Reliable estimates for differences in life expectancy (LE) by socio-economic position (SEP), that can be assessed in an international context and are comprehensive in terms of considering different SEP dimensions, are missing for the German population so far. The aim of the present study is to fill this gap by providing estimates for differences in LE by education, household income, work status and vocational class. The lack of national mortality data by SEP required an innovative methodological approach to estimate LE from survey data with a mortality followup. The main strengths of the method are the low demand on the data, its simple applicability and the estimation of a set of age-specific probabilities of dying. We employed the method to the German Life Expectancy Survey and estimated period life tables for 45 male and 32 female SEP subpopulations. The results show striking differences in LE across all analysed SEP indicators. Among men, LE at age 40 ranges by more than five years between the lowest and highest household income quartiles, more than six years between individuals with low and high education, around ten years across the work status groups, and almost 15 years across the vocational classes. The proportion of those who reach the classic pension age of 65 years also varies considerably, as does the remaining LE at this age. The corresponding differences among women are smaller, yet still notable. The results yield an interesting finding for the ongoing discussion about the various consequences of an increased pension age. Moreover, they provide policy-makers, doctors, researchers and public health workers with insights into Germany's most disadvantaged SEP subpopulations and the potential extent of their disadvantages in terms of longevity and mortality.

Orientador: Rosângela Aparecida de Medeiros Hespanhol / Banca: Antonio Lázaro Sant'Ana / Banca: Darlene Aparecida de Oliveira Ferreira / Banca: Luis Antonio Barone / Banca: Ruth Youko Tsukamoto / Resumo: A questão central que orientou este trabalho constitui-se em compreender as estratégias adotadas pelo produtor rural para que permaneça vinculado a terra/propriedade e se reproduza socialmente no município de Jacarezinho/PR. Estes produtores estão inseridos em uma localidade com amplo potencial para o desenvolvimento de uma agricultura empresarial, especialmente a canavieira pela presença de duas agroindústrias sucroalcooleiras no município em questão. Dentre as estratégias para que não sejam expropriados de seus meios de produção e com base no trabalho familiar, verificou-se a diversificação de atividades nas propriedades rurais, a vinculação às agroindústrias de beneficiamento animal, além da comercialização direta ao consumidor. Assim, refletimos que para os produtores familiares permanecerem na propriedade rural utilizaram como estratégia a subordinação as regras impostas pelas agroindústrias às quais se vincularam, por possuírem uma comercialização direcionada da sua matéria-prima e um retorno econômico mais rápido dos investimentos realizados. / Abstract: The central issue that guided this work it constitutes in comprehend the strategies adopted by the rural producer so that it remain entailed for land and reproduce socially in Jacarezinho/PR's Municipal district. These producers are inserted in a place with wide potential for the development of a managerial agriculture, especially the sugarcane culture by the presence of two sugar-alcohols agro-industries in the municipal district at issue. Among the strategies so that they are not expropriated of their production means and with at work family base, it verified the activities diversification in the rural properties, the associated to agro-industries of animal benefit, besides the direct commercialization to the consumer. This way, we reflect that for the family producers to remain in the rural property used as strategy the subordination the rules imposed by agro-industries to which ones entailed, for own a commercialization addressed of your raw material and a faster economic return of the accomplished investments. / Doutor

Introdução: Vários fatores podem interferir na adesão ao tratamento dos hipertensos e conseqüentemente no controle da doença. Dentre estes se destaca o contexto socioeconômico em que vivem os hipertensos. Objetivos: Caracterizar hipertensos atendidos em unidades básicas de saúde de acordo com o nível socioeconômico em relação às variáveis biossociais, econômicas, crenças, atitudes, conhecimento sobre a doença e tratamento, falta e interrupção do tratamento; e associar o nível socioeconômico com essas variáveis. Casuística e método: O estudo foi realizado em três unidades básicas de saúde na região oeste da cidade de São Paulo. Para avaliação econômica foi feito o cálculo do índice de bens acumulados, por meio da somatória de preços de eletrodomésticos constantes na residência do paciente, dividido este por doze e posteriormente pelo valor do salário mínimo para equivalência do poder aquisitivo mensal. Os dados foram processados no sistema SPSS v.7.5. O nível de significância adotado foi de 0,05. Resultados: Foram estudados 440 hipertensos. A maioria era do sexo feminino (66%), cor branca (51%), casados (56,8%), com ensino fundamental (52%), índice de massa corporal 29,99±6,0 kg/m², idade de 57±12 anos e renda mensal familiar de 1 a 3 salários mínimos (43,6%). Do total de hipertensos estudados que interromperam o tratamento (34,8%), verificou-se que interrompeu menos de forma significativa (p<0,05) quem possuía mais televisão a cores. Em relação a faltar às consultas médicas houve associação significante (p<0,05) com geladeira duplex, verificou-se que aqueles com maior posse desse eletrodoméstico faltavam