A Hanseníase ainda é um problema para a saúde pública e um desafio para os países endêmicos, principalmente em regiões de fronteira, onde o fluxo migratório é intenso. O estudo tem como objetivo identificar as áreas de risco para a ocorrência da hanseníase e verificar sua relação com os determinantes sociais em Foz do Iguaçu-PR. Estudo ecológico que considerou os casos novos de hanseníase notificados no município de Foz do Iguaçu no período de 2003 a 2015 e as unidades de análise foram os setores censitários urbanos. Foi realizada análise descrita dos casos novos. Em sequência, para a identificação das áreas de risco para a ocorrência da hanseníase utilizou-se a Estatística de varredura espacial e espaçotemporal e para identificação das áreas de risco para incapacidades, recorreu-se a varredura espacial e ao Estimador de intensidade Kernel. A investigação da dependência espacial foi verificada através do Moran Global, Getis-Ord G e Gi*. O Índice de Moran Bivariado Global (IMBG), Regressão por Mínimo Quadrados (OLS) e Regressão Geograficamente Ponderada (GWR) foi utilizada para verificar a associação dos determinantes sociais e o risco de adoecimento por hanseníase. Foram notificados 840 casos, onde a taxa de detecção de casos novos em homens foi 25,6/100.000 hab. e 24,9/100.000 hab. para mulheres, houve predomínio da raça/cor amarela (78,6/100.000 hab.), faixa etária >=60 anos (71,5/100.000 hab.) e ensino fundamental incompleto (60/100.000 hab.). As áreas de risco para a hanseníase e incapacidade grau 2 se concentraram no Distrito Sanitário Sul, Leste, Norte e Nordeste do município; regiões estas, caracterizadas por alta densidade populacional e pobreza. Os determinantes sociais renda (IMBG: 0,1273; p=0,001), número de moradores (IMBG: 0,0703; p=0,008), domicílios sem saneamento básico (IMBG: 0,0743; p= 0,025), pessoas da raça/cor preta (IMBG: 0,0397; p= 0,04), parda (IMBG: 0,1017; p= 0,002) e indígena (IMBG: 0,0976; p= 0,005) apresentaram correlativa positiva com o risco de hanseníase. As análises de regressão revelaram que a proporção de domicílios com renda mensal domiciliar per capita maior de um salário mínimo (? = 0,025, p = 0,036) apresenta risco menor de adoecimento por hanseníase. Enquanto, as pessoas de raça/cor parda (? = -0,101, p = 0,024) apresentam maior risco de adoecimento por hanseníase. Os resultados do estudo apontam que existe associação entre os determinantes sociais e o risco de adoecimento por hanseníase no município investigado. O investimento em políticas públicas para melhoria de distribuição de renda pode favorecer a mudança deste quadro. Os achados podem contribuir para nortear ações em saúde que auxiliem no combate e controle da hanseníase nesta região de fronteira / Leprosy is still a public health problem and a challenge for endemic countries, especially in border regions where migration flows are intense. The study aims to identify the risk areas for the occurrence of leprosy and to verify its relation with the social determinants in Foz do Iguaçu-PR. An ecological study that considered the new cases of leprosy reported in Foz do Iguaçu from 2003 to 2015 and the units of analysis were the urban census sectors. A descriptive analysis of the new cases was performed in order to identify the risk areas for the occurrence of leprosy, the spatial and time-spacial scanning statistics were used and the spatial scan and Kernel intensity estimator were used to identify areas of risk for disabilities. The investigation of spatial dependence was verified through Global Moran, Getis-Ord G and Gi *. The Global Bivariate Moran Index (IMBG), Minimum Squares Regression (OLS) and Geographically Weighted Regression (GWR) were used to verify the association of social determinants and the risk of illness due to leprosy. 