Background: Serumlipid concentrations are thought to be risk factors for the development of cardiovascular disease. The present study aims to investigate the prevalence of dyslipidemia and provide sex- and age-related reference values for triglycerides, total cholesterol, LDL and HDL cholesterol as well as apolipoproteins A1 and B by using modern analytical approaches. Materials and methods: Venous blood and anthropometric data were collected from 2571 subjects of the LIFE Child study, aged between 0.5 and 16 years. Age- and gender-related reference intervals (3rd and 97th percentiles) were established by using Cole's LMS method. Results: Serumconcentrations of TC, LDL-C, TG and ApoBwere higher in girls than in boys. In girls TC reached peak levels two years earlier than in boys. Triglyceride levels initially declined until the school age.Until early adolescence there was a steady increase. The LDL-C concentrations in girls and boys followed similar patterns to that of TC. Up to the age of 8 years, a continuous increase in HDL levels for both sexeswas found. Due to the strong correlation between HDL-C and ApoA1 (r=0.87) or rather between LDL-C and ApoB (r=0.93), the respective percentiles showed very similar patterns. Dyslipidemia prevalence were as follows: increased TC 7.8%, increased LDL 6.1%, increased TG 0–9 years 22.1%, increased TG 10–16 years 11.7%, and decreased HDL 8.0%. Conclusion: Age- and sex-related trends for all parameters are similar to those of the German KIGGS study. With the exception of HDL cholesterol, the prevalence of dyslipidemias in the German LIFE Child cohort are similar to the US-American prevalence.:I Abkürzungsverzeichnis - 03 - 1 Bibliographische Beschreibung - 04 - 2 Einleitung - 05 - 2.1 Hintergrund - 05 - 2.2 Serumlipide, Apolipoproteine und Dyslipidämien - 05 - 2.3 Referenzintervalle - 08 - 2.4 Soziodemographische Faktoren - 10 - 2.5 Die LIFE-Child Studie - 12 - 2.6 Hypothesen, Frage- und Zielstellungen - 13 - 3 Publikationen - 14 - 3.1 Pediatric reference data of serum lipids and prevalence of dyslipidemia: results from a population-based cohort in Germany - 15 - 3.2 Serum lipid levels were related to socio-demographic characteristics in a German population-based child cohort. Serum lipid levels and social class - 25 - 4 Zusammenfassung - 33 - 5 Literaturverzeichnis - 36 - II Anhang - 45 - III Erklärung über die eigenständige Abfassung der Arbeit - 64 - IV Curriculum vitae - 65 - V Danksagung - 66 - / Aim: Socio-demographic factors affect the development and lives of children and adolescents. We examined links between serum lipids and apolipoproteins and sociodemographic factors in the Leipzig Research Centre for Civilization Diseases Child (LIFE Child) study. Methods: The Winkler index and the Family Affluence Scale were used to define characteristics of the social status of 938 boys and 860 girls aged from birth to 19 years. We then used univariate and multivariate regression analyses to examine the sociodemographic impact on total cholesterol, low-density lipoprotein (LDL) cholesterol, highdensity lipoprotein (HDL), cholesterol triglycerides and apolipoproteins A1 (ApoA1) and B (ApoB). Results: No significant influences on the Winkler index or the Family Affluence Scale were observed regarding the concentrations of serum lipids for total cholesterol or LDL cholesterol. However, and most importantly, children and adolescents with high social status and high family affluence showed significantly higher HDL cholesterol and ApoA1 levels than those with lower individual totals. A higher Winkler index was associated with significantly lower values for triglycerides and ApoB. Conclusion: Adolescents with higher family wealth and social status showed a lower cardiovascular risk profile, as measured by the concentrations of HDL cholesterol and triglycerides as well as ApoA1 and B.:I Abkürzungsverzeichnis - 03 - 1 Bibliographische Beschreibung - 04 - 2 Einleitung - 05 - 2.1 Hintergrund - 05 - 2.2 Serumlipide, Apolipoproteine und Dyslipidämien - 05 - 2.3 Referenzintervalle - 08 - 2.4 Soziodemographische Faktoren - 10 - 2.5 Die LIFE-Child Studie - 12 - 2.6 Hypothesen, Frage- und Zielstellungen - 13 - 3 Publikationen - 14 - 3.1 Pediatric reference data of serum lipids and prevalence of dyslipidemia: results from a population-based cohort in Germany - 15 - 3.2 Serum lipid levels were related to socio-demographic characteristics in a German population-based child cohort. Serum lipid levels and social class - 25 - 4 Zusammenfassung - 33 - 5 Literaturverzeichnis - 36 - II Anhang - 45 - III Erklärung über die eigenständige Abfassung der Arbeit - 64 - IV Curriculum vitae - 65 - V Danksagung - 66 -

Syfte: Att beskriva hur arbetsterapeuter som arbetar inom hemrehabilitering skattar sin aktivitetsbalans. Metod: I uppsatsen användes en enkätundersökning för att beskriva hur arbetsterapeuter inom hemrehabilitering skattar sin aktivitetsbalans. En tvärsnittsstudie genomfördes med en kvantitativ metod och en deskriptiv inriktning. Enkäten bestod av strukturerade frågor baserade på Occupational Balance Questionnaire (OBQ11) och sociodemografiska bakgrundsfrågor. Urvalet bestod av legitimerade arbetsterapeuter som arbetarinom hemrehabilitering och som hade arbetat minst ett år samt med en anställningsgrad på minst 50%. Resultat: Fyrtiotre arbetsterapeuters självskattade aktivitetsbalans och dess samband med sociodemografiska faktorer undersöktes. Majoriteten av deltagarna var kvinnor mellan 30–39 år som var sammanboende, hade barn och hade arbetat 1-10 år inom yrket. Majoriteten av deltagarna skattade instämmer inte i alla påståenden förutom "Jag har tillräckligt med tid att göra det jag måste göra", där 58,1% av deltagare skattade instämmer. Deltagare med barn, över 40 år, som bodde med en partner, med en anställningsgrad 80–89% och hade mer erfarenhet i yrket tenderade att rapportera högre nivåer av aktivitetsbalans. Slutsats: Arbetsterapeuterna som arbetar inom hemrehabilitering upplever låg tillfredställelse