menos às consultas. Os hipertensos que não concordaram com a crença de que “não há nada que se possa fazer para evitar a pressão alta“ apresentaram índice de bens acumulados com valores significativamente mais elevados (1,25± 0,36 vs 1,17±0,35, p<0,05). Em relação às atitudes frente ao tratamento, os hipertensos que afirmaram nunca chegarem atrasados às suas consultas apresentaram índice de bens acumulados com valores significativamente mais baixos (1,20±0,3 vs 1,31± 0,32, p<0,05). Na avaliação de como os pacientes “se sentiam em relação a sua vida como um todo”, a referência de tristeza se associou com índice de bens acumulados com valor significativamente mais baixo (0,98 ± 0,35 vs 1,28 ± 0,36 e 1,25±0,32, p< 0,05). Conclusão: A condição econômica dos hipertensos se associou com alguns aspectos relativos à adesão ao tratamento. / Introduction: A lot of factors can interfere at the adherence in the treatment and consequently control of the disease and detached among them the socioeconomic context where the hypertension people living. Objectives: To make up the people with the hypertension attending in the health basic units in agree with the socioeconomic level and the biosocial economics variables such as believes, attitudes, knowledge about the disease and treatment, lack and interruption of the treatment; and associating the socioeconomic level with these variables. Casuistic and Methods: The study was realized on three health basic units in the west region of Sao Paulo city. To economic survey was done a calculating of the accumulated capital assets from the sum up of the domestics appliances prizes in the patient residence divided for twelve and on the minimum salary value for equivalence of the monthly acquisitive power. The data were processed in the system of significance adopted were 0.05. Results: Were studied 440 hypertensive patients. The great majority were females (66%), white colour (51%), married (56,8%), with fundamental degree (52%), body mass index 29,99±6,0 kg/ m², 57±12 years of age and familiar income of 1 to 3 minimum salary monthly (43,6%). From the total of studied hypertensive patients with the interrupted the treatment (34,8%) was verified whom less significant way (p<0.05) those with the coloured television. In relationship no attendance to the medical appointment have significant association (p<0.05) with duplex freezer, those who have major posses of theses domestic appliances were less absent the medical consults. The hypertensive patients that have not agreed with the belief that ”they can not do anything about the high blood pressure” showed the accumulated capital assets index with the values significantly more elevated (1.25± 0.36 vs 1.17±0.35, p<0.05). About the attitudes to the treatment, the hypertensive patients to referred never were late to a medical appointment showed accumulated capital assets index with lower values (1.20±0.3 vs 1.31± 0.32, p<0.05). In the evaluation of the patients with “How to feel with the life” the reference with sadness have a association with accumulated capital assets index with lower values (0.98 ± 0.35 vs 1.28 ± 0.36 e 1.25±0.32, p< 0.05). Conclusion: The economic situation of the hypertensive patients is linked with some aspects related to the adherence of treatment.

Introdução: A partir da segunda metade da década de noventa, a oferta de tratamento com a Terapia Antiretroviral de Alta Potência contribuiu para a redução da mortalidade de pessoas vivendo com aids nos locais com acesso universal a medicação. Porém, a introdução de procedimentos efetivos tem sido apontada como associada a desigualdades em saúde, quando fatores sociais dificultam o acesso e a aderência ao tratamento. Objetivo: Descrever a evolução temporal da mortalidade nos bairros de Campinas, verificando se houve declínio após a disponibilização da terapêutica antirretroviral de alta potência em 1997 e se este declínio foi homogêneo entre três agregados de áreas da cidade, ou se foi de algum modo associada com a condição socioeconômica das mesmas. Métodos: Foram avaliadas as taxas de mortalidade por aids em bairros de Campinas, São Paulo, de 1996 a 2012, a fim de testar sua associação com o status socioeconômico da área de residência após o início da oferta universal e sem custo de Terapia Antiretroviral de Alta Potência. Foram calculadas as taxas de mortalidade anuais por aids, ajustadas por sexo e faixa etária, com base em informações oficiais de população e mortalidade. Foi estimada a tendência de declínio da mortalidade por aids, usando o procedimento de auto-regressão de Prais- Winsten para séries temporais. A taxa de declínio anual nos três agregados de bairros da cidade foi comparada segundo índices socioeconômicos estimados para o Índice de Condições de Vida. Resultados: A mortalidade por aids ajustada por sexo e idade em Campinas caiu de 13,6 óbitos/100.000 habitantes em 1996 para 4,6 óbitos /100.000 habitantes em 2012. O decréscimo anual foi de 5,5 por cento (Intervalo de Confiança 95 por cento 3,3 por cento -7,5 por cento ). Não foram observadas diferenças significantes de mortalidade (magnitude e taxa de redução) entre as áreas de moradia. Na faixa etária de adultos (20 a 49 anos), houve menor queda da mortalidade no sexo feminino, principalmente na área de pior status socioeconômico. Conclusões: O programa de tratamento para as pessoas com aids foi efetivo para a redução global da mortalidade devida à doença na cidade de Campinas. A redução de mortalidade foi homogênea entre as áreas, o que é compatível com a hipótese de redução das desigualdades em saúde. Porém, a menor redução na mortalidade de mulheres, na faixa etária de adultos, principalmente na região de pior condição socioeconômica, aponta a