Introdução: A agricultura familiar (AF) e o PNAE após um processo de evolução política se vincularam em 2009 por meio da Lei n°11.947. O agricultor familiar a partir desse momento passou a dispor de um importante mercado institucional. Entretanto, esse ator apresenta dificuldades em atender à demanda do PNAE. Objetivo: Caracterizar a venda da AF para o PNAE e analisar os fatores associados à compra da AF para o PNAE nos municípios do estado de São Paulo em 2012. Metodologia: Trata-se de estudo transversal, envolvendo métodos de análise quantitativa. Os dados analisados foram coletados da pesquisa \"O encontro entre o Programa Nacional de Alimentação Escolar (PNAE) e a agricultura familiar: avaliação do processo de implementação e dos possíveis efeitos das compras locais, segundo a Lei n°11.947/2009\", a qual avaliou 38 municípios do Estado de São Paulo. Foram coletados dados de 110 agricultores que venderam para o PNAE. Os eixos de variáveis dos agricultores estudadas foram: características socioeconômicas dos municípios, características do agricultor, apoio institucional e característica da venda. O PIB, IFDHM, presença de PAA no município e o apoio técnico e institucional oferecidos aos Agricultores Familiares dos 38 municípios estudados foram elencados em modelo hierárquico com o intuito de identificar os fatores associados à compra da AF para o PNAE. A compra da AF para o PNAE foi a variável desfecho do estudo. A descrição e caracterização foram calculadas por meio de medidas de tendência central e dispersão e frequências absolutas e relativas. O teste de McNemar foi utilizado para verificar diferenças entre a comercialização antes e depois da Lei n° 11.947/09. Foi feita uma regressão simples bivariada com o intuito de verificar o incremento no percentual da compra da AF para o PNAE entre 2011 e 2015. E foi utilizada a análise de regressão logística múltipla para analisar os fatores associados à compra da AF para o PNAE. Resultados: Os 16 municípios dos AFs apresentaram IDHM alto (87%); os alimentos produzidos pelos agricultores eram em sua quase totalidade in natura; os agricultores depois da Lei n°11.947/2009 aumentaram suas vendas para os mercados institucionais; a média no percentual da compra da agricultura familiar nos 16 municípios estudados subiu de 25,3% para 36,3% entre os anos de 2011 a 2015. Com relação aos fatores associados à compra da AF para o PNAE o apoio da prefeitura aos AFs do município e o levantamento da produção agrícola junto aos AFs do município feito pela nutricionista se associaram com a compra da agricultura familiar para o PNAE. Conclusão: O apoio técnico da nutricionista e o apoio institucional da prefeitura oferecidos aos Agricultores Familiares são fatores importantes associados à compra da AF para o PNAE. / Introduction: The Family Farming and The Brazilian School Feeding Program (PNAE) after a process of political evolution were associated in 2009 by Brazilian act 11.947/2009. Since that time, the family farmer has an important institutional market available. However, this actor has difficulties to achieve the market demand. Objective: To analyze the factors associated to the sale of Family Farming to the PNAE in the cities of the state of São Paulo in 2012. Methodology: The study is transverse, using quantitative analysis methods. The analyzed data were collected from the study \"The meeting of the National School Feeding Program and Family Farming: evaluation of the implementation process and the possible effects of local purchases, according to the act 11.947/2009\", which evaluated 38 cities in the São Paulo state. Data were collected from 110 family farmers who sold to the PNAE. The main variables studied were: cities socioeconomic characteristics, farmer characteristics, institutional support and sale characteristics. The highest Gross Domestic Product (GDP), High Human Development Index (HDI), previous experience with the Family Agriculture Food Acquisition Program (PAA) and technical and institutional support to family farmers of 38 municipalities studied were listed in a hierarchical model in order to identify the associated factors. The purchase of AF for PNAE was the variable outcome of the study. The description and characterization were calculated through measures of central tendency and dispersion and absolute and relative frequencies. McNemar´s test was used to verify differences between sales before and after the act 11.947/09. A simple bivariate linear regression was performed in order to verify the increase in the percentage of the FF purchases for the PNAE between 2011 and 2015. The multiple logistic regression analysis was used to analyze the factors associated to the FF purchase to PNAE. Results: The studied cities had high Human Development Index (HDI) (87%); the produced food by family farmers was almost entirely in natura; the family farmers after the act 11.947/09 increased their sales to the institutional markets; the average percentage of FF purchases in the 16 studies cities increased from 25.3% to 36.3% between 2011 and 2015. Regarding the factors associated with the purchase of family farming for PNAE, the support of the municipality offered to the family farmers and the survey of the agricultural production made by the nutritionist were associated with the outcome. Conclusion: The technical support of the nutritionist and the institutional support of the cities to family farmers are important factors associated with the local purchases.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-07-24T14:50:25Z No. of bitstreams: 0 / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-07-25T15:02:16Z (GMT) No. of bitstreams: 0 / Made available in DSpace on 2018-07-25T15:02:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-08 / O consumo de álcool em doses excessivas pode causar riscos importantes na saúde, trazendo consequências fisiológicas, cognitivas e comportamentais, para quem bebe e para aqueles com quem se relaciona. O uso de álcool é explicado pelo modelo biopsicossocial, mas o trabalho não é citado como uma variável explicativa. Visto que este é uma das dimensões centrais da vida, compreender como se manifesta a satisfação no trabalho em contexto do serviço público e as possíveis correlações deste constructo sobre os padrões de uso de álcool poderá contribuir para compreender o fenômeno. Neste sentido, o objetivo geral do presente estudo consiste em examinar a associação entre consumo de álcool e satisfação no trabalho e os demais fatores relacionados a cada um, em uma amostra de servidores de Universidade Federal. Foi realizado estudo transversal entre servidores (N = 1011). A informação foi coletada utilizando instrumentos de rastreio do uso de álcool, escala de satisfação no trabalho, qualidade de vida, estado de saúde física e psiquiátrica. As características demográficas e os fatores como tempo e local de trabalho também foram levados em consideração. Os odds ratios ajustados (OR) e os intervalos de confiança de 95% (IC 95%) foram calculados através de regressões logbinomiais e regressões lineares. Entre os entrevistados, 15% bebem regularmente, 10% usam em padrão binge consumindo uma média de 8,05 (±4,05). A maioria dos bebedores que fazem consumo de risco possuem escolaridade até ensino fundamental completo e a distribuição do consumo em padrão binge manteve-se em 13% em áreas administrativas e acadêmicas, enquanto na unidade hospitalar em 7% . Além da escolaridade nível de pósgraduação e sexo feminino, a OR de fazer consumo de risco do álcool foi menor entre aqueles que praticam alguma religião e foi significativamente associado a apresentar preocupação com condições físicas, com a relevância no tratamento destas condições e dificuldades com funções cognitivas de atenção, concentração, memória, em com o controle de temperamento e tentativa de suicídio. A satisfação no trabalho foi associada, além de características sóciodemográficas como escolaridade e prática de religião, à unidade de trabalho, unidade de lotação, importância de tratamento de condições clínicas, e às dimensões físicas, relacionamentos e meio ambiente da qualidade de vida. Ou seja, o uso problemático do álcool está mais relacionado às questões intrínsecas do indivíduo, experiências pessoais e como vivenciam estas experiências, enquanto que a satisfação é respondida por questões intrínsecas e extrínsecas do trabalho. / Excessive alcohol consumption can cause significant health risks, with physiological, cognitive and behavioral consequences for the drinker and those with whom he is related. Alcohol use is explained by the biopsychosocial model, but the work is not cited as an explanatory variable. Since this is one of the central dimensions of life, understanding how satisfaction is manifested in work in the context of public service and the possible correlations of this construct on patterns of alcohol use may contribute to understanding the phenomenon. In this sense, the general objective of the present study was to examine the association between alcohol consumption and job satisfaction, the other factors related to each one, in a sample of Federal University employee. A cross-sectional study was performed between employees (N = 1011). The information was collected using alcohol use screening instruments, work satisfaction scale, quality of life, physical and psychiatric health status. Demographic characteristics and factors such as time and place of work were also taken into account. Adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using log-binomial regressions and linear regressions. Among those interviewed, 15% drink regularly, 10% use in standard binge consuming an average of 8.05 (± 4.05). The majority of drinkers who consume at risk have schooling until full elementary school and the distribution of consumption in binge remained in 13% in administrative and academic areas, while in the hospital unit in 7%. In addition, the postgraduate level of education and the female gender, the OR to consume alcohol risk was lower among those who practice some religion and was significantly associated with concern about physical conditions, with relevance in the treatment of these conditions and difficulties with cognitive functions of attention, concentration, memory, in with temperament control and attempted suicide. Work satisfaction was associated, in addition to socio-demographic characteristics such as schooling and religious practice, to the unit of work, unit of stocking, importance of treatment of clinical conditions, and to the physical dimensions, relationships and environment of quality of life. The Problematic use of alcohol is more related to the intrinsic issues of the individual, personal experiences and how they experience these experiences, while satisfaction is answered by intrinsic and extrinsic issues of work.

