Trata-se de investigação qualitativa para conhecer a Concepção e Prática de Docentes, da cidade de São Paulo, sob a Influência de Programas de Prevenção da Doença Cardiovascular. Foram comparados grupos de professores que passaram pela formação e outros que não passaram, para verificar o que sabiam e como ensinavam o tema transversal saúde, quanto aos fatores de risco à doença cardiovascular, nos aspectos, alimentação, sedentarismo, tabagismo e uso do álcool. A entrevista como diagnóstico inicial demonstrou que existiam professores receptivos a participações inovadoras e outros resistentes a mudanças de qualquer natureza. O grupo focal confirmou esse resultado, pois, mesmo não tendo participado dos Programas, um número significativo de professores destacou-se como inovador e preocupado com as questões de saúde. A vantagem desta técnica sobre a anterior é ter permitido evidenciar na reflexão conjunta, os professores que passaram pela formação demonstraram avanço nas formas de intervenção em relação à prática de saúde em sala de aula e em todos os espaços escolares. A análise documental reforçou os resultados e identificou obstáculos internos e externos apresentados pelos professores. Os dois grupos apresentaram diferentes níveis de informações conceituais e de práticas em prevenção de doenças crônico-degenerativas, os passaram pela formação valorizaram o enfoque transversal e investigativo, relacionados ao desenvolvimento de hábitos, comportamentos, atitudes e valores. Por meio da triangulação dos dados, ficou confirmada a existência de obstáculos internos e externos à atuação docente, que interferem na evolução da concepção e prática, manifestada nas atitudes pelas simplificações do saber, que os conduzem a pensamentos dicotômicos e fragmentados. Conclui-se que a grande maioria dos professores não está informada quanto ao impacto da morbi-mortalidade por doença cardiovascular, e o valor atribuído se faz por conhecimento pessoal. Programas de capacitação devem considerar prioritariamente a forma de abordagem, em vez da extensão e profundidade dos conteúdos. O conhecimento do professor pode evoluir se houver formação continuada que o coloque em situação de diálogo e reflexão sobre sua concepção e prática. Os docentes capacitados adotam mais facilmente em sua práxis, a metodologia dialógica atuando como agente formador de atitudes e valores em estilo de vida saudável para a prevenção da doença cardiovascular. Os programas informam, motivam, promovem ações, mas não alcançam o último estágio de manutenção e empoderamento. Os professores necessitam da presença da universidade para que o conhecimento novo, em termos de ação, possa se manter e se consolidar de forma adequada a cada realidade. Para a implementação de programas o cenário ideal deve mesclar o conhecimento específico do educador com os conhecimentos das experiências dos especialistas em saúde, pondo em discussão os obstáculos de formação didático-pedagógicos que o impede de evoluir. / This is a qualitative investigation to learn the conception and practices of teachers in different curriculum subjects, at the city of São Paulo under the influence of Cardiovascular Disease Prevention Programs. Groups of teachers who went through the training given by Programs and others who did not, were compared to verify what they knew and how the taught the theme transversal health, related to risk factors of cardiovascular disease, in aspects such as nutrition, sedentary lifestyle, tobaccoism and alcohol intake.The interview as initial diagnostic showed that there were teachers receptive to innovative participations and others resistant to changes of any kind. The focal group confirmed this result because, even as participant of the Programs, a significant number of teachers distinguished as innovator and concerned with health matters. The advantage of this technique over the previous one is that it allows accentuating the collective reflection that teachers who went through the training showed concerns and ways of intervention related to the students health in all school spaces. The documental analysis performed strengthened the results and identified internal and external obstacles presented by the teachers. The two researched groups presented different levels of conceptual and practical information in prevention of chronic-degenerative diseases, and the ones who went through the training valued the transversal and investigative approach, related to the development of habits, behaviors, attitudes and values. By the triangulation of data the existence of internal and external obstacles to the teacher performance was confirmed, which interfere with the evolution of the conception and practice, revealed by attitudes of simplification of the knowledge, which leads them to dichotomous and fragmented thoughts. The conclusion is that the majority of the teachers, is not aware of the impact of mortality due to cardiovascular disease and the value imputed is made by personal knowledge. Capacitating programs must consider, primarily, the approach instead of the range and depth of their contents. For the methodological matrixes it was established an analogy among them as of how the teachers behave themselves concerning health programs presented in schools. The teachers education is important and may evolve if there is continuous education which places them in a dialogue and reflection situation about their conception and practice. The qualified teachers adopt in their praxis the dialogical methodology acting as moulder agent of attitudes and values in healthy lifestyle for the prevention of the cardiovascular disease, more easily. The programs inform, motivate, promote actions, but do not achieve the last stage of maintenance and empowerment. The teachers need support, the presence of the university so that the new knowledge in terms of action may stay and create bonds. The ideal scene to implement the programs should mix the specific knowledge of the educator, the didactic-pedagogical obstacles which restrain them from evolving and the knowledge resulted from the health specialists experiences

