Objetivo: A hipertensão arterial constitui o principal fator de risco modificável para as doenças cardiovasculares e a maioria dos hipertensos necessitará de medicamento para controlar a pressão. Este estudo analisa a prevalência da hipertensão arterial referida e a utilização de anti-hipertensivos por adultos do município de São Paulo de acordo com variáveis socioeconômicas e demográficas. Métodos: Análise de dados do Inquérito de Saúde no Município de São Paulo – ISA Capital, estudo transversal, de base populacional conduzido em 2003 que possui 1668 adultos com 20 anos ou mais. Para investigar a distribuição das principais classes de anti-hipertensivos, utilização de genérico, forma de obtenção e custeio utilizou-se de um recordatório de três dias. Resultados: A prevalência de hipertensão referida foi de 16,9%, sendo maior nos indivíduos com idade mais avançada, menor escolaridade e sem ocupação. Entre os que referiam hipertensão, a prevalência do consumo de anti-hipertensivo nos três dias que antecederam a entrevista foi de 73,1%. Dos indivíduos que consumiram anti-hipertensivos 38,3% obtiveram o medicamento através do SUS e 35,3% utilizaram genéricos. As principais classes consumidas em monoterapia foram: inibidores da enzima conversora de angiotensina – IECA (41,9%) e diuréticos (24,6%). As principais associações foram: IECA + diurético (36,0%) e diurético + betabloqueador (22,3%). Conclusões: A hipertensão arterial referida se distribui de maneira desigual entre diferentes subgrupos da população. No acesso a medicamento anti-hipertensivo o SUS consegue promover equidade no fornecimento dessas drogas para a população mais desfavorecida. As classes consumidas não estão totalmente de acordo com as diretrizes de hipertensão. / Objective: Hypertension is the major modifiable risk factor for cardiovascular diseases and most of hypertensive patients will require medication for the control of blood pressure. This study analyses the prevalence of self-reported hypertension and the utilization of antihypertensive agents by adults in São Paulo City, Brazil, according to socioeconomic and demographic variables. Methods: Analysis of data from the Health Survey of São Paulo City – ISA Capital, a cross-sectional, population-based survey conducted in 2003 with 1668 adults aged 20 years or over. To investigate the distribution of the main antihypertensive drug classes, utilization of generic drugs and information about how the drugs were obtained, individuals who self-reported hypertension were asked about any drug use for high blood pressure in the previous three days. Results: The prevalence of self-reported hypertension was 16.9%. Advanced age, lower education and not having a job were independently associated with hypertension. The consumption of antihypertensive drugs was 73.1%. Among those who took antihypertensive drugs 38.3% and 35.3%, respectively, obtained the medication from the Brazilian Public Health System (SUS) and used generics. Angiotensin-converting enzyme inhibitors (ACEi) (41.9%) and diuretics (24.6%) were the most used drugs utilized as monotherapy and the most used combinations were ACEi + diuretics (36.0%) and diuretics + beta-blockers (22.3%). Conclusions: The distribution of self-reported hypertension is not equal among different subgroups of the population. The equity in the delivery of antihypertensive drugs is an important component of treatment and control of hypertension and the SUS could perform it to the less advantaged people. The classes consumed do not agree fully with the hypertension guidelines.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / There has been a tremendous influx in the number of Hispanic immigrants into the US over the past couple of decades. Many newcomers have families with small children, and dental needs in this pediatric population are disproportionately high. The purpose of this study was to determine if there was any correlation between the increased prevalence of caries and socioeconomic or cultural factors in Hispanic children ages six months to eight years old. To accomplish this, 127 children were given dental examinations by a calibrated dental examiner, and their parents completed a two-page questionnaire with questions regarding socioeconomic factors, den1ographics, and cultural issues. The bivariate relation between caries status and demographic and cultural variables was examined using chi-square tests or Fisher's exact tests for categorical variables and logistic regression for continuous variables. Bivariate relation between defs and demographic and cultural variables was examined using analysis of variance (ANOVA). The mean defs for children up to age two was 1.53; ages two to five the mean defs was 7.73, and for ages six to eight, 9.18. As the prevalence of caries increases with age, the child is more likely to access dental care, but despite this, there is an overall mean 79 percent of untreated decay (of decayed, missing and filled surfaces). In the permanent dentition, the