O câncer representa um importante problema de saúde pública no mundo, devido ao aumento da sua prevalência, além do grande impacto individual, institucional e social. Assim, merece uma abordagem ampliada, integral e interdisciplinar, a fim de minimizar as seqüelas decorrentes da doença ou do seu tratamento, visando à cura com manutenção da qualidade de vida (QV). Dessa forma, este trabalho teve como objetivos descrever o perfil sócio-demográfico e de saúde bucal de pacientes com câncer de cabeça e pescoço assistidos no HNSC, Porto Alegre – RS e, verificar o impacto na QV destes de um protocolo de cuidados odontológicos sistemático, antes, durante e depois da terapia oncológica. O estudo, delineado como um Ensaio Clínico Randomizado, teve a participação de 46 sujeitos com diagnóstico de neoplasia primária de cabeça e pescoço, captados por conveniência, consecutivamente e distribuídos aleatoriamente em dois grupos. No grupo controle, os pacientes foram examinados e orientados sobre os possíveis efeitos do tratamento oncológico e encaminhados aos serviços de atenção básica de referência para atendimento odontológico. No grupo intervenção, os pacientes foram examinados e orientados, sobre os possíveis efeitos do tratamento oncológico. Os sujeitos incluídos neste grupo receberam um protocolo de cuidados odontológicos na instituição, com acompanhamento profissional sistemático antes, durante e depois da terapia oncológica. Também foram fornecidas, aos cuidadores e pacientes, em ambos os grupos, orientações sobre os possíveis efeitos secundários da terapia oncológica e de ações para minimizar estes problemas. Os dados coletados referem-se a condições sócio-demográficas e de saúde bucal e também de avaliação da QV através de dois questionários - EORTC (específico para pacientes com câncer de cabeça e pescoço) e WHOQOL (avaliação geral da QV), aplicados em dois momentos distintos: antes e quinze dias depois da terapia oncológica concluída. Os resultados mostraram uma maior prevalência do câncer de cabeça e pescoço em homens, de baixo nível educacional e sócio-econômico, com pobre condição oral e média de idade de 54,2 anos. O diagnóstico histopatológico mais freqüente foi o carcinoma epidermóide, sendo as localizações preferenciais a língua e orofaringe. Mais de 60% dos diagnósticos foram realizados nas fases avançadas (III e IV – TMN) e os principais tratamentos realizados a cirurgia e a radioterapia. Apesar das características basais serem desfavoráveis, o grupo intervenção apresentou melhora na avaliação geral de QV e manutenção da específica após o tratamento oncológico, enquanto que o grupo controle mostrou piora em ambos, porém não houve diferença significativa entre os grupos. Entretanto, a variação das medidas (delta) no grupo intervenção, quando comparadas as características basais e finais, mostra uma projeção que tendencia uma melhoria significativa ao longo do tempo. Verifica-se também uma redução de candidíase (p<0,05) e mucosite no grupo intervenção. Conclui-se que os pacientes assistidos no Serviço de Oncologia do HNSC apresentaram o perfil típico dos tumores de localização de cabeça e pescoço no país, com maior prevalência de homens, tabagistas, de baixo nível sócio-econômico e educacional e pobre saúde oral. O protocolo de cuidados odontológicos desenvolvido foi capaz de reduzir danos decorrentes da terapia oncológica, além de poder contribuir para uma melhoria da QV ao longo do tempo aos pacientes com câncer de cabeça e pescoço. / Cancer represents a major public health problem all over the world due to the increase in its prevalence, besides its great individual institutional, and social impact. Thus, it deserves a wide, integral, and interdisciplinary approach in order to minimize the sequelae resulting from the disease or its treatment, and aiming to the healing with maintenance of the quality of life (QoL). This way, this study aimed to describe the social-demographic and oral health profile of head and neck cancer patients treated in Hospital Nossa Senhora da Conceição (HNSC), Porto Alegre, Brazil, and to check the impact of a systematic dental care guideline on the QoL before, during, and after the oncological therapy. The study, designed as a Randomized Clinical Trial, had the participation of 46 subjects with diagnosis of head and neck primary neoplasy, captured by convenience, consecutively, and randomly distributed in two groups. In the control group, patients were examined and advised about the possible effects of the oncological treatment and referred to the basic health care services for dental care. In the test group, patients