<p>УВОД: Нeпрaвилнa исхрaнa и нeдoвoљнa физичкa aктивнoст припaдajу групи нajзнaчajниjих здрaвствeнo-ризичних пoнaшaњa шкoлскe дeцe. Незадовољавајући трендови стања ухрањености и физичке активности деце школског узраста у Србији намећу потребу креирања и евалуације програма за унапређење исхране и физичке активности деце. Према искуствима других земаља, најефективнији програми унапређења исхране и физичке активности деце су програми који комбинују учење кроз наставни програм и утицај на родитеље или школску средину. Унапређење исхране и физичке активности у школама у Србиjи спрoвoди сe углaвнoм крoз краткотрајне кампање, промоције правилне исхране и физичке активности чији резултати нису евалуирани. У образовном систему Р. Србије не придаје се довољно значаја садржајима везаним за правилну исхрану и физичку активност у највећој мери због оптерећења наставника и ученика другим наставним предметима и садржајима. Интегрисана едукације деце и родитеља прeдстaвљa jeдaн нaчин нa кojи сe мoжe oргaнизoвaти едукација о исхрани и физичкој активности у нижим рaзрeдимa oснoвнe шкoлe, бeз дoдaтнoг oптeрeћeњa учeникa и aнгaжoвaњa нaстaвникa. ЦИЉЕВИ: Циљеви овог рада били су да се утврди да ли интегрисана едукација деце о исхрани и физичкој активности може значајно да унапреди знање и навике деце везане за исхрану и физичку активност, те стање ухрањености деце узраста 7 до 10 година. МАТЕРИЈАЛ И МЕТОДЕ: У истрaживaњу су употребљене мeтoде eкспeримeнтa сa пaрaлeлним групaмa, дескриптивна и аналитичка метода. У истраживање су укључена деца узраста 7 до 10 година из две основне школе у Сомбору. Формирање узорка вршено је по принципу једнофазног кластер узорковања. Нeзaвисне вaриjaбле истраживања биле су едукација деце о исхрани и физичкој активности и едукација родитеља о исхрани и физичкој активности. Зависне варијабле истраживања чинили су: ниво знања дeцe o прaвилнoj исхрaни и физичкoj aктивнoсти, навике у исхрани, одлике породичне исхране, физичка активност, седентарно понашање и стaњe ухрaњeнoсти дeцe. Утврђивање навика у исхрани, стања физичке активности, стања ухрањености деце и одлика породичне исхране у експерименталној групи спроведено је пре (термин Т1) и по завршетку примене едукације деце и родитеља (термин Т2). Утврђивање нивоа знања о правилној исхрани и физичкој активности спроведено је пре (термин Т1), по завршетку (термин Т2) и два месеца после примене интегрисане едукације деце и родитеља (термин Т3). Утврђивање значајних разлика између Е и К групе у терминима Т1, Т2 и Т3 вршено је применом &chi;2 теста за категоријске податке, Mann Whitney U теста за нумеричке непараметријске варијабле односно t-теста за параметријске варијабле. Утврђивање значајних разлика унутар Е и К групе у одпносу на термине Т1 и Т2 односно Т2 и Т3 вршено је применом hi2 теста за категоријске податке, Вилкоксоновог теста за упарене непараметарске податке односно t-теста упарених узорака за параметријске податке. Евалуација је извршена у односу на пол и узрасне групе деце. РЕЗУЛТАТИ: У термину Т1 узорак је чинило укупно 167 испитаника (94 испитаника у Е-експерименталној групи, а 73 испитаника у К-контролној групи), док је у термину Т2 узорак чинило 177 испитаника (92 испитаника у Е-експерименталној групи, а 85 испитаника у К-контролној групи). У термину Т2 постигнуто је значајно повећање знања деце првог разреда о улогама хране (T1=0,84; Т2=1,56; рТ1:Т2&lt;0,001), поступку прања руку (T1=0,28; Т2=1,85; рТ1:Т2&lt;0,001), пореклу производа (T2=2,12; Т3=3,10; рТ2:Т3=0,001), сезонској доступности воћа и поврћа (T1=1,58; Т2=2,66; рТ1:Т2&lt;0,001), пирамиди физичких активности (T1=0,88; Т2=3,21; рТ1:Т2&lt;0,001) и способности деце да примене стечено знање о исхрани на састављање јеловника (T1=1,14; Т2=1,98; рТ1:Т2=0,001). У Т2 постигнуто је значајно повећање знања деце другог разреда о улогама хране (T1=1,25; Т2=1,71; рТ1:Т2=0,001), прању руку (T1=0,32; Т2=1,48; рТ1:Т2&lt;0,001), пореклу производа (T1=1,89; Т2=2,92; рТ1:Т2=0,004), пирамиди исхране (T1=2,46; Т2=3,89; рТ1:Т2&lt;0,001), штетности седентарног понашања (T1=0,42; Т2=1,04; рТ1:Т2&lt;0,001) и хранљивим својствима намирница (T1=0,52; Т2=0,73; рТ1:Т2=0,002). Применa интегрисане едукације о исхрани и физичкој активности допринела је значајном унапређењу знања деце узраста 9 година о прању руку (T1=0,47;Т2=1,88;рТ1:Т2&lt;0,001), систему органа за варење (T1=0,86; Т2=1,38; рТ1:Т2=0,019), сировинама и производима (T1=1,48; Т2=2,45; рТ1:Т2=0,001)., пирамиди исхране (T1=1,89; Т2=3,18; рТ1:Т2=0,007), хранљивим својствима намирница (T1=0,57; Т2=0,78; рТ1:Т2=0,021) и штетности седентарног понашања (T1=0,06; Т2=2,03; рТ1:Т2&lt;0,001), као и унапређењу способности примене знања о исхрани на састављање једноставног оброка (T1=0,82; Т2=1,80; рТ1:Т2=0,026), јеловника (T1=1,23; Т2=2,22; рТ1:Т2&lt;0,009) и решавање проблема гојазности деце (T1=0,21; Т2=3,00; рТ1:Т2&lt;0,001). У Т2 дошло је до значајног унапређења знања деце четвртог разреда о улогама хране (T1=2,75; Т2=4,93; рТ1:Т2&lt;0,001), прању руку (T1=0,70; Т2=1,57; рТ1:Т2&lt;0,001), сезонској доступности воћа и поврћа (T1=1,04; Т2=2,57; рТ1:Т2&lt;0,001), пирамиди исхране (T1=3,08; Т2=3,69; рТ1:Т2&lt;0,001) и штетности седентарног понашања (T1=0,87; Т2=1,66; рТ1:Т2=0,023). У Т2 постигнуто је значајно унапређење знања деце узраста 7 до 10 година на нивоу памћења (р=0,040), разумевања (р&lt;0,001), примене (р&lt;0,001), анализе (р&lt;0,001), синтезе (р=0,026) и евалуације (р&lt;0,001). У Т3 значајно је опало знање на нивоу памћења (р=0,016) и разумевања (р=0,029). У обе групе испитаника дошло је до значајног повећања конзумирања поврћа (Е:р&lt; 0,001; К:р= 0,016) у термину Т2. Само у Е групи дошло је до значајног повећања конзумирања воћа (Е:р&lt; 0,001; К: р= 0,440) и млека и млечних производа (Е:р=0,005; К:р=0,916) у Т2. Значајно смањење времена проведеног у гледању телевизора (Е:р=0,005; К:р=0,782) и игрању на рачунару (Е:р=0,047; К:р=0,390) постигнуто је у експерименталној групи у Т2. Време проведено у умереним физичким активностима значајно се повећало у обе групе испитаника (Е:р&lt;0,001; К:р&lt;0,001), док је значајно повећање времена проведеног у интензивним физичким активностима утврђено само у експерименталној групи (Е:р=0,046; К:р=0,217) у Т2. после примене интегрисане едукације утврђени благи трендови промена стања ухрањености деце узраста 7 до 10 година и експерименталне и контролне групе. У Т1 утврђене су значајне разлике у слагању родитеља Е и К групе са ставом да правилна исхрана значи јести сву храну у одређеним количинама (р=0,014) и да деци треба забранити унос слаткиша и грицкалица (р=0,001), гледање телевизора и играње на рачунару (р=0,008). Значајне разлике у слагању родитеља обе групе са ставом да децу треба натерати да се баве спортом постојале су и у Т1(р=0,027) и у Т2 (р=0,016). Није утврђена статистички значајна разлика у дистрибуцији испитаника у односу на степен ухрањености у терминима Т1 и Т2 ни у Е групи (р=0.271) ни у К групи (р=0.534). ЗАКЉУЧЦИ: Применом интегрисане едукације о исхрани и физичкој активности постигнуто је значајно повећање знања деце узраста 7 година о улогама хране, поступку прања руку, пореклу производа, сезонској доступности воћа и поврћа, пирамиди физичких активности и способности деце да примене стечено знање о исхрани на састављање јеловника. Применом интегрисане едукације о исхрани и физичкој активности постигнуто је значајно повећање знања деце узраста 8 година о улогама хране, систему органа за варење, прању руку, пореклу производа, пирамиди исхране, штетности седентарног понашања и хранљивим својствима намирница, као и способности деце да примене стечено знање о исхрани на састављање јеловника. Применa интегрисане едукације о исхрани и физичкој активности допринела је значајном унапређењу знања деце узраста 9 година о прању руку, систему органа за варење, сировинама и производима, пирамиди исхране, хранљивим својствима намирница и штетности седентарног понашања. Применом интегрисане едукације постигнуто је значајно унапређење способности деце узраста 9 година да примене знање о исхрани на састављање једноставног оброка, јеловника и решавање проблема гојазности деце. Применa интегрисане едукације о исхрани и физичкој активности допринела је значајном унапређењу знања деце узраста 10 година о улогама хране, прању руку, сезонској доступности воћа и поврћа, хранљивим својствима намирница, пирамиди исхране и штетности седентарног понашања. Применом интегрисане едукације постигнуто је значајно унапређење знања деце узраста 7 до 10 година на нивоу памћења, разумевања, примене, анализе, синтезе и евалуације. Знање на нивоу памћења и разумевања нису били трајног карактера. После примене интегрисане едукације дошло је до значајног пораста уноса воћа, поврћа, млека и млечних производа у експерименталној групи деце узраста 7 до 10 година. Применом интегрисане едукације постигнуто је значајно смањење времена проведеног у гледању телевизора и игрању на рачунару код деце експерименталне групе узраста 7 до 10 година. После примене интегрисане едукације дошло је до значајног пораста времена проведеног у умереним физичким активностима у експерименталној групи деце узраста 7 до 10 година. Значајно повећање времена проведеног у интензивним физичким активностима утврђено је у експерименталној групи деце узраста 9 до 10 година. Реализација програма интегрисане едукације родитеља била је успешна у развијању свести родитеља експерименталне групе о принципима правилне исхране и штетности седентарног понашања. Примена интегрисане едукације није имала значајан ефекат на стање ухрањености деце.</p> / <p>UVOD: Nepravilna ishrana i nedovoljna fizička aktivnost pripadaju grupi najznačajnijih zdravstveno-rizičnih ponašanja školske dece. Nezadovoljavajući trendovi stanja uhranjenosti i fizičke aktivnosti dece školskog uzrasta u Srbiji nameću potrebu kreiranja i evaluacije programa za unapređenje ishrane i fizičke aktivnosti dece. Prema iskustvima drugih zemalja, najefektivniji programi unapređenja ishrane i fizičke aktivnosti dece su programi koji kombinuju učenje kroz nastavni program i uticaj na roditelje ili školsku sredinu. Unapređenje ishrane i fizičke aktivnosti u školama u Srbiji sprovodi se uglavnom kroz kratkotrajne kampanje, promocije pravilne ishrane i fizičke aktivnosti čiji rezultati nisu evaluirani. U obrazovnom sistemu R. Srbije ne pridaje se dovoljno značaja sadržajima vezanim za pravilnu ishranu i fizičku aktivnost u najvećoj meri zbog opterećenja nastavnika i učenika drugim nastavnim predmetima i sadržajima. Integrisana edukacije dece i roditelja predstavlja jedan način na koji se može organizovati edukacija o ishrani i fizičkoj aktivnosti u nižim razredima osnovne škole, bez dodatnog opterećenja učenika i angažovanja nastavnika. CILJEVI: Ciljevi ovog rada bili su da se utvrdi da li integrisana edukacija dece o ishrani i fizičkoj aktivnosti može značajno da unapredi znanje i navike dece vezane za ishranu i fizičku aktivnost, te stanje uhranjenosti dece uzrasta 7 do 10 godina. MATERIJAL I METODE: U istraživanju su upotrebljene metode eksperimenta sa paralelnim grupama, deskriptivna i analitička