INTRODUÇÃO: Problemas de saúde mental são responsáveis por uma morbidade significativa em todo o mundo, por sua frequência e pela associação com comorbidades físicas, níveis de incapacitação e prejuízo na qualidade de vida de portadores e cuidadores. A ocorrência de transtornos mentais comuns (TMC) é influenciada por fatores biológicos, sociais, econômicos e demográficos. O contexto social pode ter papel importante na etiologia dos transtornos mentais e na sua prevalência. OBJETIVOS: Investigar fatores de risco que contribuem para a prevalência, incidência e prognóstico de TMC em população de baixa renda da cidade de São Paulo, considerando distintos níveis contextuais: indivíduo, domicílio e setor censitário. MÉTODO: O presente estudo utilizou dados da investigação longitudinal de base populacional \"São Paulo Ageing & Health Study\" (SPAH). Os indivíduos selecionados eram residentes em domicílios em que houvesse pelo menos dois participantes do estudo com avaliação para presença de TMC, identificada pelo instrumento Self Reporting Questionaire (SRQ-20). Foram avaliadas as associações independentes entre TMC e características sociodemográficas e dos domicílios dos participantes, através de modelos de regressão logística multinível, tendo como desfechos a prevalência de TMC na inclusão e a presença de TMC em avaliação de dois anos de seguimento. RESULTADOS: Foram incluídos 2.366 indivíduos no estudo transversal, realizado no período de 2003 a 2005. A prevalência de TMC nesta amostra foi de 43%. As características individuais sexo, idade, escolaridade e ocupação estiveram associadas à prevalência de TMC. As características de domicílios aglomeração, morar com crianças, bens materiais, saneamento básico e renda familiar também se associaram à prevalência de TMC. Modelos de regressão logística multinível mostraram que parte da variância na prevalência de TMC foi associada ao nível do domicílio, com associações entre aglomeração, renda familiar e prevalência de TMC, mesmo após controle para características individuais. No estudo longitudinal foram incluídos 1.733 indivíduos, reavaliados no período de 2005 a 2007. A prevalência de TMC na avaliação de seguimento foi de 33%, sendo que 8% não apresentavam TMC na inclusão. As características individuais sexo, idade e ocupação, e a característica de domicílio renda familiar estiveram associadas à presença de TMC na avaliação de seguimento. Modelos de regressão logística multinível para os dados longitudinais mostraram que a maior parte da variância na presença de TMC foi associada ao nível do indivíduo, com associações entre sexo, faixa etária, escolaridade, ocupação e TMC, mesmo após controle para características do domicílio. O nível de domicílio também contribuiu de forma independente para a variância relacionada à presença de TMC no seguimento, com associação de efeito fixo para renda familiar, mesmo após controle para características individuais. CONCLUSÃO: Os resultados mostraram que características individuais contribuem para a maior parte da variância na prevalência, incidência e prognóstico de TMC, mas há uma associação independente com o nível domicílio, que não é explicada completamente pela renda familiar. Esses resultados indicam que características do ambiente onde as pessoas vivem contribuem para sua saúde mental, sugerindo que pesquisas futuras se concentrem nas características psicossociais de domicílios e vizinhanças para estudo de contexto social e TMC / INTRODUCTION: Mental health problems are responsible for significant morbidity worldwide, due to its high frequency and association with physical comorbidities, levels of disability and impact in quality of life of patients and caregivers. The occurrence of common mental disorders (CMD) is influenced by biological, social, economic and demographic factors. The social context may play an important role in the etiology of mental disorders and their prevalence. OBJECTIVES: To investigate risk factors associated with the prevalence, incidence and prognosis of CMD in a low income population from the city of São Paulo, considering different contextual levels: individual, household, and census tract. METHOD: The present study used data from the population-based prospective investigation \"São Paulo Ageing & Health Study\" (SPAH). The individuals selected were living in households in which there were at least two study participants with assessments for presence of TMC, identified by the instrument Self Reporting Questionnaire (SRQ-20). We assessed independent associations between CMD and the sociodemographic and households characteristics of the participants, through multilevel logistic regression models, having as outcome variables the prevalence of CMD at inclusion and the presence of TMC at the 2-year follow-up assessment. RESULTS: We included 2.366 individuals in the cross-sectional study, carried out in the period from 2003 to 2005. The prevalence of CMD in this sample was 43%. Individual characteristics sex, age, education and occupation were associated with the prevalence of CMD. The household characteristics crowding, living with children, possessions, basic sanitation and family income were also associated with the prevalence of CMD. Multilevel logistic regression