Introdução: A tuberculose (TB) continua sendo um grave problema de saúde global, sendo classificada como a principal causa de morte por doenças infecciosas em todo o mundo. Objetivou-se analisar a distribuição e risco espacial e espaço-temporal da mortalidade por TB e sua relação com marcadores de desenvolvimento social em Natal/RN. Métodos: Trata-se de um estudo ecológico. Os setores censitários e as Unidades de Desenvolvimento Humano (UDHs) foram utilizados como unidades de análise. A população do estudo foi composta de casos de óbito por TB como causa básica, registrados no Sistema de Informações sobre Mortalidade no período de 2008 a 2014. Realizou-se análise univariada das variáveis socioeconômicas com cálculo de frequências absolutas e relativas. Para a construção dos marcadores de desenvolvimento social considerou-se a técnica de análise de componentes principais, utilizando-se da base de informações de variáveis das UDHs. A geocodificação dos endereços foi processada no TerraView versão 4.2.2. Posteriormente, seguiu-se com a análise da estimativa de Kernel. Para detecção de aglomerados espaciais e espaço-temporais foi aplicada a técnica de varredura espacial. Taxas brutas e bayesianas empíricas globais de mortalidade foram calculadas. A existência de autocorrelação espacial da mortalidade por TB foi verificada pelos índices de Moran Global e Local. Para analisar a relação entre mortalidade por TB e os marcadores de desenvolvimento social realizaram-se análises de regressão linear múltipla. Os resíduos da regressão linear foram investigados quanto à existência de autocorrelação espacial por meio do Teste Global de Moran. Para escolha do modelo final foi considerado o critério de informação de Akaike (AIC). Para as análises foram considerados os softwares Statistica versão 12.0, ArcGIS versão 10.2, SaTScan(TM) versão 9.2 e OpenGeoDa versão 1.0.1. Em todos os testes estatísticos foi fixado o nível de significância em 5% (p< 0,05). Resultados: Identificaram-se 154 óbitos por TB, desse total, 91,5% dos endereços foram geocodificados. A estatística de Kernel mostrou áreas quentes para a mortalidade por TB. A técnica de análise de varredura espacial identificou três aglomerados estatisticamente significativos, sendo dois de alto risco (RR=5,77 IC95% = 5,19 - 6,34; RR= 3,82 IC95% = 3,38 - 4,24) e um de baixo risco (RR = 0,34 IC95% = 0,08 - 0,76). Já a análise de varredura espaço-temporal apresentou apenas um aglomerado de alto risco (RR= 5,97; IC95% =5,26 - 6,66) no ano de 2008. As maiores taxas bayesianas foram identificadas no distrito de saúde leste. Foi identificada autocorrelação espacial dessas taxas (I = 0,324, p = 0,002). Para a construção dos marcadores de desenvolvimento social, duas componentes principais apresentaram 85,3% de variância total. O primeiro marcador foi denominado de áreas de menor desenvolvimento social (DS-) e o segundo, de áreas de maior desenvolvimento social (DS+). Na modelagem estatística, observou-se uma associação negativa entre a mortalidade por TB e áreas de maior desenvolvimento social (R2 = 0,207; p=0,03). Sendo o modelo final escolhido o Spatial Lag. Conclusão: A identificação de áreas vulneráveis à ocorrência do óbito por tuberculose e sua relação com o desenvolvimento social permitem o direcionamento das ações intersetoriais de controle da doença às populações conhecidamente mais afetadas / Introduction: Tuberculosis (TB) continues a serious global health problem and has been classified as the leading cause of death from infectious diseases worldwide. The objective of this study was to analyze spatial and spatial-temporal risk for TB mortality, the spatial distribution of this event and its relationship with index of social development in Natal / RN. Methods: This is an ecological study. The census tracts and the Human Development Units (HDUs) were used as units of analysis. The study\'s population was composed by cases of death due to TB as a basic cause, registered in the Mortality Information System from 2008 to 2014. A univariate analysis of the socioeconomic variables was performed estimating absolute and relative frequency. For the construction social development index we have used the technique Principal Components considering the variables obtained from HDUs. The geocoding of Address was performed through TerraView version 4.2.2. In addition, we applied the Kernel estimation analysis. Scan Statistic was used to detection of spatial and spatial-temporal clusterd. The authors calculated TB mortality rate, it was smoothed by Empirical Bayes Method. Autocorrelation of TB mortality was analyzed by Moran Global and Local Indexes. Multiple linear regression analysis was performed to analyze the relation of social development index with TB mortality. The residues of linear regression model were investigated to identify the existence of spatial autocorrelation through the Moran Global Test. The final model was defined considering the Akaike information criterion (AIC). Statistica version 12.0, ArcGIS version 10.2, SaTScan (TM) version 9.2 and OpenGeoDa version 1.0.1 were used in the analysis. It was defined level of significance at 5% as statistically significant (p <0.05) for all statistical tests. Results: We identified 154 deaths per TB, of this total, 91.5% of the addresses were geocoded. Hot spots for TB mortality has been showed by Kernel statistics . Three statistically significant clusters were observed when applied Sat Scan, two of which were higher risk (RR=5.77 CI 95% = 5.19 - 6.34; RR= 3.82 CI 95% = 3.38 - 4.24) and one with lower risk (RR = 0.34 CI95% = 0.08 - 0.76). The spatial-temporal scan statistic analysis revealed only one cluster with high risk (RR = 5.97, CI95%= 5.26 - 6.66) in the year 2008. The highest Bayesian rates were identified in the Eastern health district. Spatial autocorrelation of these rates was identified (I = 0.324, p = 0.002). For the construction of social development index, two first Principal Components (PC) accumulated 85.3% from total variance. The first PC was named areas with lower social development (SD-) and the second one was designed area with higher social development (SD +). In statistical modeling, a negative association was observed with areas of higher social development with TB mortality (R2 = 0.207, p = 0.03). The final model has been chosen by Spatial Lag. Conclusion: The study evidenced areas vulnerable to tuberculosis mortality and its relationship with social development, which allows addressing of intersectoral actions to TB elimination especially in the populations in risks