Magister Psychologiae - MPsych / Substance abuse is recognised as one of the greatest health and social problems in South Africa (SA). There is a need to explore the problem of substance use in the South African context in terms of the Bio-ecological Systems Theoretical Framework. All of the reviewed local and international studies on instruments that are used to measure factors associated with adolescent substance use, while yielding useful information; do not adequately address the issues of an instrument that successfully includes all the levels of the Bio-ecological Systems Theoretical Framework at the dimension level. As a result, a need for an applicable instrument exists. The overall purpose of the current study was to evaluate the content validity of the dimensions of the proposed self-administered questionnaire in terms of the Bio-ecological Systems Theoretical Framework, which will assist the factors associated with youth at risk of substance abuse in low socio economic status communities in the South African context. The study was framed in psychometric test theory focusing specifically on the procedures for content validation. It is being increasingly recognized that the development of a valid test requires multiple procedures, which are employed sequentially, at different stages of test construction. Validity is thus built into the test development from the outset. Participants were selected by means of purposive sampling. The sampling method was appropriate since the participants were required to meet certain inclusive criteria. The participants comprised of two groups of community leaders within two different communities on the Cape Flats. An adapted version of the Nominal Group Technique method was employed to collect data. The data for aim one was collected using a self administered questionnaire (Content Validity Questionnaire) consisting of two sections. The first section was presented in the form of a ranking scale with all relevant factors associated with adolescent substance use. The second section of part 1 was in the form of open-ended questions. The second aim was collected in the form of focus groups. Data was analysed quantitatively and qualitatively in the relevant sections. Data collected from the Content Validity Questionnaire (CVQ) was analysed quantitatively by means of statistical analysis making use of frequencies, and the open-ended questions of the content validity and data from the focus groups was analysed qualitatively by means of thematic analysis. The study concluded that all factors presented in the CVQ are important factors associated with adolescent substance use in the two low socio-economic statuses communities that were analysed in both the quantitative and qualitative components of the study.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-07-15T00:58:46Z No. of bitstreams: 1 Disserta??o vers?o final p?s defesa.pdf: 1222902 bytes, checksum: 40007ee76422c5102a64eba0abe995f4 (MD5) / Made available in DSpace on 2016-07-15T00:58:46Z (GMT). No. of bitstreams: 1 Disserta??o vers?o final p?s defesa.pdf: 1222902 bytes, checksum: 40007ee76422c5102a64eba0abe995f4 (MD5) Previous issue date: 2015-03-25 / Objective: To analyze the survival and factors associated with death in children, adolescents and young adults infected with HIV through vertical transmission, enrolled in the Municipal Reference Center (CRM) STD / HIV / AIDS Feira de Santana. Methods: An observational, longitudinal study, developed from a cohort of HIV-positive to HIV, infected by vertical transmission from secondary data obtained from the review of clinical records of 37 children, 21 adolescents and five (5) young adults, ranging age between 0 and 24 years enrolled in the Specialized Care Service (SAE) of CRM, from 2003 to 2014. In the analyzes we used Pearson X2 test, exact Fisher test and its value p, to investigate factors associated with death. In addition, it used survival analysis with construction of Kaplan-Meier curves and log-rank test to verify statistically significant association between groups of variables listed. Finally, we used regression Cox proportional hazards to estimate adjusted risk factors for death. Results: There was a predominance of groups of 0-12 years (58.7%) and 13-19 years (33.3%), female (52.4%) and black / mulatto (71.8%). Most of the study population made use of ART (71.4%), 82.5% had no comorbidities and 65.1% were not affected by non-oral opportunistic infections, though, 85.7% had at least one episode oral candidiasis. . Of the subjects studied, 71.4% were alive at the end of the follow-up period; 23.8% had AIDS as a cause death and three 4.8% patients died from other causes. Risk factors associated with death highlighted the variables "age" (p = 0.02), "non-oral opportunistic infection" (p = 0.00), " oral candidiasis "(p = 0.00)," CD4 "(p = 0.03). Survival analysis showed reduction in the probability of survival time only for individuals who came to the service with CD4 cell counts less than 350 cells / mm 3 (p = 0.00). The median overall survival time was 8.8 years, and the individuals using HAART had a higher survival (10.6 years) compared to those who have not used antiretroviral (6.0 years). In the multivariate analysis, statistically significant variables were age (<13 years), behaving as a protective factor (HR: 0.88; 95% CI: 0.78 to 0.98) and non-oral opportunistic infection as a factor of risk of death (HR: 4.3; 95% CI 1.51 to 12.1). Conclusion: This study points to the increased survival among infected by vertical route, evidenced by the significant number of individuals who have reached adolescence and possibly this is due to the use of antiretroviral with longer survival time among those who used the therapy, which shows that good results can be achieved, even in countries with limited resources. Causes of death resembled the national standard, although this is in transition, considering the causes unrelated to AIDS. The opportunistic infection remained a risk factor for death, according to the literature. The results show continuing need for adjustments and developments, in order to deal with the challenge of a chronic infection among individuals in a vulnerable stage, own youth. / Objetivo: analisar a sobrevida e fatores associados ao ?bito em crian?as, adolescentes e adultos jovens infectados pelo HIV , por transmiss?o vertical, matriculados no Centro de Refer?ncia Municipal (CRM) DST/HIV/AIDS de Feira de Santana. M?todos: estudo observacional, longitudinal, desenvolvido a partir de uma coorte de soropositivos para HIV, infectados por transmiss?o vertical, a partir de dados secund?rios obtidos da revis?o de prontu?rios cl?nicos de 37 crian?as, 21 adolescentes e cinco (5) adultos jovens, na faixa et?ria compreendida entre 0 e 24 anos , matriculados no Servi?o de Aten??o Especializada (SAE) do CRM, no per?odo de 2003 a 2014. Nas an?lises foi utilizado teste ?2 de Pearson, teste exato de Fisher e respectivo valor p, para investigar fatores associados ao ?bito. Al?m disso, foi utilizada an?lise de sobrevida com constru??o das curvas de Kaplan-Meier e teste log-rank a fim de verificar associa??o estatisticamente significante entre os grupos das vari?veis elencadas. Finalmente, utilizou-se regress?o de riscos proporcionais de cox para estimativa ajustada dos fatores de risco para ?bito. Resultados: Houve predom?nio das faixas de 0-12 anos (58,7%) e 13 a 19 anos (33,3%), sexo feminino (52,4%) e cor negra/parda (71,8%).. A maioria da popula??o estudada fazia uso de TARV (71,4%), 82,5% n?o apresentavam comorbidades e 65,1% n?o foram acometidos por infec??es oportunistas n?o orais, embora, 85,7% apresentaram, pelo menos, um epis?dio de candid?ase oral. . Dos indiv?duos estudados, 71,4% estavam vivos at? o fim do per?odo de seguimento; 23,8% tiveram Aids como causa morte e tr?s 4,8% ?bitos ocorreram por outras causas. Como fatores de risco associados ao ?bito destacaram-se as vari?veis ?faixa et?ria? (p=0,02), ?infec??o oportunista n?o oral? ( p=0,00), ?candid?ase oral? (p=0,00), ?contagem de c?lulas CD4? (p=0,03). A an?lise de sobreviv?ncia demonstrou probabilidade na redu??o do tempo de sobrevida apenas para indiv?duos que chegaram ao servi?o com contagem de c?lulas CD4 menor que 350 c?lulas/mm3 ( p=0,00). A mediana do tempo de sobrevida geral foi de 8,8 anos, sendo que os indiv?duos em uso de TARV apresentaram sobrevida maior (10,6 anos) quando comparados aos que n?o usaram antirretroviral (6,0 anos). Na an?lise multivariada, as vari?veis estatisticamente significativas foram idade (< 13 anos), comportando-se como fator de prote??o (HR:0,88; IC 95%: 0,78-0,98) e infec??o oportunista n?o oral como fator de risco para ?bito (HR:4,3; IC 95%: 1,51-12,1). Conclus?o: Este estudo aponta para o aumento da sobrevida entre infectados por via vertical, evidenciado atrav?s do n?mero significativo de indiv?duos que chegaram ? adolesc?ncia e, possivelmente, isto deve-se ? utiliza??o de antirretroviral com tempo de sobrevida maior entre aqueles que faziam uso da terapia, o que demonstra que bons resultados podem ser alcan?ados, mesmo em pa?ses com recursos limitados. As causas de ?bito assemelharam-se ao padr?o nacional, embora esse esteja em processo de transi??o, considerando as causas n?o relacionadas ? Aids. A infec??o oportunista permaneceu como fator de risco para ?bito, concordando com a literatura. Os resultados apontam necessidade cont?nua de adequa??es e empreendimentos, a fim de lidar com o desafio de uma infec??o cr?nica entre indiv?duos em fase de vulnerabilidade, pr?prias da juventude.

