaram de 1,24 a 10,66 internações por TB por 100.000 habitantes/ano. O Distrito Norte apresentou as taxas mais altas (> 6,57); os Distritos Sul, Oeste e Norte apresentaram taxas moderadas (3,70 - 6,56); os Distritos Leste e Central apresentaram as taxas mais baixas (< 3,69). Houve uma maior concentração de internações em regiões mais densas e entre os anos de 2008 a 2009 e 2014 a 2015. Referente ao IVS, os Distritos Sul, Leste, Oeste e Central foram classificados em sua maioria no Grupo 2 (vulnerabilidade muito baixa); os Distritos Norte e Oeste, no Grupo 3 (vulnerabilidade baixa) e uma área foi classificada com vulnerabilidade muito alta (Distrito Norte). Na modelagem espacial também não se observou relação estatisticamente significativa do IVS com as internações evitáveis por TB. O estudo, identificou as áreas da APS mais deficientes quanto à coordenação das RAS e cartografou as áreas mais vulneráveis às internações por TB, possibilitando à gestão local um planejamento em saúde mais direcionado àqueles grupos mais vulneráveis, a fim de diminuir o número de internações evitáveis e injustas e avançar na melhoria da qualidade e fortalecimento de um sistema de saúde orientado pela APS sob a conformação de Redes / Tuberculosis (TB) still stands as a global emergency and presents high magnitude, transcendence and vulnerability. Thus, the aim was to investigate determinants of tuberculosis hospitalizations, their spatial distribution and temporal trend. An ecological study whose primary data were obtained from interviews with Primary Health Care (PHC) professionals in the year 2014 and secondary data of hospitalizations for TB were collected between 2006 and 2015 and recorded in the Hospital Information System of the Health Unique System (SIH/SUS). Also, it was possible to use the Paulista Social Vulnerability Index, 2010 version, to measure social vulnerability in the territories. Initially, data analyses were carried out through descriptive statistics and performed by Statistica 12.0. For spatial analysis, it was carried out hospitalizations geocoding through TerraView, version 4.2.2. The 46 areas covered by the APS were considered as analyses units and classified according to their modalities. It was possible to estimate the gross and empirical Bayesian rate of avoidable hospitalizations by TB and smoothed by the Bayesian Empiric Method. It was also used the multiple linear regression through the method of least squares and spatial regression to verify the spatial dependence relation of avoidable hospitalizations by TB, with the APS capacity to coordinate the Health Care Networks (RAS) and Index of Social vulnerability. Coropletic maps were constructed in the ArcGis 10.2. Of a total of 46 APS, only five were classified in the regular condition to coordinate the RAS. Regarding the attributes, none of the areas was classified as unsatisfactory condition and only one of them was categorized in the optimal condition. In the spatial modeling, there were no attributes significantly related to avoidable hospitalizations for TB. A total of 265 cases of preventable hospitalizations for TB were identified. Rates ranged from 1.24 to 10.66 hospitalizations for TB per 100,000 inhabitants a year. The Northern District had the highest rates (> 6.57); The South, West and North Districts presented reasonable rates (3.70 - 6.56); The Eastern and Central Districts had the lowest rates (<3.69). There was a greater concentration of hospitalizations in denser regions between the years 2008-2009 and 2014-2015. Regarding the IVS, South, East, West and Central Districts were classified mostly in the Group 2 (very low vulnerability). North and West Districts in Group 3 (low vulnerability) and one area was ranked with very high vulnerability (Northern District). In the spatial modeling, there was no statistically significant relationship between the IVS and avoidable hospitalizations for TB. The study identified the most deficient areas of APS in the coordination of RAS and mapped the most vulnerable areas to hospitalizations for TB. Thus, it was possible for the local management to plan a health care more targeted to the most vulnerable groups to reduce the number of avoidable and unjust hospitalizations and advance in quality and strengthening improvement of a health system oriented to the APS, under the formation of Networks