were examined and advised about the possible effects of oncological treatment. The subjects included in this group received a dental care guideline in the institution, with a systematic professional follow-up before, during, and after the oncological therapy. Also, both caretakers and patients from each group received guidance about the possible secondary effects of the oncological therapy and the actions to minimize these problems. Collected data refer to the social-demographic and oral health status, as well as the evaluation of QoL by means of two questionnaires - EORTC (specific for head and neck cancer patients), and WHOQOL (general evaluation of QoL). These were administered in two distinct moments: before the onset and fifteen days after the conclusion of the oncological therapy. Results showed a higher prevalence of head and neck cancer in men, with low educational and social-economic level, with a poor oral condition, and an average age of 54.2 years. The most frequent histopathological diagnosis was epidermoidis carcinoma, being the preferential sites the tongue and the oropharynx. More than 60% of the diagnosis was done in the advanced phases (III e IV – TMN), and the main treatments performed were surgery and radiotherapy. In spite of the unfavorable baseline characteristics, the test group showed an improvement in the general evaluation of QoL, and maintenance of the specific QoL after the oncological treatment. The control group showed a worsening in both of them, although there was no significant difference between the groups. However, the range of the measures (delta) in the test group, when compared to the baseline and final characteristics, shows a projection tending to a significant improvement along time. A decrease in candidiasis (p<0,05) and muccositis was also shown in the test group. It is concluded that the patients treated in the Oncology Service of HNSC have shown a profile that is typical of the head and neck tumors in the country, with higher prevalence in men, smokers, low social-economic and educational level, and poor oral health. The dental care guideline that was developed was able to decrease harm resulting from the oncological therapy, as well as to contribute for an improvement of QoL along the time for the patients with head and neck cancer.

O câncer representa um importante problema de saúde pública no mundo, devido ao aumento da sua prevalência, além do grande impacto individual, institucional e social. Assim, merece uma abordagem ampliada, integral e interdisciplinar, a fim de minimizar as seqüelas decorrentes da doença ou do seu tratamento, visando à cura com manutenção da qualidade de vida (QV). Dessa forma, este trabalho teve como objetivos descrever o perfil sócio-demográfico e de saúde bucal de pacientes com câncer de cabeça e pescoço assistidos no HNSC, Porto Alegre – RS e, verificar o impacto na QV destes de um protocolo de cuidados odontológicos sistemático, antes, durante e depois da terapia oncológica. O estudo, delineado como um Ensaio Clínico Randomizado, teve a participação de 46 sujeitos com diagnóstico de neoplasia primária de cabeça e pescoço, captados por conveniência, consecutivamente e distribuídos aleatoriamente em dois grupos. No grupo controle, os pacientes foram examinados e orientados sobre os possíveis efeitos do tratamento oncológico e encaminhados aos serviços de atenção básica de referência para atendimento odontológico. No grupo intervenção, os pacientes foram examinados e orientados, sobre os possíveis efeitos do tratamento oncológico. Os sujeitos incluídos neste grupo receberam um protocolo de cuidados odontológicos na instituição, com acompanhamento profissional sistemático antes, durante e depois da terapia oncológica. Também foram fornecidas, aos cuidadores e pacientes, em ambos os grupos, orientações sobre os possíveis efeitos secundários da terapia oncológica e de ações para minimizar estes problemas. Os dados coletados referem-se a condições sócio-demográficas e de saúde bucal e também de avaliação da QV através de dois questionários - EORTC (específico para pacientes com câncer de cabeça e pescoço) e WHOQOL (avaliação geral da QV), aplicados em dois momentos distintos: antes e quinze dias depois da terapia oncológica concluída. Os resultados mostraram uma maior prevalência do câncer de cabeça e pescoço em homens, de baixo nível educacional e sócio-econômico, com pobre condição oral e média de idade de 54,2 anos. O diagnóstico histopatológico mais freqüente foi o carcinoma epidermóide, sendo as localizações preferenciais a língua e orofaringe. Mais de 60% dos diagnósticos foram