angående sin aktivitetsbalans, vilket kan påverkas av faktorer som kön, ålder, anställningsgrad, boendesituation och familjesituation. Kvinnor som har fler roller i livet kan uppleva det svårt att upprätthålla en balans mellan arbete och privatliv, vilket kan påverka deras arbetsmiljö och välbefinnande negativt. Uppsatsen kan användas för att utveckla strategier för att förbättra aktivitetsbalansen hos arbetsterapeuter inom hemrehabilitering och därmed förbättra deras arbetsmiljö och välbefinnande. / Aim: To describe how occupational therapists working in home rehabilitation perceive their occupational balance. Method: The study used a survey to describe how occupational therapists working in home rehabilitation perceived their occupational balance. A cross-sectional study was conducted with a quantitative approach and a descriptive focus. The survey consisted of structured questions and clear background questions and was designed based on the Occupational Balance Questionnaire (OBQ11). The sample consisted of licensed occupational therapists in home rehabilitation who had worked for at least one year and had an employment rate of at least 50%. Results: The study examined the self-reported occupational balance of 43 occupational therapists and it´s relationship with sociodemographic factors. The majority of participants were women aged 30-39, living with children, and had worked in the profession for 1-10 years. The majority of participants estimated that they did not agree with all the statements except for "I have enough time to do what I need to do", where 58.1% of participants estimated that they agreed. Participants with children, over 40 years old, living with a partner, working 80-89% of full-time hours, and with more experience in the profession tended to report higher levels of occupational balance. Conclusion: The study shows that occupational therapists working in home rehabilitation experience a low occupational balance, which can be influenced by factors such as gender, age, employment status, living situation and family situation. Women who have multiple roles in life may have difficulty maintaining a balance between work and personal life, which can have negative consequences for their work environment and well-being. The study can be used to develop strategies to improve occupational balance among occupational therapists in home rehabilitation and thus improve their work environment and well-being.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Orientador: Márcia Guimarães da Silva / Resumo: Objetivo: O objetivo do presente estudo foi identificar determinantes do clearance da infecção pelo Papilomavírus Humano (HPV) em mulheres brasileiras em idade reprodutiva. Métodos: Trata-se de estudo de coorte denominado HPV-UNESP, no qual 1638 mulheres em idade reprodutiva foram recrutadas no período de setembro de 2012 e janeiro de 2013. Desse total, 544 mulheres positivas para a infecção pelo HPV participaram do seguimento longitudinal durante 30 meses, em mais 4 visitas. A infecção por HPV foi definida como detecção de qualquer um dos 36 genótipos testados pelo Linear Array Genotyping Test (Roche Molecular Systems, Inc.) e o desfecho de interesse foi o clearance da infecção, definido como a eliminação da infecção pelo HPV por, pelo menos, duas visitas consecutivas. Um questionário estruturado com 58 questões relativas à dados sociodemográficos, características comportamentais e ginecológicas foi aplicado em cada visita. Imediatamente após a entrevista, todas as mulheres realizaram exame ginecológico, no qual, após inserção de espéculo de Collins, não lubrificado, foi aferido o pH vaginal com fita (pH 4.0-7.0, Merck, Germany) no terço médio da parede vaginal. Para avaliação da microbiota vaginal, amostras foram coletadas com swab da parede vaginal e o padrão de microbiota foi classificado de acordo com os critérios de Nugent et al. (1991). O whiff test realizado por adição de solução de 10% de KOH ao conteúdo vaginal foi interpretado como positivo, negativo ou duvidoso. A... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: The objective of the present study was to identify determinants of Human Papillomavirus (HPV) infection clearance in Brazilian women of reproductive age. Methods: This is a cohort study called HPV-UNESP, in which 1638 women of reproductive age were recruited from September 2012 to January 2013. Of this total, 544 women positive for HPV infection participated in longitudinal follow-up for 30 months, in 4 more visits. HPV infection was defined as detection of any of the 36 genotypes tested by the Linear Array Genotyping Test (Roche Molecular Systems, Inc.) and the outcome of interest was infection clearance, defined as the elimination of HPV infection by least two consecutive visits. A structured questionnaire with 58 questions regarding sociodemographic data, behavioral and gynecological characteristics was applied at each visit. Immediately after the interview, all women underwent a gynecological exam, in which, after insertion of the non-lubricated Collins speculum, the vaginal pH with tape (pH 4.0-7.0, Merck, Germany) was measured in the middle third of the vaginal wall. For vaginal microbiota evaluation, samples were collected with vaginal wall swab and the microbiota pattern was classified according to the criteria of Nugent et al. (1991). The whiff test performed by adding 10% KOH solution to the vaginal content was interpreted as positive, negative or doubtful. Endocervical samples were collected with cytobrush for molecular analysis of HPV, Chlamydia trachom... (Complete abstract click electronic access below) / Doutor