840 cases were reported, where the detection rate of new cases in men was 25.6/100,000 inhabitants and 24.9/100,000 inhabitants for women, there was a predominance of yellow color / race (78.6/100,000 inhabitants), age group >=60 years (71.5/100,000 inhabitants) and incomplete elementary school (60/100,000 inhabitants). Areas at risk for leprosy and degree of disability 2 were concentrated in the South, East, North and Northeast Health District of the city; regions, characterized by high population density and poverty. The social determinants of income (IMBG: 0.1273, p = 0.001), number of residents (IMBG: 0.0703, p = 0.008), households without basic sanitation (IMBG: 0.0743, p = 0.025) (IMBG: 0.0976, p = 0.04), black color/race (IMBG: 0.1017, p = 0.002) and native color/race (IMBG: 0.0976; p = 0.005) presented a positive correlation with the risk of leprosy. The regression analysis revealed that the proportion of households with monthly household income per capita greater than a minimum wage (? = 0.025, p = 0.036) had the lowest risk of illness due to leprosy. While people of black race/color (? = -0.101, p = 0.024) are at higher risk of illness due to leprosy. The results of the study indicate that there is an association between the social determinants and the risk of illness due to leprosy in the city under investigation. The investment in public policies to improve income distribution can favor the change of this framework. The findings may contribute to health actions that help combat and control leprosy in this border region

Cette thèse utilise des modèles d’économétrie spatiale pour explorer les déterminants de la localisation spatiale de l’IDE au Vietnam. Le premier chapitre présente la littérature théorique relative à la localisation de l’IDE, et les faits stylisés de la localisation de l’IDE au Vietnam. Le deuxième chapitre analyse les déterminants de la localisation spatiale de l’IDE en ASEAN. Les résultats d’estimation indiquent une grande différence de motivation entre la localisation de l’IDE extra-ASEAN et intra-ASEAN. Les flux d’IDE extra-ASEAN sont de forme verticale complexe, alors que les flux d’IDE intra-ASEAN sont de plateforme d’exportation. Le troisième chapitre étudie les déterminants de la localisation spatiale de l’IDE dans les provinces au Vietnam. Les résultats d’estimation indiquent que l’IDE dans une province n’est pas seulement attiré par la taille du marché, la main-D'oeuvre qualifiée, la qualité des infrastructures, et l’agglomération des firmes dans cette province, mais aussi dans ses voisines. En outre, le coût du travail, la productivité du travail, et les politiques nationales et locales jouent également un rôle important. Le quatrième chapitre porte sur le rôle des institutions locales dans la localisation spatiale de l’IDE dans les provinces du Vietnam. Les résultats d’estimation montrent que la qualité des institutions locales mesurées par la transparence, la politique d’appui au secteur privé et la politique sur le travail affectent significativement la localisation spatiale de l’IDE dans les provinces au Vietnam. / This thesis uses spatial econometric models to explore the determinants of spatial location of FDI in Vietnam. The first chapter presents the theoretical literature on FDI location, and the stylized facts of the FDI location in Vietnam. The second chapter analyzes the determinants of the spatial location of FDI in ASEAN. Results indicate a significant difference in motivation between the location of extra-ASEAN FDI and intra- ASEAN FDI. The extra-ASEAN FDI are of the form of complex vertical FDI, while intra- ASEAN FDI are of the form of export platform FDI. The third chapter examines the determinants of the spatial location of FDI in the provinces in Vietnam. Results indicate that FDI in a province is not only attracted by the market size, skilled workforce, quality infrastructure, and agglomeration of firms in this province, but also in its neighbors. In addition, labor costs, labor productivity, and national and local policies also play an important role in the spatial location of FDI. The fourth chapter focuses on the role of local institutions on the spatial location of FDI in the provinces in Vietnam. Results show that the quality of local institutions, measured by transparency, political support to the private sector and labor policy, significantly affects the spatial location of FDI in the provinces in Vietnam.

