The aim of this study was to assess the environmental sanitation conditions with regard to water, sanitation, waste management and personal hygiene of households of Dukem town in Ethiopia. A cross-sectional study design was used to conduct the research. A total of 391 households had participated in the study. Majority of households had access to improved source of drinking water. The mean per capita per day water consumption of the households was low. Two-thirds of households had improved toilet facilities. Availability of improved waste management was grossly inadequate. Two-thirds of households had washed hands after visiting toilet. Generally households had good domestic environmental sanitation conditions but it also emerged that the households were deprived from full range of access to the most essential environmental sanitation services. Therefore, the inadequate level of service to the study area could be seen as opportunity for further focused improvements towards universal access to improved environmental sanitation. / Health Studies / M.A. (Public Health)

Thesis (MPA)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Urban renewal is fairly new in South Arica compared to North America where the concept was introduced around 1949. Some urban areas in South Africa lacked basic subsistence needs while others had deteriorated into slums. That prompted the present government to act against such living conditions and make environments conducive to its motto of “better life for all”. One such area was Evaton within Emfuleni Local Municipality in Gauteng. The semi-rural centennial settlement is one of the few that enjoys freehold land tenure in South Africa. Unfortunately, that contributed to its underdevelopment as the politics of land release before 1996 prevented any development by the regime. The situation led Evaton developing into a slum without basic needs such as proper infrastructure, proper sanitation, refuse removal system, adequate water supply and social amenities. The situation manifested itself in poor community health status. The health status of the community was also influenced by the prevailing socio-economic conditions such as unemployment and poverty. Communities depended on home farming and animal husbandry to support their households. Unemployment and poverty resulted in crimes of stock-theft, house robberies and muggings. Gangsterism became the lifestyle of hooligans which made life difficult for vulnerable community members. Moreover, environmental health conditions were appalling. Water was drawn from improperly covered wells. Pit latrines and ash dumps were used for sanitation thus causing fly-breeding and rodent habourage. Animals roamed about while backyards were overpopulated with shacks instead of decent housing. Fossil fuel fires used inside mud houses with poor ventilation caused carbon monoxide poisoning. Particulate matter from dusty streets polluted the air. Diseases spread easily due to dust, overcrowding, and poor ventilation and sanitation. Families could hardly afford proper medical care which was scarce, remote and expensive. The intended urban renewal project aimed to improve the living conditions in Evaton. Improved housing was provided where possible, sewerage reticulation system was widened, electricity was installed and some service roads were tarred. More clinics were built to provide better and free health services to the community. Modern shopping malls were built. Municipal health and other essential services were partly delivered. The prospects of improved health status were beaming. Unfortunately, the project was hampered by obstacles such as politics of resistance to land release by landlords, which retarded housing progress. Funding was problematic and allegedly misused. Housing, roads and sanitation remained poor. Air quality remained poor as fossil fuel continued to be used due to high electricity costs. Animals were still kept and unemployment rate remained high. Research findings revealed that suspicions regarding clandestine land release deals were abound. Residents blamed leaders for offering jobs to friends and associates. Provision of affordable housing was rather too slow and made tedious by squabbles over management issues. Local economic development crucial to job creation and poverty alleviation needed strengthening to encourage self-reliance. It would be recommended that the situation in Evaton be afforded