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No. of bitstreams: 1 PDF - Thaíse Alves Bezerra.pdf: 1470688 bytes, checksum: e56f9e6c1c1880c899872ebac94e2109 (MD5) Previous issue date: 2014-04-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Objectives: To determine the food insecurity prevalence, as well as its associated factors in different epidemiological contexts in Brazil and to assess the situation of food (in)security of families with children under five years living in socially vulnerable areas and its association with biological characteristics and health status of children and with the family socioeconomic context. Methods: Two studies were carried out: a systematic review with meta-analysis considering data from SciELO, LILACS, and PubMed databases and a cross-sectional study on the food (in)security situation among families living in socially vulnerable areas. In the first study, articles published between January 2004 and January 2014 using the keyword "Food and Nutrition Security" were selected. The studies were categorized considering different epidemiological contexts. The second study included families with some ex-recyclable materials collectors from the disabled Campina Grande landfill and with children under five years of age. This study evaluated the influence of biological characteristics and health status of children, as well as the family socioeconomic context in food insecurity. The Brazilian Food Insecurity Scale was adopted as a tool for measuring food security. Results: In the literature review, the results of 31 articles were systematized, indicating high weighted averages on the prevalence of food insecurity identified in different scenarios (schools / daycares = 61.8 %, health services / beneficiaries of the Bolsa Família Program = 76.6 %, populations under social inequities = 87.2 % , population-based studies = 25.9 %). Family income, number of individuals in the household and the type of property were the conditions that showed significant inverse relationship with the most severe food insecurity. Among the families living nearby the Campina Grande landfill, only 3.9 % of them were classified as in food security condition. The frequency of moderate (34.2 %) and severe food insecurity (32.4 %) was predominant. Higher chances of food insecurity were found in families with destination of uncollected garbage and children who had lost weight in the last 15 days prior to data collection. Conclusions: Taken together, the findings of this study reinforce the social determinants of food insecurity among Brazilian families. In this sense, social and economic policies that allow actions to improve the living conditions of families in social inequality in order to ensure timely access to food and to guarantee them the human right to adequate food should be strengthened. / Objetivos: Apontar prevalências de insegurança alimentar, assim como seus fatores associados, em diferentes cenários epidemiológicos do Brasil; e avaliar a situação de (in)segurança alimentar de famílias com crianças menores de cinco anos residentes em área de vulnerabilidade social e sua associação com características biológicas e da situação de saúde das crianças, e com o contexto socioeconômico familiar. Métodos: Realizaram-se dois estudos: uma revisão sistemática com metanálise considerando as bases de dados SciELO, LILACS e PubMed, e um estudo transversal sobre a situação de (in)segurança alimentar entre famílias em área de vulnerabilidades social. No primeiro estudo, foram selecionados artigos publicados entre janeiro de 2004 e janeiro de 2014, usando-se a palavra-chave “Segurança Alimentar e Nutricional”. Os estudos analisados foram categorizados considerando diferentes cenários epidemiológicos. No segundo estudo, foram observadas famílias com algum membro ex-catador de materiais recicláveis do lixão desativado de Campina Grande e com crianças menores de cinco anos. Nesse estudo, avaliou-se a influência de características biológicas e da situação de saúde das crianças, bem como do contexto socioeconômico familiar, na insegurança alimentar. A Escala Brasileira de Insegurança Alimentar foi adotada como instrumento na medição da segurança alimentar. Resultados: Na revisão da literatura, foram sistematizados os resultados de 31 artigos, indicando-se altas médias ponderadas das prevalências de insegurança alimentar nos diferentes cenários identificados (escolas/creches = 61,8%, serviços de saúde/beneficiários do Programa Bolsa Família = 76,6%, populações em iniquidades sociais = 87,2%, estudos de base populacional = 25,9%). A renda familiar, a quantidade de indivíduos no domicílio e o tipo de moradia foram as condições que apresentaram relação inversa significante com a insegurança alimentar mais grave. Entre as famílias avaliadas residentes nas proximidades do lixão desativado de Campina Grande, somente 3,9% das mesmas foram classificadas na categoria de segurança alimentar. As frequências de insegurança alimentar moderada (34,2%) e grave (32,4%) foram as predominantes. Maiores chances de insegurança alimentar foram encontradas em famílias com destino do lixo não coletado e com crianças que tiveram perda de peso nos últimos 15 dias que antecederam a coleta dos dados. Conclusões: Em conjunto, os achados deste trabalho reforçam a determinação social da insegurança alimentar entre as famílias brasileiras. Neste sentido, devem ser reforçadas ações políticas sociais e econômicas que possibilitem a melhoria das condições de vida de famílias em desigualdade social, no intuito de assegurar o acesso oportuno aos alimentos e lhes garantir o direito humano à alimentação adequada.