models showed that part of the variance in the prevalence of CMD was associated with the household level, with associations between crowding, family income and prevalence of CMD, even after controlling for individual characteristics. In the longitudinal study, 1.733 individuals were reassessed in the period of 2005-2007. The prevalence of CMD at 2 years was 33%, with 8% in individuals without TMC at inclusion. Individual characteristics sex, age and occupation and household characteristic family income were associated with presence of CMD at follow-up. Multilevel logistic regression models for longitudinal data showed that most of the variance associated with presence of CMD was associated with the level of the individual, with associations between sex, age, education, occupation and CMD, even after controlling for household characteristics. The household level also contributed independently to the variance related to the presence of TMC at follow-up, with associated fixed effect for family income, even after controlling for individual characteristics. CONCLUSION: The results showed that individual characteristics contribute to most of the variance in the prevalence, incidence and prognosis of TMC, but there is an independent association with the household level, which is not fully explained by family income. These results indicate that characteristics of the environment where people live contribute to their mental health, suggesting that future research focus on the psychosocial characteristics of households and neighborhoods to study the social and TMC

Objetivos: a) Estimar a prevalência da violência por parceiro íntimo (VPI) na gestação e verificar sua associação com fatores sócio-demográficos, de saúde reprodutiva, sexual e mental entre usuárias de serviços públicos de saúde da Grande São Paulo; b) Identificar aspectos da vulnerabilidade individual e contextual relacionados à violência. Metodologia: a) entrevistas estruturadas (questionário) com 1922 usuárias, entre 15 e 49 anos, em 14 serviços públicos de saúde; b) 3 grupos focais com gestantes e c) 4 entrevistas em profundidade com mulheres que sofreram VPI na gestação. Resultados: 20% (IC95% 18,2 a 21,8) referem algum episódio de VPI na gestação. Em análise multivariada, observou-se que diversos fatores estão associados à VPI na gestação. As usuárias que referem VPI na gestação apresentam padrão mais grave e freqüente de VPI na vida. Este fenômeno relaciona-se com desproteção na família de origem; gravidez indesejada; mudanças no corpo e na libido da mulher. Conclusão: A alta prevalência de VPI na gestação sugere que esta questão deve ser vista como importante problema de saúde pública / Objectives: a) To examine de prevalence of intimate partner violence (IPV) during pregnancy and its association with demographics and reproductive, sexual and mental health factors among public health care users in São Paulo, Brazil; b) To identify individual and contextual vulnerability to VPI during pregnancy. Methodology: a) interview with 1922 users, aged from 15 to 49, of 14 public health services; b) 3 focal groups with pregnant women c) 4 interviews with women abused during pregnancy. Results: 20% (IC95% 18,2 a 21,8) reported IPV during pregnancy. Multiple logistic regression indicated that several factors are associated with VPI during pregnancy. Women who referred IPV during pregnancy were significantly more likely to have severe and frequent pattern of IPV during their lives. This event is related to unsafe family context, unintended pregnancy, changes on women body and libido. Conclusion: High prevalence rates for IPV during pregnancy points out that this issue should be regarded as a major public health problem

En France, la vaccination repose principalement sur l’action des médecins généralistes (MG). L’augmentation de l’opinion défavorable du public envers la vaccination, associée au constat d’une couverture vaccinale insuffisante, démontre l’importance de prendre en compte les attitudes et perceptions des MG vis-à-vis de la vaccination. Les objectifs de ce travail de thèse étaient d’évaluer les connaissances, perceptions, attitudes, et pratiques des MG français vis-à-vis de certains vaccins, pour lesquels la couverture vaccinale est sub-optimale et/ou pour lesquelles des polémiques existent. En 2014, une vague d’enquêtes par questionnaire téléphonique a été mise en place auprès de 1582 MG français pour mieux connaître leurs comportements, attitudes et pratiques vaccinales. Plusieurs résultats ont mis en évidence l’hétérogénéité des pratiques et des perceptions des MG concernant la vaccination. Tout d’abord, nous avons mis en évidence que les MG avaient une attitude discordante entre leurs pratiques vaccinales pour leurs propres enfants et leurs recommandations vaccinales pour leurs patients. Ensuite, nous avons étudié la perception par les MG des polémiques vaccinales concernant les effets indésirables des vaccins. Cependant, les MG interrogés étaient soit sensibles aux polémiques, soit les rejetaient, sans que cela soit associé au caractère fondé ou non de la polémique. Puis nous avons étudié les recommandations des MG pour la vaccination à méningocoque C, qui étaient très insuffisantes dans notre étude, ce