urgent intervention by government, with the support of strong community participation, which is crucial for smooth implementation of processes meant to improve living conditions in Evaton. Regeneration, with its envisaged prospects, needed the co-operation of all stakeholders. All suspicions regarding projects and processes had to be overcome. It would be important to employ persons with appropriate expertise, preferably from the local community; to strengthen project management for positive outcomes that would impact on the health status of the community was important. / AFRIKAANSE OPSOMMING: Stedelike hernuwing in Suid-Afrika is ‘n redelike nuwe konsep in vergelyking met Noord- Amerika waar stedelike hernuwing reeds vanaf 1949 plaasgevind het Sommige stedelike areas in Suid-Afrika het agteruitgegaan as agtergebuurtes met ‘n tekort aan basiese lewensbehoeftes. Hierdie situasie het die huidige regering aangemoedig om aksie te neem teen hierdie lewenskondisies en ook beheer oor hierdie agtergebuurtes te neem ter ondersteuning van die regering se slagspreuk: “Beter lewe vir almal”. Een so ‘n area in Gauteng is Evaton, wat onder beheer van Emfuleni Plaaslike Munisipaliteit is. ‘n Honderd jare oue semi-plaaslike plek het vrye besitreg van eiendom in Suid-Afrika bepaal. Ongelukkig het hierdie bygedra tot onderontwikkeling aangesien politiese besluite rakende grond ontplooiing en ontwikkeling in Evaton negatief beïnvloed was deur die beherende bewind van daardie tyd. Hierdie situasie het ook bygedra dat Evaton in ‘n agtergebuurte verval het sonder voldoening aan basiese behoeftes soos aanvaarbare infrastruktuur, sanitasie, vullisverwydering, genoegsame water voorsiening en sosiale geriewe. Hierdie omstandighede het gevolglik aanleiding gegee dat Evaton gemeenskap onder andere lae gesondheidstatus geniet. Die gesondheidstatus van Evaton gemeenskap is verder ook beïnvloed deur heersende sosioekonomiese kondisies soos werkloosheid en armoede. Die gemeenskap was dus afhanklik van selfonderhoudende landbou- en veeboerdery ter wille van oorlewing. Werkloosheid en armoede het gevolglik ook aanleiding gegee tot misdade soos veediefstal, huisinbrake en rooftogte. Bendewese het ‘n leefstyl geword van straatboewe wat die lewe verder bemoeilik het vir kwetsbare gemeenskapslede. Walglike omgewingsgesondheid kondisies het gevolglik ook verder die oorhand gekry. Water is uit onbeskermde putte getap en buite toilette en ashope is vir sanitasie geriewe gebruik. Vlieë het uitgebroei en knaagdiere het daar begin aanteel. Vee het vry gewei en agtererwe was vol oorbevolkte krotte instede van aanvaarbare wonings Vure van fossielbrandstof is binne-in modderhuise met swak ventilasie gebrand en dit het tot koolstofmonoksied vergiftiging by inwoners gelei. Stofdeeltjies van stofstrate het lugbesoedeling veroorsaak. Siektes het vinnig versprei as gevolg van stof, oorbevolking, swak ventilasie en onhigiëniese sanitasie. Gesinne kon skaars geskikte mediese behandeling bekostig wat ver, skaars en duur was. Die stedelike hernuwingsprogram beoog om lewenskondisies in Evaton te verbeter. Beter behuising is verskaf waar moontlik, ‘n wyer rioolnetwerk is voorsien, elektrisiteit is voorsien en sekere dienspaaie is geteer. Meer klinieke is gebou om sodoende beter asook gratis gesondheidsdienste aan Evaton gemeenskap te voorsien. Ongelukkig was daar struikelblokke wat die stedelike hernuwingsprogram vertraag het. Die behuising projek kon nie volgens beplanning verloop nie aangesien grondeienaars onwillig was om hul grond af te staan. Fondse was nie genoeg nie en volgens aantuigings misbruik. Behuising, paaie en sanitasie bly nog swaak. Lugbesoedeling is steeds hoog aangesien fossielbrandstof steeds gebruik word as gevolg van hoë elektrisiteitskostes. Vee word steeds vrylik aangehou en die werkloosheid syfer is steeds baie hoog. Hierdie situasie in Evaton eis onmiddellik intervensie. Suspisies rakende grondhervorming moet oorkom word. Voorsiening van bekostigbare behuising moet verskerp word. Plaaslike ekonomiese ontwikkeling wat noodsaaklik is vir werk skepping en armoede verligting moet aangespreek word om sodoende self-versorging aan te moedig. Intervensie van die Regering, met goeie gemeenkap deelname, is noodsaaklik vir gesonde lewenstandaarde in Evaton. Hervorming met beplande vooruitsigte sal dringend verskerp moet word sodat die impak van gesondheid standaarde op Evaton gemeenskap positief beïnvloed kan word.