realizados nas fases avançadas (III e IV – TMN) e os principais tratamentos realizados a cirurgia e a radioterapia. Apesar das características basais serem desfavoráveis, o grupo intervenção apresentou melhora na avaliação geral de QV e manutenção da específica após o tratamento oncológico, enquanto que o grupo controle mostrou piora em ambos, porém não houve diferença significativa entre os grupos. Entretanto, a variação das medidas (delta) no grupo intervenção, quando comparadas as características basais e finais, mostra uma projeção que tendencia uma melhoria significativa ao longo do tempo. Verifica-se também uma redução de candidíase (p<0,05) e mucosite no grupo intervenção. Conclui-se que os pacientes assistidos no Serviço de Oncologia do HNSC apresentaram o perfil típico dos tumores de localização de cabeça e pescoço no país, com maior prevalência de homens, tabagistas, de baixo nível sócio-econômico e educacional e pobre saúde oral. O protocolo de cuidados odontológicos desenvolvido foi capaz de reduzir danos decorrentes da terapia oncológica, além de poder contribuir para uma melhoria da QV ao longo do tempo aos pacientes com câncer de cabeça e pescoço. / Cancer represents a major public health problem all over the world due to the increase in its prevalence, besides its great individual institutional, and social impact. Thus, it deserves a wide, integral, and interdisciplinary approach in order to minimize the sequelae resulting from the disease or its treatment, and aiming to the healing with maintenance of the quality of life (QoL). This way, this study aimed to describe the social-demographic and oral health profile of head and neck cancer patients treated in Hospital Nossa Senhora da Conceição (HNSC), Porto Alegre, Brazil, and to check the impact of a systematic dental care guideline on the QoL before, during, and after the oncological therapy. The study, designed as a Randomized Clinical Trial, had the participation of 46 subjects with diagnosis of head and neck primary neoplasy, captured by convenience, consecutively, and randomly distributed in two groups. In the control group, patients were examined and advised about the possible effects of the oncological treatment and referred to the basic health care services for dental care. In the test group, patients were examined and advised about the possible effects of oncological treatment. The subjects included in this group received a dental care guideline in the institution, with a systematic professional follow-up before, during, and after the oncological therapy. Also, both caretakers and patients from each group received guidance about the possible secondary effects of the oncological therapy and the actions to minimize these problems. Collected data refer to the social-demographic and oral health status, as well as the evaluation of QoL by means of two questionnaires - EORTC (specific for head and neck cancer patients), and WHOQOL (general evaluation of QoL). These were administered in two distinct moments: before the onset and fifteen days after the conclusion of the oncological therapy. Results showed a higher prevalence of head and neck cancer in men, with low educational and social-economic level, with a poor oral condition, and an average age of 54.2 years. The most frequent histopathological diagnosis was epidermoidis carcinoma, being the preferential sites the tongue and the oropharynx. More than 60% of the diagnosis was done in the advanced phases (III e IV – TMN), and the main treatments performed were surgery and radiotherapy. In spite of the unfavorable baseline characteristics, the test group showed an improvement in the general evaluation of QoL, and maintenance of the specific QoL after the oncological treatment. The control group showed a worsening in both of them, although there was no significant difference between the groups. However, the range of the measures (delta) in the test group, when compared to the baseline and final characteristics, shows a projection tending to a significant improvement along time. A decrease in candidiasis (p<0,05) and muccositis was also shown in the test group. It is concluded that the patients treated in the Oncology Service of HNSC have shown a profile that is typical of the head and neck tumors in the country, with higher prevalence in men, smokers, low social-economic and educational level, and poor oral health. The dental care guideline that was developed was able to decrease harm resulting from the oncological therapy, as well as to contribute for an improvement of QoL along the time for the patients with head and neck cancer.