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-04-17T12:15:08Z No. of bitstreams: 1 paolaisabelcarrascoasin.pdf: 2461102 bytes, checksum: c0a131f2f9b01da40870a3dc42ff4294 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-04-18T13:39:42Z (GMT) No. of bitstreams: 1 paolaisabelcarrascoasin.pdf: 2461102 bytes, checksum: c0a131f2f9b01da40870a3dc42ff4294 (MD5) / Made available in DSpace on 2017-04-18T13:39:42Z (GMT). No. of bitstreams: 1 paolaisabelcarrascoasin.pdf: 2461102 bytes, checksum: c0a131f2f9b01da40870a3dc42ff4294 (MD5) Previous issue date: 2016-11-28 / Introdução: feminicídios ou femicídios são assassinatos sustentados nas relações de poder, desigualdade e subordinação da mulher. Estes são a última escala da violência contra a mulher, que durante o período 2010 -2014 vitimaram mais de 15.877 vidas (Peru – Brasil). Os estudos sobre este tema são de vital importância porque segundo as estatísticas, uma mulher é morta a cada hora e meia no Brasil e a cada vinte segundos uma mulher é violentada no Peru. Inicialmente, promulgaram leis contra a violência de gênero ou intrafamiliar, anos depois, tornaram-se leis contra os feminicídios. Procurando proteção para a mulher que contribuía na possibilidade de igualdade de oportunidades sociais, lutando assim contra a desigualdade de gênero através da aplicação de políticas públicas que contribuíam com o tempo na erradicação dos feminicídios. Objetivos: analisar os determinantes sociais que fazem parte do índice de desigualdade de gênero associadas à ocorrência dos feminicídios no Peru e no Brasil e construir as taxas padronizadas dos feminicídios no Peru e no Brasil. Metodologia: estudo ecológico e descritivo, utilizando dados secundários cuja população alvo foram todas as mulheres peruanas e as mulheres brasileiras acima dos 15 anos de idade. Realizou-se uma análise multivariada através do coeficiente de correlação linear de Pearson e da significância de associação entre a taxa de feminicídio e os indicadores que fazem parte do IDG (no caso de Peru) e com os óbitos femininos por agressão dos municípios com mais de 50.000 habitantes e os indicadores do IDG (no caso do Brasil). Resultados: foram construidas as taxas padronizadas dos feminicídios no Peru, assim como as taxas padronizadas dos óbitos femininos por agressão no Brasil. Não se encontrou associação alguma entre os indicadores do IDG e os feminicídios no Peru. No caso do Brasil, a porcentagem dos assentos ocupados pelo sexo feminino no parlamento municipal durante as três ultima eleições, foi o único indicador do IDG que não foi significativo. Conclusões: a partir dos resultados podemos concluir que os determinantes sociais que constituem parte do IDG não se mostram associados à ocorrência dos feminicídios no Peru, podendo-se formular a hipóteses que uma possível subestimação de dados não permite determinar a existência da associação das determinantes sócias com os feminicídios. Aliás, no caso de Brasil o nível de educação é inversamente proporcional à ocorrência de morte das mulheres por agressão, observando que quanto maior é o nível de educação da mulher a incidência das mortes destas por agressão diminui. / Introduction: femicides are murders sustained in the power relation, inequality and women`s subordination. These are the last step of women`s violence, which during o period 2010 – 2014 victimized more than 15.877 lives (Peru – Brazil), leaving children in orphan status and many still free murderers in society. Studies on this issue are of vital importance because according to statistics one woman is killed every hour and a half in Brazil and twenty seconds a woman is raped in Peru. Were initially enacted laws against gender violence or domestic, meanwhile, women continued to be killed as a result of violence in most times by their partners or former partners, which resulted, years later in laws against femicide. Seeking protection for the woman who contributed to the possibility of equal social opportunities, thus fighting against gender inequality through the application of public policies that contributed over time to the eradication of feminicides Objectives: Analyze the social determinants that are part of the index of gender inequality associated with the occurrence of femicide in Peru and Brazil and build the standardized rates of femicide in Peru and Brazil. Metodology: ecological and descriptive study, using secondary data whose target population was all Peruvians women and all Brazilian women above 15 years old. A multivariate analysis was made using a Pearson's linear correlation coefficient and the significance of association between the rate of femicide and indicators that are part of the GDI (in the case of Peru) and municipality’s female deaths with more than 50.000 inhabitants and GDI indicators (in the case of Brazil). Results: The standardized rates of Peruvian’s feminicides were constructed, like with the standardized rates of Brazilian’s women deaths for aggression. It was not found any association between indicators of IDG and femicide in Peru. In the case of Brazil, the percentage of seats occupied by the female sex in the municipal parliament during the three last elections was the unique indicator of IDG that was not significant. Conclusions: From the results we can conclude that the social determinants that are part of the GDI are not shown to be associated with the occurrence of the feminicides in Peru, being able to formulate the hóstesis of a possible underestimation of data does not allow to determine the existence of the association to the occurrence of femicide. However, in the case of Brazil, the level of education is inversely proportional to the occurrence of the death of women due to aggression, observing that the higher the level of education of women, the incidence of women's deaths due to aggression decreases.