Em países em desenvolvimento significantes fontes de poluição do ar podem ocorrer em áreas que não possuem uma qualificada estrutura de medição dos contaminantes. Neste contexto, a simplificação dos métodos de medição de partículas no ambiente, tais como impactador portátil e a acumulação de elementos traço em cascas de árvores podem fornecer informações na determinação da área de influência da fonte emissora de poluição. Neste estudo foram combinadas medidas de acumulação dos elementos traço em cascas de árvores e de partículas finas (diâmetro aerodinâmico inferior a 2,5 m) em filtros para avaliar os possíveis efeitos sobre a saúde da população das emissões de uma indústria de xisto operando em São Mateus do Sul, PR. As análises foram realizadas pela técnica de fluorescência de raios X por dispersão de energia (EDXRF) para determinação dos elementos Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, S, Si, V e Zn nas cascas de árvores e Fe, S e Si no material particulado PM2,5. Dados de saúde da população estudada foram coletados nos prontuários médicos dos pacientes no posto de saúde local. Mapas de distribuição das concentrações dos elementos foram obtidos. Estes mapas foram utilizados para identificar hot spots de poluição, para estimar a mobilidade dos elementos Fe, S e Si presentes no ar, bem como para correlacionar as concentrações destes elementos com dados da saúde da população local. O programa geoestatístico SURFER 8.0 (Golden software Surfer) e o modelo de atenuação foram utilizados nos tratamentos de dados e os softwares STATISTIC 8.0 e SPSS 13.0 utilizados nos testes estatísticos. Os resultados obtidos indicam significante associação entre morbidade respiratória e as emissões industriais. Estes resultados mostram que as emissões da indústria de xisto afetam a saúde dos habitantes da cidade de São Mateus do Sul. Isto também foi demonstrado nas medições das concentrações dos elementos no PM2,5 e na acumulação de elementos traço nas cascas de árvores. A análise fatorial e a análise descritiva, feitas a partir das concentrações determinadas nas cascas de árvores, considerando a direção dos ventos a partir da indústria de xisto sugerem que Fe, S e Si podem ser usados como marcadores da poluição desta indústria. A combinação da caracterização espacial da poluição e dados clínicos mostrou que os efeitos adversos foram significativos (p = 0, 042, ANOVA) para a população com mais de 38 anos. A partir dos resultados obtidos, também podemos concluir que a utilização de cascas de árvores como bioindicador é uma estratégia adequada em estudos sobre impacto ambiental em regiões sem rede convencional de monitoramento da poluição atmosférica / In developing countries significant sources of air pollution may go undetected in areas that do not have qualified structure to measure air contaminants. In this context, simplified methods of measuring ambient particles, such as portable impactors and trace elements accumulate in tree barks, may provide information to identify areas influenced by source emissions. In this study, simplified methods to measure trace elements in tree barks and in fine particles in filters to evaluate the possible health effects of the emissions of a shale oil plant operating in São Mateus do Sul (Paraná, Brazil) were used. These analyses were carried out by energy dispersive X ray fluorescence spectrometry (EDXRF) to determine concentrations of Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, S, Si, V and Zn in tree bark and Fe, S and Si in particulate matter PM2.5. Health data of respiratory diseases of the studied population was obtained from the patient files from the local public health center. The resulting data were evaluated obtaining element concentration distribution maps. These maps were also used to identify hot spots, to estimate element mobility of Fe, S and Si present in the air, as well as, to correlate element concentrations found with health data of the local population. The SURFER geo-statistical software (Golden software Surfer) and the attenuation model of concentration were used to treat these results. For statistical tests, STATISTICÒ 8.0 software and SPSS 13.0 was used. Results obtained indicated significant associations between respiratory morbidity and industrial emissions. Thus the emissions from the shale oil industry affect the health of inhabitants of the city of São Mateus do Sul. This was also demonstrated by measurements of element concentrations in PM2.5 and the accumulation of trace elements in tree barks. Factor analysis and the descriptive analysis (ANOVA) of element concentrations in tree barks downwind of the shale plant suggest that Fe, S and Si may be used as tracers of shale industry pollution. The combination of spatial characterization of pollution and clinical data revealed that adverse effects were significant (p = 0.042, ANOVA) for the population older than 38 years. From the results obtained it was also concluded that the use of tree bark as a bioindicator is an adequate strategy in environmental impact studies in those areas with no conventional network of air pollution monitoring