overall mean DMFS was found to be 2.22. There were several factors found to be statistically significant to the incidence of defs. If the child had dental insurance, the child was more likely to have higher defs. If a child had more siblings, the defs score was higher. If the child was on the bottle at less than age one-and-a-half, the child was less likely to have dental caries. If the child on the bottle was older than age one-and-a-half, the child was much more likely to have dental caries. The older the child is when the child goes off the bottle, the more likely the child will have a higher caries experience. There is an extraordinarily large number of untreated caries found in Hispanic children. The reasons for this are multifactorial, but involve cost, language barriers, being new to the area, and not having seen a dentist yet. Identifying those at high risk such as single mothers, those with increased numbers of siblings, and infants that are still on the bottle, or older children that are at increased jeopardy due to prolonged use of the bottle are important factors in treating those that are underserved. Local dental and community organizations could benefit from being apprised of the unmet dental need of Hispanic children and some of the contributing factors. By further investigating and understanding some of the socioeconomic and cultural issues that present barriers to care, treatment might become more accessible and available. Adverse outcomes such as missed school and opportunities for acculturation, inadequate nutrition, pain, and infection might be avoided or diminished.

During their lifetime, Black/African Americans have a higher likelihood of developing the diabetes mellitus metabolic disorder than other racial and ethnic groups in the United States. While research indicates that socioeconomic status, diet, and obesity factor into race disparities, the epigenetics field additionally identifies historical and contemporary racism as contributors to race disparities. This study is a qualitative analysis that examines a sample of health science research articles that use an epigenetics approach to understand diabetes among Black/African Americans. I analyzed the extent and mechanisms through which articles subtly reproduce dominant stereotypes of Black/African Americans and diabetes through representations of culture, diet, and sugar consumption, among other factors. Moreover, our analysis shows how these articles recreate new scripts that view biological differences as a product of historical and ongoing racism. The result of this analysis indicates three categories: 1) presentations of race as a social construction and racism as a cause of biological outcomes; 2) utilization of cultural perspectives that reify racial categories and point to social environments within households/neighborhoods and diet as a cause; 3) advocating for a multidisciplinary approach in medicine to foster collaborative change within minority communities. These results further emphasize the importance for sociologists and other research scholars to become more educated in the field of epigenetics. Furthermore, by becoming more educated on epigenetics, this can allow sociologists to further contribute to the field.

Fire incidents are a central issue in Saudi civil defence. Despite detailed regulation concerning firefighting equipment dealing with dwelling fires, fires occur frequently. Globally, research on dwelling fire safety is relatively new. Most studies focus on human factors, incidence and causal issues. Few studies examine management or policy-making perspectives towards managing these individual agents. Thus, a detailed study on understanding the management of these factors for dwelling fires is long overdue. The study uses an inductive approach to investigate key management issues in reducing dwelling fires in Saudi Arabia. This qualitative study consisted of twelve indepth semi-structured interviews and four focus groups with senior managers of the Civil Defence Division dealing with fire safety. A sustainability-based framework is developed to map the critical issues in generating a long-term planning solution to policy and management of fire hazard and risk in Saudi Arabia. Critical drivers of this sustainability approach are good management, regulation, governance practices: especially accountability and transparency; reduction of tribalism, bureaucracy, and burns unit efficiency. However, given the modern environment of communications, information technology and communications, and in particular public education, are viewed as important mediators between drivers and sustainability. The critical role of knowledge generation is also positioned as a mediator. The framework proposed is a paradigm shift from merely managing fire incidents on a case by case basis to a proactive risk reduction strategy. This represents an original solution to managing fire hazards at a national level and an important contribution to the fire management literature.