Master of Public Health - MPH / Background: Parental perceptions of health and child health needs have not been explored within Early Childhood Care and Development (ECCD) centres in the Eastern Cape of South Africa. Although the relationship between social, economic and environmental conditions and health status has been well documented in the literature, it is unknown whether parents of children attending rural ECCD centres, share this understanding. Children have the right to a healthy environment. Many children in rural Eastern Cape live in environments that present challenges in regards to water and sanitation, food security and safety. ECCD centres are the daily environment for the attending pre-school children and have a role to play in promoting child health. In order to develop effective, sustainable health promotion initiatives in ECCD centres a baseline recording was needed of the parental understanding of health, their children’s health needs and perceived solutions. Study Design: This study was an exploratory study, which used qualitative research methods to describe the parents’ perceptions of health and health needs of their children in ECCD centres in Amathole District, South Africa. Data Collection: Focus group discussions were the data collection method used to record the parental perceptions of health and child health needs. Because there was limited parental involvement in the ECCD centres, it was hoped that the focus groups would be a suitable method to generate more community involvement. Four focus groups were conducted using a semi-structured. The researcher facilitated the focus group discussions with the assistance of an isiXhosa speaking research assistant. The voice recordings of the discussions were professionally translated and transcribed for analysis. Analysis of Results: Content analysis of the transcriptions revealed a thick description of parental perceptions of health and child health needs. Participants saw health in holistic terms and identified a complex inter-relationship of various social determinants of health, consistent with Dahlgren and Whitehead's determinants of health model. Parents were aware of the absence of many of these determinants of health and the challenges to child health that this brought. The child health needs perceived by parents were related to nutrition, hygiene, social interaction, safety and protection from disease. Five recurring themes emerged as a result of this study, including individual lifestyle factors, social interaction, environmental challenges to health, safety and lastly poverty. The ECCD centres were considered a resource for child health and suggestions were given as to how to strengthen the ECCD centres' role in further promoting health. Conclusion: The participants' broad definition of health and depth of understanding regarding the determinants of health, allows for a range of stakeholders to be involved in the promotion of health in the ECCD centres. The majority of the perceived challenges to health existed in the living conditions of the children and families. The Health Promoting Schools (HPS) framework could enhance the current work of the Eco-Schools Programme in the ECCD centres.

Objective Objective of this study was to investigate the impact of the recent economic crisis of 2007/2008 on the subjective well-being and health status in thirteen European countries. Methods The European Social Survey (ESS) database was searched for individual health and wellbeing indicators and the database of the European Commission Eurostat for economic indicators. Data representing social determinants like education, housing and employment status and others before, during and after the crisis were retrieved. Eurostat data were used to analyse economic indicators and health outcomes on country level. Descriptive statistics were used to describe the changes in the different parameters over time. Regression analysis was performed to demonstrate relations between subjective well-being and different social determinants. Results Between 2006 and 2012 all countries experienced changes in their populations' subjective well-being. From 2006 to 2010 (crisis) the number of people with good or very good subjective well-being increased in France, Ireland, Belgium and Portugal by 0.6%, 1.0%, 1.2% and 6.5%, respectively. In Denmark and Spain this number remained basically stable. In Sweden, the United Kingdom, Finland and Germany the percentage of the population with good or very good subjective well-being decreased by 1.1%, 2.7%, 1.7% and 2.8%, respectively. Regression analysis demonstrated a significant relation between good and very good subjective well-being and level of education, main activity during the last 7 days, satisfaction with life, satisfaction with household income, main source of household income, gender and age. This relation differed for various factors and countries. In none of the countries satisfaction with national health services and satisfaction with current state of economy within the country was found significantly related to subjective well-being. The main amendable determinant correlating with a higher degree of subjective well-being is good education. The correlation between education and subjective well-being got stronger after the crisis than before or during the crisis. Conclusion Economic development does not have a uniform impact on subjective well-being. Education is a major amendable determinant influencing individual well-being. We could not find evidence for any significant impact of the organization of the healthcare services or social system on the subjective well-being.