Objetivo: Analisar a prevalência da desnutrição e fatores associados em crianças menores de 60 meses em dois municípios do estado do Acre. Métodos: Estudo transversal de base populacional com 667 crianças da área urbana dos municípios de Acrelândia e Assis Brasil. As prevalências de déficits nutricionais para os índices estatura para idade (E/I), peso para idade (P/I) e peso para estatura (P/E) foram calculadas com o ponto de corte -2 escores Z, utilizando-se o padrão de crescimento infantil da Organização Mundial da Saúde de 2006. Informações sobre condições socioeconômicas, acesso aos serviços e cuidado da criança, peso ao nascer e morbidades foram obtidas por questionário estruturado e pré-codificado. Análise múltipla e hierarquizada de regressão de Poisson (erro padrão robusto) foi utilizada para identificar os fatores associados à desnutrição infantil. Resultados: As prevalências dos déficits E/I, P/I e P/E foram de 9,9%, 6,3% e 4,1%, respectivamente. Os principais fatores associados ao déficit E/I foram: baixo índice de riqueza domiciliar (razão de prevalência [RP]: 1,74; intervalo de confiança [IC95%]: 0,95 - 3,18), analfabetismo do pai ou padrasto (RP: 1,82; IC95%: 1,01 - 3,27), ter 2 ou mais irmãos menores (RP: 2,88; IC95%: 1,45 - 5,72), ausência da mãe biológica no domicílio (RP: 2,63; IC95%: 1,32 - 5,24) e exposição ao esgoto a céu aberto no âmbito domiciliar (RP: 2,46; IC95%: 1,51 - 4,00). Para o déficit de P/E houve associação somente com o peso ao nascer igual ou abaixo de 2.500 g (RP: 2,91; IC95%: 1,16 - 7,24). Conclusão: Nos municípios estudados, a desnutrição infantil apresenta-se como um importante problema de saúde pública, associada aos indicadores de iniquidades sociais, acesso aos serviços de saúde e ausência da mãe no domicílio. / Objective: To describe malnutrition prevalence and associated factors in children under the age of 60 months from two municipalities in the state of Acre. Methods: A population-based, cross-sectional study was carried out using 667 children from urban areas in the municipalities of Acrelândia and Assis Brasil. The occurrence of nutritional deficit was determined by indexes of height for age (H/A), weight for age (W/A) and height for weight (H/W), which were calculated with cut point -2 for Z scores as determined by 2006 World Health Organization child growth standards. A structured and precoded questionnaire was applied to gather information about socioeconomic conditions, access to the services and child care, birth weight and morbidity. Multiple and hierarchical analysis of Poisson regression (robust standard error) was used to identify the factors associated to child malnutrition. Results: The incidence of H/A, W/A and H/W deficits was 9.9%, 6.3% and 4.1%, respectively. The main factors associated to H/A were low household wealth index (prevalence ratio [PR]: 1.74; 95% confidence interval [95% CI]: 0.95 3.18), illiterate father or stepfather (PR: 1.82; 95% CI: 1.01 3.27), the existence of 2 or more young siblings (PR: 2.88; 95% CI: 1.45 5.72), the absence of the biological mother at home (PR: 2.63; 95% CI: 1.32 5.24) and exposure to open wastewater near the house (PR: 2.46; 95% CI: 1.51 4.00). The W/H deficit was associated only to birth weight equal or lower than 2,500 g (PR: 2.91; 95% CI: 1.16 7.24). Conclusions: Child malnutrition in the municipalities studied is an important public health problem, which is associated to indicators of social inequality, access to health services and absence of a mother at home.

This dissertation compares and connects the parallel histories of two indigenous community-controlled health services, the Seattle Indian Health Board (SIHB) and The Aboriginal Medical Service (AMS) of Sydney. These were among the first clinics of their kind to be established and run by and for urban indigenous communities in the U.S. and Australia. Formed in the 1970s within months of each other, I bring their seemingly disconnected histories together to illuminate a larger transnational history about the political ramifications of twentieth-century postwar urbanization (and the associated growth of an indigenous diaspora) on native people’s concepts and practices of political sovereignty. By considering how these clinics provided a key forum for new urban pan-indigenous forms of political and cultural identity—and claims to indigenous rights—to be expressed and recognized, my work makes two significant contributions. First, it reveals the importance of health as an arena of indigenous political action in the twentieth century. Second, it underscores that indigenous sovereignty, as a political project, must be understood as both adaptive and responsive to change. Drawing on archival research and oral histories conducted over two years across Australia and the United