Objetivo General: Evaluar los factores asociados al tamizaje de Cáncer en la población adulta residente del territorio peruano que participó en la ENDES 2019. Métodos y Población: Se realizó un estudio transversal analítico por base secundaria (ENDES). La población abarcó a quienes se realizó la encuesta y tenían entre 25 y 70 años dando como muestra 24 962 personas. Resultados: La prevalencia de detención de cáncer fue de 23.1% en general; 34.5% para examen clínico de mama; 78.2% de Papanicolau y 25.4% de prevalencia para mamografía. Se encontró que en la costa centro fue la región donde más se realizaban pruebas de tamizaje. Además, considerarse nativo o indígena posee menor adherencia a la realización de dichas pruebas (p<0.05). A excepción de la prueba de Papanicolaou, la mayoría de quienes se hacen la prueba cuentan con seguro de salud (p<0.05). Respecto a descarte de cáncer, tener educación superior universitaria y considerarse nativo o indígena presenta un RPa 2,24; 95% IC: [1,29-3,89]; y RPa 0.62; 95% IC: [0,46-0,82] respectivamente. Conclusiones: Se encontró que la población femenina tiene mayor predisposición a realizarse algún tamizaje de cáncer. Además, la mayor cobertura de exámenes de tamizaje de cáncer se relaciona con el nivel de educación, con considerarse ser de raza blanca o mestizo, vivir en macrorregión costa centro y contar con seguro de salud y también aumenta la probabilidad de realizarse dichos descartes. Este estudio dará un panorama a futuros análisis respecto a la cobertura del cáncer en el país previo a la pandemia. / General Objective: To evaluate the factors associated with Cancer screening in the adult population residing in the Peruvian territory that participated in the ENDES 2019. Methods and Population: An analytical cross-sectional study by secondary base (ENDES) was carried out. The population was people who carried out the survey and were between 25 and 70 years of age, giving 24 962 as a sample. Results: The prevalence of cancer arrest was 23.1% overall; 34.5% for clinical breast examination; 78.2% for Pap smears and 25.4% prevalence for mammography. It was found that the central coast was the region where the most screening tests were carried out. In addition, considering oneself native or indigenous has less adherence to performing these tests (p <0.05). With the exception of the Pap test, the majority of those who get tested have health insurance (p <0.05). Regarding cancer ruling out, having a higher university education and considering oneself native or indigenous presents an RPa of 2.24; 95% CI: [1.29-3.89]; and RPa 0.62; 95% CI: [0.46-0.82] with p <0.05 respectively. Conclusions: It was found that the female population has a greater predisposition to undergo some cancer screening. In addition, the greater coverage of cancer screening examinations is related to the level of education, considering being white or mestizo, living in the central coast macro-region and having health insurance, and it also increases the probability of such discards. This study will provide an overview of future analyzes regarding cancer coverage in the country prior to the pandemic. / Tesis

Objetivo: Determinar los factores asociados a la anemia en niños de 6 a 36 meses en el Centro de Salud Toribia Castro, Lambayeque 2020-2021. Metodología: El tipo de estudio fue observacional analítico de diseño transversal, la población estuvo formada por 1046 niños de 6 a 36 meses; teniendo en cuenta una frecuencia esperada de 40.1 %, se calculó una muestra de 273 niños los cuales fueron seleccionados a través de un muestreo aleatorio simple. En el análisis estadístico para verificar la distribución normal en las variables cuantitativas de los datos se utilizó la prueba de kolmogorov-smirnov y en las variables cualitativas, se presentaron en frecuencias absolutas y relativas. Para el análisis bivariado, se utilizaron las pruebas chi cuadrado y Fisher. Resultados: La muestra estudiada fue de 257, la frecuencia de anemia fue de 54.5 %; el 50 % de ellos tenían menor o igual a 10 meses de nacido con un rango intercuartílico entre 7 y 12 meses. En el análisis bivariado, las variables anemia gestacional, el consumo de alimentos con hierro y el grado de estudio del apoderado resultaron ser estadísticamente significativas (P<0.05). Respecto a las características clínicas, se encontró que el 64.2 % cumple con sus controles CRED, el 89.9 % recibe suplemento de hierro y no existe diferencia significativa de la anemia con respecto a las inmunizaciones, estado nutricional, EDAS, infecciones respiratorias o parasitarias. También se demostró que no existe diferencia estadísticamente significativa entre la anemia en niños de 6 a 36 meses y los factores socioeconómicos, sociodemográficos y características gestacionales de la madre. Conclusiones: La frecuencia de anemia fue de 54.5 % siendo el tipo más frecuente la anemia leve; los factores asociados fueron anemia gestacional, el consumo insuficiente de alimentos con hierro y el grado de estudios del apoderado. Los niños cuyas madres tuvieron anemia gestacional tienen 34 % más de probabilidad de presentar anemia; así mismo aquellos niños que consumen diariamente alimentos con hierro presentan 47 % menos probabilidad de presentar anemia a comparación de aquellos que consumen dichos alimentos de forma interdiaria. / Objective: To determine the factors associated with anemia in children from 6 to 36 months at the Toribia Castro Health Center, Lambayeque 2020. Methodology: The study was of type analytical observational with a cross-sectional design, the population consisted of 1046 children from 6 to 36 months treated at the Health Center; Taking into account an expected frequency of 40.1%, a sample of 273 children was calculated, who were selected through simple random sampling. In the statistical analysis, the Kolmogorov-Smirnov test was used in order to verify the normal distribution for the quantitative variables of the data. In the other hand, absolute and relative frequencies were presented for qualitative variables. Chi-square and Fisher tests were used for bivariate analysis. Results: The sample size was 257, the frequency of anemia was 54.5%; 50% of them were less than or equal to 10 months old with an interquartile range between 7 and 12 months. In the bivariate analysis, the variables gestational anemia, consumption of foods with iron and the educational level of the guardian turned out to be statistically significant (P<0.05). In relation to clinical characteristics, it was found that 64.2% of them fit their CRED controls, 89.9% receive iron supplements and there is no significant difference in anemia when it comes to immunizations, nutritional status, EDAS, respiratory or parasitic infections. It was also shown that there is no statistically significant difference between anemia in children from 6 to 36 months and socioeconomic, sociodemographic factors and gestational characteristics of the mother. Conclusions: The frequency of anemia was 54.5%, with mild anemia being the most common type; associated factors were gestational anemia, insufficient consumption of foods rich in iron and the guardian’s educational level. Children whose mothers had gestational anemia are 34% more likely to have anemia; likewise, children who consume food rich in iron daily are 47% less likely to present anemia in comparison with those who consume such foods every two days.