qui participe à la couverture vaccinale basse de ce vaccin. Le manque de communication autour de ce vaccin pourrait être imputé en partie à une campagne de vaccination insuffisante. Par la suite, nous avons étudié la décision des MG face à un enfant devant être vacciné, mais présentant une infection mineure fébrile. Une majorité des MG a préféré reporter cette vaccination, la fièvre étant le facteur influençant le plus cette décision. Les recommandations officielles françaises ne permettent pas de définir clairement l’attitude à adopter dans cette situation. Enfin, nous avons décrit les outils plébiscités par les MG pour améliorer leur pratique vaccinale au quotidien. Certains de ces outils existent mais semblent manquer de visibilité. En conclusion, les MG ne peuvent améliorer leurs pratiques qu’avec une formation spécifique à la vaccination, des outils identifiés et disponibles, et un soutien des pouvoirs publics qui s’engagent avec des recommandations claires / In France, vaccination relies mainly on general practitioners (GPs). The increase in the public's unfavourable opinion on vaccination, associated with the insufficient vaccination coverage, demonstrates the importance of taking into account the attitudes and perceptions of GPs regarding vaccination. The objectives were to assess the knowledge, perceptions, attitudes, and practices of French GPs regarding vaccines with insufficient vaccination coverage and / or for which controversies exist. In 2014, a telephone survey questionnaire was conducted on 1582 French GPs to learn more about their behaviours, attitudes and vaccine practices. Our results have highlighted the heterogeneity of GPs’ practices and perceptions regarding vaccination. First, we found that GPs reported discordances between their vaccine practices for their own children and their vaccine recommendations for their patients. Then, we studied the GPs’ perception of the vaccine polemics concerning adverse effects of some vaccines. However, the interviewed GPs were either sensitive to the polemics or rejected them, without being associated with the well-founded nature of the controversy. Then we looked at GPs’ recommendations for meningococcal C vaccination to their patients, which were very low in our study. These low recommendations contributes to the low vaccine coverage of this vaccine. The lack of communication about this vaccine could be partly attributed to an insufficient vaccination campaign. Subsequently, we examined GPs’ decision facing a child to be vaccinated, but presenting an uncomplicated common cold. A majority of GPs decided to postpone this vaccination, with fever being the most important factor influencing this decision. The French official recommendations do not define clearly the attitude to be adopted in this situation. Finally, we described the tools that GPs would find useful to improve their daily immunization practice. Some of these tools exist but seem to lack visibility. In conclusion, GPs can only improve their practices with specific immunization training, identified and available tools, and with the support of public authorities who commit themselves with clear recommendations

<p>Small firms often have inadequate access to the capital necessary for sucessful management. The Swedish Government introduced in the mid-1990s allowance rules that facilitate retention of profit for sole proprietorships and partnership firms. The tax credits arising from the allowances give certain benefits as a source of financing compared to traditional forms of credits. Among the more essential benefits are that the payment for some parts of the tax credit can be put on hold almost indefinitely, or alternatively never be paid. The firms are free to use these means, and the responsibility of future payment of the postponed tax debt stays with the individual firms. The comprehensive purpose of the dissertation may be stated as to increase the understanding of small Swedish firms, especially sole proprietorships, utilizing possibilities for allowances for income smoothing and internal financing. At the beginning the dissertation describes case studies, comprising a smaller selection of microfirms. With a starting-point from the accounted and reported income-tax returns, alternative calculations are made where additional positive tax and finance effects appear possible to obtain. One purpose of these studies is to increase the insight regarding the possibilities of income smoothing and internal financing that arise from utilizing these allowances. </p><p>These studies also illuminate, to what extent and in what way they are being used in reality. Another objective of these studies is to give a more substantive insight into the technics behind the different allowances, appropriation to positive or negative interest rate allocation appropriation or dissolving of tax allocation reserve appropriation or dissolving of “expansion fund” Theories regarding the creation of resources, through building of capital, and theories on financial planning and strategy are studied. The purpose is to find support for the choice of theoretical grounded underlying independent variables that can be used in cross-sectional studies to explain the use of the possibilities of appropriations. Theories of finance that are of greatest interest, in the operationalisation of these variables, are theories that discuss the choices of different financing alternatives for small firms. The “pecking order theory”, describes the firm’s order of priority when choices of finance alternatives are made. The concept of “financial bootstrapping” expands the frame for different forms of financing choices that especially very small firms have at their disposal.