metoda. U istraživanje su uključena deca uzrasta 7 do 10 godina iz dve osnovne škole u Somboru. Formiranje uzorka vršeno je po principu jednofaznog klaster uzorkovanja. Nezavisne varijable istraživanja bile su edukacija dece o ishrani i fizičkoj aktivnosti i edukacija roditelja o ishrani i fizičkoj aktivnosti. Zavisne varijable istraživanja činili su: nivo znanja dece o pravilnoj ishrani i fizičkoj aktivnosti, navike u ishrani, odlike porodične ishrane, fizička aktivnost, sedentarno ponašanje i stanje uhranjenosti dece. Utvrđivanje navika u ishrani, stanja fizičke aktivnosti, stanja uhranjenosti dece i odlika porodične ishrane u eksperimentalnoj grupi sprovedeno je pre (termin T1) i po završetku primene edukacije dece i roditelja (termin T2). Utvrđivanje nivoa znanja o pravilnoj ishrani i fizičkoj aktivnosti sprovedeno je pre (termin T1), po završetku (termin T2) i dva meseca posle primene integrisane edukacije dece i roditelja (termin T3). Utvrđivanje značajnih razlika između E i K grupe u terminima T1, T2 i T3 vršeno je primenom &chi;2 testa za kategorijske podatke, Mann Whitney U testa za numeričke neparametrijske varijable odnosno t-testa za parametrijske varijable. Utvrđivanje značajnih razlika unutar E i K grupe u odpnosu na termine T1 i T2 odnosno T2 i T3 vršeno je primenom hi2 testa za kategorijske podatke, Vilkoksonovog testa za uparene neparametarske podatke odnosno t-testa uparenih uzoraka za parametrijske podatke. Evaluacija je izvršena u odnosu na pol i uzrasne grupe dece. REZULTATI: U terminu T1 uzorak je činilo ukupno 167 ispitanika (94 ispitanika u E-eksperimentalnoj grupi, a 73 ispitanika u K-kontrolnoj grupi), dok je u terminu T2 uzorak činilo 177 ispitanika (92 ispitanika u E-eksperimentalnoj grupi, a 85 ispitanika u K-kontrolnoj grupi). U terminu T2 postignuto je značajno povećanje znanja dece prvog razreda o ulogama hrane (T1=0,84; T2=1,56; rT1:T2&lt;0,001), postupku pranja ruku (T1=0,28; T2=1,85; rT1:T2&lt;0,001), poreklu proizvoda (T2=2,12; T3=3,10; rT2:T3=0,001), sezonskoj dostupnosti voća i povrća (T1=1,58; T2=2,66; rT1:T2&lt;0,001), piramidi fizičkih aktivnosti (T1=0,88; T2=3,21; rT1:T2&lt;0,001) i sposobnosti dece da primene stečeno znanje o ishrani na sastavljanje jelovnika (T1=1,14; T2=1,98; rT1:T2=0,001). U T2 postignuto je značajno povećanje znanja dece drugog razreda o ulogama hrane (T1=1,25; T2=1,71; rT1:T2=0,001), pranju ruku (T1=0,32; T2=1,48; rT1:T2&lt;0,001), poreklu proizvoda (T1=1,89; T2=2,92; rT1:T2=0,004), piramidi ishrane (T1=2,46; T2=3,89; rT1:T2&lt;0,001), štetnosti sedentarnog ponašanja (T1=0,42; T2=1,04; rT1:T2&lt;0,001) i hranljivim svojstvima namirnica (T1=0,52; T2=0,73; rT1:T2=0,002). Primena integrisane edukacije o ishrani i fizičkoj aktivnosti doprinela je značajnom unapređenju znanja dece uzrasta 9 godina o pranju ruku (T1=0,47;T2=1,88;rT1:T2&lt;0,001), sistemu organa za varenje (T1=0,86; T2=1,38; rT1:T2=0,019), sirovinama i proizvodima (T1=1,48; T2=2,45; rT1:T2=0,001)., piramidi ishrane (T1=1,89; T2=3,18; rT1:T2=0,007), hranljivim svojstvima namirnica (T1=0,57; T2=0,78; rT1:T2=0,021) i štetnosti sedentarnog ponašanja (T1=0,06; T2=2,03; rT1:T2&lt;0,001), kao i unapređenju sposobnosti primene znanja o ishrani na sastavljanje jednostavnog obroka (T1=0,82; T2=1,80; rT1:T2=0,026), jelovnika (T1=1,23; T2=2,22; rT1:T2&lt;0,009) i rešavanje problema gojaznosti dece (T1=0,21; T2=3,00; rT1:T2&lt;0,001). U T2 došlo je do značajnog unapređenja znanja dece četvrtog razreda o ulogama hrane (T1=2,75; T2=4,93; rT1:T2&lt;0,001), pranju ruku (T1=0,70; T2=1,57; rT1:T2&lt;0,001), sezonskoj dostupnosti voća i povrća (T1=1,04; T2=2,57; rT1:T2&lt;0,001), piramidi ishrane (T1=3,08; T2=3,69; rT1:T2&lt;0,001) i štetnosti sedentarnog ponašanja (T1=0,87; T2=1,66; rT1:T2=0,023). U T2 postignuto je značajno unapređenje znanja dece uzrasta 7 do 10 godina na nivou pamćenja (r=0,040), razumevanja (r&lt;0,001), primene (r&lt;0,001), analize (r&lt;0,001), sinteze (r=0,026) i evaluacije (r&lt;0,001). U T3 značajno je opalo znanje na nivou pamćenja (r=0,016) i razumevanja (r=0,029). U obe grupe ispitanika došlo je do značajnog povećanja konzumiranja povrća (E:r&lt; 0,001; K:r= 0,016) u terminu T2. Samo u E grupi došlo je do značajnog povećanja konzumiranja voća (E:r&lt; 0,001; K: r= 0,440) i mleka i mlečnih proizvoda (E:r=0,005; K:r=0,916) u T2. Značajno smanjenje vremena provedenog u gledanju televizora (E:r=0,005; K:r=0,782) i igranju na računaru (E:r=0,047; K:r=0,390) postignuto je u eksperimentalnoj grupi u T2. Vreme provedeno u umerenim fizičkim aktivnostima značajno se povećalo u obe grupe ispitanika (E:r&lt;0,001; K:r&lt;0,001), dok je značajno povećanje vremena provedenog u intenzivnim fizičkim aktivnostima utvrđeno samo u eksperimentalnoj grupi (E:r=0,046; K:r=0,217) u T2. posle primene integrisane edukacije utvrđeni blagi trendovi promena stanja uhranjenosti dece uzrasta 7 do 10 godina i eksperimentalne i kontrolne grupe. U T1 utvrđene su značajne razlike u slaganju roditelja E i K grupe sa stavom da pravilna ishrana znači jesti svu hranu u određenim količinama (r=0,014) i da deci treba zabraniti unos slatkiša i grickalica (r=0,001), gledanje televizora i igranje na računaru (r=0,008). Značajne razlike u slaganju roditelja obe grupe sa stavom da decu treba naterati da se bave sportom postojale su i u T1(r=0,027) i u T2 (r=0,016). Nije utvrđena statistički značajna razlika u distribuciji ispitanika u odnosu na stepen uhranjenosti u terminima T1 i T2 ni u E grupi (r=0.271) ni u K grupi (r=0.534). ZAKLJUČCI: Primenom integrisane edukacije o ishrani i fizičkoj aktivnosti postignuto je značajno povećanje znanja dece uzrasta 7 godina o ulogama hrane, postupku pranja ruku, poreklu proizvoda, sezonskoj dostupnosti voća i