Objetivos: Identificar a distribuição do índice de massa corporal (IMC), da circunferência da cintura (Ccintura), da razão cintura-quadril (RCQ) e do índice de conicidade (IC), segundo variáveis demográficas, socioeconômicas, relacionadas à saúde e comportamentais na população de 30 anos e mais, residente no município de Ribeirão Preto - SP, em 2006; avaliar o efeito modulador das regiões geográficas do município sobre os fatores associados aos indicadores antropométricos e estimar a contribuição do nível agregado para esses desfechos. Métodos: Estudo epidemiológico transversal, de base populacional, com amostragem em três estágios de sorteio. Pesos amostrais foram calculados para a recomposição do total de elegíveis e correção da taxa de não-resposta, em cada setor censitário, originando amostra ponderada de 2.197 participantes. Médias e intervalos de confiança (95%) dos indicadores antropométricos foram calculados, segundo sexo, nas categorias das variáveis independentes. Análise de variância, com um critério de classificação foi utilizada para a comparação das médias dos desfechos nas categorias das variáveis independentes. Testes de tendência linear foram aplicados para variáveis com mais de duas categorias. O nível de significância adotado foi ?=5%. Para a identificação de fatores associados aos indicadores antropométricos foram construídos modelos lineares multinível de efeitos fixos com dois níveis. Os 81 setores censitários sorteados foram agrupados em quatro regiões geográficas do município (nível agregado). A análise multinível seguiu modelo conceitual hierarquizado para avaliação do efeito direto de variáveis de nível individual e a contribuição do nível agregado sobre os desfechos (rho). Medidas de efeito (?) foram estimadas por pontos e por intervalos com 95% de confiança para as variáveis independentes. As medidas de associação foram calculadas, inicialmente, em modelos parciais que incluíram as variáveis de cada bloco hierárquico, ajustadas para as de blocos precedentes. Nos modelos finais, permaneceram as variáveis que mantiveram significância estatística (p < 0,05), após ajustamento simultâneo para os blocos precedentes. Para cada um dos desfechos considerados, calcularam-se médias ajustadas nas categorias das variáveis independentes, segundo regiões geográficas do município. Diferenças das médias ajustadas entre os extremos das categorias das variáveis independentes foram calculadas para avaliar o efeito modulador das regiões geográficas. Todas as estimativas calculadas levaram em consideração o efeito de desenho amostral. Resultados: Em relação ao IMC e em ambos os sexos, médias de maior magnitude foram detectadas entre os que referiram antecedentes familiares de excesso de peso, história pessoal de obesidade, utilizaram medicamentos nos últimos 15 dias e seguiram dieta alimentar para perda de peso. No sexo feminino, médias mais elevadas de IMC foram detectadas entre as mais velhas, com menor escolaridade, maior tempo de residência no município e que referiram antecedentes familiares de acidente vascular cerebral (AVC). O elenco de fatores associados ao IMC foi constituído por: sexo (?= -0,814; IC95% : -1,514 - -0,113), idade (?= 0,050; IC95% : 0,014 - 0,086), escolaridade (?= -0,101; IC95% : -0,206 - -0,005) , antecedentes familiares de excesso de peso (?= 1,214; IC95% : 0,468 - 1,961), história pessoal de obesidade (?= 6,422; IC95%: 5,724 - 7,119) e consumo de lipídios (?= 0,029; IC95% : 0,008 - 0,051), considerando-se a contribuição de 11% do nível agregado. As menores diferenças entre as médias ajustadas do IMC foram detectadas, principalmente, nos extremos das categorias das variáveis: sexo, faixas etárias, escolaridade e consumo de lipídios nas regiões Norte e Oeste do município. Médias de maior magnitude para os três indicadores de obesidade central (Ccintura, RCQ e IC), foram observadas entre os participantes mais velhos, com menor escolaridade, classificados nos estratos mais baixos de renda, com maior tempo de residência no município, com antecedentes familiares de excesso de peso, história pessoal de obesidade e entre aqueles classificados como \"pré-obesos\" e \"obesos\". O elenco de fatores associados à Ccintura foi constituído por: sexo (?= -8,686; IC95% : -9,439 - -7,932), idade (?= 0,169; IC95% : 0,122 - 0,216), antecedentes familiares de AVC (?= 0,689; IC95% : 0,051 - 1,327), história pessoal de obesidade (?= 2,363; IC95% : 0,320 - 4,410), IMC (?= 1,689; IC95% : 1,437 - 1,941), nº de medicamentos (?= 0,259; IC95% : 0,078 - 0,440), tempo de tabagismo (?= 0,035; IC95% : 0,008 - 0,061) e energia total da dieta (?= 0,084; IC95% : 0,012 - 0,157), considerando-se a contribuição de 12,4% do nível agregado. As menores diferenças entre as médias ajustadas da Ccintura foram detectadas nos extremos das categorias das variáveis: antecedentes familiares de AVC, tempo de tabagismo e energia total da dieta nas regiões Norte e Oeste. Em relação à RCQ, permaneceram associadas as variáveis: sexo (?= -0,099; IC95% : -0,107 - -0,090), idade (?= 0,002; IC95% : 0,001 - 0,003), IMC (?= 0,004; IC95% : 0,003 - 0,005), nº de medicamentos (?= 0,004; IC95% : 0,001 - 0,007), tempo de tabagismo (?= 0,0006; IC95% : 0,0004 - 0,0009), dependência de álcool (?= 0,013; IC95% : 0,003 - 0,022), dieta para perder peso (?= 0,017; IC95% : 0,004 - 0,030) e consumo de carboidratos (?= 0,0001; IC95% : 0,0001 - 0,0002). A contribuição do nível agregado foi equivalente a 12%. As menores diferenças entre as médias ajustadas da RCQ foram detectadas nos extremos das categorias das variáveis: nº de medicamentos e consumo de carboidratos na região Oeste. O elenco de fatores associados ao IC foi composto por: sexo (?= -0,068; IC95% : -0,076 - -0,056), idade (?= 0,003; IC95% : 0,002 - 0,004), antecedentes familiares de AVC (?= 0,008; IC95% : 0,001 - 0,016), IMC (?= 0,005; IC95% : 0,004 - 0,006), acesso a serviços de saúde (?= -0,011; IC95% : -0,020 - -0,002), nº de medicamentos (?= 0,004; IC95% : 0,002 - 0,007), tempo de tabagismo (?= 0,0004; IC95% : 0,0001 - 0,0007), dependência de álcool (?= 0,011; IC95% : 0,001 - 0,020), dieta para perder peso (?= 0,015; IC95% : 0,002 - 0,030) e consumo de ácidos graxos monoinsaturados (?= -0,0005; IC95% : -0,0010 - -0,0001), com contribuição do nível agregado equivalente a 14,1%. As menores diferenças entre as médias ajustadas do IC foram detectadas nos extremos das categorias das variáveis: acesso a serviços de saúde e dependência de álcool, na região Norte. Conclusões: No município de Ribeirão Preto, as regiões Norte e Oeste foram identificadas como regiões obesogênicas. Medidas de promoção de hábitos saudáveis, bem como de prevenção da obesidade, no município, não devem ser direcionadas apenas para mudanças de hábitos individuais, visto que o impacto de tais intervenções pode ser minimizado ou refreado pelo efeito de contexto destas regiões. / Objectives: To identify the distribution of the body mass index (BMI), waist circumference (waistC), waist-to-hip ratio (WHR) and conicity index (CI), according to demographic, socioeconomic, health-related and behavioral variables, in the population aged 30 years and older, living in Ribeirão Preto - SP, Brazil, in 2006; to assess shaping effect of geographical regions on associated factors related to anthropometric indexes as well as to estimate the contribution of the ecological level to the outcomes. Methods: Population-based cross-sectional epidemiological study with multistage sampling. Sampling weights were calculated to compose the total number of eligible participants and correct for the non-response rate, in each census tract, resulting in a weighted sample of 2,197 participants. Means and confidence intervals (95%) were calculated for the anthropometric indexes, according to gender, in the categories of the independent variables. To compare the mean outcomes in the categories of the independent variables, ANOVA (one criterion) was used. Linear trend tests were applied for variables with more than two categories. Significance level was 5%. To identify anthropometric indexes correlates, two-level fixed-effects multilevel linear models were applied. The 81 census tracts drawn were grouped in four geographical regions of the city (ecological level). Multilevel analysis followed a hierarchical conceptual model to assess the direct effect of individual variables and the contribution of the ecological level to the outcomes (rho). Point and confidence intervals (95%) for the effect measures (?) were calculated for independent variables. Firstly, these effect measures were calculated in partial models that included the variables of each hierarchical block, adjusted for the preceding blocks\' variables. In the final models, statistically significant variables (p< 0.05) were kept, after adjusting for the preceding blocks. For the outcomes, the adjusted means were calculated in the categories of the independent variables, according to geographical regions. Adjusted means differences between extreme categories of independent variables were calculated to assess the shaping effect of the geographical regions. All estimates took into account the design effect. Results: Higher mean of BMI were detected, in both gender, among those who reported familial antecedents of overweight, personal history of obesity, took medicines in the last 15 days, and adopted a weight loss diet. Among women, higher mean of BMI were found among the older, those with lower education level, who had lived in the city for longer time and reported familial antecedents of stroke (STR). The BMI correlates were: gender (?