States—including interviews with activists and health workers who were on the front lines of indigenous politics in the 1950s-1970s—I explain why in their pursuit of self-determination, urban pan-indigenous communities steadily turned away from a purely western conception of sovereignty as jurisdiction over land. The health struggles of urban indigenous peoples since the Second World War are a pointed demonstration of how the loss of even limited territorial sovereignty (that is, relocation from reserves and reservations) led to damaging structural invisibility, discrimination, and neglect within the social welfare system. Thus, this dissertation shows how and why the communities in Seattle and Sydney were driven to pursue other forms of practiced, or what I call “deterritorialized”, sovereignty centering on their rights to self-governance through the creation and transformation of various social organizations (in this case health clinics) in line with distinctive cultural perspectives. This is the first book-length study to take healthcare reform seriously as an arena in which indigenous political actors worked to redefine the reach and the meaning of indigenous sovereignty for communities without recourse to land or nationhood in the assertion of their sovereign rights. Moreover, by bringing a comparative view to this historical inquiry, my work reminds us that trans-Pacific networks of ideas and people formed a shared context for these peoples and histories. I argue that indigenous health activists in the U.S. and Australia became active at precisely the same moment, because each saw their struggle for recognition and self-determination as part of a global challenge to racism during the Civil Rights era. Moreover, these indigenous community-controlled clinics should be recognized as part of broader changes taking place in grassroots health advocacy at the time, as reflected in the contemporaneous community and women’s health movements, and the movement to form People’s Free Clinics by the Black Panthers. In its consideration of the unique problems of recognition faced by urban pan-indigenous communities, “Sovereign Bodies” also contributes towards an understanding of processes of ‘place-making’ in a period of great mobility following the Second World War. This dissertation argues that the indigenous urban health clinics very quickly came to represent the social production of a new kind of political space: not a tribal homeland or even a mosaic of different homelands, but a generic native space in the city that gave physical form to new ideas of a non-territorial, or ‘deterritorialized’ sovereignty. Moreover, it shows that at work in the efforts of Seattle and Sydney’s urban indigenous health activists, was the idea of a ‘portable’ or ‘mobile’ indigenous status. This was intended, among other things, to allow indigenous people to live in cities—or wherever they choose for that matter—without having to give up their identity, cultural practices, or their legal status as indigenous people and ensuing ability to make special claims on the government. At stake in their health activism, this dissertation argues, was a form of place-making that aimed to make indigenous people at home everywhere within the national spaces of the U.S. and Australia.

O presente trabalho baseou-se em um corte de base populacional com amostra aleatória e representativa de 3.276 crianças de 5 a 9 anos da zona urbana de Sobral - CE, município de 153.000 habitantes do Nordeste do Brasil, com elevada cobertura assistencial do Programa de Saúde da Família (PSF). O objetivo do estudo foi descrever a morbidade referida em crianças de 5 a 9 anos de idade residentes na área urbana do município e analisar as relações existentes entre morbidade referida e seus possíveis condicionantes. Foram realizadas entrevistas domiciliares para 3276 crianças da amostra e exame clínico em uma sub-amostra de 2594 crianças. As morbidades referidas pelas mães foram classificadas segundo os Capítulos da Décima Revisão da Classificação Internacional de Doenças (CID 10). Os dados coletados foram digitados em EPI Info 6. 04 e analisados utilizando-se o Stata 7.0. Os desfechos analisados foram morbidade referida nos últimos 15 dias, causas de internamento hospitalar referidas para 12 meses, déficit de estatura para idade e cadastramento no PSF. Crianças de Baixa Estatura para Idade foram aquelas que apresentaram um escore-z <-2, calculado pelo módulo Epi-Nut, do software Ep-Info. As variáveis independentes foram agrupadas em socioeconômicas, ambientais, de acesso e utilização de serviços de saúde e estado nutricional. As morbidades mais prevalentes nos 15 dias anteriores a entrevista foram às doenças do aparelho respiratório (DAR), 28,7%, sinais e sintomas não classificados em outra parte, 5,5%, doenças da pele, 3,4% e doenças infecciosas e parasitárias (2,2%). As variáveis independentes que tiveram relação estatisticamente significativa com o aumento da