persistência de desigualdades sociais em saúde. / Introduction: Since the second half of the 1990s, the provision of highly active antiretroviral therapy (HAART) contributed to the reduction in mortality of people living with AIDS in places with universal access to medication. However, the introduction of effective interventions has been identified as associated with health inequalities, when social factors hinder the access and adherence to treatment. Objective: to describe trends of mortality in the districts of Campinas, checking if there was decline after the release of the HAART in 1997 and if this decline was homogeneous among the three aggregate areas of the city, or was somehow associated with their socioeconomic status. Methods: We assessed AIDS mortality in neighborhoods of Campinas, São Paulo, from 1996 to 2012 in order to compare differences among areas of residence after the introduction of universal, free-of-cost provision of HAART. We estimated annual death rates by AIDS, as adjusted for sex and age, based on official information from population and mortality. The annual percent change of AIDS mortality was calculated using the procedure of Prais-Winsten for auto-regression of time series. We assessed differences of the annual percent change between the three clusters of neighborhoods; their socioeconomic status was informed by a socioeconomic index assessed by local health authorities. Results: The adjusted death rate by AIDS in Campinas reduced from 13.6 deaths/100,000 inhabitants in 1996 to 4.6 deaths/100,000 inhabitants in 2012. The annual percent change was 5.5 per cent (95 per cent Confidence Interval 3.3 per cent -7.5 per cent ). No significant differences of mortality (magnitude and annual percent change) among the living areas was observed. In the age group of adults (20-49 years old), a lower decrease of mortality in women was observed, especially in the area of lower socioeconomic status. Conclusions: The program of treatment for people with AIDS was effective in the city of Campinas, as refers to the overall reduction of mortality due to the disease. This reduction was homogeneous among the areas, which is consistent with the hypothesis of a reduction of inequalities in health. However, the lower reduction in mortality in women in the age group of adults, especially in the region of lower socioeconomic status, indicates the persistence of social inequalities in health.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2017-04-27T18:52:43Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) reila.pdf: 1511057 bytes, checksum: 0d2c272827e237aaa1cce4897d1cef01 (MD5) / Made available in DSpace on 2017-04-27T18:52:43Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) reila.pdf: 1511057 bytes, checksum: 0d2c272827e237aaa1cce4897d1cef01 (MD5) Previous issue date: 2016-05-26 / Este estudo teve como objetivo analisar a correlação entre o acesso ao saneamento básico, características socioeconômicas e a Esquistossomose nos municípios do estado de Pernambuco, no período de 2008 a 2014. Para tanto, realizou-se um estudo descritivo e analítico com dados coletados nos seguintes sistemas de informação: Departamento de Informática do SUS/MS (DATASUS), Sistema de Controle da Esquistossomose (SISPCE), Sistema de Mortalidade (SIM), Instituto Brasileiro de Geografia e Estatística (IBGE) e do Sistema Informação da Atenção Básica (SIAB), tendo como unidade de análise os municípios do estado de Pernambuco. Para avaliar a correlação entre a prevalência de esquistossomose com o número de casos, quantidade de exames realizados, óbito, cobertura de atenção básica, renda, taxa de analfabetismo, fornecimento de água pública, coleta de lixo, sistema de esgoto, % de domicilio atendido por saneamento básico nos municípios de estudo, foram aplicados o teste de correlação de Spearman. Todas as conclusões foram tiradas considerando o nível de significância de 5% e 1%. Verificou-se correlação significativa e negativa entre a prevalência da esquistossomose e o esgotamento sanitário, analfabetismo e renda. Em relação ao abastecimento da água, observou-se uma correlação pouco significativa e positiva. Diante disso, conclui-se que fatores socioeconômicos como analfabetismo, renda e saneamento básico estão correlacionados com a prevalência da esquistossomose nos municípios de Pernambuco. / This study aimed to analyze the correlation between access to basic sanitation, socioeconomic characteristics and Schistosomiasis in the municipalities of the state of Pernambuco, from 2008 to 2014. Therefore, there was a descriptive and analytical study with data collected in the following information systems: SUS Department of Informatics / MS (DATASUS), Control System Schistosomiasis (SISPCE) Mortality System (SIM), the Brazilian Institute of Geography and Statistics (IBGE) and System information Primary Care (SIAB) , with the unit of analysis municipalities in the state of Pernambuco. To evaluate the correlation between the prevalence of schistosomiasis with the number of cases, number of tests performed, death, primary care coverage, income, illiteracy, public water supply, garbage collection, sewage system,% of household attended by sanitation in the study municipalities were applied the Spearman correlation test. All conclusions were drawn considering the significance level of 5% and 1%. There was a significant negative correlation between the prevalence of schistosomiasis and sanitation, literacy and income. Regarding the supply of water, it was observed a minor positive correlation. Therefore, it i concluded that socioeconomic factors such as illiteracy, income and sanitation are correlated with the prevalence of schistosomiasis in the municipalities of Pernambuco.