A tuberculose é uma das dez principais causas de morte dentre as doenças infecciosas no mundo, o que evidencia a doença como um problema de saúde pública. A redução da mortalidade por tuberculose em 95% até 2035, proposta pela Estratégia End TB, tem sido desafiadora para o Brasil devido sua extensão territorial, variações culturais e desigualdades na distribuição dos recursos de proteção social e de saúde. Assim, buscou-se analisar a relação espacial e espaço-temporal dos determinantes sociais e o risco de mortes por tuberculose em Cuiabá. Trata-se de um estudo ecológico, realizado na cidade de Cuiabá, capital do estado de Mato Grosso. As unidades de análise do estudo foram as Unidades de Desenvolvimento Humano (UDHs) e a população foi constituída por casos de óbitos que apresentaram como causa básica a TB registrados no Sistema de Informação sobre Mortalidade (SIM) entre 2006 a 2016, residentes na zona urbana do município. Para identificação das áreas de risco das mortes por tuberculose, utilizou-se a estatística de varredura. Em seguida, recorreu-se à técnica da Análise de Componentes Principais que permitiu a elaboração das dimensões dos determinantes sociais. A associação entre os determinantes sociais e as áreas de risco das mortes por tuberculose foi obtida, por meio da regressão logística binária. As modelagens Bayesianas foram empregadas, por meio da abordagem Integrated Nested Laplace Approximation (INLA), para verificar os riscos relativos temporais e espaciais e avaliar sua a relação com covariáveis representativas dos determinantes sociais. Nesse período foram registradas 225 mortes por tuberculose, identificou-se aglomerado de risco para a mortalidade por tuberculose, com RR = 2,09 (IC95% = 1,48-2,94; p = 0,04). No modelo logístico, os determinantes sociais relacionados ao déficit escolar e pobreza estiveram associados ao aglomerado de risco de mortes por tuberculose (OR=2,92; IC95% = 1,17-7,28), a renda apresentou uma associação negativa (OR=0,05; IC95% = 0,00 - 0,70). O valor da curva ROC do modelo foi de 92,1%. Em relação aos modelos Bayesianos observou-se redução do risco de morte por tuberculose entre 2006 (RR=1,03) e 2016 (RR=0,98) e ainda áreas de risco que persistem por mais de uma década. Dentre os determinantes sociais, a renda foi um importante fator associado ao risco de morte por tuberculose, sendo que o aumento de um desvio padrão na renda correspondeu à diminuição de 31% no risco de mortalidade por tuberculose. Os resultados do estudo apontam que existe associação entre os determinantes sociais e o risco de mortalidade por tuberculose no município investigado, sendo este um fenômeno que persiste no tempo. O investimento em políticas públicas de melhoria de distribuição de renda pode favorecer a mudança dessa realidade. Espera-se que os achados possam nortear gestores e trabalhadores no âmbito local e regional / Tuberculosis is one of the top 10 causes of death among infectious diseases in the world, which shows the disease as a public health problem. The reduction of tuberculosis mortality by 95% up to 2035, proposed by the End TB Strategy, has been challenging for Brazil due to its territorial extension, cultural variations and inequalities in the distribution of social protection and health resources. Thus, we sought to analyze the spatial and spatial-temporal relationship of social determinants and the risk of deaths from tuberculosis in Cuiabá.This is an ecological study conducted in the city of Cuiaba, capital of Mato Grosso. The units of analysis of the study were the Human Development Units (UDHs) and the population was constituted by cases of deaths that presented the basic cause of TB registered in the Mortality Information System (SIM) between 2006 and 2016, of the municipality.To identify the risk areas for tuberculosis deaths, the scan statistic was used. Next, we used the technique of Principal Component Analysis that allowed the elaboration of the dimensions of social determinants. The association between social determinants and risk areas for tuberculosis deaths was obtained through binary logistic regression. Bayesian modeling was used, through the Integrated Nested Laplace Approximation (INLA) approach, to verify temporal and spatial relative risks and to evaluate its relationship with covariables representative of social determinants. During this period, there were 225 deaths due to tuberculosis and a risk cluster was identified for tuberculosis mortality, with RR = 2.09 (IC95% = 1.48-2.94, p = 0.04). In the logistic model, the social determinants related to school deficit and poverty were associated with the risk cluster of deaths due to tuberculosis (OR = 2.92, IC95% = 1.17-7.28), income had a negative association (OR = 0.05, IC95% = 0.00 - 0.70). The value of the ROC curve of the model was 92.1%. In relation to Bayesian models, there was a reduction in the risk of death due to tuberculosis between 2006 (RR = 1.03) and 2016 (RR = 0.98), as well as risk areas that persisted for more than a decade. Among the social determinants, income was an important factor associated with the risk of death due to tuberculosis, and the increase of a standard deviation in the income corresponded to a 31% decrease in the risk of mortality due to tuberculosis. The results of the study indicate that there is an association between the social determinants and the risk of mortality due to tuberculosis in the municipality under investigation, which is a phenomenon that persists over time. Investment in public policies to improve income distribution may favor a change in this reality. It is hoped that the findings will guide managers and workers at local and regional levels

This thesis considers symmetric functions and algebraic combinatorics via the polynomial representation theory of GL(N,C). In particular, we utilise the theory of Jacobi-Trudi determinants to prove some new results pertaining to the Littlewood-Richardson coefficients. Our results imply, under some hypotheses on the strictness of the partition an equality between Littlewood-Richardson coefficients and Kostka numbers. For the case that a suitable partition has two rows, an explicit formula is then obtained for the Littlewood-Richardson coefficient using the Hook Length formula. All these results are then applied to compute branching laws for GL(m+n,C) restricting to GL(m,C) x GL(n,C). The technique also implies the well-known Racah formula.