Orientador: Fabio Luiz Mialhe / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-26T11:32:04Z (GMT). No. of bitstreams: 1 Paula_JaniceSimpsonde_D.pdf: 2936736 bytes, checksum: b902ec93fa51db820dff8577e0662b77 (MD5) Previous issue date: 2015 / Resumo: O objetivo geral dessa Tese foi avaliar os determinantes sociais da saúde (DSS) associados à saúde bucal, ao rendimento escolar e a qualidade de vida em crianças e adolescentes, além de testar as propriedades psicométricas longitudinais de questionários de Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) e comparar um questionário genérico de qualidade de vida com outro de QVRSB. Para isso, foram usadas duas amostras: uma composta por crianças de 8 a 10 anos, participantes do Programa Sempre Sorrindo (PSS), no município de Piracicaba, São Paulo, e outra composta por escolares de 12 anos provenientes de escolas públicas e privadas do município de Juiz de Fora, Minas Gerais. Foram coletados dados referentes às condições clínicas e aplicados questionários para avaliação da qualidade de vida (Child Perception Questionnaire ¿ CPQ8-10 e CPQ11-14 e AUQUEI ¿ Autoquestionnaire Qualité de Vie Enfant Image), bem como do nível socioeconômico, do ambiente familiar e do rendimento escolar das crianças. Os resultados demonstraram que os DSS apresentaram associações com cárie dentária e que, em particular, os aspectos socioeconômicos possuíram maior associação com a experiência de cárie, quando comparados com variáveis relacionadas ao ambiente familiar. Observou-se, ainda, que tanto aspectos socioeconômicos, do ambiente familiar e a presença de lesões de cárie, mesmo que tratadas, foram indicadores de risco para o pobre rendimento escolar, e a experiência de cárie foi um importante preditor para mudanças na QVRSB de adolescentes ao longo do tempo. Sobre a responsividade dos instrumentos de QVRSB, verificou-se que o questionário CPQ11-14 apresentou-se responsivo às mudanças longitudinais, avaliadas pelo critério de Longitudinal Construct Validity, mas com pequena alteração quando avaliada pela análise de effect size. Os resultados também demonstraram que o CPQ11-14 apresentou correlação com o instrumento genérico de qualidade de vida AUQUEI e que ambos apresentaram associações com variáveis clinicas e socioambientais. Por fim, verificou-se que o tratamento da cárie dentária impactou positivamente na melhora da QVRSB de escolares, e o CPQ8-10 apresentou boas propriedades psicométricas para avaliar estas mudanças ao longo do tempo. Conclui-se, a partir dos resultados dos estudos supracitados, que houve associações entre DSS e a cárie dentária, e que ambos estiveram associados a um pior rendimento escolar. Da mesma forma, verificou-se que a QVRSB esteve correlacionada à qualidade de vida nesta população. Quando os escolares foram avaliados longitudinalmente, constatou-se que a experiência de cárie foi um preditor importante para mudanças da QVRSB ao longo do tempo nesta população, mensurada pelos questionários Child Perception Questionnaire, que apresentaram boas propriedades psicométricas de responsividade às mudanças de qualidade de vida relacionada à saúde bucal. Dentro deste contexto, o acesso ao tratamento odontológico foi um importante fator para a melhoria da qualidade de vida relacionada à saúde bucal de escolares que vivem sob vulnerabilidade social / Abstract: The overall objective of this thesis was to evaluate the social determinants of health (SDH) associated with oral health, school performance and the quality of life in children and adolescents, as well as test the longitudinal psychometric properties of Oral Health realte Quality of Life (OHRQoL) questionnaires and compare a generic questionnaire of quality of life with other of OHRQoL. For this, two samples were used: one consisting of children 8-10 years participating in the Program Always Smiling (PSS), in Piracicaba, São Paulo, and another composed of schoolchildren of 12 years from public and private schools in the city Juiz de Fora, Minas Gerais. Data were collected regarding on clinical conditions and questionnaires to assess quality of life (Child Perception Questionnaire - CPQ8-10 and CPQ11-14 and AUQUEI - Autoquestionnaire Qualité de Vie Enfant Image) and socioeconomic status, home environment and school performance of schoolchildren. The results showed that the SDH were associated with dental caries and, in particular, the socioeconomic aspects contained higher association with caries experience compared to variables related to the home environment. It was observed also that both socioeconomic aspects of the home environment and the presence of caries lesions, even if treated, were risk factors for poor school performance, and caries experience was an important predictor of changes in QVRSB adolescents over time. On the responsiveness of OHRQoL instruments, it has been found that the questionnaire is presented CPQ11-14 responsive to longitudinal changes, as evaluated by Longitudinal Construct Validity, but with little change as determined by the effect size analysis. The results also showed that CPQ11-14 correlated with the generic instrument of quality of life AUQUEI and both were associated with clinical, social