Orientador: Fábio Luiz Mialhe / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-18T05:09:36Z (GMT). No. of bitstreams: 1 Paula_JaniceSimpsonde_M.pdf: 1969283 bytes, checksum: aaac5bdcd96aaabe9c3b380db0c6642d (MD5) Previous issue date: 2011 / Resumo: Considerando o crescente interesse pelas percepções subjetivas do indivíduo em relação à sua saúde bucal e qualidade de vida, o presente trabalho, teve como objetivo geral avaliar o impacto das percepções subjetivas e condições socioambientais no auto-relato de qualidade de vida relacionada à saúde bucal (QVRSB) em escolares. Para tal, foram desenvolvidas três análises baseadas em um estudo epidemiológico observacional do tipo transversal que apresentou os seguintes objetivos específicos: 1. Investigar, por meio de um inquérito epidemiológico, a existência de associações entre a variável desfecho QVRSB e as variáveis preditoras saúde bucal, nível socioeconômico, ambiente familiar, percepções subjetivas dos escolares e dos seus pais sobre sua saúde geral e bucal; 2. Testar associações entre as condições clínicas e socioambientais e a variável desfecho (QVRSB) de acordo com os domínios do instrumento usado para este fim (Child Perceptions Questionnaires - CPQ11-14); 3. Avaliar a existência de associações entre a percepção dos pais sobre a saúde bucal e geral de seus filhos, as condições de saúde bucal e a QVRSB em escolares. Para o estudo 1, a amostra foi composta de 515 escolares de 12 anos de idade, provenientes de escola públicas e particulares do município de Juiz de Fora, Minas Gerais, mediante processo amostral por conglomerado. Para os estudos 2 e 3, uma subamostra de 283 escolares foi utilizada. Foram coletados dados clínicos relativos à presença de cárie, trauma dentário, sangramento gengival, defeitos do desenvolvimento do esmalte, necessidade de tratamento e má oclusão. Para isto, foram utilizados os seguintes índices: CPOD, ceod, SiC, índice modificado de defeitos de desenvolvimento do esmalte (DDE) e índice de estética dental (DAI). Informações relativas a QVRSB nos escolares foram obtidas por meio da aplicação da versão brasileira do questionário CPQ11-14. Os escolares também responderam as questões referentes ao ambiente familiar e as percepções sobre sua saúde bucal e geral. Aos pais foi enviado um questionário com a finalidade de avaliar as percepções dos mesmos em relação à saúde bucal e geral de seus filhos, além de questões sobre o nível socioeconômico. A análise dos dados foi realizada por meio de estatística descritiva, teste qui-quadrado e regressão de Poisson. Também foram utilizados testes não paramétricos. Em relação ao estudo 1, controlando variáveis confundidoras, observou-se que as variáveis percepção da criança sobre sua saúde bucal ruim, renda familiar menor que três salários, gênero feminino, necessidade de tratamento ortodôntico, mãe com até 8 anos de escolaridade, até 2 irmãos e aglomeração por domicílio maior que uma pessoa por cômodo apresentaram impacto negativo em sua auto-percepção relacionada à QVRSB (p<0,05). Para o estudo 2, verificou-se que o gênero da criança, renda e escolaridade da mãe foram estatisticamente associados com os quatro domínios do CPQ11-14, assim como a necessidade de tratamento ortodôntico foi fortemente associada com o domínio 'limitações funcionais'. As crianças com presença de sangramento e que não moravam com ambos os pais biológicos relataram maior impacto nos domínios bem-estar emocional e social da QVRSB. Para o estudo 3, de acordo com testes não-paramétricos, observaram-se associações estatisticamente significantes entre a percepção dos pais sobre saúde bucal e geral dos escolares e o relato de QVBSB (p<0.05). Conclui-se que as condições socioambientais podem ter influências negativas sobre a qualidade de vida relacionada à saúde bucal (Capítulo 1), constatando-se que o impacto desses fatores pode ser diferente entre os quatro domínios do instrumento utilizado (Capítulo 2). Além disso, verificou-se que houve associação entre a percepção subjetiva dos pais e a QVRSB dos escolares (Capítulo 3), demonstrando que o ambiente familiar pode exercer influência sobre aspectos subjetivos relacionados à saúde bucal em escolares / Abstract: Considering the growing interest in the individual's subjective perceptions about their oral health and quality of life, the present study aimed at evaluating the impact of subjective perceptions and socio-environmental conditions on schoolchildren's oral health-related quality of life (OHRQoL). To this end, we developed an analysis based on three observational epidemiological transversal that revealed the following specific objectives: 1. Investigate, by epidemiological survey, the associations outcome variable OHRQoL and oral health, socioeconomic status, home environment, subjective perceptions of parents and schoolchildren about oral and general health; 2. To test associations between clinical conditions and socioenvironmental and outcome variable (OHRQoL) according to the domains of the instrument (Child Perceptions Questionnaires - CPQ11-14); 3. To evaluate the associations between parents'perception about oral and general health of their children, the oral health status of schoolchildren and OHRQoL. For the study a sample composed of 515 students from 12 years old, from public and private schools in the city of Juiz de Fora, Minas Gerais, through conglomerate sampling process. For studies 2 and 3, a sub-sample of 283 students was used. We collected data on the presence of caries, dental trauma, bleeding gums, developmental enamel defects and dental and malocclusion treatment needs. For this, we used the following indices: DMFT, dmft, SiC, modified developmental defects of enamel index (DDE) and dental aesthetic index (DAI). Information concerning the OHRQoL in schoolchildren were obtained through the application of the Brazilian version of questionnaire CPQ11-14. The students also answered questions relating to home environment and perceptions about oral and general health. Parents were sent a questionnaire about their