Para muitos médicos de diversas especialidades, a transfusão é considerada a primeira linha na abordagem dos pacientes com anemia e perdas sanguíneas, apesar dos riscos atualmente reconhecidos. Patient Blood Management é uma forma de abordagem das transfusões baseada em um conhecimento multimodal e multidisciplinar, que tem como objetivo central a transfusão de hemocomponentes com base nas necessidades individuais dos pacientes, reduzindo a utilização de hemocomponentes alogênicos às situações em que não existem outras alternativas mais seguras e custo eficazes disponíveis. Neste estudo foram analisados indicadores de eficácia de implantação de um programa de Patient Blood Management, baseados nos pilares consagrados na literatura, particularmente no primeiro e terceiro pilares, que dependem de um envolvimento direto dos médicos para sua efetivação. A implantação de um novo protocolo ocorreu após divulgação interna, palestras e treinamentos para residentes e outros membros do corpo clínico interessados. O resultado do estudo mostrou que a adoção de um novo protocolo, baseado nos conceitos de Patient Blood Management não contribuiu para a mudança efetiva das práticas e em alguns indicadores houve piora em relação às práticas anteriores à sua implantação. Foi realizada também uma revisão bibliográfica sobre o tema e elaborado um programa educacional para estudantes, para os médicos e enfermeiros estudantes e profissionais não familiarizados com o tema. / For many doctors of various specialties, transfusion is considered the first line in the approach to patients with anemia and blood loss, despite the currently recognized risks. Patient Blood Management is a way of approaching transfusions based on multimodal and multidisciplinary knowledge, whose main objective is the transfusion of blood components based on the needs of individual patients. This procedure reduces the use of allogeneic blood components in situations where there are safer alternatives and cost-effective solutions. In this study, we analyzed indicators of the effectiveness of the implementation of a Patient Blood Management program, based on the pillars established in the literature, particularly in the first and third pillars, which depend on a direct involvement of the physicians for their implementation. The use of a new protocol took place after an internal disclosure, a number of lectures and a training procedure for both residents and other members of the medical staff. The results of the study showed that the adoption of a new protocol, based on the concepts of Patient Blood Management, did not contribute to the effective change of practices. Some indicators pointed to a worsening of the practices after its adoption. A bibliographic review was also carried out on the topic and an educational program was developed for students, nurse students and professionals who are not familiar with the topic.

Suicide is an issue that plagues adolescents in the United States. Suicide crosses socioeconomic, racial, and gender divides and is difficult to predict and prevent. Primary care providers (PCPs) are in a position to detect suicidality in adolescents; however, PCPs lack the knowledge and confidence necessary to accurately identify suicidal adolescents. The author conducted an extensive review of current literature (meta-analyses, systematic reviews, literature reviews, case reports, and existing clinical practice guidelines) on identification of adolescent suicidality in pediatric primary care settings. This paper provides a set of recommendations for primary care providers on how to properly identify adolescents with suicidal ideation and behavior.

Bakgrund: Vårdrelaterade infektioner (VRI) är den vårdskada som är mest frekvent förekommande inom slutenvården. Detta drabbar inte bara den enskilda patienten utan skapar även stora kostnader och påfrestningar på organisations- och samhällsnivå. Sjuksköterskors tillämpning och följsamhet till evidensbaserade riktlinjer angående basala hygienrutiner är det mest effektiva sättet att förhindra uppkomst av VRI. Att undersöka vilka faktorer som påverkar följsamheten till basala hygienrutiner är av stor vikt, detta för att sjuksköterskor ska kunna öka sin teoretiska samt praktiska kunskap angående det preventiva arbete och på så vis utföra en säkrare patientvård. Syfte: Syftet med litteraturstudien var att identifiera och beskriva faktorer som kan påverka sjuksköterskans följsamhet till basala hygienrutiner i arbetet med att förhindra vårdrelaterade infektioner samt att beskriva datainsamlingsmetoderna i de inkluderade vetenskapliga artiklarna. Metod: En beskrivande litteraturstudie med resultat från tolv stycken vetenskapliga artiklar. Litteratursökningen utfördes i databaserna PubMed och Cinahl. Huvudresultat: Litteraturstudien visade att det var flera olika faktorer som bidrog till sjuksköterskors följsamhet till de evidensbaserade riktlinjerna angående basala hygienrutiner. Sjuksköterskors tillgänglighet till hygienprodukter visade sig vara en primär orsak. Bristande kunskap, tidsbrist samt hög arbetsbelastning var ytterligare orsaker till att rutiner kring basala hygienrutiner inte utfördes korrekt. Bra kollegor, god kommunikation och en trygg arbetsplats var däremot faktorer som påverkade det preventiva arbetet positivt. Enkäter, observationer och kombinerade datainsamlingsmetoder användes i de inkluderade vetenskapliga artiklarna. Slutsatser: Det framkommer ett flertal faktorer som ses påverka sjuksköterskors följsamhet till riktlinjer gällande basala hygienrutiner. Genom att skapa en medvetenhet hos sjuksköterskor angående dessa faktorer ges möjlighet att förbättra det preventiva arbetet mot VRI. / Background: Health-related infections (HRI) are the most frequent occurring care damages in inpatient care. HRI’s does not only impact the individual patient, but it also creates high costs and causes high levels of stress at the organization, as well as the community level. Nurses’ application of and compliance with evidence-based guidelines regarding basic hygiene routines is the most effective way to prevent HRI. An examination of the various factors that contributes to the lack of compliance with the different guidelines are crucial in order to increase the theoretical and practical knowledge amongst nurses. This automatically leads to the performing of a safer patient care. Aim: The purpose of this literature study was to identify and describe the various factors that may impact the nurse's compliance with basic hygiene routines in the prevention of healthcare related infections and to describe the data collection methods in the academic literature. Method: A descriptive literature study with results from 12 scientific articles. The literature research was performed in the databases PubMed and Cinahl. The articles were also reviewed based on their data collection method. Main results: Several factors contributed to how the nurses followed evidence-based guidelines regarding basic hygiene routines. The accessibility that nurses had to hygiene products was a primary cause. Lack of knowledge, time shortage, and high workload were additional causes as to why the basic hygiene routines were not properly performed. Contrary to this, good colleagues, good communication, and a safe workplace proved to be factors with a positive impact on preventive work. Surveys, observations and combined data collection methods were used in the included scientific articles. Conclusion: There are several factors that affect nurses compliance with guidelines regarding basic hygiene routines. By creating awareness among nurses regarding these factors, they are given the possibility of improving the preventive work against HRI.

Bakgrund: Den intensivvårdskrävande patienten är många gånger i behov av transport utanför intensivvårdsavdelningen för diagnostiserande undersökning eller behandling. Transporten är riskfylld då patienten kräver komplicerad utrustning och avancerad medicinsk behandling. Studier visar att patientsäkerheten ökar om policydokument används vid transportprocessen. Syfte: Studiens syfte var att kartlägga antalet policydokument som reglerar intrahospital transport i Stockholms län och jämföra dem med en guideline. Metod: Urvalet bestod av policydokument från 11 intensivvårdsavdelningar i Stockholms län. Metoden utgjordes av deskriptiv dokumentinnehållsanalys. Resultat: Sex av elva intensivvårdsavdelningar i Stockholms län hade policydokument som reglerar intrahospital transport. Policydokumenten hade fem gemensamma huvudämnen: Riskbedömning, bemanning, förberedelse, övervakning och utrustning vilka överensstämde med dem i guidelinen. Detaljnivån avseende utrustning skiljde sig dock policydokumenten emellan. Ett policydokument, som bestod av både riktlinje och checklista, utmärkte sig då det bäst överensstämde med innehållet i guidelinen. Slutsats: Studien visar att många intensivvårdsavdelningar i Stockholms Län saknar policydokument vid intrahospital transport. Existerande policydokument varierar i omfång, utformning och till viss del även avseende innehåll. Klinisk betydelse: Förhoppningen är att studien kan ligga till grund för omarbetning av befintliga riktlinjer och checklistor eller utformning av nya. Ytterst avser studien med detta förbättra patientsäkerheten. / Background: The intensive care patient often needs transportation outside the intensive care unit for diagnostic examination or treatment. Transports are associated with major risks due to critically ill patient requirements of complex equipment and advanced medical treatment. Studies show that the use of protocols in intrahospital transports increases patient safety. Objective: The study aimed to examine protocols that regulate intrahospital transport of patients in intensive care units in Stockholm County and compare them with a guideline. Method: The sample consisted of protocols from 11 intensive care units in Stockholm County. The method used was a document content analysis. Results: Six out of eleven intensive care units in Sweden possessed a protocol governing the intrahospital transport. The protocols had five main topics in common: Risk assessment, staffing, preparation, supervision and equipment, which were consistent with the guideline. The level of detail regarding equipment differed between them. Protocols containing both a guideline and checklist, stood out as the most integrated document. Conclusion: The result of the study shows that several intensive care units in Stockholm County are missing protocols regarding intrahospital transport. Existing protocols vary in size, design, and to some extent also in content. Clinical significance: This study has a goal to provide a basis for revision of existing guidelines and checklists or for designing new ones. Furthermost the aim of this study is to improve patient safety.