</p><p>The last part of the theoretical frame deals with the phenomenon of “income smoothing,” which can be translated as leveling out profits/losses. A number of financial and non-financial variables are supported by and operationalised from these financial theories e.g., return on sales, capital turnover, quick ratio and debt-to-equity ratio, respectively age, gender and line of business. Cross-sectional studies are implemented for the taxation years of 1996 and 1999, on databases that have been extracted from Statistics Sweden. The group of 87,276 sole proprietorships included in the study were required to complete tax returns and pay taxes for the business activity according to the supporting schedule, N2, information from the sole proprietorships’ income statement and balance sheet in an accounting statement that comes with the income tax return form. The possibilities of allowances are considered as dependent variables. The intention of the cross-sectional studies is to survey and describe the utilization of possible allowances, with the support of the financial and non-financial independent variables. The connection of these variables to the decision of sole proprietorships to appropriate to the tax allocation reserve is also summarized in a logistic regression model. A number of theoretically based propositions are made for the purpose of observing how the variables are connected to the chances that sole proprietorships actually appropriate to this form of allowance. Appropriation to the tax allocation reserve stands out as the most practiced form of allowance. The studies also clarify that utilization varies among different forms of allowances, but that not all firms that have the prerequisites to utilize the possibilities really do so to the full. A further utilization of the different possibilities of allowances is often conceivable. For the sole proprietorships that are not utilizing these possibilities, the allowances should be considered eligible as a contribution to internal financing and to increase access to capital.</p>

The theme of this thesis is suicide mortality in its various aspects, seen from an international, European perspective. It questions the existence of social (structural) concomitants to suicide mortality and investigates attitudes towards and legislation concerning suicide, as well as some historical processes pertaining to their development. Paper 1 replicates an authoritative study of the "correlates of suicide" on a national level in European countries. It shows that the findings of this study do not hold 16 years later, and it presents some ideas as to why these changes have taken place. It is suggested that there are no simple social correlates to suicide on this level, and that suicide rates tend to vary according to, among other things, international cultural influences. Paper 2 investigates penal legislation relating to suicide in European countries. Three types of punishable action are found: 1) aiding suicide, 2) abetting suicide, and 3) driving somebody to suicide. A majority of European countries include some of these acts in their criminal laws. However, the laws vary very widely between countries, thereby constituting a notable exception to the common presumption of uniformity of law. The scope of the criminalization and the severity of the penalties for the crimes covary both with cultural attitudes towards suicide and with suicide rates. The results are interpreted as indicating the existence of a cultural-normative system, consisting of the cultural attitudes towards suicide, the laws regulating the actions relating to suicide and, perhaps, religion. It influences the occurrence of suicide, mainly by offering individuals cultural models of behavior. Paper 3 describes the process towards the decriminalization of suicide (in 1864) in Sweden, its causes and consequences. It is suggested that the law change took place because of a) the international ideological currents of the time (the heritage of the Enlightenment), b) the examples presented by other European countries, and c) the radical changes in people's behavior. The reform was long overdue, and thus did not have a direct effect on suicide mortality. The increase in Swedish suicide rates in the 19th century is seen as connected with certain aspects of the "modernization" process. Paper 4 addresses the prospects and problems connected with the ap-plication of Talcott Parsons's functionalist theory to suicide research, in particular when contrasting it with Durkheim's theory. It is found that the latter, despite its shortcomings, still dominates socially oriented suicide research. Parsons's theory is seen as implicating the cultural primacy of suicide mortality. Its general usability is, however, highly uncertain since many of its essential constituent parts are not well suited to the subject. A model for suicide rates, consisting of cultural (domestic and inter-national), political, social, diffusion and availability factors is presented. Taken together, the papers constitute a case for cultural (as opposed to socio-structural) research into suicide mortality. They question the repeated testing of structural variables in favor of creating cultural indicators. They suggest some new lines of research, and call for a consistently universal perspective on the problem of suicide and suicide mortality. / <p>Härtill fyra uppsatser.</p>