prevalência das DAR foram ter idade entre 5 e 7 anos, residir no núcleo urbano principal do município e freqüentar a escola. Estas variáveis permaneceram significativas após análise multivariada. As causas de internamento hospitalar mais freqüentes foram às doenças infecciosas, doenças respiratórias, sinais e sintomas não classificados em outra parte e lesões e envenenamentos. As crianças que freqüentavam a escola tiveram freqüência 69% menor de internamento hospitalar por lesões e envenenamentos, odds ration=0,31 (IC 95% 0,10 - 0,90). A forma mais prevalente de desnutrição foi o déficit de estatura para idade (11,6%), cuja prevalência foi maior no sexo masculino e 54% menos freqüente entre crianças que freqüentavam a escola, odds ration=0,46 (IC 95% 0,31 - 0,66). Também, diminuiu à medida que aumentou a renda per capita e a escolaridade da mãe. Como recomendações sugeriu-se a inclusão de 100% das crianças na escola e a educação para prevenção de acidentes de transporte e no domicílio. A qualificação das equipes de saúde da família para atenção integral as crianças desta faixa etária, que inclui antropometria, triagem oftalmológica e avaliação ortopédica também deve ser priorizada, inclusive aproveitando as oportunidades freqüentes em que as crianças são levadas para unidade de saúde por ocasião de doenças leves. A autora propõe um modelo explicativo para a morbidade referida com base em conceitos etnoepidemiológicos, sugerindo que ela engloba tanto as enfermidades, na perspectiva dos pacientes, como as doenças, na perspectiva médico biológica, principalmente em sociedades como a brasileira em que o acesso à saúde é universal. / The current study was based on a slice of population base with aleatoric and representative sample of 3,276 children aged 5 to 9 years from the urban zone of Sobral - CE, municipality with 173,000 inhabitants in the Northeast of Brazil, with elevated assistance coverage from the Family Health Program (PSF). The objective of this study was to describe the referred morbidity in children aged 5 to 9 years resident in the urban area of the municipality and to analyze the existing relationships between referred morbidity and their possible conditionings. Home interviews were carried out with 3,276 children from the sample and clinical exam in a sub-sample of 2,594 children. The referred morbidities by the mothers were classified according to the Chapters from the Tenth Review of the International Disease Classification (ICD 10). The data collected were put into EPI Info 6.04 and analyzed using Stata 7.0. The outcomes analyzed were referred morbidity in the last 15 days, causes of referred hospital internment for 12 months, stature deficit for age and register in PSF. Low Stature for Age Children were those who presented a score-z <-2, calculated by the module Epi-Nut, from the software Ep-Info. The independent variables were grouped in socioeconomic, environmental, health service access and usage and nutritional state. The more prevalent morbidities in the 15 days prior to the interview were the sicknesses of the respiratory apparatus (SRA), 28.7%, non-classified sign and symptoms in other part, 5.5%, skin sicknesses, 3.4% infectious illnesses and parasitic (2.2%). The independent variables that had statistically significant relationship with the prevalence increase for SRA were being aged 5 to 7 years, residing in the main urban nucleus of the municipality and attending school. These variables remain significant after multi-varied analysis. The most frequent causes of hospital internment were infectious sicknesses, respiratory sicknesses, non-classified signs and symptoms in other part and lesions and poisonings. The children who attended school had frequency 69% lower of hospital internment for lesions and poisonings, odds ration=0.31 (IC 95% 0.10 - 0.90). The most prevalent form of malnutrition was stature deficit for age (11.6%), whose prevalence was greater in the male sex and 54% less frequent amongst children who attended school, odds ration=0.46 (IC 95% 0.31 - 0.66). Also, it reduced to the measure that income per capita and mother\'s schooling increased. As recommendations it is suggested the 100% inclusion of children in school and education for the prevention of accidents with transport and in the home. The qualification of the family health teams for integral care of children in this age range, which includes anthropometry, ophthalmologic filtering and orthopedic evaluation should be given priority, inclusive taking advantage of the frequent opportunities in which the children are taken to the health unit on occasion of simple sicknesses. The author proposes an explicative model for the referred morbidity based on ethno-epidemiological concepts, suggesting that it embody as much the illnesses, in the patient\'s perspective, as the diseases, in the medical biological perspective, especially in societies as the Brazilian one in which access to health is universal.