Introduction Schistosomiasis is one of the most important and widespread diseases of rural poverty. Worldwide, approximately 779 million people are at risk of infection, with 207 million already infected. Infections with Ascaris lumbricoides, hookworms and Trichuris trichiura, collectively known as the soil-transmitted helminths (STHs), are also highly endemic throughout the tropics, particularly in resource-poor settings. An estimated 1 billion people worldwide are estimated to be infected with STHs. Schistosomes and STHs often co-exist in the same epidemiological settings and, given the high prevalence of concurrent multiple species infections (multiparasitism), a combined approach to prevention and control could lead to significant improvements, including reducing costs associated with single-species control programmes. In China, rigorous national schistosomiasis control efforts over the past 60 years have decreased the prevalence by over 90%; however, since 2000 the number of infected individuals has been rising, possibly indicative of a re-emergence. Fishermen, migrant communities and poor households in rural areas may be most at risk of single and multiple-species parasitic infections and the associated morbidity. Objectives This Ph.D. thesis is structured according to four main goals and a number of specific objectives: Firstly, to update estimates of S. japonicum prevalence, intensity and associated morbidity levels in Hunan province, China, according to the third national PES carried out in 2004; Secondly, to investigate existing barriers in access to preventive, diagnostic and treatment services for advanced schistosomiasis; Thirdly, to compare and evaluate direct and proxy methods of measuring household socio-economic position, according to data on income, savings and asset-based estimations of wealth; and Finally, to explore and identify behavioural, demographic, economic, environmental and social risk factors associated with the distribution of S. japonicum, STHs and multiple species infections, in two villages of the Dongting Lake region, Hunan province, China. Methods Firstly, we used data from the third national schistosomiasis periodic epidemiological survey (PES) of 2004. In Hunan province, the PES was carried out in 47 villages of the endemic Dongting lake area. A total of 47144 human serological, 7205 stool, and 3893 clinical examinations were performed. For the reservoir hosts, stools from 874 buffaloes and other domestic animals were examined for schistosomiasis by the miracidial hatching test. Secondly, we conducted an in-depth study involving interviews with 66 schistosomiasis control staff and 79 advanced schistosomiasis patient, and six focus group discussions (FGDs), in the Dongting lake region, between August 2002 and February 2003. Using the Health-Access Livelihood framework we examined availability, accessibility, affordability, adequacy and acceptability of schistosomiasis control in the Dongting lake area. Lastly, we carried out two village-wide parasitological, clinical and questionnaire-based investigations between October and December 2006. Parasitological examinations for the prevalence of S. japonicum and the STHs were performed by the Kato-Katz thick smear method, with repeated sampling of each individual. We took fingerprick blood samples to assess haemoglobin levels, using a B-haemoglobin HemoCue photometer. The household-based questionnaire focused on direct and proxy measurements of household wealth, while the individual-based questionnaire focused on demographic and behavioural factors, treatment history and self-perceived symptoms. Results Human sero-prevalence was 11.9% (range: 1.3-34.9% at village level), and the rate of egg-positive stools was 1.9% (0-10.9%) for the same population. The prevalence of infection among buffaloes was 9.5% (0-66.7%). Extrapolating to the entire population of the Dongting Lake region, an estimated 73225 people and 13973 buffaloes were infected. Most frequently reported symptoms were abdominal pain (6.2%) and bloody stools (2.7%). Accessibility and affordability were major barriers in access to schistosomiasis control. Many of staff interviewed indicated that a majority of patients who develop advanced schistosomiasis resided in mildly-endemic or non-endemic settings. None of the patients interviewed had any form of health insurance, and most of their health expenses were out-of-pocket payments. Exploratory