Increasing environmental awareness and an acceptance of accountability by the public and by businesses internationally and locally, could motivate organisations to adopt Environmental Management as part of their operations. The new direction the tourism and related industries are obliged to follow, in accordance with new government initiatives, will require responsibility in terms of the environment, management of the impacts these activities have on the environment and a commitment to the philosophy of sustainable development. Even though international standards and benchmarks for Environmental Management exist for the hotel industry, standards and guidelines do not yet exist for the South African environment. Furthermore, guidelines for an Environmental Management System in accordance with ISO 14001 have not yet been drafted for this industry, either internationally or locally. The aim of this study is to compile a guideline document for the implementation of Operational Environmental Management in accordance with the requirements of an ISO 14001 Environmental Management System. Three South African hotels, belonging to a local group of hotels but with international exposure, were researched as case studies to establish the impacts hotels may have on the environment. Literature on Environmental Management was studied to extract the requirements for Environmental Management, and combined with the requirements for the establishment of an Environmental Management System as prescribed by ISO 14001. The research confirmed that hotel activities, facilities and services impact on the environment. Environmental Management procedures previously documented for hotels have not been incorporated into an ISO 14001 Environmental Management System. The study successfully combined Environmental Management procedures for the environmental impacts identified for hotel activities, facilities and services with the procedures of establishing an ISO 14001 Environmental Management System. In summary, hotels have activities, facilities and services that impact significantly on the environment, but these significant impacts are site-specific. Detailed site-specific assessments should be undertaken when implementing this guideline for specific hotels, to establish the significance of each of the environmental impacts in relation to the site that is studied. Further studies should adapt this guideline document to the different accommodation types offered in the hospitality industry to ensure that an ISO 14000 Environmental Management System can be implemented at each of these accommodation types. / Dissertation (ML(Landscape Architecture))--University of Pretoria, 2004. / Architecture / unrestricted

Leadership is important to quality improvement initiatives in healthcare. However, few studies have evaluated leadership interventions to enhance nurses’ use of guideline recommendations in the field of knowledge translation. Purpose: To develop and evaluate an intervention designed to operationalize a leadership strategy composed of relations, change, and task-orientated leadership behaviours, and to examine its influence on nurses’ use of guideline recommendations in home-care nursing. Design: Sequential mixed methods pilot study with post-only cluster randomized controlled trial. Methods Phase I: Intervention Development 1. A participatory approach was used at a community healthcare organization with 23 units across the province of Ontario, Canada. The guideline selected was developed by the Registered Nurses’ Association of Ontario for the assessment and management of foot ulcers for people with diabetes. 2. Integrative literature review, qualitative interviews, and baseline chart audits were conducted. 3. Four units were randomized to control or experimental groups. 4. Clinical and management leadership teams participated in a 12-week intervention consisting of printed materials, interactive workshop, and teleconferences. Participants received summarized chart audit data, identified priority indicators for change, and created a team leadership action plan to address barriers and influence guideline use. Phase II: Evaluation 5. Chart audits compared differences in nursing process and patient outcomes. Primary outcome: eight-item nursing assessment score. 6. Qualitative interviews evaluated the intervention and leadership behaviours. Results: No significant difference was found in the primary outcome. A significant difference was observed in nurses’ documentation of five priority indicators chosen by the experimental groups (p=.02). Gaps in care included: 53%, 76%, and 94% of patients not assessed for ulcer depth, foot circulation, or neuropathy (respectively); 75% and 93% did not receive wound debridement or hydrogel dressings. Receiving data to identify priority indicators for change and developing a leadership action plan were reported as useful to guideline implementation. The experimental group described using more relations-oriented leadership behaviours conducting audit and feedback, and sending reminders. Conclusion: Findings from this pilot study suggest that leadership is a team process involving relations, change, and task-oriented behaviours enacted by managers and clinical leaders. A leadership model is proposed as a beginning taxonomy to inform future leadership intervention studies.