and environmental variables. Finally, it was found that treatment of dental caries has impacted positively on improving of OHRQoL, and had good psychometric properties of CPQ8-10 for measuring changes over time. In conclusion, from the results of the aforementioned studies, there were associations between SDH and tooth decay, and both were associated with poorer school performance. Likewise, it was found that the OHRQoL was correlated to quality of life in population. When the students were assessed longitudinally, it was found that caries experience was an important predictor of changes OHRQoL over time in this population, as measured by the Child Perception Questionnaire questionnaires, which showed good psychometric properties of responsiveness to quality of life changes related to oral health. Within this context, access to dental treatment was an important factor in improving the quality of life related to oral health of children living under social vulnerability / Doutorado / Odontologia em Saude Coletiva / Doutora em Odontologia

A discriminação étnico-racial é um evento estressor capaz de produzir múltiplos danos físicos e mentais. Apesar do crescente interesse científico mundial e de ser tema estratégico para a saúde coletiva, permanece pouco estudado no Brasil, especialmente quando comparado aos EUA, responsável por expressiva produção acadêmica nessa área. Acerca das comunidades remanescentes de quilombo, são ainda mais escassos os dados disponíveis na literatura sobre a sua situação de saúde, sendo nula a investigação abrangendo discriminação étnico-racial entre esses indivíduos. Buscando contribuir para essas questões, a presente pesquisa analisou as frequências de discriminação entre os adultos quilombolas do município de São Lourenço do Sul/RS, por intermédio da escala Experiences of Discrimination, além de verificar as condições sociodemográficas e de saúde dessa população, mensurados pelos questionários da Pesquisa Nacional de Saúde adaptados para esse trabalho. Foram realizadas 103 entrevistas, sendo a amostra composta por 55,3% de mulheres, 71,8% com idades entre 18 e 59 anos e 72,8% da raça/cor preta. A prevalência de discriminação étnico-racial percebida em algum momento da vida foi de 59,2%, resultado superior ao encontrado em outros estudos importantes acerca do tema no país. As frequências com que os entrevistados reportaram ter sofrido discriminação nos contextos cotidianos investigados variaram de 1,9% ao pedir crédito ou empréstimo bancário até 28,2% ao frequentar a escola. Os itens acerca de agravos em saúde revelaram alta (64,1%) frequência de doenças crônicas, sendo a hipertensão arterial sistêmica (45,6%) a doença mais prevalente. Foram baixos os índices de tabagismo e de uso abusivo de álcool. Os resultados desse estudo permitem concluir que a prevalência de discriminação racial nas comunidades remanescentes de quilombo do município de São Lourenço do Sul foi alta e o local no qual ela foi percebida com maior frequência foi o ambiente escolar. É de suma importância que se reconheça a existência da prática do racismo dentro da sociedade brasileira para que se sistematizem ações para transformar essa realidade. / The ethnic-racial discrimination is a stressor event related to multiple physical and mental damages. However, despite the growing scientific interest in a global scale, it remains little studied in Brazil, especially when compared to the USA, responsible for expressive academic production in this area. Concerning the remaining communities of quilombo, the data available in the literature about their health status is even scarcer, with no research covering ethnic-racial discrimination on these individuals. In order to analyze these questions, the present study investigated the frequencies of discrimination among quilombola adults in the city of São Lourenço do Sul / RS, through the scale “Experiences of Discrimination”, beside verifying the sociodemographic and health conditions of this population, measured by questionnaires of the National Health Survey adapted for this work. A total of 103 interviews were conducted, with 55.3% of women, 71.8% between 18 and 59 years old, and 72.8% of blacks. The prevalence of ethnic-racial discrimination perceived at some point in life was 59.2%, a result superior to that found in other important studies on this matter in the country. The frequencies with which respondents reported discrimination in the daily contexts of the questionnaire ranged from 1.9% when applying for credit or bank loan up to 28.2% when attending school. The items about health problems revealed a high (64.1%) frequency of chronic diseases, with systemic arterial hypertension (45.6%) being the most prevalent disease. The rates of smoking and alcohol abuse were low. The results of this study allow us to conclude that the prevalence of racial discrimination in the remaining communities of quilombo in the municipality of São Lourenço do Sul was high and the place where it was most frequently perceived was the school environment. It is extremely important to recognize the existence of the practice of racism within Brazilian society to systematize actions to change this reality.