factor analysis generated internally robust proxy wealth indices, however these were not complementary to direct measures of household wealth, as indicated by low correlation co-efficients. We found wide disparities in household ownership of durable assets, utility and sanitation, within both settings. Pooled data from the rural and peri-urban settings highlighted structural differences in socioeconomic position (SEP), more likely a result of localised urbanization and modernization. We found higher infection prevalences in rural settings, than in peri-urban settings, for schistosomiasis (6.3% and 6.7% respectively), ascariasis (8.3% and 2.2%, respectively) and trichuriasis (5.1% and 0.5%, respectively), but lower for hookworms (0.1% and 1.5% respectively). Multiple species infections (2.6% and 0.2%, respectively) were less prevalent than single species infections (14.5% and 10.4%). There were significant disparities in the prevalence of parasitic infections between poorest and least poor quintiles of the cohort population. Anaemia and other symptoms, especially headache, stomach ache and swollen stomach, were common in both rural and peri-urban village settings. Conclusion The studies conducted within the framework of this Ph.D. thesis document the current situation pertaining to schistosomiasis and the STHs in Hunan province, China. Our findings highlight the need for increased surveillance, monitoring and health education, with relation to schistosomiasis and STHs, in non-endemic or post-transmission control settings. Based upon these results, we call for improved diagnostic tools, particularly in the case of low intensity infections and for hookworm, and propose an extension of the use of available infrastructure, human resources, knowledge and technology by integrating prevention and control of schistosomiasis with that of other intestinal helminths, particularly STHs. In the future, our studies may form a base from which to further examine local needs and priorities for parasitic disease control in the area.

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 130-152).

Background: The importance of tackling economic, social and health-related inequities is increasingly accepted as a core concern for the post-Millennium Development Goal framework. However, there is a global dearth of high-quality, policy-relevant and actionable data on inequities within populations, which means that development solutions seldom focus on the people who need them most. INTREC (INDEPTH Training and Research Centres of Excellence) was established with this concern in mind. It aims to provide training for researchers from the INDEPTH network on associations between health inequities, the social determinants of health (SDH), and health outcomes, and on presenting their findings in a usable form to policy makers. Objective: As part of a baseline situation analysis for INTREC, this paper assesses the current status of SDH training in three of the African INTREC countries - Ghana, Tanzania, and South Africa - as well as the gaps, barriers, and opportunities for training. Methods: SDH-related courses from the three countries were identified through personal knowledge of the researchers, supplemented by snowballing and online searches. Interviews were also conducted with, among others, academics engaged in SDH and public health training in order to provide context and complementary material. Information regarding access to the Internet, as a possible INTREC teaching medium, was gathered in each country through online searches. Results: SDH-relevant training is available, but 1) the number of places available for students is limited; 2) the training tends to be public-health-oriented rather than inclusive of the broader, multi-sectoral issues associated with SDH; and 3) insufficient funding places limitations on both students and on the training institutions themselves, thereby affecting participation and quality. We also identified rapidly expanding Internet connectivity in all three countries, which opens up opportunities for e-learning on SDH, though the current quality of the Internet services remains mixed. Conclusions: SDH training is currently in short supply, and there is a clear role for INTREC to contribute to the training of a critical mass of African researchers on the topic. This work will be accomplished most effectively by building on pre-existing networks, institutions, and methods.