= -0.814; CI95% : -1.514 - -0.113), age (?= 0.050; CI95% : 0.014 - 0.086), education (?= -0.101; CI95% : -0.206 - -0.005), familial antecedents of overweight (?= 1.214; CI95% : 0.468 - 1.961), personal antecedents of overweight (?= 6.422; CI95% : 5.724 - 7.119) and total fat consumption (?= 0.029; CI95% : 0.008 - 0.051), considering the 11% contribution of the ecological level. The smallest adjusted means differences of BMI were mainly detected at the extreme categories of the following variables: gender, age strata, education and total fat consumption in the North and West regions. Higher means for the three central obesity indexes (waistC, WHR and CI) were observed among the older, with a lower education level, classified in the lowest income groups, who had lived in the city for longer time, with familial antecedents of overweight, personal antecedents of obesity, and among those classified as \"pre-obese\" and \"obese\". The waistC correlated included: gender (?= -8.686; CI95% : -9.439 - -7.932), age (?= 0.169; CI95% : 0.122 - 0.216), familial antecedents of STR (?= 0.689; CI95% : 0.051 - 1.327), personal antecedents of obesity (?= 2.363; CI95% : 0.320 - 4.410), BMI (?= 1.689; CI95% : 1.437 - 1.941), nº of medicines taken (?= 0.259; CI95% : 0.078 - 0.440), smoking time (?= 0.035; CI95% : 0.008 - 0.061), and total energy of diet (?= 0.084; CI95% : 0.012 - 0.157), considering the 12.4% contribution of the ecological level. The smallest adjusted means differences of waistC were detected at the extreme categories of the following variables: familial antecedents of STR, smoking time, and total energy of diet in the North and West. The correlates of WHR were: gender (?= -.099; CI95% : -0.107 - -0.090), age (?= 0.002; CI95%: 0.001 - 0.003), BMI (?= 0.004; CI95% : 0.003 - 0.005), nº of medicines taken (?= 0.004; CI95% : 0.001 - 0.007), smoking time (?= 0.0006; CI95% : 0.0004 - 0.0009), alcohol addiction (?= 0.013; CI95% : 0.003 - 0.022), weight loss diet (?= 0.017; CI95% : 0.004 - 0.030) and carbohydrate consumption (?= 0.0001; CI95% : 0.0001 - 0.0002). The ecological level contributed with 12%. The smallest adjusted means differences of WHR were detected at the extreme categories of the variables: nº of medicines taken and carbohydrate consumption in the West of the city. The CI correlates included: gender (?= -0.068; CI95% : -0.076 - -0.056), age (?= 0.003; CI95% : 0.002 - 0.004), familial antecedents of STR (?= 0.008; CI95% : 0.001 - 0.016), BMI (?= 0.005; CI95% : 0.004 - 0.006), access to health services (?= -0.011; CI95% : -0.020 - -0.002), nº of medicines taken (?= 0.004; CI95% : 0.002 - 0.007), smoking time (?= 0.0004; CI95% : 0.0001 - 0.0007), alcohol addiction (?= 0.011; CI95% : 0.001 - 0.020), weight loss diet (?= 0.015; CI95% : 0.002 - 0.030) and MUFA´s consumption (?= -0.0005; CI95% : -0.0010 - -0.0001), with 14.1% of contribution from the ecological level. The smallest adjusted means differences of CI were detected at the extreme categories of the variables: access to health services and alcohol addiction, in the North region. Conclusions: In the Ribeirão Preto city, the North and West regions were identified as obesogenic areas. Thus to promoting health behaviors and preventing the obesity in the city it should be taken into account that interventions might be applied not only for changing individual behaviors, since the impact of those interventions may be minimized or constrained by the contextual effect imposed by those regions.

Submitted by Ricardo Ernesto Vasquez Beltrão (revbeltrao@yahoo.com.br) on 2014-09-26T11:43:42Z No. of bitstreams: 1 TESE_BELTRAO_versao_final.pdf: 4066891 bytes, checksum: 31031af3df7530771019e79dc7d9a9f6 (MD5) / Rejected by PAMELA BELTRAN TONSA (pamela.tonsa@fgv.br), reason: Bom dia Ricardo. De acordo com as normas você deverá colocar a dedicatória a direita da folha. No resumo a configuração da letra não pode estar em itálico e necessário que seja normal. Apos os ajustes, submeter novamente para a aprovação. Qualquer duvida estou a disposição. Att, Pamela Tonsa 3799-7852 on 2014-09-26T11:59:10Z (GMT) / Submitted by Ricardo Ernesto Vasquez Beltrão (revbeltrao@yahoo.com.br) on 2014-09-26T12:41:57Z No. of bitstreams: 1 TESE_BELTRAO_versao_final.pdf: 4067208 bytes, checksum: 497a29f3d852139d00191824654d4fea (MD5) / Approved for entry into archive by PAMELA BELTRAN TONSA (pamela.tonsa@fgv.br) on 2014-09-26T12:47:00Z (GMT) No. of bitstreams: 1 TESE_BELTRAO_versao_final.pdf: 4067208 bytes, checksum: 497a29f3d852139d00191824654d4fea (MD5) / Made available in DSpace on 2014-09-26T14:14:47Z (GMT). No. of bitstreams: 1 TESE_BELTRAO_versao_final.pdf: 4067208 bytes, checksum: 497a29f3d852139d00191824654d4fea (MD5) Previous issue date: 2014-08-22 / This work analyze the child labor occurrence in Brazil, the factors associated with its development were investigated and some limits of the Program for Child Labor Eradication (PETI) to face the question nowadays. This work was organized in four chapters. In the first chapter are shown the research problem, its objectives and presuppositions, and the main characteristics of the PETI, and then the theoretical background about the intergovernmental cooperation in ambit of the public politics in Brazil was analyzed. In the second chapter the child labor in the international ambit was discussed, by means of analytical work that compares the association between the activity rates of the population from 10 to 14 years old and a set of variables that express the socioeconomic and demographic factors for one sample of the 25 countries with more than 20 millions habitants. The third chapter was developed in a similar way to the previous, analyzing how the children employment developed in the country since middle of last century, and to what extent the differences among these Brazilian states are associated with its socioeconomic and demographic variables, with emphasis on the labor market structure. The fourth chapter analyzes the differences among the Brazilian cities, and concludes that the PETI cannot be considered among the main factors that explain the variations in rates activity of the child population in the last decade, pointing out some of the Program limits related to the promotion of intergovernmental cooperation necessary for the country keep on advancing in an effective way to confronting this theme. The work also includes an overview of the Brazilian academic literature about child labor, one set of studies focused on the analysis of the State actions to face this question were highlighted (Appendix A). / O estudo analisa a ocorrência do trabalho infantil no Brasil, investigando os fatores associados à sua evolução e alguns dos limites do Programa de Erradicação do Trabalho Infantil (PETI) para o enfrentamento da questão na atualidade. O trabalho está organizado em quatro capítulos, além daquele que o encerra com um breve comentário conclusivo. No primeiro são apresentados o problema de pesquisa, seus objetivos e pressupostos, e as principais características do PETI, para em seguida ser analisado o referencial teórico sobre a cooperação intergovernamental no âmbito das políticas sociais no Brasil. No segundo capítulo é discutida a ocorrência do trabalho infantil em âmbito internacional, por meio de esforço analítico que compara a associação entre as taxas de atividade da população de 10 a 14 anos e um conjunto de variáveis que expressam fatores de ordem socioeconômica e demográfica para uma amostra de 25 países com mais de 20 milhões de habitantes. O terceiro capítulo é desenvolvido em termos similares ao anterior, analisando como evoluiu a ocupação de crianças no país desde meados do século passado, e em que medida as diferenças entre os Estados brasileiros a respeito estão associadas a variáveis socioeconômicas e demográficas, com ênfase na estrutura do mercado de trabalho. O quarto capítulo analisa as diferenças entre os municípios brasileiros a respeito, e conclui que o PETI não pode ser considerado entre os principais fatores que explicam as variações nas taxas de atividade da população infantil na década passada, apontando alguns dos limites do Programa relacionados à promoção da cooperação intergovernamental necessária para que o país continue avançando de forma mais efetiva no enfrentamento da questão. O trabalho inclui também um balanço sobre a produção acadêmica brasileira a respeito do trabalho infantil, destacando o conjunto de estudos voltados à análise das ações do Estado frente à questão (Apêndice A).