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Objetivos: Identificar características da adesão do paciente idoso para que cumpra o tratamento com medicamentos através da construção de uma nova escala. Comparar a escala Morisky, outras escalas e a elaboração de uma nova escala de adesão com variáveis: sexo, idade, saber ler e escrever, freqüentar grupo de idosos, renda, consultas, especialistas, consultas de emergência e internações hospitalares; Analisar se a qualidade de vida interfere nessas variáveis e verificar se a qualidade de vida interfere nas escalas de adesão em estudo. Método: a pesquisa consiste em um estudo transversal, constituindo-se na aplicação de 245 questionários em idosos de Porto Alegre e Bagé. Resultados: do questionário aplicado foram selecionados objetivos para elucidar a adesão: conhecimento dos medicamentos, lembrança do regime terapêutico, apoio para melhoria da adesão e acesso aos serviços de saúde e aos medicamentos. Esses objetivos compõem as escalas Morisky, Adesão 1, Adesão 2 e Hespanha categorizada. Ao se comparar essas escalas com fatores sociodemográficos e as variáveis em questão há significativa associação da escala Adesão 1 com as pessoas que: sabem ler e escrever (p= 0,006), vão a consultas médicas (p= 0,000) e consultas com especialistas (p= 0,020). Ao comparar a escala Morisky com a escala Hespanha categorizada as pessoas que aderem mais são aquelas que consultam, Morisky (n= 164) e Hespanha categorizada (n= 124) e que procuram especialistas, Morisky (n= 177) e Hespanha categorizada (n= 136). Quanto à qualidade de vida, há diferença significativa no domínio global para sexo (p= 0,016), saber ler e escrever (p= 0,002) e consultas de emergência (p= 0,000). Para o domínio físico há diferença significativa em sexo (p= 0,035), saber ler e escrever (p= 0,038) e consultas de emergência (p= 0,007). Para o domínio psicológico há diferença significativa em saber ler e escrever (p= 0,008). Para o domínio meio ambiente, há diferença significativa em saber ler e escrever (p= 0,000), consultas com especialistas (p= 0,047) e consultas de emergência (p= 0,010). Na qualidade de vida comparada às escalas, a adesão foi significativa na escala Adesão 2 para o domínios: global, físico, psicológico e meio ambiente (todos com p= 0,000), e para o domínio relações sociais (p= 0,009). E na escala Hespanha categorizada a adesão foi significativa para o domínio meio ambiente (p= 0,004). Conclusões: os objetivos relacionados afetam a adesão ao tratamento com medicamentos em idosos. Por isso, houve a elaboração da escala Hespanha categorizada. Observa-se que há uma grande relevância quando se trata de saber ler e escrever que pode estar relacionada a questão do letramento em saúde (health literacy). Assim, a compreensão correta das prescrições médicas e uma boa relação médico-paciente fazem com que o indivíduo entenda o porquê de seu seguimento terapêutico. A melhoria da qualidade de vida está pautada principalmente por fatores sociais e ambientais que sustentam os demais domínios. Comprova-se que os fatores de apoio (relações sociais, parentes, amigos) ao idoso melhoram sua qualidade de vida. / Objectives: To identify characteristics of the accession of elderly patients to keep the treatment with medicines through the construction of a new scale. Compare the scale Morisky, other scales and the drafting of a new scale with variables: gender, age, knowing how to read and write, attend group of elderly, income, consultations, specialists, emergency consultations and hospital admissions; Examine whether the quality of life interferes in these variables and see if the quality of life interferes with the scales of membership under study. Method: The study consists of a cross-sectional study, constituted in the implementation of 245 questionnaires in the elderly of Porto Alegre and Bagé. Results: of selected questionnaire was applied to elucidate the membership goals: knowledge of medicines, remembering the therapeutic regimen, support for membership and improving access to health services and medicines. These goals make up the scales Morisky, Accession 1, Accession 2 and Hespanha categorized. While comparing these scales with sociodemographic factors and variables in question there are a combination of scale Accession 1 with people that can read and write (p = 0006), go to medical appointments (p = 0000) and consultations with specialists (p = 0020). By comparing the scale with the scale Morisky Hespanha reduced categorized people who adhere most are those who consult, Morisky (n = 164) and Hespanha categorized (n = 124) and seeking experts, Morisky (n = 177) and Hespanha categorized (n = 136). As for the quality of life, there is a significant difference in total for sex (p = 0016), knowing how to read and write (p = 0002) and emergency consultations (p = 0000). For the physical domain there are significant differences in gender (p = 0035), knowing how to read and write (p = 0038) and emergency consultations (p = 0007). For the psychological field there is a significant difference in learning to read and write (p = 0008). For the domain environment, there is a significant difference in learning to read and write (p = 0000), consultations with specialists (p = 0047) and emergency consultations (p = 0010). The quality of life compared to the scales, the accession was significant in scale Accession 2 for areas: overall physical, psychological and environmental (all with p = 0000), and the field social relations (p = 0009). And in small-scale Hespanha categorized the accession was significant for the field environment (p = 0004). Conclusions: The objectives related affect adherence to treatment with medications in the elderly. Therefore, there was the development of small scale Hespanha categorized. It is observed that there is a very important when it comes to knowing how to read and write may be related to the issue of literacy in health (health literacy). Thus, the correct understanding of medical prescriptions and a good doctor-patient relationship mean that the individual understands the reason for its therapeutic action. The improve the quality of life is guided mainly by social and environmental factors that sustain the other areas. Shows that the factors supporting (social relations, relatives, friends) to the elderly improve their quality of life.