Small firms often have inadequate access to the capital necessary for sucessful management. The Swedish Government introduced in the mid-1990s allowance rules that facilitate retention of profit for sole proprietorships and partnership firms. The tax credits arising from the allowances give certain benefits as a source of financing compared to traditional forms of credits. Among the more essential benefits are that the payment for some parts of the tax credit can be put on hold almost indefinitely, or alternatively never be paid. The firms are free to use these means, and the responsibility of future payment of the postponed tax debt stays with the individual firms. The comprehensive purpose of the dissertation may be stated as to increase the understanding of small Swedish firms, especially sole proprietorships, utilizing possibilities for allowances for income smoothing and internal financing. At the beginning the dissertation describes case studies, comprising a smaller selection of microfirms. With a starting-point from the accounted and reported income-tax returns, alternative calculations are made where additional positive tax and finance effects appear possible to obtain. One purpose of these studies is to increase the insight regarding the possibilities of income smoothing and internal financing that arise from utilizing these allowances. These studies also illuminate, to what extent and in what way they are being used in reality. Another objective of these studies is to give a more substantive insight into the technics behind the different allowances, appropriation to positive or negative interest rate allocation appropriation or dissolving of tax allocation reserve appropriation or dissolving of “expansion fund” Theories regarding the creation of resources, through building of capital, and theories on financial planning and strategy are studied. The purpose is to find support for the choice of theoretical grounded underlying independent variables that can be used in cross-sectional studies to explain the use of the possibilities of appropriations. Theories of finance that are of greatest interest, in the operationalisation of these variables, are theories that discuss the choices of different financing alternatives for small firms. The “pecking order theory”, describes the firm’s order of priority when choices of finance alternatives are made. The concept of “financial bootstrapping” expands the frame for different forms of financing choices that especially very small firms have at their disposal. The last part of the theoretical frame deals with the phenomenon of “income smoothing,” which can be translated as leveling out profits/losses. A number of financial and non-financial variables are supported by and operationalised from these financial theories e.g., return on sales, capital turnover, quick ratio and debt-to-equity ratio, respectively age, gender and line of business. Cross-sectional studies are implemented for the taxation years of 1996 and 1999, on databases that have been extracted from Statistics Sweden. The group of 87,276 sole proprietorships included in the study were required to complete tax returns and pay taxes for the business activity according to the supporting schedule, N2, information from the sole proprietorships’ income statement and balance sheet in an accounting statement that comes with the income tax return form. The possibilities of allowances are considered as dependent variables. The intention of the cross-sectional studies is to survey and describe the utilization of possible allowances, with the support of the financial and non-financial independent variables. The connection of these variables to the decision of sole proprietorships to appropriate to the tax allocation reserve is also summarized in a logistic regression model. A number of theoretically based propositions are made for the purpose of observing how the variables are connected to the chances that sole proprietorships actually appropriate to this form of allowance. Appropriation to the tax allocation reserve stands out as the most practiced form of allowance. The studies also clarify that utilization varies among different forms of allowances, but that not all firms that have the prerequisites to utilize the possibilities really do so to the full. A further utilization of the different possibilities of allowances is often conceivable. For the sole proprietorships that are not utilizing these possibilities, the allowances should be considered eligible as a contribution to internal financing and to increase access to capital.