povrća, piramidi fizičkih aktivnosti i sposobnosti dece da primene stečeno znanje o ishrani na sastavljanje jelovnika. Primenom integrisane edukacije o ishrani i fizičkoj aktivnosti postignuto je značajno povećanje znanja dece uzrasta 8 godina o ulogama hrane, sistemu organa za varenje, pranju ruku, poreklu proizvoda, piramidi ishrane, štetnosti sedentarnog ponašanja i hranljivim svojstvima namirnica, kao i sposobnosti dece da primene stečeno znanje o ishrani na sastavljanje jelovnika. Primena integrisane edukacije o ishrani i fizičkoj aktivnosti doprinela je značajnom unapređenju znanja dece uzrasta 9 godina o pranju ruku, sistemu organa za varenje, sirovinama i proizvodima, piramidi ishrane, hranljivim svojstvima namirnica i štetnosti sedentarnog ponašanja. Primenom integrisane edukacije postignuto je značajno unapređenje sposobnosti dece uzrasta 9 godina da primene znanje o ishrani na sastavljanje jednostavnog obroka, jelovnika i rešavanje problema gojaznosti dece. Primena integrisane edukacije o ishrani i fizičkoj aktivnosti doprinela je značajnom unapređenju znanja dece uzrasta 10 godina o ulogama hrane, pranju ruku, sezonskoj dostupnosti voća i povrća, hranljivim svojstvima namirnica, piramidi ishrane i štetnosti sedentarnog ponašanja. Primenom integrisane edukacije postignuto je značajno unapređenje znanja dece uzrasta 7 do 10 godina na nivou pamćenja, razumevanja, primene, analize, sinteze i evaluacije. Znanje na nivou pamćenja i razumevanja nisu bili trajnog karaktera. Posle primene integrisane edukacije došlo je do značajnog porasta unosa voća, povrća, mleka i mlečnih proizvoda u eksperimentalnoj grupi dece uzrasta 7 do 10 godina. Primenom integrisane edukacije postignuto je značajno smanjenje vremena provedenog u gledanju televizora i igranju na računaru kod dece eksperimentalne grupe uzrasta 7 do 10 godina. Posle primene integrisane edukacije došlo je do značajnog porasta vremena provedenog u umerenim fizičkim aktivnostima u eksperimentalnoj grupi dece uzrasta 7 do 10 godina. Značajno povećanje vremena provedenog u intenzivnim fizičkim aktivnostima utvrđeno je u eksperimentalnoj grupi dece uzrasta 9 do 10 godina. Realizacija programa integrisane edukacije roditelja bila je uspešna u razvijanju svesti roditelja eksperimentalne grupe o principima pravilne ishrane i štetnosti sedentarnog ponašanja. Primena integrisane edukacije nije imala značajan efekat na stanje uhranjenosti dece.</p> / <p>INTRODUCTION: Improper diet and lack of physical activity belonging to the group the most significant health risks behavior of school children. Current trends in nutritional status and physical activity of schoolchildren in Serbia impose the need for creating and evaluating programs to improve nutrition and physical activity of children. According to the experience of other countries, the most effective programs for the improvement of nutrition and physical activity of children are programs that combine learning across the curriculum and the impact on parents or the school environment. Programs for improving nutrition and physical activity in schools in Serbia are usually carried out through short-term campaigns whose results are not evaluated. Contents about nutrition and physical activity are not properly represented in the curriculum for elementary schools in Serbia partly due to the workload of teachers and students in other school subjects and contents. Integrated education of children and parents may be a solution for conducting nutrition and physical activity education in primary schools without the additional burden of engaging students and teachers. AIMS: Aims of this study were to determine whether integrated education of 7 to 10 year/old children may have significant influence on children`s knowledge about nutrition and physical activity, dietary habits, physical activity, sedentary behavior, characteristics of family nutrition and children`s nutritional status. MATERIAL AND METHODS: The study used experimental methods with parallel groups, descriptive and analytical methods. The study included children aged 7 to 10 years from two primary schools in Sombor. Single-phase cluster sampling was used to form sample. Independent research variables were nutrition and physical activity program education for children and nutrition and physical activity education program for parents. Dependent research variables were the level of knowledge about proper nutrition and physical activity, dietary habits, physical activity, sedentary behavior, characteristics of family nutrition, and nutritional status of children. Determining sohrani habits, physical activity status, nutritional status of children and the quality of family nutrition in the experimental group was carried out before (the term T1) and after application of educating children and parents (a term T2). Determining the level of knowledge about proper nutrition and physical activity was carried out before (term T1) at the end (term T2) and two months after the application of the integrated education of children and parents ( term T3). Determination of significant differences between the groups E and K in terms of T1, T2 and T3 was conducted using hi2 test for categorical variables, the Mann-Whitney U test for numerical non-parametric variables and t-tests for continuous variables. Determining significant differences within the group E and K in relation to the time slots T1 and T2 or T2 and T3 was performed using hi2 test for categorical variables, the Wilcoxon test for paired data for the non-parametric variables and t-test for paired samples for parametric data. The evaluation was made in relation to gender and age groups of children. RESULTS: In the term T1 total sample included 167 subjects (94 