perception in relation to oral and general health of their children, as well as questions about socioeconomic status. Data analysis was performed using descriptive statistics, chi-square test and Poisson regression, and nonparametric tests. In relation to Study 1, controlling confounding variables, it showed that the variables children's self perception of their oral health, low family income, female gender, orthodontic treatment need, 8 years of mother's education, until 2 siblings and household overcrowding with more one person for room had negative impact on their self perception related to OHRQoL. For the second study, it was found that the gender of the child, income and mother's education were statistically associated with the four domains of CPQ11-14, as well as the orthodontic treatment need was strongly associated with the domain 'functional limitations'. Children with presence of bleeding and that not living with both biological parents reported greater impact on emotional and social well-being of OHRQoL. For study 3, According to nonparametric tests, it was found statistically significant associations between parents' perception about oral and general health and report of OHRQoL of schoolchildren (p <0.05). We conclude that the socio-environmental conditions can have negative influences on OHRQoL (Chapter 1), noting that the impact of these factors may be different among the four domains of the instrument used - CPQ11-14 (Chapter 2). Moreover, it was found that there was an association between the subjective perception of the parents and schoolchildren's OWRQoL (Chapter 3), demonstrating that the family environment can influence the subjective aspects related to oral health in children / Mestrado / Saude Coletiva / Mestre em Odontologia

Orientador: Marcelo de Castro Meneghim / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-15T05:51:22Z (GMT). No. of bitstreams: 1 Tonello_AlineSampieri_D.pdf: 1951799 bytes, checksum: 27b4d5ce5f510d6096bf44b78d9cfbd9 (MD5) Previous issue date: 2010 / Resumo: O presente trabalho, composto por dois estudos teve como objetivos: a) descrever as prevalências de cárie e fluorose dentária em escolares de 12 anos de idade de Piracicaba/SP e Iracemápolis/SP, Brasil, 2007 e comparar estes dados com outros levantamentos epidemiológicos realizados anteriormente, em Piracicaba para a cárie dentária (1971-2005) e para a fluorose dentária (1991-2001) e em Iracemápolis para a cárie e fluorose dentária (1991-2004); b) avaliar a experiência de cárie e a prevalência de fluorose dentária em escolares de 12 anos de idade de Piracicaba/SP, Brasil, 2007 e verificar a relação entre essas alterações e os fatores socioeconômicos e variáveis comportamentais relacionadas com a saúde bucal. A amostra constituiu de 724 escolares provenientes de escolas públicas e privadas de Piracicaba/SP e 197 escolares provenientes de escolas públicas de Iracemápolis/SP. Os exames foram realizados por um examinador previamente calibrado, no pátio das escolas, sob luz natural, com auxílio de espelho bucal plano, sonda IPC e escovação prévia, seguindo as recomendações da OMS. A cárie dentária foi avaliada utilizando os índices CPOD e SiC (Significant Caries Index), e a fluorose pelo índice T-F. As variáveis socioeconômicas (renda familiar, número de residentes na mesma casa, escolaridade do pai e da mãe e habitação) e as informações comportamentais foram obtidas por meio de um questionário semi estruturado enviado aos pais. A associação entre as variáveis dependentes (CPOD e fluorose) e as variáveis independentes (variáveis socioeconômicas e comportamentais) foi determinada por meio de análise de regressão logística múltilpa. O CPOD médio foi de 0,85 (dp=1,54) e 1,02 (dp=1,61) e o índice SiC de 2,52 (dp=1,72) e 2,83 (dp=1,60) em Piracicaba e Iracemápolis, respectivamente. A prevalência de fluorose foi de 29,4% e 25,4% em Piracicaba e Iracemápolis, respectivamente. Comparando o presente estudo com outros levantamentos realizados anteriormente, foi observada uma significativa redução da experiência de cárie em ambas as cidades, (90,12%) em Piracicaba e 85,07% em Iracemápolis (p<0,01). Com relação à prevalência da fluorose dentária, verificou-se um aumento de 44,1% em Piracicaba, observando uma menor prevalência entre alguns anos. Já em Iracemápolis, o aumento foi de 1170%. Com base no modelo de regressão logística múltipla, as crianças pertencentes a uma família com renda mensal inferior ou igual a quatro salários mínimos apresentaram 2,58 vezes mais chances de terem cárie (CPOD>0) do que aquelas pertencentes a uma família com renda mensal superior a quatro salários mínimos. Além disso, aquelas crianças que consultaram ao dentista apresentaram 4,27 vezes mais chances de serem diagnosticadas ou tratadas em relação à cárie do que aquelas que nunca foram ao dentista. Porém, em relação à fluorose, o modelo de regressão logística não foi significativo. Em conclusão, os resultados desta tese demonstraram uma contínua redução da experiência de cárie em ambas as cidades no decorrer dos anos. Em relação à fluorose dentária, verificou-se uma tendência de estabilização em Piracicaba, porém em Iracemápolis, observou-se um aumento constante. Adicionalmente, observou-se uma associação entre a presença de cárie e renda familiar mensal, como também entre cárie e consultas ao dentista. Entretanto, em relação à fluorose dentária, nenhuma das variáveis testadas foi associada com esta alteração / Abstract: The present study was composed by two papers which aims were: a) to describe the prevalence of dental caries and dental fluorosis in 12-years-old schoolchildren from Piracicaba/SP and Iracemápolis/SP, Brazil, 2007 and to compare current prevalence rates with those from previous epidemiological surveys developed in Piracicaba, for dental caries (1971-2005), and for dental fluorosis (1991-2001) and in Iracemápolis for dental caries and dental fluorosis (1991-2004); b) to evaluate the caries experience and dental fluorosis prevalence in 12-years-old schoolchildren from Piracicaba/SP, Brazil, 