Diabetes is a critical public health concern with considerable financial and personal costs in the United States. Research has identified several interventions available to primary care providers to prevent diabetes. These interventions may prevent diabetes by influencing personal, community, and public health policy factors. These factors are key components of the social ecological model, which examines the influence of diverse social influences on health. Therefore, the purpose of this study was to determine the univariate relationship between PCP density and diabetes prevalence, as well as the multivariate relationship between PCP density and diabetes prevalence with physical inactivity prevalence, obesity prevalence, and social vulnerability scores held constant. This study also accounted for state-level differences in diabetes prevalence through fixed-level state effects. The initial univariate analysis yielded no significant relationship. The final multivariate regression yielded a statistically significant relationship in a model that better fit the data—as seen by p values <0.001 and information criteria decreases from 12,538.67 to 11,099.72 (AIC) and 12,538.67 to 11,099.72 (BIC). In this final multivariate regression, a 1% increase in primary care provider density was associated with a 0.0019% decrease in diabetes prevalence. Meanwhile, a 1%- or 1-point increase in physical inactivity prevalence, obesity prevalence, and social vulnerability scores led to 0.20%, 0.06%, and 0.14% increases in diabetes prevalence respectively. These findings highlight the value of social ecological factors in diabetes research, as well as the increased need for evidence-based diabetes prevention in primary care, including strategies that target personal, community, and public health policy factors related to diabetes.

El presente trabajo de investigación tuvo como objetivo general “Analizar si los factores socioeconómicos influyen en el comportamiento tributario de los comerciantes de abarrotes del mercado modelo de Lambayeque del año 2022”. Según Ríos (2016) señala que el comportamiento tributario se conforma como un sistema de valores y normas que tienen las personas y estos son los factores que guían el comportamiento de las personas en el ámbito tributario. Es por eso que, ha sido necesario emplear una metodología con enfoque cuantitativo, de tipo aplicada y el diseño descriptivo. Con respecto el diseño es no experimental. Para el levantamiento de información se requiere elaborar una encuesta, por medio del instrumento de un cuestionario. Con referencia a lo mencionado se han tomado 2 variables, la variable dependiente es comportamiento tributario y la variable independiente es factores socioeconómicos. / The present research work had the general objective of "Analyzing whether socioeconomic factors influence the tax behavior of grocery merchants in the Lambayeque model market of the year 2022". According to Ríos (2016) he points out that tax behavior is formed as a system of values and norms that people have and that these are the ones that drive their actions in the payment of taxes. That is why, it has been necessary to use a methodology with a quantitative approach, of an applied type and a descriptive design. Regarding the design is non-experimental. For the collection of information it is required to elaborate a survey, through the instrument of a questionnaire. With reference to the aforementioned, 2 variables have been taken, the dependent variable is tax behavior and the independent variable is socioeconomic factors.

La investigación tuvo como propósito determinar los factores socioeconómicos que influyen en las contingencias tributarias de los comerciantes del centro comercial Feria Balta de Chiclayo, la investigación fue abordada bajo un enfoque cualitativo, de nivel descriptivo, con diseño no experimental. La muestra fue 100 comerciantes, se utilizó como técnica la encuesta y como instrumento una ficha de encuesta. Se obtuvo como resultado, que en el factor social a nivel cultural y desempleo influyen de manera significante a un 38% sobre las contingencias tributarias, también los factores económicos influyen significativamente en un 36% sobre las contingencias tributarias debido que no emiten comprobantes de pago con el propósito de evitar pagar elevadas sumas de impuestos. Se concluye que muchos de los comerciantes de manera voluntaria incumplen con las normas tributarias y con el pago correcto de las obligaciones tributarias, también debido a la desinformación en temas tributarios. / The purpose of the research was to determine the socioeconomic factors that influence the tax contingencies of the merchants of the Balta Fair Shopping Center in Chiclayo, the research was approached under a qualitative, descriptive approach, with a non-experimental design. The sample was 100 merchants, the survey was used as a technique and a survey form was used as an instrument. The results showed that the social factor at the cultural level and unemployment have a significant influence of 38% on the tax contingencies, also the economic factors have a significant influence of 36% on the tax contingencies due to the fact that they do not issue payment receipts in order to avoid paying high amounts of taxes. It is concluded that many of the merchants voluntarily fail to comply with tax regulations and with the correct payment of tax obligations, also due to misinformation on tax issues.