Objetivos: Identificar características da adesão do paciente idoso para que cumpra o tratamento com medicamentos através da construção de uma nova escala. Comparar a escala Morisky, outras escalas e a elaboração de uma nova escala de adesão com variáveis: sexo, idade, saber ler e escrever, freqüentar grupo de idosos, renda, consultas, especialistas, consultas de emergência e internações hospitalares; Analisar se a qualidade de vida interfere nessas variáveis e verificar se a qualidade de vida interfere nas escalas de adesão em estudo. Método: a pesquisa consiste em um estudo transversal, constituindo-se na aplicação de 245 questionários em idosos de Porto Alegre e Bagé. Resultados: do questionário aplicado foram selecionados objetivos para elucidar a adesão: conhecimento dos medicamentos, lembrança do regime terapêutico, apoio para melhoria da adesão e acesso aos serviços de saúde e aos medicamentos. Esses objetivos compõem as escalas Morisky, Adesão 1, Adesão 2 e Hespanha categorizada. Ao se comparar essas escalas com fatores sociodemográficos e as variáveis em questão há significativa associação da escala Adesão 1 com as pessoas que: sabem ler e escrever (p= 0,006), vão a consultas médicas (p= 0,000) e consultas com especialistas (p= 0,020). Ao comparar a escala Morisky com a escala Hespanha categorizada as pessoas que aderem mais são aquelas que consultam, Morisky (n= 164) e Hespanha categorizada (n= 124) e que procuram especialistas, Morisky (n= 177) e Hespanha categorizada (n= 136). Quanto à qualidade de vida, há diferença significativa no domínio global para sexo (p= 0,016), saber ler e escrever (p= 0,002) e consultas de emergência (p= 0,000). Para o domínio físico há diferença significativa em sexo (p= 0,035), saber ler e escrever (p= 0,038) e consultas de emergência (p= 0,007). Para o domínio psicológico há diferença significativa em saber ler e escrever (p= 0,008). Para o domínio meio ambiente, há diferença significativa em saber ler e escrever (p= 0,000), consultas com especialistas (p= 0,047) e consultas de emergência (p= 0,010). Na qualidade de vida comparada às escalas, a adesão foi significativa na escala Adesão 2 para o domínios: global, físico, psicológico e meio ambiente (todos com p= 0,000), e para o domínio relações sociais (p= 0,009). E na escala Hespanha categorizada a adesão foi significativa para o domínio meio ambiente (p= 0,004). Conclusões: os objetivos relacionados afetam a adesão ao tratamento com medicamentos em idosos. Por isso, houve a elaboração da escala Hespanha categorizada. Observa-se que há uma grande relevância quando se trata de saber ler e escrever que pode estar relacionada a questão do letramento em saúde (health literacy). Assim, a compreensão correta das prescrições médicas e uma boa relação médico-paciente fazem com que o indivíduo entenda o porquê de seu seguimento terapêutico. A melhoria da qualidade de vida está pautada principalmente por fatores sociais e ambientais que sustentam os demais domínios. Comprova-se que os fatores de apoio (relações sociais, parentes, amigos) ao idoso melhoram sua qualidade de vida. / Objectives: To identify characteristics of the accession of elderly patients to keep the treatment with medicines through the construction of a new scale. Compare the scale Morisky, other scales and the drafting of a new scale with variables: gender, age, knowing how to read and write, attend group of elderly, income, consultations, specialists, emergency consultations and hospital admissions; Examine whether the quality of life interferes in these variables and see if the quality of life interferes with the scales of membership under study. Method: The study consists of a cross-sectional study, constituted in the implementation of 245 questionnaires in the elderly of Porto Alegre and Bagé. Results: of selected questionnaire was applied to elucidate the membership goals: knowledge of medicines, remembering the therapeutic regimen, support for membership and improving access to health services and medicines. These goals make up the scales Morisky, Accession 1, Accession 2 and Hespanha categorized. While comparing these scales with sociodemographic factors and variables in question there are a combination of scale Accession 1 with people that can read and write (p = 0006), go to medical appointments (p = 0000) and consultations with specialists (p = 0020). By comparing the scale with the scale Morisky Hespanha reduced categorized people who adhere most are those who consult, Morisky (n = 164) and Hespanha categorized (n = 124) and seeking experts, Morisky (n = 177) and Hespanha categorized (n = 136). As for the quality of life, there is a significant difference in total for sex (p = 0016), knowing how to read and write (p = 0002) and emergency consultations (p = 0000). For the physical domain there are significant differences in gender (p = 0035), knowing how to read and write (p = 0038) and emergency consultations (p = 0007). For the psychological field there is a significant difference in learning to read and write (p = 0008). For the domain environment, there is a significant difference in learning to read and write (p = 0000), consultations with specialists (p = 0047) and emergency consultations (p = 0010). The quality of life compared to the scales, the accession was significant in scale Accession 2 for areas: overall physical, psychological and environmental (all with p = 0000), and the field social relations (p = 0009). And in small-scale Hespanha categorized the accession was significant for the field environment (p = 0004). Conclusions: The objectives related affect adherence to treatment with medications in the elderly. Therefore, there was the development of small scale Hespanha categorized. It is observed that there is a very important when it comes to knowing how to read and write may be related to the issue of literacy in health (health literacy). Thus, the correct understanding of medical prescriptions and a good doctor-patient relationship mean that the individual understands the reason for its therapeutic action. The improve the quality of life is guided mainly by social and environmental factors that sustain the other areas. Shows that the factors supporting (social relations, relatives, friends) to the elderly improve their quality of life.