O presente trabalho baseou-se em um corte de base populacional com amostra aleatória e representativa de 3.276 crianças de 5 a 9 anos da zona urbana de Sobral - CE, município de 153.000 habitantes do Nordeste do Brasil, com elevada cobertura assistencial do Programa de Saúde da Família (PSF). O objetivo do estudo foi descrever a morbidade referida em crianças de 5 a 9 anos de idade residentes na área urbana do município e analisar as relações existentes entre morbidade referida e seus possíveis condicionantes. Foram realizadas entrevistas domiciliares para 3276 crianças da amostra e exame clínico em uma sub-amostra de 2594 crianças. As morbidades referidas pelas mães foram classificadas segundo os Capítulos da Décima Revisão da Classificação Internacional de Doenças (CID 10). Os dados coletados foram digitados em EPI Info 6. 04 e analisados utilizando-se o Stata 7.0. Os desfechos analisados foram morbidade referida nos últimos 15 dias, causas de internamento hospitalar referidas para 12 meses, déficit de estatura para idade e cadastramento no PSF. Crianças de Baixa Estatura para Idade foram aquelas que apresentaram um escore-z <-2, calculado pelo módulo Epi-Nut, do software Ep-Info. As variáveis independentes foram agrupadas em socioeconômicas, ambientais, de acesso e utilização de serviços de saúde e estado nutricional. As morbidades mais prevalentes nos 15 dias anteriores a entrevista foram às doenças do aparelho respiratório (DAR), 28,7%, sinais e sintomas não classificados em outra parte, 5,5%, doenças da pele, 3,4% e doenças infecciosas e parasitárias (2,2%). As variáveis independentes que tiveram relação estatisticamente significativa com o aumento da prevalência das DAR foram ter idade entre 5 e 7 anos, residir no núcleo urbano principal do município e freqüentar a escola. Estas variáveis permaneceram significativas após análise multivariada. As causas de internamento hospitalar mais freqüentes foram às doenças infecciosas, doenças respiratórias, sinais e sintomas não classificados em outra parte e lesões e envenenamentos. As crianças que freqüentavam a escola tiveram freqüência 69% menor de internamento hospitalar por lesões e envenenamentos, odds ration=0,31 (IC 95% 0,10 - 0,90). A forma mais prevalente de desnutrição foi o déficit de estatura para idade (11,6%), cuja prevalência foi maior no sexo masculino e 54% menos freqüente entre crianças que freqüentavam a escola, odds ration=0,46 (IC 95% 0,31 - 0,66). Também, diminuiu à medida que aumentou a renda per capita e a escolaridade da mãe. Como recomendações sugeriu-se a inclusão de 100% das crianças na escola e a educação para prevenção de acidentes de transporte e no domicílio. A qualificação das equipes de saúde da família para atenção integral as crianças desta faixa etária, que inclui antropometria, triagem oftalmológica e avaliação ortopédica também deve ser priorizada, inclusive aproveitando as oportunidades freqüentes em que as crianças são levadas para unidade de saúde por ocasião de doenças leves. A autora propõe um modelo explicativo para a morbidade referida com base em conceitos etnoepidemiológicos, sugerindo que ela engloba tanto as enfermidades, na perspectiva dos pacientes, como as doenças, na perspectiva médico biológica, principalmente em sociedades como a brasileira em que o acesso à saúde é universal. / The current study was based on a slice of population base with aleatoric and representative sample of 3,276 children aged 5 to 9 years from the urban zone of Sobral - CE, municipality with 173,000 inhabitants in the Northeast of Brazil, with elevated assistance coverage from the Family Health Program (PSF). The objective of this study was to describe the referred morbidity in children aged 5 to 9 years resident in the urban area of the municipality and to analyze the existing relationships between referred morbidity and their possible conditionings. Home interviews were carried out with 3,276 children from the sample and clinical exam in a sub-sample of 2,594 children. The referred morbidities by the mothers were classified according to the Chapters from the Tenth Review of the International Disease Classification (ICD 10). The data collected were put into EPI Info 6.04 and analyzed using Stata 7.0. The outcomes analyzed were referred morbidity in the last 15 days, causes of referred hospital internment for 12 months, stature deficit for age and register in PSF. Low Stature for Age Children were those who presented a score-z <-2, calculated by the module Epi-Nut, from the software Ep-Info. The independent variables were grouped in socioeconomic, environmental, health service access and usage and nutritional state. The more prevalent morbidities in the 15 days prior to the interview were the sicknesses of the respiratory apparatus (SRA), 28.7%, non-classified sign and symptoms in other part, 5.5%, skin sicknesses, 3.4% infectious illnesses and parasitic (2.2%). The independent variables that had statistically significant relationship with the prevalence increase for SRA were being aged 5 to 7 years, residing in the main urban nucleus of the municipality and attending school. These variables remain significant after multi-varied analysis. The most frequent causes of hospital internment were infectious sicknesses, respiratory sicknesses, non-classified signs and symptoms in other part and lesions and poisonings. The children who attended school had frequency 69% lower of hospital internment for lesions and poisonings, odds ration=0.31 (IC 95% 0.10 - 0.90). The most prevalent form of malnutrition was stature deficit for age (11.6%), whose prevalence was greater in the male sex and 54% less frequent amongst children who attended school, odds ration=0.46 (IC 95% 0.31 - 0.66). Also, it reduced to the measure that income per capita and mother\'s schooling increased. As recommendations it is suggested the 100% inclusion of children in school and education for the prevention of accidents with transport and in the home. The qualification of the family health teams for integral care of children in this age range, which includes anthropometry, ophthalmologic filtering and orthopedic evaluation should be given priority, inclusive taking advantage of the frequent opportunities in which the children are taken to the health unit on occasion of simple sicknesses. The author proposes an explicative model for the referred morbidity based on ethno-epidemiological concepts, suggesting that it embody as much the illnesses, in the patient\'s perspective, as the diseases, in the medical biological perspective, especially in societies as the Brazilian one in which access to health is universal.