Objetivos: Identificar a distribuição do índice de massa corporal (IMC), da circunferência da cintura (Ccintura), da razão cintura-quadril (RCQ) e do índice de conicidade (IC), segundo variáveis demográficas, socioeconômicas, relacionadas à saúde e comportamentais na população de 30 anos e mais, residente no município de Ribeirão Preto - SP, em 2006; avaliar o efeito modulador das regiões geográficas do município sobre os fatores associados aos indicadores antropométricos e estimar a contribuição do nível agregado para esses desfechos. Métodos: Estudo epidemiológico transversal, de base populacional, com amostragem em três estágios de sorteio. Pesos amostrais foram calculados para a recomposição do total de elegíveis e correção da taxa de não-resposta, em cada setor censitário, originando amostra ponderada de 2.197 participantes. Médias e intervalos de confiança (95%) dos indicadores antropométricos foram calculados, segundo sexo, nas categorias das variáveis independentes. Análise de variância, com um critério de classificação foi utilizada para a comparação das médias dos desfechos nas categorias das variáveis independentes. Testes de tendência linear foram aplicados para variáveis com mais de duas categorias. O nível de significância adotado foi ?=5%. Para a identificação de fatores associados aos indicadores antropométricos foram construídos modelos lineares multinível de efeitos fixos com dois níveis. Os 81 setores censitários sorteados foram agrupados em quatro regiões geográficas do município (nível agregado). A análise multinível seguiu modelo conceitual hierarquizado para avaliação do efeito direto de variáveis de nível individual e a contribuição do nível agregado sobre os desfechos (rho). Medidas de efeito (?) foram estimadas por pontos e por intervalos com 95% de confiança para as variáveis independentes. As medidas de associação foram calculadas, inicialmente, em modelos parciais que incluíram as variáveis de cada bloco hierárquico, ajustadas para as de blocos precedentes. Nos modelos finais, permaneceram as variáveis que mantiveram significância estatística (p < 0,05), após ajustamento simultâneo para os blocos precedentes. Para cada um dos desfechos considerados, calcularam-se médias ajustadas nas categorias das variáveis independentes, segundo regiões geográficas do município. Diferenças das médias ajustadas entre os extremos das categorias das variáveis independentes foram calculadas para avaliar o efeito modulador das regiões geográficas. Todas as estimativas calculadas levaram em consideração o efeito de desenho amostral. Resultados: Em relação ao IMC e em ambos os sexos, médias de maior magnitude foram detectadas entre os que referiram antecedentes familiares de excesso de peso, história pessoal de obesidade, utilizaram medicamentos nos últimos 15 dias e seguiram dieta alimentar para perda de peso. No sexo feminino, médias mais elevadas de IMC foram detectadas entre as mais velhas, com menor escolaridade, maior tempo de residência no município e que referiram antecedentes familiares de acidente vascular cerebral (AVC). O elenco de fatores associados ao IMC foi constituído por: sexo (?= -0,814; IC95% : -1,514 - -0,113), idade (?= 0,050; IC95% : 0,014 - 0,086), escolaridade (?= -0,101; IC95% : -0,206 - -0,005) , antecedentes familiares de excesso de peso (?= 1,214; IC95% : 0,468 - 1,961), história pessoal de obesidade (?= 6,422; IC95%: 5,724 - 7,119) e consumo de lipídios (?= 0,029; IC95% : 0,008 - 0,051), considerando-se a contribuição de 11% do nível agregado. As menores diferenças entre as médias ajustadas do IMC foram detectadas, principalmente, nos extremos das categorias das variáveis: sexo, faixas etárias, escolaridade e consumo de lipídios nas regiões Norte e Oeste do município. Médias de maior magnitude para os três indicadores de obesidade central (Ccintura, RCQ e IC), foram observadas entre os participantes mais velhos, com menor escolaridade, classificados nos estratos mais baixos de renda, com maior tempo de residência no município, com antecedentes familiares de excesso de peso, história pessoal de obesidade e entre aqueles classificados como \"pré-obesos\" e \"obesos\". O elenco de fatores associados à Ccintura foi constituído por: sexo (?= -8,686; IC95% : -9,439 - -7,932), idade (?= 0,169; IC95% : 0,122 - 0,216), antecedentes familiares de AVC (?= 0,689; IC95% : 0,051 - 1,327), história pessoal de obesidade (?= 2,363; IC95% : 0,320 - 4,410), IMC (?= 1,689; IC95% : 1,437 - 1,941), nº de medicamentos (?= 0,259; IC95% : 0,078 - 0,440), tempo de tabagismo (?= 0,035; IC95% : 0,008 - 0,061) e energia total da dieta (?= 0,084; IC95% : 0,012 - 0,157), considerando-se a contribuição de 12,4% do nível agregado. As menores diferenças entre as médias ajustadas da Ccintura foram detectadas nos extremos das categorias das variáveis: antecedentes familiares de AVC, tempo de tabagismo e energia total da dieta nas regiões Norte e Oeste. Em relação à RCQ, permaneceram associadas as variáveis: sexo (?= -0,099; IC95% : -0,107 - -0,090), idade (?= 0,002; IC95% : 0,001 - 0,003), IMC (?= 0,004; IC95% : 0,003 - 0,005), nº de medicamentos (?= 0,004; IC95% : 0,001 - 0,007), tempo de tabagismo (?= 0,0006; IC95% : 0,0004 - 0,0009), dependência de álcool (?= 0,013; IC95% : 0,003 - 0,022), dieta para perder peso (?= 0,017; IC95% : 0,004 - 0,030) e consumo de carboidratos (?= 0,0001; IC95% : 0,0001 - 0,0002). A contribuição do nível agregado foi equivalente a 12%. As menores diferenças entre as médias ajustadas da RCQ foram detectadas nos extremos das categorias das variáveis: nº de medicamentos e consumo de carboidratos na região Oeste. O elenco de fatores associados ao IC foi composto por: sexo (?= -0,068; IC95% : -0,076 - -0,056), idade (?= 0,003; IC95% : 0,002 - 0,004), antecedentes familiares de AVC (?= 0,008; IC95% : 0,001 - 0,016), IMC (?= 0,005; IC95% : 0,004 - 0,006), acesso a serviços de saúde (?= -0,011; IC95% : -0,020 - -0,002), nº de medicamentos (?= 0,004; IC95% : 0,002 - 0,007), tempo de tabagismo (?= 0,0004; IC95% : 0,0001 - 0,0007), dependência de álcool (?= 0,011; IC95% : 0,001 - 0,020), dieta para perder peso (?= 0,015; IC95% : 0,002 - 0,030) e consumo de ácidos graxos monoinsaturados (?