Asthma is a chronic lung inflammatory disease that causes inflammation and narrowing of the airways. Swelling of the airways can be caused by the activation of cytokines that lead to an inflammatory or allergenic-like response. Environmental factors, both indoors and outdoors, have been found to increase the likelihood of asthma in children. Among those found to impact disease are air pollutants such as ozone, nitric dioxide, and particulate matter, as well as home exposures, like cockroaches and rodents. Those who have multiple or increased exposure to these pollutants are more likely to experience exacerbated symptoms and uncontrolled asthma. There currently is no cure for asthma, but effective therapies have been found to treat the symptoms associated with asthmatic episodes. During an asthma attack, due to narrowing of the airways, individuals experience wheezing, chest tightness, and even shortness of breath. To combat these occurrences, physicians use inhaled corticosteroids (ICS), Beta-agonist, or a combination of both to relieve symptoms. In the United States asthma affects 25.8 million people. This number is projected to increase as the US continuously becomes more industrialized and as environmental conditions deteriorate. Research conducted by the Center for Disease Control concluded that the prevalence of asthma increased amongst the general population, however, once the data were disaggregated by race, age, gender, and SES significant increases were noted amongst some groups but not others. Most notably, on average, children, women, Puerto Ricans, and people living in poverty as defined by federal guidelines had the highest asthma prevalence. Chronic diseases like asthma also produce substantial burdens on the healthcare system. Asthmatics on average require three-times as many prescriptions, twice as many emergency room visits and four-times as many hospitalizations as individuals without asthma in the same demographic population. Additionally, when an expenditure analysis was carried out, it revealed that children with asthma cost approximately three-times more per capita per child than adolescents without asthma. Chronic disease occurs over the duration of individual lives. Thus, poorly managed, they will cause preventable increases in disability-adjusted-life years, premature death, and health care expenditure for both the individual and the broader healthcare system. The observed increases will predominantly impact the indicated high-risk populations. The prevalence of asthma in urban settings was anticipated by researchers based on known environmental influences. However, the discovery of a higher prevalence and mortality rate of asthma within impoverished communities, in comparison to other urban communities, is not yet fully understood. Through this research an association between high-risk populations with uncontrolled asthma and a lack of patient education, low socioeconomic status, and utilization of Medicaid insurance was found, which indicates the influence of these factors on asthma control. Improving current asthma interventions by remodeling them to take a broader stance on asthma prevention, treatment and maintenance and through acknowledgement of the impact disparities, asthma will likely be better controlled for all individuals in the Unites States.