Objetivos: Identificar características da adesão do paciente idoso para que cumpra o tratamento com medicamentos através da construção de uma nova escala. Comparar a escala Morisky, outras escalas e a elaboração de uma nova escala de adesão com variáveis: sexo, idade, saber ler e escrever, freqüentar grupo de idosos, renda, consultas, especialistas, consultas de emergência e internações hospitalares; Analisar se a qualidade de vida interfere nessas variáveis e verificar se a qualidade de vida interfere nas escalas de adesão em estudo. Método: a pesquisa consiste em um estudo transversal, constituindo-se na aplicação de 245 questionários em idosos de Porto Alegre e Bagé. Resultados: do questionário aplicado foram selecionados objetivos para elucidar a adesão: conhecimento dos medicamentos, lembrança do regime terapêutico, apoio para melhoria da adesão e acesso aos serviços de saúde e aos medicamentos. Esses objetivos compõem as escalas Morisky, Adesão 1, Adesão 2 e Hespanha categorizada. Ao se comparar essas escalas com fatores sociodemográficos e as variáveis em questão há significativa associação da escala Adesão 1 com as pessoas que: sabem ler e escrever (p= 0,006), vão a consultas médicas (p= 0,000) e consultas com especialistas (p= 0,020). Ao comparar a escala Morisky com a escala Hespanha categorizada as pessoas que aderem mais são aquelas que consultam, Morisky (n= 164) e Hespanha categorizada (n= 124) e que procuram especialistas, Morisky (n= 177) e Hespanha categorizada (n= 136). Quanto à qualidade de vida, há diferença significativa no domínio global para sexo (p= 0,016), saber ler e escrever (p= 0,002) e consultas de emergência (p= 0,000). Para o domínio físico há diferença significativa em sexo (p= 0,035), saber ler e escrever (p= 0,038) e consultas de emergência (p= 0,007). Para o domínio psicológico há diferença significativa em saber ler e escrever (p= 0,008). Para o domínio meio ambiente, há diferença significativa em saber ler e escrever (p= 0,000), consultas com especialistas (p= 0,047) e consultas de emergência (p= 0,010). Na qualidade de vida comparada às escalas, a adesão foi significativa na escala Adesão 2 para o domínios: global, físico, psicológico e meio ambiente (todos com p= 0,000), e para o domínio relações sociais (p= 0,009). E na escala Hespanha categorizada a adesão foi significativa para o domínio meio ambiente (p= 0,004). Conclusões: os objetivos relacionados afetam a adesão ao tratamento com medicamentos em idosos. Por isso, houve a elaboração da escala Hespanha categorizada. Observa-se que há uma grande relevância quando se trata de saber ler e escrever que pode estar relacionada a questão do letramento em saúde (health literacy). Assim, a compreensão correta das prescrições médicas e uma boa relação médico-paciente fazem com que o indivíduo entenda o porquê de seu seguimento terapêutico. A melhoria da qualidade de vida está pautada principalmente por fatores sociais e ambientais que sustentam os demais domínios. Comprova-se que os fatores de apoio (relações sociais, parentes, amigos) ao idoso melhoram sua qualidade de vida. / Objectives: To identify characteristics of the accession of elderly patients to keep the treatment with medicines through the construction of a new scale. Compare the scale Morisky, other scales and the drafting of a new scale with variables: gender, age, knowing how to read and write, attend group of elderly, income, consultations, specialists, emergency consultations and hospital admissions; Examine whether the quality of life interferes in these variables and see if the quality of life interferes with the scales of membership under study. Method: The study consists of a cross-sectional study, constituted in the implementation of 245 questionnaires in the elderly of Porto Alegre and Bagé. Results: of selected questionnaire was applied to elucidate the membership goals: knowledge of medicines, remembering the therapeutic regimen, support for membership and improving access to health services and medicines. These goals make up the scales Morisky, Accession 1, Accession 2 and Hespanha categorized. While comparing these scales with sociodemographic factors and variables in question there are a combination of scale Accession 1 with people that can read and write (p = 0006), go to medical appointments (p = 0000) and consultations with specialists (p = 0020). By comparing the scale with the scale Morisky Hespanha reduced categorized people who adhere most are those who consult, Morisky (n = 164) and Hespanha categorized (n = 124) and seeking experts, Morisky (n = 177) and Hespanha categorized (n = 136). As for the quality of life, there is a significant difference in total for sex (p = 0016), knowing how to read and write (p = 0002) and emergency consultations (p = 0000). For the physical domain there are significant differences in gender (p = 0035), knowing how to read and write (p = 0038) and emergency