= -0,0005; IC95% : -0,0010 - -0,0001), com contribuição do nível agregado equivalente a 14,1%. As menores diferenças entre as médias ajustadas do IC foram detectadas nos extremos das categorias das variáveis: acesso a serviços de saúde e dependência de álcool, na região Norte. Conclusões: No município de Ribeirão Preto, as regiões Norte e Oeste foram identificadas como regiões obesogênicas. Medidas de promoção de hábitos saudáveis, bem como de prevenção da obesidade, no município, não devem ser direcionadas apenas para mudanças de hábitos individuais, visto que o impacto de tais intervenções pode ser minimizado ou refreado pelo efeito de contexto destas regiões. / Objectives: To identify the distribution of the body mass index (BMI), waist circumference (waistC), waist-to-hip ratio (WHR) and conicity index (CI), according to demographic, socioeconomic, health-related and behavioral variables, in the population aged 30 years and older, living in Ribeirão Preto - SP, Brazil, in 2006; to assess shaping effect of geographical regions on associated factors related to anthropometric indexes as well as to estimate the contribution of the ecological level to the outcomes. Methods: Population-based cross-sectional epidemiological study with multistage sampling. Sampling weights were calculated to compose the total number of eligible participants and correct for the non-response rate, in each census tract, resulting in a weighted sample of 2,197 participants. Means and confidence intervals (95%) were calculated for the anthropometric indexes, according to gender, in the categories of the independent variables. To compare the mean outcomes in the categories of the independent variables, ANOVA (one criterion) was used. Linear trend tests were applied for variables with more than two categories. Significance level was 5%. To identify anthropometric indexes correlates, two-level fixed-effects multilevel linear models were applied. The 81 census tracts drawn were grouped in four geographical regions of the city (ecological level). Multilevel analysis followed a hierarchical conceptual model to assess the direct effect of individual variables and the contribution of the ecological level to the outcomes (rho). Point and confidence intervals (95%) for the effect measures (?) were calculated for independent variables. Firstly, these effect measures were calculated in partial models that included the variables of each hierarchical block, adjusted for the preceding blocks\' variables. In the final models, statistically significant variables (p< 0.05) were kept, after adjusting for the preceding blocks. For the outcomes, the adjusted means were calculated in the categories of the independent variables, according to geographical regions. Adjusted means differences between extreme categories of independent variables were calculated to assess the shaping effect of the geographical regions. All estimates took into account the design effect. Results: Higher mean of BMI were detected, in both gender, among those who reported familial antecedents of overweight, personal history of obesity, took medicines in the last 15 days, and adopted a weight loss diet. Among women, higher mean of BMI were found among the older, those with lower education level, who had lived in the city for longer time and reported familial antecedents of stroke (STR). The BMI correlates were: gender (?= -0.814; CI95% : -1.514 - -0.113), age (?= 0.050; CI95% : 0.014 - 0.086), education (?= -0.101; CI95% : -0.206 - -0.005), familial antecedents of overweight (?= 1.214; CI95% : 0.468 - 1.961), personal antecedents of overweight (?= 6.422; CI95% : 5.724 - 7.119) and total fat consumption (?= 0.029; CI95% : 0.008 - 0.051), considering the 11% contribution of the ecological level. The smallest adjusted means differences of BMI were mainly detected at the extreme categories of the following variables: gender, age strata, education and total fat consumption in the North and West regions. Higher means for the three central obesity indexes (waistC, WHR and CI) were observed among the older, with a lower education level, classified in the lowest income groups, who had lived in the city for longer time, with familial antecedents of overweight, personal antecedents of obesity, and among those classified as \"pre-obese\" and \"obese\". The waistC correlated included: gender (?= -8.686; CI95% : -9.439 - -7.932), age (?= 0.169; CI95% : 0.122 - 0.216), familial antecedents of STR (?= 0.689; CI95% : 0.051 - 1.327), personal antecedents of obesity (?= 2.363; CI95% : 0.320 - 4.410), BMI (?= 1.689; CI95% : 1.437 - 1.941), nº of medicines taken (?= 0.259; CI95% : 0.078 - 0.440), smoking time (?= 0.035; CI95% : 0.008 - 0.061), and total energy of diet (?= 0.084; CI95% : 0.012 - 0.157), considering the 12.4% contribution of the ecological level. The smallest adjusted means differences of waistC were detected at the extreme categories of the following variables: familial antecedents of STR, smoking time, and total energy of diet in the North and West. The correlates of WHR were: gender (?= -.099; CI95% : -0.107 - -0.090), age (?= 0.002; CI95%: 0.001 - 0.003), BMI (?= 0.004; CI95% : 0.003 - 0.005), nº of medicines taken (?= 0.004; CI95% : 0.001 - 0.007), smoking time (?= 0.0006; CI95% : 0.0004 - 0.0009), alcohol addiction (?= 0.013; CI95% : 0.003 - 0.022), weight loss diet (?= 0.017; CI95% : 0.004 - 0.030) and carbohydrate consumption (?= 0.0001; CI95% : 0.0001 - 0.0002). The ecological level contributed with 12%. The smallest adjusted means differences of WHR were detected at the extreme categories of the variables: nº of medicines taken and carbohydrate consumption in the West of the city. The CI correlates included: gender (?= -0.068; CI95% : -0.076 - -0.056), age (?= 0.003; CI95% : 0.002 - 0.004), familial antecedents of STR (?= 0.008; CI95% : 0.001 - 0.016), BMI (?= 0.005; CI95% : 0.004 - 0.006), access to health services (?= -0.011; CI95% : -0.020 - -0.002), nº of medicines taken (?= 0.004; CI95% : 0.002 - 0.007), smoking time (?= 0.0004; CI95% : 0.0001 - 0.0007), alcohol addiction (?= 0.011; CI95% : 0.001 - 0.020), weight loss diet (?= 0.015; CI95% : 0.002 - 0.030) and MUFA´s consumption (?= -0.0005; CI95% : -0.0010 - -0.0001), with 14.1% of contribution from the ecological level. The smallest adjusted means differences of CI were detected at the extreme categories of the variables: access to health services and alcohol addiction, in the North region. Conclusions: In the Ribeirão Preto city, the North and West regions were identified as obesogenic areas. Thus to promoting health behaviors and preventing the obesity in the city it should be taken into account that interventions might be applied not only for changing individual behaviors, since the impact of those interventions may be minimized or constrained by the contextual effect imposed by those regions.