2007 and to verify the relationship between these trends, socioeconomic factors, and behavioral variables related to oral health. The sample consisted of 724 schoolchildren from public and private schools from Piracicaba/SP and 197 schoolchildren from public schools from Iracemápolis/SP. Examinations were executed by a previously calibrated examiner, in outdoor settings, under natural light, using dental mirror, CPI probe, and previous tooth brushing, followed the WHO recommendations. Dental caries was measured by DMFT and SiC (Significant Caries Index) indexes and dental fluorosis by T-F index. Socioeconomic variables (monthly income, number of residents in home, mother's and father's education and home ownership) and behavioral information were collected by means of a parental semi structured questionnaire. Then multiple logistic regression analyses using the stepwise procedure were performed in order to verify the relationship among the dependent variables (DMFT and fluorosis) and the independent variables (socioeconomic and behavioral variables). The mean of DMFT was 0.85 (SD=1.54) and 1.02 (SD=1.61) and the SiC Index was 2.52 (SD=1.72) and 2.83 (SD=1.60) in Piracicaba and Iracemápolis, respectively. The fluorosis prevalence was 29.4% and 25.4% in Piracicaba and Iracemápolis, respectively. Comparing the present study to another previous epidemiological surveys, in both towns, a significant caries reduction of 90.12% (Piracicaba) and of 85.07% (Iracemápolis) (p<0.01), have been observed. Concerning dental fluorosis prevalence, an increase of 44.1% was noted in Piracicaba, where a small prevalence was observed throughout the years. Although, the increase was 1170% in Iracemápolis. By means of multiple logistic regression model, children, whose family earned up to four minimum wages, were 2.58 more prone to have caries (DMFT>0) than those whose family earned over four minimum wages. Besides, those children who visited the dentist were 4.27 more prone of being diagnosed with dental caries and receive treatment in comparison to those who never had visited the dentist. However, for fluorosis prevalence the multiple logistic regression model was not significant. In conclusion, the results of this thesis demonstrated continuous decrease in dental caries experience in both Brazilian towns. Concerning dental fluorosis, stabilization trends were observed in Piracicaba. In Iracemápolis, however, a constant increase was noted. Moreover, significant associations between the presence of dental caries and monthly family income, as well as between dental caries and visiting to the dentist, were observed. However, in relation to dental fluorosis, no tested variable was associated with the disturb / Doutorado / Saude Coletiva / Doutor em Odontologia

Este estudo mostrou uma forte influência dos fatores socioeconômicos e ambientais na prevalência da cárie dentária. Vinte e duas variáveis socioeconômicas e ambientais foram relacionadas a um indicador de saúde bucal. Este indicador consiste na soma dos índices CPO-D e ceo-d nos grupos de alunos de 5 a 12 anos para os 131 municípios que fizeram parte do Levantamento de Saúde Bucal do Estado de São Paulo em 1998. Destes 131 municípios estudados, 9% apresentaram Indicador baixo (&#61603; 2,6); 55% dos municípios, Indicador moderado (2,7 - 4,4); 34% dos municípios, Indicador considerado alto (4,5 - 6,5) e 2% apresentaram indicador muito alto (> 6,6). A prevalência de cárie dentária no Estado de São Paulo para esta faixa etária de 5 a 12 anos, medida por meio do Indicador, mostrou correlação significativa (p<0,05) com 17 das variáveis utilizadas. O modelo de regressão multifatorial mostrou correlação direta de 63% com três fatores principais: presença de flúor na água de abastecimento público, porte populacional do município e Índice de Desenvolvimento Humano Municipal para Educação. Este modelo final pode explicar 38% da variação da prevalência da cárie dentária no Estado de São Paulo em 1998. Em relação aos aspectos geográficos, a epidemiologia espacial evidenciou que os maiores índices de cárie dentária encontraram-se nas regiões Sudoeste, Central e Nordeste do Estado de São Paulo. Os resultados mostraram que condições socioeconômicas e ambientais satisfatórias podem contribuir de maneira importante para a saúde bucal. Mostraram, também, que o emprego da epidemiologia espacial pode contribuir para a identificação de áreas com maior necessidade de cuidados odontológicos e preventivos. / The result of this study showed a strong influence of socioeconomic and environmental background in the dental caries. Twenty-two socioeconomic and environmental variables were correlated to an oral health indicator. This indicator consisted of the sum of the DMFT and dmft indices in students from 5 to 12 years old in 131 cities, which were participants in the Epidemiological Survey of Oral Health in São Paulo State in 1998. Out of the 131 cities studied, 9% had a low indicator (&#61603; 2,6); 55% had a medium indicator (2,7 - 4,4); 34% had a considerable high indicator (4.5 - 6.5) and 2% had a very high indicator (> 6.6). The indicators showed that the prevalence of dental caries in the Sao Paulo State for this age range is significantly related (p<0.05) to 17 of the variables used. The regression multifactor model showed direct correlation of 63% with three main factors: the presence of fluoride in public water, population size of each city and Municipal Human Development index in education. This final model could explain 38% of the variation of the presence of dental decay in the São Paulo State in 1998. With regard to the geographical aspects, spatial epidemiology pointed out that the higher dental caries indices are located in the southwest, central and northwest areas of the studied State. The results showed that the socioeconomic and environmental conditions might greatly contribute to the dental health. In addition to this, the use of spatial epidemiology can contribute to identify the areas in need of oral health promotion and dental care.