consultations (p = 0007). For the psychological field there is a significant difference in learning to read and write (p = 0008). For the domain environment, there is a significant difference in learning to read and write (p = 0000), consultations with specialists (p = 0047) and emergency consultations (p = 0010). The quality of life compared to the scales, the accession was significant in scale Accession 2 for areas: overall physical, psychological and environmental (all with p = 0000), and the field social relations (p = 0009). And in small-scale Hespanha categorized the accession was significant for the field environment (p = 0004). Conclusions: The objectives related affect adherence to treatment with medications in the elderly. Therefore, there was the development of small scale Hespanha categorized. It is observed that there is a very important when it comes to knowing how to read and write may be related to the issue of literacy in health (health literacy). Thus, the correct understanding of medical prescriptions and a good doctor-patient relationship mean that the individual understands the reason for its therapeutic action. The improve the quality of life is guided mainly by social and environmental factors that sustain the other areas. Shows that the factors supporting (social relations, relatives, friends) to the elderly improve their quality of life.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2018-02-28T13:56:33Z No. of bitstreams: 1 walteiralvesmagalhaes.pdf: 950220 bytes, checksum: f2e36568b6b0b6ec44556a8420eed1a6 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-03-01T15:57:36Z (GMT) No. of bitstreams: 1 walteiralvesmagalhaes.pdf: 950220 bytes, checksum: f2e36568b6b0b6ec44556a8420eed1a6 (MD5) / Made available in DSpace on 2018-03-01T15:57:36Z (GMT). No. of bitstreams: 1 walteiralvesmagalhaes.pdf: 950220 bytes, checksum: f2e36568b6b0b6ec44556a8420eed1a6 (MD5) Previous issue date: 2015-03-25 / PROQUALI (UFJF) / A Hanseníase é uma doença causada pelo bacilo Mycobacterium leprae. É considerada um problema de Saúde Pública devido ao seu poder incapacitante, atingindo, principalmente, a faixa etária economicamente ativa. Esta pesquisa teve por objetivo descrever o perfil epidemiológico e o grau de incapacidade em casos novos notificados de Hanseníase no período de 2007 a 2013 em Governador Valadares, Minas Gerais, Brasil. Trata-se de um estudo observacional, descritivo, de corte transversal, que utiliza uma abordagem quantitativa. A amostra foi constituída por 986 casos notificados com Hanseníase no referido município. Foram incluídos todos os registros de casos novos, encontrados entre o período de 2007 e 2013, e excluídos os registros detectados com erro de diagnóstico no momento da investigação. As variáveis sociodemográficas utilizadas foram: Ano de notificação; Gênero; Faixa etária; Escolaridade; Local de residência. As clínico-epidemiológicas foram: Número de lesões; Forma Clínica; Classificação operacional no diagnóstico e na cura; Grau de incapacidade no diagnóstico e na cura; modo de entrada; modo de saída. Para análise um banco de dados foi estruturado a partir do programa estatístico Epiinfo, versão 6.0. Como resultado obteve-se que os aspectos sociodemográficos dos casos notificados com Hanseníase no período determinado revelam uma população de indivíduos adultos (85.6%) acima de 20 anos, com equilíbrio entre o gênero feminino e masculino ambos 50%, pardos (42.1%), predomínio de baixa escolaridade (fundamental I, 24.2% e fundamental II, 23.4%) e provenientes da região urbana do município estudado (94.2%). Em relação às características clínico-epidemiológicas houve predomínio da forma clínica Tuberculóide (38.2%), destaca-se também a presença da forma clínica Dimorfa (34.2%). A classificação operacional paucibacilar teve o diagnóstico clínico identificado em 53.9% dos casos. Verificou-se que ocorreu um maior número de detecção de casos novos/ entrada (87.6%) do que alta por cura (72.1%). Foram identificados entre os casos notificados de Hanseníase os três tipos de grau de incapacidade física (Grau zero, I e II). Entretanto, o Grau zero foi o mais frequente (79,7%). Esses casos em geral, apresentaram baixa predominância de incapacidade física quando da admissão para o esquema terapêutico. Os graus de incapacidades físicas dos casos notificados nos dois momentos (notificação e alta por cura) foram considerados baixos, mantendo abaixo de 15%. Conclui-se que o município estudado parece possuir serviços de saúde eficientes em realizar o diagnóstico precoce da doença, pois apresentou baixos percentuais de casos com incapacidades físicas. Além de prevenir a ocorrência de novos casos da doença, há outro grande desafio a ser enfrentado na prevenção do desenvolvimento/agravamento das incapacidades a fim de minimizar os impactos negativos da doença. / Leprosy is a disease caused by the bacillus Mycobacterium leprae. It is considered