Introduction : Chaque année, 703 000 personnes décèdent par suicide à travers le monde et une proportion encore plus importante de personnes pensent au suicide ou font une tentative de suicide. L’étude des facteurs associés aux idées et aux comportements suicidaires vise à améliorer notre compréhension de cette problématique pour mieux cibler les personnes à risque, mieux les soutenir et, ultimement, diminuer les taux de décès par suicide. Les troubles psychotiques sont associés à une vulnérabilité accrue au suicide, particulièrement dans les premières années suivant l’émergence de la psychose, c’est-à-dire lors du premier épisode psychotique (PEP). L’objectif général de la thèse est de mieux comprendre l’évolution des idées suicidaires et des comportements suicidaires ainsi que les facteurs qui y sont associés chez les personnes présentant un PEP. Méthode : Trois études ont été réalisées. La première est une recension systématique des écrits réalisée en accord avec les critères PRISMA. Les études longitudinales portant sur la prévalence et les facteurs associés aux idées et aux comportements suicidaires chez les personnes présentant un PEP ont été répertoriées à partir de cinq banques de données et des références bibliographiques des articles pertinents. Le tri des articles, l’extraction des données ainsi que l’évaluation de la qualité des articles ont été réalisés par deux codeurs indépendants. La deuxième étude a identifié les trajectoires des idées suicidaires sur une période de cinq ans et la distribution des tentatives de suicide à travers ces trajectoires chez les patients présentant un PEP, admis entre 2005 et 2013, dans deux services d’intervention précoce pour la psychose à Montréal, Québec. Les données sur les idées suicidaires, les tentatives de suicide, les décès par suicide, et les facteurs potentiellement associés ont été évalués annuellement pendant cinq ans par des entrevues de recherche, la révision des dossiers médicaux et les rapports du coroner. Des analyses de trajectoires latentes ont été réalisées. Enfin, le troisième article a comparé l’évolution des idées et des comportements suicidaires dans des services d’intervention précoce pour la psychose, structurés de façon similaire, dans deux contextes socioculturels différents, soit à Montréal, au Canada et à Chennai, en Inde. Les données sur les idées et les comportements suicidaires ainsi que sur les facteurs potentiellement associés ont été colligées à sept temps de mesure sur une période de deux ans par des entrevues de recherche, des questionnaires standardisés ainsi qu’une révision des dossiers médicaux. Pour chacun des sites, les facteurs associés à la présence et à la sévérité des idées et des comportements suicidaires ont été comparés à l’admission avec un modèle en deux parties de type « hurdle » (modèle linéaire généralisé pour une distribution binomiale et un second modèle de régression logistique pour variable ordinale). L’évolution des idées et des comportements suicidaires a été comparée entre les sites avec un modèle à effets mixtes pour réponse ordinale. Résultats : La recension des écrits comprend 17 articles, réalisés dans des pays à haut revenu, et révèle que près du tiers des patients présentant un PEP rapporte avoir eu des idées suicidaires et fait une tentative de suicide avant leur admission dans les services d’intervention précoce pour la psychose. En général, une diminution des idées suicidaires et des comportements suicidaires a été observée pendant le suivi. Les symptômes dépressifs ainsi les antécédents d’idées et de comportements suicidaires ont été associés à un plus grand risque de comportements suicidaires. Les services d’intervention précoce pour la psychose ont plutôt été associés à un moindre risque de décès par suicide. La deuxième étude, incluant 382 patients, a démontré l’hétérogénéité de l’évolution des idées suicidaires chez les personnes présentant un PEP en identifiant trois trajectoires distinctes : Une première trajectoire caractérisée par un risque faible et décroissant de présenter des idées suicidaires (85.1%), une seconde marquée par un déclin précoce des idées suicidaires suivi d’une augmentation en fin de suivi à la clinique PEP (7.8%), ainsi qu’une troisième trajectoire caractérisée par une persistance des idées suicidaires au cours des cinq années de suivi (7.1%). Alors que les antécédents d’idées suicidaires et le trouble d’usage de cocaïne ont été associés à la seconde trajectoire, les antécédents d’idées suicidaires et de tentatives de suicide ainsi que le trouble d’usage d’alcool ont été associés à la troisième trajectoire. La troisième étude, incluant 333 patients (165 à Montréal, 168 à Chennai), a révélé une diminution des idées et des comportements suicidaires dans les deux sites au cours du suivi, avec toutefois un risque suicidaire plus élevé tout au long du suivi pour les patients suivis à Montréal. Certains facteurs ont été associés à un plus grand risque d’idées et de comportements suicidaires dans les deux contextes (comme la dépression et les antécédents de tentatives de suicide) alors que certains facteurs étaient plutôt spécifiques au contexte (comme le statut relationnel et le genre). Conclusion : Les trois manuscrits soutiennent que la prévalence des idées suicidaires et des comportements suicidaires est élevée chez les personnes présentant un PEP, quel que soit le milieu ou le contexte socioculturel. Les résultats plaident en faveur de la détection précoce de la psychose afin d’évaluer le risque suicidaire et intervenir rapidement auprès des personnes vivant un PEP puisque les taux d’idées et de comportements suicidaires sont particulièrement élevés avant l’entrée dans les services et au début du suivi. Une évaluation continue du risque suicidaire est nécessaire jusqu’à la toute fin du suivi pour soutenir les différents sous-groupes de patients, dont ceux plus à risque de présenter des idées suicidaires croissantes ou persistantes. Les personnes présentant des symptômes dépressifs, des antécédents d’idées et de tentatives de suicide ainsi qu’un trouble de l’usage de substances devraient être ciblées pour bénéficier d’interventions visant à prévenir le suicide, et ce, dès le début du suivi. Enfin, la thèse a permis de mieux comprendre l’évolution des idées et des comportements suicidaires chez les personnes présentant un PEP et d’identifier différentes avenues de recherches futures. / Introduction: Every year, 703,000 persons die by suicide worldwide and an even greater proportion of people think of or attempt suicide. Studying factors associated with suicidal thoughts and behaviours aims to improve our understanding of this issue to better target and support those at risk and ultimately decrease rates of suicide deaths. Psychotic disorders are associated with an increased vulnerability to suicide, particularly in the first years following psychosis onset, i.e., during first-episode psychosis (FEP). The overall goal of the dissertation is to better understand the course of suicidal thoughts and behaviours and the factors associated therewith in persons with FEP. Method: Three studies were conducted. The first was a systematic review in compliance with PRISMA guidelines. Longitudinal studies on the prevalence of and factors associated with suicidal thoughts and behaviours in FEP were identified from five databases and reference lists of relevant articles. Screening, data extraction, and quality assessment of selected studies were performed by two independent reviewers. The second study identified trajectories of suicidal ideation over a five-year period and the distribution of suicide attempts across these trajectories in patients with FEP admitted between 2005 and 2013 to two early intervention services for psychosis in Montreal, Quebec. Data on suicidal ideation, suicide attempts, suicide deaths, and potentially associated factors were assessed annually for five years through research interviews, medical records review, and coroners' reports. Latent trajectory analyses were performed. Finally, the third study compared the course of suicidal thoughts and behaviours in similarly structured early intervention services for psychosis in two different sociocultural contexts, Montreal, Canada and Chennai, India. Data on suicidal thoughts and behaviours and potentially associated factors were collected at seven time points over two years through research interviews, standardized questionnaires, and medical records review. For each site, factors associated with presence and severity of suicidal thoughts and behaviours were compared at admission with a two-part hurdle model (generalized linear model for a binomial distribution and a second ordered logistic regression model). Course of suicidal thoughts and behaviours was compared between sites with a mixed-effects ordered logistic regression. Results: The systematic review included 17 articles from high-income countries and found that nearly one third of patients with FEP reported suicidal ideation and attempts prior to admission to early intervention services for psychosis. In general, a decrease in suicidal thoughts and behaviours was observed during follow-up. Depressive symptoms and a history of suicidal thoughts and behaviours were associated with a greater risk of suicidal behaviours. Early intervention services for psychosis were rather associated with a lower risk of death by suicide. The second study, including 382 patients, showed heterogeneity in the evolution of suicidal ideation in persons with FEP by identifying three distinct trajectories: a first trajectory characterized by a low and decreasing risk of presenting suicidal ideation (85.1%), a second trajectory marked by an early decline in suicidal ideation followed by an increase at the end of follow-up (7.8%), and a third trajectory characterized by persistence of suicidal ideation during the five-year follow-up (7.1%) While history of suicidal ideation and cocaine use disorder were associated with the second trajectory, history of suicidal ideation and suicide attempts, and alcohol use disorder were associated with the third trajectory. The third study, including 333 patients (165 in Montreal, 168 in Chennai), found a decrease in suicidal thoughts and behaviours over follow-up in both sites, although the risk was higher throughout follow-up for Montreal patients. Some factors were associated with a higher risk of suicidal thoughts and behaviours across contexts (e.g., depression and history of suicide attempts), while some factors were rather context-specific (e.g., relationship status and gender). Conclusion: The three manuscripts support that the prevalence of suicidal thoughts and behaviours is high among persons with FEP, regardless of sociocultural context or setting. The results argue for early detection of psychosis to assess suicidal risk and intervene promptly with individuals with FEP, as rates of suicidal thoughts and behaviours are particularly high prior to service entry and at the beginning of follow-up. Ongoing assessment of suicidal risk is needed until the very end of follow-up to support different subgroups of patients, including those at higher risk of developing increasing or persistent suicidal ideation. Individuals with depressive symptoms, a history of suicide ideation and attempts, and a substance use disorder should be targeted for suicide-focused interventions early in follow-up. Finally, the dissertation provided a better understanding of the course of suicidal thoughts and behaviours in persons with FEP and allowed for the identification of different areas for future research.