subjects in the experimental group E, and 73 subjects in the K-control group), while in the term T2 sample consisted of 177 subjects (92 subjects in the experimental group E and 85 respondents in K-the control group). Significant increase in the knowledge of 7 year-old children in the term T2 was achieved on the roles of food (T1 = 0.84, T2 = 1.56; T1: T2 &lt;0.001), hand washing (T1 = 0.28; T2 = 1.85; T1: T2 &lt;0.001), the origin of foods (T2 = 2.12; T3 = 3.10; pT2: T3 = 0,001), the seasonal availability of fruits and vegetables (T1 = 1.58; T2 = 2.66; T1: T2 &lt;0.001), physical activity pyramid (T1 = 0.88; T2 = 3.21; T1: T2 &lt;0.001) and the ability to apply knowledge of nutrition to compose menus (T1 = 1.14; T2 = 1.98; T1: T2 = 0.001). Significant increase in knowledge of 8 year-old children was determined for the roles of the food (T1 = 1.25; T2 = 1.71; T1: T2 = 0.001), hand washing (T1 = 0.32; T2 = 1.48; T1: T2 &lt;0.001), the origin of food products (T1 = 1.89; T2 = 2.92; T1: T2 = 0.004), the food pyramid (T1 = 2.46, T2 = 3.89; T1: T2 &lt;0.001), harmfulness of sedentary behavior (T1 = 0.42, T2 = 1.04; T1: T2 &lt;0.001) and nutritional properties of foods (T1 = 0.52, T2 = 0.73; T1: T2 = 0.002). In the term T2 it was determined significant improvement of 9 year-old children`s knowledge of hand washing (T1 = 0.47, T2 = 1.88; T1: T2 &lt;0.001), digestive organ system (T1 = 0.86 ; T2 = 1.38; T1: T2 = 0.019), origins of food products (T1 =1.48; T2 = 2.45; T1: T2 = 0.001), the food pyramid (T1 = 1.89; T2 = 3 18; T1: T2 = 0.007), nutritional properties of foods (T1 = 0.57; T2 = 0.78; T1: T2 = 0.021) harmfulness of sedentary behavior (T1 = 0.06, T2 = 2.03; T1 T2 &lt;0.001), as well as improving the ability to apply knowledge of nutrition to assemble a simple meal (T1 = 0.82; T2 = 1.80; T1: T2 = 0.026), the menu for one day (T1 = 1.23; T2 = 2, 22; T1: T2 &lt;0.009) and to solve the problem of obesity in children (T1 = 0.21, T2 = 3.00; T1: T2 &lt;0.001). In the term T2 there was a significant improvement of the knowledge of 10 year-old children of the roles of food (T1=2.75; T2=4.93; T1:T2 &lt;0.001), hand washing (T1=0.70; T2=1.57; T1 T2&lt;0.001), the seasonal availability of fruits and vegetables (T1 = 1.04; T2 = 2.57; T1: T2 &lt;0.001), the food pyramid (T1 = 3.08; T2 = 3.69; T1:T2 &lt;0.001) and harmfulness of sedentary behavior (T1=0.87; T2=1.66; T1:T2 p=0.023). Significant improvement of knowledge of 7 to 10 year-old children in the term T2 was determined at the level of memory (p=0.040), understanding (p &lt;0.001), application (p&lt;0.001), analysis (p&lt;0.001), synthesis (p=.026) and evaluation (p &lt;0.001). In the term T3 there was a significant decrease of knowledge at the level of memory (p=0.016) and understanding (p= 0.029). In both groups there was a significant increase in the consumption of vegetables (E: p &lt;0.001; K: p = 0.016) in the term T2. A significant increase in the consumption of fruit (E: p &lt;0.001; K: p = 0.440) and milk and dairy products (E: p = 0.005; K: p= 0.916) at T2 was determined only in experimental group. A significant reduction in the time spent watching television (E: p = 0.005; K: p = 0.782) and playing on the computer (E p=0.047; K: p= 0.390) was achieved in the experimental group in the term T2. The time spent in moderate physical activities significantly increased in both groups (E: p &lt;0.001; P: p &lt;0.001), while the time spent in intense physical activities significantly increased only in experimental group (E: p = 0.046; K: p= 0.217) in the term T2. There were found significant differences in the agreement between parents from experimental and control group with the view that proper nutrition means eating all foods in proper quantities (p=0.014), and that children should be prohibited to consume sweets (p= 0.001), watch television and play on the computer (p = 0.008) in the term T2. Significant differences in the agreement between parents from experimental and control group with the view that children should be forced to engage in sports were found in terms T1 (p=0.027) and T2 (p=0.016). There were not found significant changes in the nutritional status of children in experimental (p=0.271) and control groups (p=0.534) in the term T2. CONCLUSIONS: Integrated nutrition and physical activity education contributed to significant increase in knowledge on health and safe food handling in 7 to 10 year-old children. Significant increase in knowledge on the roles of food was achieved in 7, 8 and 10 year-old children. Knowledge of the origin and types of food significantly increased in 7,8 and 9 year-old children. Knowledge of the seasonal availability of fruits and vegetables significantly improved in 7,9 and 10 year-old children. Significant improvement in knowledge on food pyramid, nutritional properties of foods and harmfulness of sedentary behavior was found in 8,9 and 10 year-old children. The ability to apply knowledge of nutrition to compose menus significantly improved in 7,8 and 9 year-old children. Integrated nutrition and physical activity education significantly improved 9 year-old children`s ability to apply knowledge of nutrition at solving the problem of obesity in children. Integrated nutrition and physical activity education significantly improved the knowledge of 7 to 10 year-old children at the level of memory, comprehension, application, analysis, synthesis and evaluation. Knowledge at the level of memory and understanding were not permanent. After the application of integrated nutrition and physical activity education, there was a significant increase in the intake of fruit, vegetables, milk and dairy products in the experimental group of 7 to 10 year-old children. Integrated nutrition and physical activity education contributed to significant reduction in the time spent watching television and playing on the computer in the experimental group of 7 to 10 year-old children. After the application of integrated education, there was a significant increase in the time spent in moderate to intense physical activity in the experimental group of 7 to 10 year-old children.</p>