The study examined the impact of maternal employment and family life cycle stage on the psychological well-being o£ middle socioeconomic status women. One hundred twenty eight mothers of children at the stages of birth to 6 years, 7 to 12 years and 13 to 17 years, completed a self-report questionnaire. To test the hypothesis of the study, a 3 X 3 (employment X family life cycle stage) analysis of covariance was conducted with age, income, time employed and psychological resources as covariates. Results indicated that middle socioeconomic status mothers employed full-time experienced significantly higher levels of role overload, occupational strain, spouse support and job commitment. A post hoc exploratory analysis using conflict level between commitment to work and parenting, yielded data which indicated that individuals with a large discrepancy between commitment to one role versus the other, experienced the greatest degree of difficulty. Results were evaluated in the light of selective characteristics of the sample. Recommendations for future research included the use of projective assessment to reduce the effect of defensive response styles. A life span approach using the concept of perceived conflict between roles was advanced, instead of the age specific developmental construct of family life cycle stage.

Philosophiae Doctor - PhD / The research problem for this study is the limited and unsuccessful implementation of the IWRM concept. This thesis has argued that comprehensive assessment of physical and socioeconomic conditions is essential to provide explanation on factors that limit the successful execution of the IWRM approach. It has further argued that the local IWRM works as proxy for full and successful implementation of the IWRM approach.To contextualise this thesis, the prevailing physical and socioeconomic factors in Malawi in relation to current management and usage of water resources were explained.With 1,321m3 per capita per year against index thresholds of 1,700-1,000m3 per capita per year, this study showed that Malawi is a physically water stressed country but not physically water scarce country although economically it is a water scarce country. This novelty is against some literature that present Malawi as a water abundant country.Again, this study showed that executing a full and successful IWRM in Malawi remains a challenge because of the prevailing socioeconomic situation in terms of water policies,water laws, institutions and management instruments. These aspects have not been reformed and harmonised to facilitate a successful operation of the IWRM approach.The main water-related problem in Malawi is the mismanagement of the available water resources. This is largely due to the lack of implementing management approaches which can generate systematic data for practical assessment of water resources to guide the coordinated procedure among water stakeholders working in catchments. This lack of implementing a coordinated management approach commonly known as integrated water resources management (IWRM) can be attributed to various reasons that includei) lack of comprehensive assessment of factors that can explain lack of successful IWRM implementation at catchment level and ii) lack of methods to demonstrate data generation and analysis on quantity, quality and governance of water that show practical operation of IWRM at community level using groundwater as a showcase among others.This study revealed that introducing local IWRM requires a prior knowledge of the evolution and role of the full IWRM concept in the international water policy which aimed at addressing broader developmental objectives. Globally, the current status of the IWRM concept has potential to address such broader developmental objectives, but sustaining IWRM projects where they have been piloted showed slow progress. Basing on the factors that slow such a progress, local IWRM approach has emerged as a proxy to execute the full IWRM as demonstrated in chapter 8 in this thesis. However, the observed lack of sustainable resources to fund continual functioning of local IWRM activities will defeat its potential solution to water management challenges. The main threat for sustainable local IWRM activities is the tendency of national governments to decentralise roles and responsibilities to local governments and communities without the accompanying financial resources to enable the implementation of the local participation, investments and initiatives at local level. If this tendency could be reversed, the contribution by local IWRM towards solving management problems in the water sector will be enormous. Chapter four has provided the general case-study approach used in this study in terms of research design, data collection methods, data analysis methods, ethical consideration and limitation of the current study within the context of water resource management with a focus on groundwater management.Using geologic map, satellite images, photographs and hydrogeologic conceptual model, the following results emerged: 1) that the Upper Limphasa River catchment has fractured rock aquifer with limited permeability and storage capacity; 2) The topographic nature and north-south strikes of the lineaments explained the north-south flow direction of groundwater in the catchment; 3) The drainage system observed in the Kandoli and Kaning’ina Mountains to the east and west of the Upper Limphasa River catchment respectively (Fig. 5.1; Fig.5.2) formed a groundwater recharge boundary; 4)The regional faults in the same mountains (Fig. 5.1; Fig.5.2) formed structural boundar as well as hydrogeologic boundary which controlled flow direction of the groundwater;5) the hydrogeologic conceptual model showed the existence of the forested weathered bedrock in the upland areas of the entire catchment which formed no-flow boundary and groundwater divide thereby controlling the water flow direction downwards (Fig. 5.9);6) The major agricultural commercial activities existed in Lower Limphasa catchment while only subsistence farming existed in Upper Limphasa catchment. This knowledge and visualization from the map (Fig. 5.3) and conceptual model (Fig.5.9) showed interactions between upland and lowland areas and the role of physical factors in controlling groundwater flow direction in the catchment. It also provided the enlightenment on implications of socioeconomic farming activities on water management. These insights enabled this study to recommend the need for expedited implementation of holistic effective management for sustainable water utilization.Using different physical factors, water scarcity indices and methodologies, this study showed that Malawi is a physically water stressed as well as an economic water scarce country. This novelty is against some literature that present Malawi as a water abundant country. Again, despite the high proportion (85%) of Malawians relying on groundwater resource, groundwater availability (storage in km3) is relatively low (269 km3 in Table 6.10) compared to other countries within SADC and Africa. Given