Dissertation (Ph.D.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 118 pages. Includes vita. Includes bibliographical references.

Thesis (Ph.D. in Analytic Health Sciences, Department of Preventive Medicine and Biometrics) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 75-77). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph.D.)--Pardee Rand Graduate School, 2006. / Title from PDF cover. Includes bibliographical references. Issued also in print.

O câncer do colo do útero corresponde a cerca de 15% de todos os tipos de câncer em mulheres, no mundo. No Brasil, em 2002, o câncer de colo do útero foi responsável por 7,1% de todas as mortes por câncer em mulheres, ocupando a quarta posição entre os demais. Para o mesmo ano, a taxa de mortalidade por câncer do colo do útero ajustada por idade, pela população padrão mundial, foi de 5,03/100.000. Já as taxas de incidência ajustadas por idade variaram entre 14,3 por 100.000 mulheres em Salvador e 50,7 por 100.000 mulheres no Distrito Federal, para o período compreendido entre 1991 e 2001. O câncer do colo do útero inicia-se a partir de uma lesão pré-invasiva, curável em até 100% dos casos, que geralmente progride lentamente, por anos, antes de atingir o estágio invasor da doença, quando a cura se torna mais difícil, quando não impossível. A abordagem mais efetiva para o controle do câncer do colo do útero continua sendo o rastreamento por meio do exame preventivo de Papanicolaou. O objetivo deste estudo foi identificar fatores associados à não realização do exame de Papanicolaou em mulheres de 25 a 59 anos nos três anos anteriores à pesquisa, nos municípios de Fortaleza e Rio de Janeiro. Para cada localidade foi utilizado o delineamento transversal, de base populacional com amostragem por conglomerados com dois estágios de seleção e auto-ponderada. Os dados foram analisados por regressão de Poisson obedecendo a um modelo hierárquico previamente determinado. O percentual de mulheres não submetidas ao exame de Papanicolaou nos três anos anteriores à pesquisa, em Fortaleza e no Rio de Janeiro, foi de 19,1% (IC95%: 16,1-22,1) e 16,5% (IC95%: 14,1-18,9), respectivamente. Mulheres de baixa escolaridade, de menor renda per capita, de maior idade, não casadas, não submetidas a mamografia, ao exame clínico das mamas, aos exames de glicemia e colesterolemia foram as que apresentaram as maiores de razões de prevalências para a não realização do exame de Papanicolaou, em ambas as localidades. As fumantes foram menos submetidas ao exame em relação às demais mulheres, sendo essa diferença estatisticamente significativa somente no Rio de Janeiro. Finalmente, as informações aqui apresentadas apontam para a necessidade de intervenção em um grupo específico de mulheres. Deve-se priorizar atividades de educação para o diagnóstico precoce e rastreamento em mulheres sintomáticas e assintomáticas, respectivamente, além da garantia de acesso aos métodos de diagnóstico e tratamento adequados.