To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.

Contexte : Un accès adéquat aux aliments sains dans les environnements résidentiels peut contribuer aux saines habitudes alimentaires. Un tel accès est d’autant plus important pour les personnes âgées, où les changements associés au vieillissement peuvent accentuer leur dépendance aux ressources disponibles dans le voisinage. Cependant, cette relation n’a pas encore été établie chez les aînés. Objectifs : La présente thèse vise à quantifier les associations entre l’environnement alimentaire local et les habitudes alimentaires de personnes âgées vivant à domicile en milieu urbain. La thèse s’est insérée dans un projet plus large qui a apparié les données provenant d’une cohorte d’aînés québécois vivant dans la région métropolitaine montréalaise avec des données provenant d’un système d’information géographique. Trois études répondent aux objectifs spécifiques suivants : (1) développer des indices relatifs de mixité alimentaire pour qualifier l’offre d’aliments sains dans les magasins d’alimentation et l’offre de restaurants situés dans les quartiers faisant partie du territoire à l’étude et en examiner la validité; (2) quantifier les associations entre la disponibilité relative de magasins d’alimentation et de restaurants près du domicile et les habitudes alimentaires des aînés; (3) examiner l’influence des connaissances subjectives en nutrition dans la relation entre l’environnement alimentaire près du domicile et les habitudes alimentaires chez les hommes et les femmes âgés. Méthodes : Le devis consiste en une analyse secondaire de données transversales provenant de trois sources : les données du cycle 1 pour 848 participants de l’Étude longitudinale québécoise « La nutrition comme déterminant d’un vieillissement réussi » (2003-2008), le Recensement de 2001 de Statistique Canada et un registre privé de commerces et services (2005), ces derniers regroupés dans un système d’information géographique nommé Mégaphone. Des analyses bivariées non paramétriques ont été appliquées pour répondre à l’objectif 1. Les associations entre l’exposition aux commerces alimentaires dans le voisinage et les habitudes alimentaires (objectif 2), ainsi que l’influence des connaissances subjectives en nutrition dans cette relation (objectif 3), ont été vérifiées au moyen d’analyses de régression linéaires. Résultats : Les analyses ont révélé trois résultats importants. Premièrement, l’utilisation d’indices relatifs pour caractériser l’offre alimentaire s’avère pertinente pour l’étude des habitudes alimentaires, plus particulièrement pour l’offre de restaurants-minute. Deuxièmement, l’omniprésence d’aspects défavorables dans l’environnement, caractérisé par une offre relativement plus élevée de restaurants-minute, semble nuire davantage aux saines habitudes alimentaires que la présence d’opportunités d’achats d’aliments sains dans les magasins d’alimentation. Troisièmement, un environnement alimentaire plus favorable aux saines habitudes pourrait réduire les écarts quant à la qualité de l’alimentation chez les femmes ayant de plus faibles connaissances subjectives en nutrition par rapport aux femmes mieux informées. Conclusion : Ces résultats mettent en relief la complexité des liens entre l’environnement local et l’alimentation. Dans l’éventualité où ces résultats seraient reproduits dans des recherches futures, des stratégies populationnelles visant à résoudre un déséquilibre entre l’accès aux sources d’aliments sains par rapport aux aliments peu nutritifs semblent prometteuses. / Context: Adequate access to healthful foods in residential environments may contribute to healthful dietary practices. Such access is important for older adults where changes associated with aging may accentuate their dependence on resources available in their residential neighborhood. However, this relationship has not been established for seniors. Objectives: This thesis aims to quantify associations between the local food environment and dietary patterns of independent urban-dwelling older adults. The thesis is part of a larger project involving the linkage of data from a cohort of Québec seniors living in the Montréal metropolitan area and data from a geographic information system. Three studies addressed the following specific objectives: (1) to develop relative indices of local-area food sources outlets to qualify stores potentially selling healthful foods and supply of restaurants in neighborhoods that were part of the study area, (2) to quantify associations between the relative availability of food stores and restaurants in residential area and dietary patterns of members of the cohort, (3) to examine the influence of subjective nutrition knowledge in the relationship between the residential food environment and dietary patterns among older men and women. Methods: Cross-sectional analysis of data from three different sources was performed: (1) person-level data on 848 participants from cycle 1 of the Québec Longitudinal Study on Nutrition and Successful Aging , (2) 2001 Census data from Statistics Canada and (3) data from private businesses and services registry (2005), these two gathered in a geographic information system called Megaphone. Nonparametric bivariate analyses were applied to address objective 1. Associations between exposure