Introdução: A medida da qualidade de vida relacionada à saúde vem se tornando um modelo importante de avaliação em muitos estudos clínicos. Especial consideração deve ser dada à doença cerebrovascular por ser freqüente e de graves conseqüências físicas, sociais, familiares e econômicas. No Brasil não dispomos de um instrumento específico de avaliação da qualidade de vida validado para uso em pacientes com doença cerebrovascular isquêmica. Este estudo avaliou as medidas psicométricas do instrumento de avaliação da qualidade de vida específico para a doença cerebrovascular do tipo isquêmico, adaptado transculturalmente para a língua portuguesa (Stroke specific quality of life scale, SS-QOL). Metodologia: Foram avaliados 50 pacientes com história de doença cerebrovascular do tipo isquêmico, com idade superior a 45 anos e com evolução clínica superior a 3 meses da data do íctus, assistidos no Centro Catarinense de Reabilitação em Florianópolis, Santa Catarina. O instrumento SS-QOL foi aplicado em duas entrevistas com intervalo médio, entre elas, de 2 a 4 semanas. Paralelo a esta medida, foram aplicados, na primeira entrevista, os instrumentos: índice Barthel, inventário de depressão de Beck, escala de doença cerebrovascular do Instituto Nacional de Saúde dos Estados Unidos da América (NIHSS) e o estudo de resultados médicos - versão curta de 36 itens (SF-36). A avaliação da confiabilidade (estabilidade e consistência interna) do SS-QOL foi testada por meio da análise do coeficiente de confiabilidade, com o modelo teste-reteste, e do valor alfa de Cronbach. A validação do constructo e de critério foi estabelecida através da correlação linear entre os resultados obtidos para cada domínio e os resultados obtidos nas medidas escolhidas como padrão ouro para aquele domínio medido pelo coeficiente de correlação de Pearson (r). A capacidade discriminativa do constructo foi testada comparando o escore médio do SS-QOL entre os pacientes que referiam alteração da qualidade de vida e os pacientes que não referiram alteração da qualidade de vida em relação à época antes do infarto cerebral. Ela também foi avaliada comparando o escore médio do SS-QOL em relação à gravidade clínica da doença medida pela escala NIHSS e pelo grau de incapacidade funcional avaliado pela escala de Rankin modificado. Resultados: O SS-QOL, versão para a língua portuguesa, apresentou boa aceitabilidade, não tendo informações perdidas nem porcentagem aumentada de respostas com efeito teto ou solo. A confiabilidade do instrumento foi considerada excelente, com coeficiente de correlação intraclasse de 0,95 (p < 0,001) e o valor alfa de Cronbach de 0,98 (p < 0,001). O grau de correlação linear dos domínios do SS-QOL com as demais medidas escolhidas para cada domínio foi considerado de razoável a moderadamente elevado, com valor de r variando de 0,42 a 0,91 (p < 0,01). O SS-QOL mostrou capacidade discriminativa adequada ao detectar diferenças estatisticamente significantes no escore médio dos pacientes que referiram alteração da qualidade de vida e dos que não alegaram alteração da qualidade de vida em relação a antes de a doença ter ocorrido e no escore médio dos pacientes com doença considerada leve em relação aos pacientes com doença considerada moderada (p < 0,001). A análise de variância revelou diferenças estatisticamente significantes no escore médio dos pacientes estratificados pelo grau de incapacidade funcional (p < 0,01). Conclusão: O SS-QOL, adaptado para a língua portuguesa, apresentou medidas psicométricas consideradas satisfatórias, estando adequado para a utilização como uma ferramenta de avaliação da qualidade de vida em pacientes com doença cerebrovascular na prática médica diária ou em estudos clínicos. / Introduction: Measurement of health related quality of life has become an important evaluation model in many clinical studies. Special consideration must be given to the cerebrovascular disease because it is frequent and has serious physical, social, familial and economic consequences. We do not have, in Brazil, a specific instrument to evaluate health related quality of life validated for stroke patients. This study evaluates psychometric measures of the stroke specific quality of life scale cross-culturally adapted to Portuguese language (SS-QOL). Methodology: We evaluated 50 stroke patients, admitted to the Centro Catarinense de Reabilitação in Florianópolis, Santa Catarina, older than 45 years old with time of lesion superior