Introduction: Metabolic syndrome (MetS) is a risk condition describing a clustering of traditional cardiovascular risk factors. A number of risk and protective factors have been associated with MetS, and individuals with MetS are at a higher risk for developing chronic diseases such as diabetes, cancer, and cardiovascular disease. Objective: To contribute to the understanding of MetS in Canada, and to describe how it is a risk state through which material, psychosocial, and behavioural factors associate with chronic diseases. This was examined through three objectives: (i) to describe the prevalence and distribution of MetS; (ii) to examine potential pathways linking income and education with MetS; and (iii) to examine the interplay between non-movement behaviours (NMBs, namely sleep, screen time, and sedentary behaviour) and MetS. Methods: The Canadian Health Measures Survey (2007-2009, 2009-2011, ages 18 and older) was used for all analyses, which include logistic regression, multinomial regression, and calculation of standardized logit coefficients. Results: MetS was prevalent among approximately 20% of Canadian adults. It was significantly associated with chronic diseases, such as diabetes (11.2% vs. 3.4% among those with MetS vs. the general population). A social gradient in MetS was identified, and the behavioural risk factors of alcohol use, smoking, physical inactivity, and screen time were suggested to be partial mediators of this pathway. Findings demonstrated that not adhering to physical activity guidelines (150 minutes or more of moderate-to-vigorous physical activity per week) was associated with increased odds of MetS. A stepwise moderating effect of guideline adherence on screen time and sleep behaviours was demonstrated. Conclusion: MetS is prevalent in Canadian adults, and a high proportion of individuals with MetS have chronic conditions. Addressing the modifiable determinants of physical inactivity, excess screen time, alcohol consumption, and smoking may reduce the social gradient in MetS. Furthermore, adhering to physical activity guidelines may mitigate the associations of NMBs with MetS. The current thesis suggests that healthy behaviours are associated with lower risk for MetS, and therefore, possibly for future chronic disease.

Orientador: Paulo José Fortes Villas Boas / Resumo: Introdução: A população mundial de idosos vem crescendo mais rapidamente do que todos os outros grupos etários, demandando condições específicas para os seus cuidados, com recomendações bem estabelecidas. Recomendações de qualidade são essenciais para nortear o profissional de saúde, por isso, a United States Preventive Services Task Force (USPSTF) atua desde 1984 produzindo recomendações de qualidade científica para rastreio de doenças, com base no sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation) de força de recomendação. No Brasil, o Ministério da Saúde tem publicado PCDTs (Protocolos Clínicos e Diretrizes Terapêuticas) sobre algumas condições clínicas, e as Sociedades Médicas produzem diretrizes sobre doenças específicas, mas ainda não há manuais organizados de recomendações clínicas. Recomendações com diretrizes clínicas de confiança devem ser a base para melhorar a qualidade e a segurança dos serviços de saúde. Objetivos: Revisão das recomendações da United States Preventive Services Task Force (USPSTF) destinadas ao rastreio das condições clínicas prevalentes da população idosa e comparação com recomendações desenvolvidas as Sociedades Científicas Brasileiras reconhecidas pela Associação Médica Brasileira, para produção de manual de rastreio clínico em idosos assintomáticos. Metodologia: Estudo descritivo, tendo como base principal as recomendações da USPSTF e consensos publicados pelas Sociedades Científicas Brasileiras e de órgãos gove... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: World elderly population is growing faster than any other age group, requiring specific care conditions. Recommendations of good quality are essential for health professionals in clinical practice, and the use of science-based references is the main goal. The United States Preventive Services Task Force (USPSTF) works since 1984 producing evidence-based recommendations for disease screening, based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system to evaluate the strength of evidence. In Brazil, the Ministry of Health has been publishing the Clinical Protocols and Therapeutic Guidelines (PCDT, in Portuguese) about some clinical conditions, and Medical Associations has been working on some guidelines about specific diseases, but the country still lacks organized clinical recommendations. Good quality, evidence-based recommendations must be the base to improve the quality and safety of health systems. Objectives: USPSTF clinical recommendations review of elderly prevalent diseases and comparison with Brazillian recommendations produced by national entities, with the purpose of elaborating a screening manual for asymptomatic elderly. Methodology: The research was a review of USPSTF recommendations and guidelines published by Brazilian Medical Associations and governmental entities. The USPSTF recommendations are classified according to the GRADE system, and the grades are: A. certainty of substantial benefit; B. certainty of benefi... (Complete abstract click electronic access below) / Mestre