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.

Thesis (MPH.) --University of Limpopo, 2008. / Childhood malnutrition is one of the conditions that have been identified by the world health organisation to be given high priority in terms of their control and management. This study aimed to determine the prevalence of childhood malnutrition in a rural village of Regae in the Limpopo province. The study found that stunting and underweight are 17.5% whilst wasting is at 12.9% in the village. Key words: childhood malnutrition, stunting, wasting, underweight, socioeconomic factors, educational level. / N/A

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Socioekonomiska villkor under livsloppet påverkar ålderdomen på många olika sätt. Individer som haft en lägre socioekonomisk position löper bland annat en större risk att dö i förtid och drabbas av ohälsa. Syftet med studien är att studera människors livslopp med fokus på olika socioekonomiska villkor under uppväxt och livet fram till pensionen ur ett retrospektivt perspektiv. Kärnan i uppsatsen är att undersöka deltagarnas livslopp utifrån en historisk och individuell kontext och analysera hur den subjektiva upplevelsen av livskvalitet ser ut i ålderdomen. Studiens undersökningsdesign bygger på livsloppsintervjuer och kompletterande enkät. Deltagarna är födda under trettio och fyrtiotalet och samtliga är pensionärer. För att studera hur socioekonomiska villkor påverkar livet efter pensionen är det väsentligt att deltagarnas socioekonomiska positioner ser olika ut. Hälften av våra respondenter lever under sämre socioekonomiska villkor medan resterande har en mer fördelaktig social position i samhället. Uppsatsen tillämpar fem teoretiska perspektiv där alla har olika funktion i arbetets varierande delar. Teorierna tillsammans med internationell och nationell forskning har spelat en stor roll vid analysen av det insamlade materialet. Resultatet av studien visar att ett antal faktorer under livsloppet har påverkan på de äldres liv efter pensionen. Dessa faktorer är samhällelig och historisk kontext, socioekonomiska villkor under uppväxten, kön och klass. Upplevelsen av livskvalitet efter pensioneringen visar sig vara relativt lika hos samtliga respondenter.

For the last few decades, youth behavioral problems have been constantly increasing. As an outcome of the complex interactions of multiple factors, these problems seriously challenge families, the educational system and society. The author presents a multiple case study, with three levels of analysis. Through a qualitative method, subjective data are collected through semi-structured interviews. An individual vertical analysis and a collective horizontal analysis give access to the subjective perspectives of participants (the parent, child and teacher) and the sociocultural context. The results show pattern of life marked by ruptures and conflicts, the need for relation, recognition and guidance. Furthermore, there is a marked absence of communication between the implicated people and spiritual beliefs surrounding this problematic are considered. Intervention avenues are suggested.

Gender and socioeconomic inequalities in health are ubiquitous in developed countries; however, the modifying effect of gender on the relationship between socioeconomic position (SEP) and health over time is less clear. The potentially different health effects of changes in SEP on changes in health for working-age women and men are examined over a 10-year period. Three main questions are addressed: (1) are there gender differences in health over time, (2) do changes in SEP lead to health inequalities and (3) do changes in SEP impact health differently for women and men? Generalized estimating equations (GEE) were used to analyze the Canadian National Population Health Survey for four measures of health, number of chronic conditions, self-rated health, functional health, and psychological distress, and three measures of SEP, income, education and employment status. Men and women in this nationally-representative sample of Canadians do not differentially embody changes in SEP, though both gender and SEP independently impact health.