to 3 months. The SS-QOL was applied in two interviews with average interval, between them, of 2 to 4 weeks. Parallel to the instrument, we applied, in the first interview, the Barthel index, Beck depression inventory, National Institute of Health stroke scale (NIHSS) and the Medical outcome study - short version of 36 items (SF-36). The SS-QOL reliability evaluation (stability and internal consistency) was tested with the analysis of the stability coefficient with test-retest model, and the Cronbach?s alpha value. The construct and criterion validation was established by comparing the linear correlation between the results for each domain and the results of the chosen gold standard measures for that domain measured with Pearson correlation coefficient (r). The discriminant capacity was tested comparing the SS-QOL mean scores of patients who referred changes in the quality of life and those that did not refer it in relation to the prestroke period. It was also evaluated comparing the SS-QOL mean score in relation to disease clinical gravity measured with the NIHSS and the degree of functional incapacity evaluated by Rankin modified scale. Results: The SS-QOL, Portuguese language version has good acceptability. It does not have missing data or increased percentage of ceiling or floor effect. The stability was considered excellent with intraclass correlation coefficient of 0,95 (p < 0.001) and the Cronbach?s alpha value of 0,98 (p < 0,001). The degree of linear correlation of the SS-QOL domains with the chosen measures for each domain was considered reasonable to moderately high with r values varying from 0,42 to 0.91 (p < 0,01). The SS-QOL presented suitable discriminant capacity detecting differences, statistically significant, in the mean score of patients who had referred changes in the quality of life and those that did not refer it in relation to the prestroke period and in the mean score of patients with mild stroke and those with moderate stroke. The variance analysis showed statistically significant differences in the mean score of patients stratified by the functional incapacity degree (p < 0.01). Conclusion: The SS-QOL, adapted to Portuguese language, had psychometric measures considered satisfactory. It is suitable to use as a tool of quality of life evaluation in patients with stroke in the daily clinical practice or clinical studies.

Introdução: A caracterização dos padrões alimentares dos adolescentes permite analisar os efeitos da dieta como um todo sobre a saúde. Objetivos: Identificar na literatura científica as múltiplas soluções adotadas nas técnicas multivariadas para obtenção de padrões alimentares; Analisar a relação entre os principais padrões alimentares praticados por adolescentes brasileiros com o excesso de peso e obesidade e Analisar a influência de fatores socioeconômicos sobre os principais padrões alimentares praticados por um grupo multiétnico de adolescentes. Métodos: Esta tese foi composta de três artigos. O primeiro corresponde a uma revisão da literatura sobre padrões alimentares estimados por diferentes técnicas multivariadas. Para os demais artigos duas bases de dados foram utilizadas: a Pesquisa de Orçamentos Familiares (POF) de 2008 09 e o estudo Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) conduzido em 2006-07. A análise fatorial exploratória foi utilizada para obtenção dos padrões alimentares. O segundo artigo utilizou modelo de regressão logística para verificar a associação entre os escores dos padrões alimentares e o excesso de peso e obesidade ajustado para variáveis socioeconômicas. O terceiro artigo utilizou o modelo de regressão linear para avaliar a associação entre indicadores de renda e escolaridade e os escores dos padrões alimentares. Resultados: Na revisão da literatura foi verificado grande heterogeneidade na escolha dos critérios adotados durante as múltiplas etapas das técnicas multivariadas. No segundo manuscrito, foi verificado que quanto maior a adesão ao Padrão Lanches e ao Padrão Snacks maior a chance de estar com excesso de peso e obesidade. No terceiro manuscrito, 10 padrões alimentares foram identificados entre adolescentes de áreas urbanas no Brasil e Europa. Entre os adolescentes brasileiros, maiores níveis socioeconômicos e educacionais da pessoa de referência do domicílio foram associados positivamente com o padrão composto por queijo, cereais matinais, frutas e sucos de fruta, leite e derivados. Entre os adolescentes