Gonorrhea, caused by the human pathogen Neisseria gonorrhoeae, is a severe public health problem worldwide with more than 82 million new infections each year. N. gonorrhoeae is transmitted by sexual contact and primarily causes urogenital mucosal infections in men and women. Left untreated, this infection may cause severe complications, especially in females. Eye infections of the newborn can occur. Gonorrhea infections enhance HIV transmission. The highly prevalent antibiotic resistance and the emergence of new drug resistances render treatment of the infections increasingly difficult. Close monitoring of antimicrobial susceptibility of this pathogen is crucial, and enhanced knowledge of molecular mechanisms of gonococcal antimicrobial resistance is urgently needed. There are no vaccines available against N. gonorrhoeae. Control of gonorrhea relies on comprehensive strategies which can be better formulated by understanding, at molecular levels, how N. gonorrhoeae is transmitted in communities. My research aimed to illustrate the severe burden of antimicrobial resistance in N. gonorrhoeae temporally and geographically in China and to reveal the molecular mechanisms of antibiotic resistance particularly the development of reduced susceptibility to ceftriaxone in N. gonorrhoeae isolates. To determine specific strain distributions, N. gonorrhoeae isolates were characterized using molecular typing methods such as a modified porB-based typing scheme and the N. gonorrhoeae Multi-Antigen Typing (NG-MAST) method, compared to traditional epidemiological approaches. The ultimate goal was to provide information for better formulating disease control strategies for gonorrhea. In this research, male patients with gonorrhea and their sex partners were recruited in Shanghai (2005 and 2008) and in Urumchi (2007-2008), China. Epidemiological information pertaining to sexual contacts was collected. N. gonorrhoeae isolates were investigated for their antimicrobial susceptibility. Molecular mechanisms of antimicrobial resistance were explored by analysis of potential resistant determinants (gyrA, parC, porB, mtrR, ponA and penA). The molecular data were combined with bioinformatic analysis and traditional epidemiological data. High percentages of N. gonorrhoeae isolates (11% - 19% in Shanghai, 4.5% in Urumchi) exhibited reduced susceptibility to ceftriaxone (MICs = 0.125-0.25 mg/L), the first line drug recommended for the treatment of gonorrhea in China. The majority of isolates (>98%) were susceptible to spectinomycin, an alternative regimen for gonorrhea treatment; however, the proportion of isolates having intermediate levels of susceptibility increased from 1.9% in 2005 to 9.9% in 2008. The majority of isolates tested were resistant to penicillin (80% - 93%), tetracycline (56% - 65%) and ciprofloxacin (98% - 100%). Plasmid-mediated resistance in N. gonorrhoeae isolates were highly prevalent (51% - 79%) in Shanghai and Urumchi. Analysis of 60 clinical isolates revealed that reduced susceptibility to ceftriaxone is mediated by porB1b allele and is associated with specific mutations in penicillin binding protein 2 and in the DNA binding and dimerization domains of MtrR. Penicillin binding protein 1 is not involved in reduced susceptibility to ceftriaxone. Although mutation patterns in quinolone resistant determinant regions (QRDRs) varied, the majority of ciprofloxacin resistant isolates had double mutations in GyrA (S91F and D95G/A/N) and most isolates also carried a S87R/N mutation in ParC. The presence of mutations in the QRDR of ParC is correlated with elevated ciprofloxacin MICs. A modified porB-based molecular typing scheme was developed and involved ~82% of the DNA sequence of gonococcal porB. This typing method proved to have high discriminatory ability (index of discrimination = 0.93 0.96), and was cost effective and easy to perform as compared to the NG-MAST analysis. Using the modified porB-based typing method, N. gonorrhoeae isolates were reliably differentiated, and transmission clusters were identified. Molecular epidemiology using the porB-based method confirmed direct sexual connections and identified sexual networks otherwise unrevealed by the patient self-reporting or traditional case-tracing methods.