a public health problem due to its disabling power, reaching mainly the economically active age group. This research aimed to describe the epidemiological profile and the degree of disability in new cases reported of Leprosy in the period 2007 to 2013 in Governador Valadares, Minas Gerais, Brazil. This is an observational, descriptive, cross-sectional, using a quantitative approach. The sample consisted of 986 reported cases of leprosy in the municipality. We included all the new cases of records, found between the period 2007 and 2013 and excluded the records detected with diagnostic error at the time of investigation. The sociodemographic variables were: Year of notification; gender; Age; education; Place of residence. The clinical and epidemiological were: Clinical form; Operational classification for diagnosis and cure; Degree of disability in the diagnosis and cure; input mode; output mode. To analyze a database was structured by the statistical program Epiinfo, version 6.0. A descriptive analysis of data was performed. As a result was obtained that the sociodemographic aspects of the reported cases with leprosy in the given period reveal a population of adults (85.6%) over 20 years, with balance between males and females both 50%, mulatto (42.1%), low education predominance (elementary school level I, 24.2% and elementary school II, 23.4%) and from the urban area of the city studied (94.2%). Regarding the clinical and epidemiological there was a predominance of clinical Tuberculoid (38.2%), also stands out the presence of the clinical form Dimorph (34.2%). The paucibacillary operational classification was the clinical diagnosis identified with the highest percentage (53.9%). It has been found that a higher number of new cases detected / input (87.6%) than for high cure (72.1%). Were identified among the reported cases of leprosy the three types of physical disability (zero, I and II degree). However, the zero degree was the most frequent (79.7%). These cases generally had lower prevalence of disability at admission to the treatment regimen. The degrees of physical disabilities of cases reported in the two periods (notification and high cure) were considered low, keeping below 15%. It is concluded that the city studied seems to have efficient health services to perform early diagnosis of the disease, it showed low percentage of cases with physical disabilities. In addition to preventing the occurrence of new cases of the disease, there is another major challenge to be faced in preventing the development / worsening of disabilities in order to minimize the negative impacts of the disease.

Abstract The objective of this study was to investigate intellectual disability (ID) in children, with focus on occurrence, associated biomedical and sociodemographic factors, probable psychiatric problems and temporal variations in the occurrence of ID and the associated factors in an interval of 20 years. The study population consisted of two birth cohorts of children born in northern Finland, the Northern Finland Birth Cohort 1986 (NFBC 1986, N = 9,432 live-born children) and the Northern Finland Birth Cohort 1966 (NFBC 1966, N = 12,058 live-born children). Temporal changes in ID were studied by comparing NFBC 1986 with NFBC 1966. The same definition of intellectual disability (intelligence quotient ≤70), time of follow-up (up to 11.5 years), case ascertainment methods and data sources were used. Data were collected from questionnaires, registers and records. In NFBC 1986 the incidence of ID was 12.62/1,000 by age 11.5 years and prevalence 11.23/1,000 live-born at age 11.5 years. Associated biomedical aetiology could be found in two thirds of the cases. Genetic disorders were the largest aetiological category (36.1%) associated with ID. Maternal disadvantage (unskilled worker, basic education only) had the largest impact on the incidence of ID, while among single independent factors, maternal prepregnancy obesity (body mass index ≥30) showed the highest risk for ID (OR 2.8, 95% CI 1.5, 5.3) in the offspring. According to the assessments by the teachers at school children with ID had 4.9 times more likely probable behavioural problems than their peers not having ID. In an interval of 20 years, there was no change in the incidence or in the prevalence of ID between NFBC 1986 and NFBC 1966. However, a shift occurred from more severe levels of ID towards mild ID, so that both the incidence and prevalence of mild ID increased by 50% whereas more severe ID decreased by 50%. Temporal changes appeared in the proportions of aetiological categories (NFBC 1986 vs. NFBC 1966) with a statistically significant decrease of Down syndrome and paranatally originating causes (traumas/asphyxia). The proportion of chromosomal disorders other than Down syndrome increased, as did malformations of the central nervous system. Among sociodemographic factors associated with ID, indicators