europeus, maiores níveis socioeconômicos e maior educação das mães foram positivamente associados ao padrão composto por bebidas lácteas, cereais matinais; leite e derivados, manteiga e margarina, além disso, maiores níveis socioeconômicos também foram negativamente associados com o padrão composto por óleos vegetais, nozes, sementes, pão, carnes, leguminosas, hortaliças e tubérculos, ovos e os maiores níveis de de educação materna foram associados negativamente com o padrão composto por pão; carne; bebidas açúcaradas e salgadinhos. Conclusão: Os achados mostraram a elevada prática de padrões alimentares baseados em alimentos com altas concentrações de gorduras e açúcares os quais estão sendo responsáveis pelo aumento no excesso de peso e obesidade entre os adolescentes brasileiros. No geral, os adolescentes que possuíram maior renda ou bens materiais e maior nível de escolaridade do adulto responsável praticaram padrões alimentares um pouco mais saudáveis. No entanto, no Brasil a maior escolaridade da pessoa de referência do domicílio por si só não está diretamente associada a melhores práticas alimentares entre os adolescentes, o contrário do que acontece na Europa. Sendo assim, o maior acesso à renda e a maior escolaridade dos responsáveis desempenham um papel importante na adoção de padrões alimentares mais saudáveis entre os adolescentes. / Introduction: The characterization of the dietary patterns practiced by adolescents allows analyzing the effects of diet as a whole on health outcomes. Objectives: To identify in the scientific literature the multiple solutions adopted in the multivariate techniques to obtain dietary patterns; To analyze the relationship between major dietary patterns practiced by Brazilian adolescents with overweight and obesity and To analyze the influence of socioeconomic factors on major dietary patterns practiced by a multiethnic group of adolescents. Methods: This thesis was composed of three manuscripts. The first manuscript was a literature review about dietary patterns estimated by different multivariate techniques. For the others manuscripts two databases were used: The Brazilian Household Budget Survey (HBS) conducted in 2008 09 and The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) conducted in 2006-07. Exploratory factor analysis was used to obtain dietary patterns. The second manuscript used logistic regression model to assess the association between the dietary patterns scores and overweight adjusted for socioeconomic variables. The third manuscript used linear regression to assess the association between socioeconomic indicators and dietary patterns scores. Results: A literature review showed a great diversity in the choice of criteria used during the multiple steps of multivariate techniques. The second manuscript showed that higher adherence to Sandwiches Pattern and Snacks Pattern the higher chance of being overweight among Brazilian adolescents. In the third article, 10 dietary patterns were identified among adolescents in urban areas. Among Brazilian adolescents, higher socioeconomic and educational levels of the household reference person were associated with the pattern 4 (composed of cheese, breakfast cereals, fruits and fruit juices, dairy products). Among European adolescents, higher socioeconomic levels and increased education of mothers were positively associated with pattern 2 (composed of dairy drinks, cereals, dairy products, butter and margarine), moreover, higher socioeconomic levels were also negatively associated with the pattern 6 (composed of vegetable oils, nuts, seeds, bread, meat, legumes, starchy roots, eggs) and the highest levels of maternal education were negatively associated with the pattern 5 (consisting of bread, meat, sugary drinks and snacks). Conclusion: The findings showed the high practice of dietary patterns based on foods with high concentrations of fats and sugars, which were responsible for the increase in overweight and obesity among Brazilian adolescents. In general, the study showed that adolescents who had higher socioeconomic status practiced healthier dietary patterns. However, in Brazil the highest education of the household reference person is not directly associated with better dietary practices among adolescents, in contrast with what happens in Europe. Thus, greater access to income and more education of mothers and caregivers have an important role in the adoption of healthier dietary patterns among adolescents.