Social determinants of health (SDOH) are often used to discuss health inequities and systemic barriers experienced by minority populations. In the United States, the intersection of SDOH leaves these populations vulnerable to negative health outcomes. Missing from the SDOH discourse are the underlying historical causes for these disparities. Medical-Legal Partnerships (MLPs) have undertaken the role of educating the health and human services (HHS) workforce on interdisciplinary collaboration, cultural competence, and the skills to recognize experiences of negative SDOH. However, current research does not explore the foundational impact of historical trauma, more specifically Post Traumatic Slave Syndrome (PTSS), on experiences of negative SDOH. This ethnography primarily uses the personal accounts of black female HHS workforce members and participant observation from within a MLP to examine how historical trauma acts as a foundation for understanding the complex interactions of SDOH. The SDOH discourse does not challenge the medical and legal institutions that contribute to how minority populations experience negative SDOH. As currently structured, MLPs unintentionally reproduce a pedagogical narrative that erases the lived experiences of SDOH by only focusing on individual factors and not systems. Black female HHS workforce members agree that historical context is missing (e.g. PTSS) from the SDOH discourse and contemporary experiences of racism and discrimination. Historical context would change how HHS workforce members advocate for their patients as well as engage in system-challenging praxis within the medical and legal institutions. This suggests the need to examine how American institutions exclude particular histories and reinforces a white supremacist and patriarchal narrative.

No description available.

While the concept of the community health worker (CHW) has existed since the mid-20th century, their function as a legitimate branch of the broader workforce in the United States has been tenuous. Their unique roles have the potential to reduce health disparities within marginalized communities, but stakeholder development of this position risks diminishing the crucial skills of these workers. Anthropological research on these workers has typically assessed them in the developing world, while public health research has focused primarily on their ability to impact specific health outcomes through quantitative studies. As a result of the limited and predominantly quantitative assessments of these workers, further research is needed to assess the lived realities of these workers at the grassroots level in the United States. The overarching aim of this project was to document the lived experience of CHWs in Indiana. Additionally, this project assessed their participation in advocacy and the impact of policy development on these workers. A collaborative approach was utilized in this project that embedded the researcher within a CHW organization while also amplifying the voice of the research partners. The project drew on the theoretical lenses of moral economy, deservingness, structural vulnerability, and the “regimes of care” and “politics of care.” The results demonstrate that CHWs face a variety of challenges within the professional workforce but have significant impacts within their communities. These workers emphasize empowerment through advocacy and building client self-sufficiency. Their participation in advocacy is split between impacts at the micro-, macro-, and professional-level. However, legislating the scope and responsibilities of this position by stakeholders unfamiliar with this model risks changing the foundation of the position itself. Steps to incorporate CHWs within the workforce must be collaborative and take into account their lived experience and input in order to allow them agency over the development of their position and to retain the most significant contributions. The contributions of this project are severalfold. First, this project advances theoretical debates within anthropology related to moral economy, regimes of care, politics of care while also addressing the legitimacy of CHWs as a complimentary member of the health care workforce. The findings also illustrate how the political economy of Indiana shapes the moral economy of care within which CHWs operate. Lastly, the project produced applied findings for CHWs, employers, and stakeholders to consider in further development of this position.