the complexity of groundwater abstraction, the available groundwater for use is further reduced for Malawians who depend on such a resource for their domestic and productive livelihoods. Such insights provided the basis for discussing the need for IWRM.Although daily statistics on groundwater demand (i: 21.20 litres; 116.91 litres;80,550.99 litres), use (ii: 16.8 litres; 92.55 litres; 63,766.95 litres) and abstracted but not used (iii: 4.4; 24.36; 16,784.04 litres) were relatively low per person, per household and per sub-catchment respectively, such statistics when calculated on monthly basis (i.Demand: 636 litres; 3,507.30 litres; 2,416,529.70 litres; ii.Use:504 litres; 2,776.5 litres;1, 913, 008.5 litres iii. Abstracted but not used: 132 litres; 730 litres; 503, 521.2); and on yearly basis (i. Demand: 7,632 litres; 42,087.6 litres; 28,998,356.4 litres; ii. Use: 6,048 litres; 33,318 litres; 22, 956, 102 litres; iii: Abstracted but not used: 1,584 litres; 8,769.6 litres; 6,042,254.4 litres) per person, per household and per sub-catchment provided huge amount of groundwater (Table 6.5). Given the limited storage capacity of fractured rock aquifer in the basement complex geology, the monthly and yearly groundwater demand and use on one hand and abstracted but not used on the other was considered enormous. With the population growth rate of 2.8 for Nkhata Bay (NSO, 2009) and the observed desire to intensify productive livelihoods activities coupled with expected negative effects of climate change, the need to implement IWRM approach for such groundwater resource in the study catchment remains imperative and is urgently needed.In addition to identifying and describing factors that explain the limited groundwater availability in the study catchment, the study developed a methodology for calculating groundwater demand, use and unused at both households and sub-catchment levels.This methodology provided step-by-step procedure for collecting data on groundwater demand and use as a tool that would improve availability of data on groundwater.Implications of such results for IWRM in similar environments were discussed. Despite the time-consuming procedure involved in using the developed methodology, the calculations are simple and interpretation of results is easily understood among various stakeholders. Hence, such an approach is recommended for the IWRM approach which requires stakeholders from various disciplines to interact and collaborate. Nonetheless, this recommends the use of this method as its further refinement is being sought. The analysis on groundwater quality has shown that the dominant water type in the aquifers of Upper Limphasa catchment was Ca-HCO3, suggesting that the study area had shallow, fresh groundwater with recent recharged aquifer. Analyses on physicochemical parameters revealed that none of the sampled boreholes (BHs) and protected shallow dug wells (PSWs) had physical or chemical concentration levels of health concern when such levels were compared with 2008-World Health Organisation(WHO) guidelines and 2005-Malawi Bureau of Standards (MBS). Conversely, although the compliance with 2008-WHO and 2005-MBS of pathogenic bacteria (E.coli) in BHs water was 100% suggesting that water from BHs had low risk and free from bacteriological contamination, water from PSWs showed 0% compliance with 2008-WHO and 2005-MBS values implying high risk to human health. The overall assessment on risk to health classification showed that PSWs were risky sources to supply potable water, hence the need to implement strategies that protect groundwater.On the basis of such findings, the analysis in this study demonstrated the feasibility of using IWRM approach as a platform for implementing environmental and engineering interventions through education programmes to create and raise public awareness on groundwater protection and on the need for collaborative efforts to implement protective measures for their drinking water sources. The use of different analytical methods which were applied to identify the exact sources of the observed contaminants in the PSWs proved futile. Therefore, this study concluded that rolling-out PSWs either as improved or safe sources of drinking water requires further detailed investigations.However, this research recommended using rapid assessment of drinking water-quality (RADWQ) methods for assessing the quality of groundwater sources for drinking. Despite the study area being in the humid climatic region with annual rainfall above 1,000 mm, many of the physical factors were not favourable for availability of more groundwater in the aquifers. Such observation provided compelling evidence in this study to commend the local IWRM as a proxy for the full IWRM implementation for sustainable utilization of such waters. Although institutional arrangements, water laws and water policy were found problematic to facilitate a successful implementation of full IWRM at national level in Malawi, this thesis demonstrated that local institutional arrangements, coordination among institutions, data collection efforts by local community members (active participation), self-regulation among local community committees were favourable conditions for a successful local IWRM in the Upper Limphasa River catchment. This research recommends continuation of such local participation, investment and initiatives as proxy for the full and successful IWRM beyond the study catchment. However, the observed lack of financial resource from central government to facilitates local IWRM activities were seen as counterproductive.In addition, this thesis recommended further studies which should aim at improving some observed negative implications of self-regulations on community members and the limited decentralisation elements from the Department of Water Development.Finally, one of the contributions from this study is the scientific value in using different methods to assess the quality of groundwater as presented in chapter 7. The second value is the demonstration of applying practical techniques to evaluate factors that explain the amount of groundwater storage in the aquifers that can be understood by water scientists, water users, water developers and water managers to implement IWRM collaboratively using groundwater as a showcase. The third contribution is the provision of the procedure to systematically generate data on demand (abstraction) and use of groundwater in unmetered rural areas which has the potential to guide water allocation process in the catchment. Fourthly, the thesis has provided a hydrogeologic conceptual model for the first time for Limphasa River catchment to be used as a visual tool for planning and developing management practices and addressing current water problems.Fifthly, the study has shown how local IWRM works at community level as a proxy for the full implementation of IWRM despite the absence of Catchment Management Agencies. The last contribution is the dissemination of results from this study made through publications and conference presentations as outlined in the appendix.