of socio-economic disadvantage retained their status as having the largest impact on the incidence of ID. Over the 20 years, the mother being single, living in a remote area and mother's older age at time of delivery had lost their association with ID. Only one new maternal sociodemographic factor, prepregnancy obesity, had emerged as having an association with ID with a statistically significant difference between NFBC 1986 and NFBC 1966. In conclusion, these results indicate that although the occurrence of ID remained the same in northern Finland over a period of 20 years, temporal changes have taken place in the biomedical and sociodemographic factors contributing to the incidence and prevalence of ID. There are also factors that have retained their status as associated disadvantageous factors. Studies like this with repeatedly collected data in the same geographical area, describing the occurrence of ID, and analysing associated biomedical and sociodemographic factors, are valuable for evaluating developments in the health care and service system. They are also of value for future planning of services for individuals with ID. / Tiivistelmä Tämän tutkimuksen tavoitteena oli selvittää kehitysvammaisuuden esiintyvyyttä lapsilla, siihen liittyviä lääketieteellisiä etiologisia ja sosiodemografisia tekijöitä, mahdollisia psykiatrisia ongelmia sekä kehitysvammaisuuden esiintyvyydessä ja siihen liittyvissä tekijöissä tapahtuneita muutoksia 20 vuoden aikana. Tutkimusjoukko muodostui kahden syntymäkohortin lapsista, jotka olivat syntyneet Pohjois-Suomessa, Pohjois-Suomen syntymäkohortti 1986 (NFBC 1986, N = 9432 elävänä syntynyttä lasta) ja Pohjois-Suomen syntymäkohortti 1966 (NFBC 1966, N = 12058 elävänä syntynyttä lasta). Kehitysvammaisuudessa tapahtuneita ajallisia muutoksia tutkittiin vertaamalla Pohjois-Suomen syntymäkohortti 1986:ta Pohjois-Suomen syntymäkohortti 1966:een. Tutkimuksessa käytettiin samaa kehitysvammaisuuden määritelmää (älykkyysosamäärä ≤70, seuranta-aika 11.5 vuoteen saakka), tiedonkeruun menetelmiä ja tietolähteitä. Tiedot kerättiin kyselylomakkeista, rekistereistä ja asiakirjoista. Pohjois-Suomen syntymäkohortti 1986:ssa kehitysvammaisuuden ilmaantuvuus oli 12.62/1000 11.5 vuoden ikään mennessä ja vallitsevuus 11.23/1000 11.5 vuoden iässä. Kehitysvammaisuuteen liittyvä lääketieteellinen etiologia pystyttiin selvittämään kahdessa kolmasosassa tapauksia. Geneettiset häiriöt muodostivat suurimman etiologisen luokan (36.1%). äitiin liittyvillä epäedullisilla sosiaalisilla tekijöillä (kouluttamaton työntekijä, vain peruskoulutus) oli suurin vaikutus kehitysvammaisuuden ilmaantuvuuteen, kun taas yksittäisistä sosiodemografisista tekijöistä korkein riski (vaarasuhde 2.8, luottamusväli 1.5, 5.3) oli äidin lihavuudella (painoindeksi ≥30) raskauden alussa. Koulussa opettajien arvioiden mukaan kehitysvammaisilla lapsilla esiintyi mahdollisia käytöshäiriöitä 4.9 kertaa useammin kuin ei-kehitysvammaisilla lapsilla. 20 vuoden aikana Pohjois-Suomen syntymäkohorttien 1986 ja 1966 välillä ei ollut tapahtunut muutoksia kehitysvammaisuuden kokonaisilmaantuvuudessa eikä -vallitsevuudessa. Kuitenkin tuli esiin siirtymä vaikeammasta lievempään asteeseen siten, etta lievän kehitysvammaisuuden ilmaantuvuus ja vallitsevuus lisääntyivät noin 50%, kun taas vaikeamman väheni 50%. Lääketieteellisten etiologisten luokkien osuuksissa tuli esiin ajallisia muutoksia (Pohjois-Suomen syntymäkohortti 1986 vs. Pohjois-Suomen syntymäkohortti 1966) siten, että Downin syndrooman sekä syntymän aikaan ajoittuvan vamman ja hapenpuutteen osuudet vähenivät tilastollisesti merkitsevästi. Keskushermoston epämuodostumien sekä muiden kromosomihäiriöiden kuin Downin syndrooman osuudet kasvoivat. Kehitysvammaisuuteen liittyvistä sosiodemografisista tekijöistä sosioekonomisen huono-osaisuuden osoittimet säilyttivät asemansa suurimpana ryhmänä. 20 vuoden aikana äidin naimattomuus, asuminen syrjäseudulla sekä korkeampi ikä lapsen syntymän aikaan olivat menettäneet yhteytensä kehitysvammaisuuteen. Pohjois-Suomen syntymäkohortti 1986:n ja Pohjois-Suomen syntymäkohortti 1966:n välillä tuli esiin vain yksi uusi kehitysvammaisuuteen tilastollisesti merkitsevästi liittyvä sosiodemografinen tekijä, äidin lihavuus raskauden alussa. Yhteevetona voidaan todeta, etta vaikka kehitysvammaisuuden kokonaisesiintyvyys oli pysynyt samana Pohjois-Suomessa 20 vuoden aikana niin esiintyvyyteen liittyvät etiologiset ja sosiodemografiset tekijät olivat osittain muuttuneet. Tämänkaltaiset tutkimukset, joissa peräkkäisinä ajanjaksoina kerätään tietoja samalla maantieteellisellä alueella ja jotka kuvaavat kehitysvammaisuuden esiintyvyyttä sekä analysoivat siihen liittyviä lääketieteellisiä ja sosiodemografisia tekijoitä, ovat hyödyllisiä arvioitaessa terveydenhoidossa ja palvelujärjestelmässä tapahtunutta kehitystä. Niitä voidaan hyödyntää myös suunniteltaessa tulevaisuudessa palveluja kehitysvammaisille henkilöille.