Descriure l’ agregat d’àrees petites amb un elevat risc de mortalitat detectat a la zona sud-oest d’Espanya, en particular a les províncies de Huelva, Sevilla i Cadis (HSC) durant el període 1987-1995, analitzar la seva evolució i explorar les seves possibles causes. Mètodes: Estudi ecològic mixt que examina el risc de morir en 2.218 àrees petites d’Espanya durant els períodes 1987-1995 i 1996-2004 mitjançant un enfocament bayesià empíric. Resultats: Les desigualtats geogràfiques en la mortalitat descrites a Espanya durant el període 1987-1995, on destacava una pitjor situació a la zona sud-oest i en particular a les províncies de HSC, no ha millorat en el període 1996-2004. La consistència de resultats per a diverses causes específiques de mort, sexe i períodes temporals, ha evidenciat que l’origen d’aquestes desigualtats geogràfiques és molt probablement una conseqüència de la combinació “tòxica” de factors socials (socioeconòmics, laborals i ambientals). L’exposició conjunta a substàncies tòxiques amb efectes cancerígens, que conformen una part important dels determinants laborals i ambientals de la salut, està probablement jugant un paper rellevant en l’elevada mortalitat observada a HSC. Conclusions: L’important problema en la mortalitat descrit a la zona sudoest d’Espanya entre els anys 1987-1995 contínua present durant el període 1996-2004, tant en homes com en dones. És necessari portar a terme estudis epidemiològics complementaris, així com desenvolupar un pla integral de salut pública (vigilància, detecció i tractament) al sud-oest espanyol basat en el principi de precaució. / To describe the cluster of high-risk mortality small areas detected in the southwest of Spain, specifically in the provinces of Huelva, Sevilla and Cádiz during the period 1987- 1995, to analyze their evolution and to explore their possible causes. Methods: Mixed ecological study that examines the risk of dying in 2.218 small areas of Spain during the periods 1987-1995 and 1996-2004 using an empirical bayesian approach. Results: The geographical inequalities in mortality described in Spain during the period 1987-1995, which featured the worse situation in the south-west and in particular in the provinces of HSC, has not improved in the period 1996-2004.. The consistency of results for different specific causes of death, sex and temporal period, has shown that the origin of these inequalities is most likely a result of the “toxic” combination of social factors (socioeconomic, occupational and environmental). The joint exposure to toxic substances with carcinogenic effects, which constitutes a significant part of the occupational and environmental determinants, is probably playing an important role in the high mortality observed in HSC. Conclusions: The important mortality problem described in the south-west of Spain between 1987-1995 is still present during the period 1996-2004, in both men and women. It is necessary to conduct additional epidemiologic studies, as well as to develop a comprehensive public health plan (surveillance, detection, treatment) in the southwest Spanish based on the precautionary principle.

La tesi analitza el procés d'emancipació dels joves des d'una triple vessant: social, econòmica i del mercat immobiliari. Analitza els diferents factors que intervenen en l’emancipació, tant per facilitar-la com per dificultar-la, per després complementar-los amb un apartat de propostes per a la gestió social de l’habitatge i la (re)habilitació de zones i espais susceptibles de ser transformats en habitatges assequibles. L'anàlisi consta de tres parts: una primera anàlisi bibliogràfica constitueix el marc teòric, que fonamenta les posteriors anàlisi quantitatives, la primera a partir de dades secundàries i la següent a partir de dades primàries. Finalment, un tercer apartat de propostes de gestió social de l’habitatge tanca la tesi amb unes conclusions que engloben tota l’anàlisi. El gruix de l’anàlisi recau en aquesta segona part quantitativa que primerament es basa en dades secundàries i després en dades primàries obtingudes a partir d’una enquesta. L’anàlisi quantitativa a partir de dades secundàries es basa en dades del cens, del padró i de la EPA (Encuesta de Población Activa) i analitza les característiques de les persones i les llars joves, tot comparant llurs comportaments en funció de l’edat i en contrast amb les llars adultes. Establint així una caracterització de les persones i les llars joves per a la posterior anàlisi de regressió logística que permet obtenir els elements determinants de l’emancipació. L’anàlisi quantitativa a partir de dades primàries es realitza mitjançant una enquesta a una mostra de la població jove emancipada i una petita mostra de la població jove que encara no s’ha emancipat però pretén fer-ho en els propers dos anys que possibilita l'anàlisi dels factors limitadors. L’enquesta es realitza al Maresme el 2007 i aporta una informació rellevant pel que fa a les dades subjectives del procés d'emancipació. Analitza l'emancipació en dos moments: primari (<25 anys) i consolidat (25-34 anys), incloent valoracions i aspectes de caràcter subjectiu. Es determinen així els factors que afavoreixen l'emancipació, així com els que la dificulten mitjançant una anàlisi de regressió logística que complementa la mateixa anàlisi feta a partir de dades secundàries i es complementa amb una caracterització de l’emancipació en funció dels valors més determinants. Finalment es proposen formes de gestió social de l'habitatge basades en la (re)habilitació i (re)utilització d’espais i zones en (des)ús que tant la Llei pel dret a l’habitatge com la Llei d’urbanisme permeten per facilitar l’accés a l’habitatge i diversificar l’oferta immobiliària existent, tant tipològicament com per la relació amb l’ús i el preu. S’utilitzen en aquest apartat mesures aplicables al conjunt de Catalunya però amb exemples concrets del Maresme.