The purpose of this study was to examine the preferences, impact, and attitude of respiratory care practitioners toward continuing education. A review of demographic characteristics was conducted to develop a professional profile of practitioners in Tennessee. An assessment of continuing education practices provided information concerning types of courses, preferences, and methods used to meet continuing education requirements. Data collection was made possible through the use of a questionnaire. A stratified random sample was drawn from the 1,966 respiratory care practitioners in Tennessee. Based on the practitioner's residence, 150 practitioners were selected from rural and urban communities. A total of 300 self-administered questionnaires were mailed to practitioners to comprise the sample. Data collection was conducted over a 4 week period with a second mailing occurring after the first 2 weeks. A total of 120 surveys were returned for a response rate of 40%. The findings in this study demonstrated that rural and urban respiratory care practitioners in Tennessee have similar preferences toward continuing education. Respiratory care practitioners felt mandatory continuing education was beneficial and should be retained in Tennessee. This study indicated no differences in the impact of mandatory continuing education on the attitude of rural and urban practitioners. Both groups reported that mandatory continuing education had impacted the attitude of respiratory care practitioners in a positive manner. The study produced findings that revealed differences between rural and urban practitioners most preferred and used methods of continuing education. Urban practitioners indicated an increase involvement of physicians as a method most preferred and used for continuing education when compared to rural respondents. Comparison of rural and urban respondents found both groups preferences for course content were the same. The need for continuing education in various content areas transcends geographical boundaries. The typical respiratory care practitioner tended to be a female between the ages of 26-45, while working as a full-time practitioner in an acute care hospital. However, differences were identified between the two populations when comparing professional characteristics. Most rural practitioners were credentialed as certified respiratory care technicians with urban practitioners identified themselves as registered respiratory therapist.

In recent years, studies have linked various structural and environmental factors to disproportionately increased rates of morbidity, mortality, and adverse health outcomes in low-income racial and ethnic minority neighborhoods. Among the adverse health outcomes, is the constraint on the ability to access and afford a healthy diet. While local food systems play a significant role in influencing urban health and well-being outcomes, they also present an opportunity to develop community-based assets and resilience. By identifying limitations and successes in current food system literature and practice, this report examines how a more comprehensive approach to equitable community health and wellness can be achieved and sustained. Effective disparity reduction relies on cross-sectoral partnerships that not only promote food equity, but also provide participatory social, economic, and educational opportunities to marginalized communities. / text

[Truncated abstract] The main purpose of this research was to conduct a series of studies with the aim of contributing information about methods for measuring and analyzing physical environmental attributes of neighbourhoods and the influence of these attributes on specific types of physical activity behaviour. Furthermore, this research examined the moderating affect of the objective physical environment on the relationship between cognitions and physical activity behaviours and the mediating role of the cognitions on the associations between the objective physical environment and physical activity. The research included secondary analyses of data collected as part of the Studies of Environmental and Individual Determinants of Physical Activity (SEID1 and SEID2: Corti 1998; Pikora 2003) and the Physical Activity in Localities and Community Environments study (PLACE: Leslie et al. 2005a; Leslie et al. 2005b). Demographic, cognitive, social and behavioural data from the baseline and follow-up surveys from SEID1 (Corti 1998), and objectively measured built environmental data from SEID2 (Pikora 2003) were analyzed. ... A stronger association between frequency of past trying and recreational walking was also found for respondents residing in neighbourhoods with more recreational destinations (β = 0.11), compared with fewer destinations (β = 0.00). These findings show some evidence that the built environment can affect exercise-related cognitions, which in turn influence physical activity. Findings of this and other research (Owen et al. 2000; Humpel et al. 2002; Saelens et al. 2003b; Foster & Hillsdon 2004; McCormack et al. 2004; Owen et al. 2004; Badland & Schofield 2005; Duncan et al. 2005; Heath et al. 2006) support the need to create supportive environments that encourage both recreational and transport-related physical activity. Providing more opportunities and a greater variety of destinations close to home could encourage physical activity participation, and may even assist some individuals to achieve sufficient levels to accrue health benefits. However, additional research is necessary to understand how both the perceived and objectively measured built environment influences physical activity and to provide evidence of temporal causality between environments, cognitions, and physical activity behaviour.