to residential-area food sources and dietary patterns (objective 2), as well as moderating effect of nutrition knowledge (objective 3), were tested using linear regression analyses. Results: Analyses revealed three important results. First, the use of relative indices to characterize availability of local-area food sources is relevant to the study of dietary patterns, particularly regarding the supply of fast food restaurants. Second, the ubiquity of unfavorable aspects in the food environment, characterized by relatively higher fast food restaurants offer seem more detrimental to healthful eating habits that the presence of opportunities to buy healthful foods in food stores. Third, a residential food environment more favorable to healthful dietary patterns could reduce disparities in diet quality between women with low nutrition knowledge compared to women more knowledgeable. Conclusion: These results highlight the complex links between local environment and diet. If findings can be replicated in future research, population-based strategies to address an imbalance between accessibility to healthful food sources relative to unhealthful food sources, would be promising.

O aumento da concentração populacional e as alterações do modo de vida tradicional da comunidade indígena do Distrito de Iauaretê, Município de São Gabriel da Cachoeira/AM, na Terra Indígena do Alto Rio Negro, têm resultado em inúmeros agravos à saúde da população, principalmente devido a ausência de saneamento básico. O objetivo da pesquisa foi identificar os principais problemas sanitários e socioambientais que interferem diretamente na saúde e qualidade de vida dos habitantes de Iauaretê, visando a melhoria dessas condições. O método utilizado foi a pesquisa-ação, por meio de diversos instrumentos aplicados em reuniões comunitárias, como questionários, entrevistas, mapas-falantes, painéis de fotos e observação participante. Identificou-se que os indígenas, mesmo reconhecendo situações de causa e efeito sobre os agravos à saúde a que estavam expostos, ainda não haviam incorporado esse conhecimento na vida cotidiana. Os moradores que interagiram na pesquisa demonstraram o desejo por melhorias sanitárias. Contudo, ficou claro que a oferta de infra-estrutura não será suficiente para garantir a saúde e romper ciclos de transmissão de doenças, fazendo-se necessário o desenvolvimento de um processo educativo em saúde e meio ambiente voltado para uma reflexão crítica da realidade e a sua transformação, reforçando práticas saudáveis que possam contribuir para a melhoria da qualidade de vida da população. O método da pesquisa-ação mostrou-se extremamente adequado em um processo que objetiva a busca de soluções para determinada problemática de forma participativa e dialógica e a melhoria das condições de vida da população. / The increase in population concentration and the changes in the traditional way of life of the indigenous community of the District of Iauaretê, City of São Gabriel da Cachoeira/AM, in Alto Rio Negro Indigenous Land, have been producing negative consequences for the general health of the population. This is mainly due to the lack of basic sanitation. The objective of the research was to identify the major sanitation and socio-environmental problems that directly interfere in the health and living standards of the inhabitants of Iauaretê, in order to improve such conditions. The research methodology used is known as action-research, by means of different techniques used during the community meetings, such as questionnaires, interviews, talking-maps, photography panels and active observation. Despite the indigenous population's awareness of the causes and effects of certain situations which were potentially hazardous to their health, they were as yet unable to incorporate that knowledge to their daily life. The inhabitants who interacted with the research were keen to improve sanitation. However, it was clear that infra-structural improvements will not be enough to guarantee their health, nor break the cycle of disease transmission. It is also necessary to develop environmental and heath education processes which bring about a critical understanding of reality and its transformations, thus reinforcing healthy habits which might contribute to an improvement in their quality of life. Action-research proved itself as an extremely adequate methodology for processes which aim at finding solutions to a given problem through participation and dialogue, as well as improving the general standard of living.

O aumento da concentração populacional e as alterações do modo de vida tradicional da comunidade indígena do Distrito de Iauaretê, Município de São Gabriel da Cachoeira/AM, na Terra Indígena do Alto Rio Negro, têm resultado em inúmeros agravos à saúde da população, principalmente devido a ausência de saneamento básico. O objetivo da pesquisa foi identificar os principais problemas sanitários e socioambientais que interferem diretamente na saúde e qualidade de vida dos habitantes de Iauaretê, visando a melhoria dessas condições. O método utilizado foi a pesquisa-ação, por meio de diversos instrumentos aplicados em reuniões comunitárias, como questionários, entrevistas, mapas-falantes, painéis de fotos e observação participante. Identificou-se que os indígenas, mesmo reconhecendo situações de causa e efeito sobre os agravos à saúde a que estavam expostos, ainda não haviam incorporado esse conhecimento na vida cotidiana. Os moradores que interagiram na pesquisa demonstraram o desejo por melhorias sanitárias. Contudo, ficou claro que a oferta de infra-estrutura não será suficiente para garantir a saúde e romper ciclos de transmissão de doenças, fazendo-se necessário o desenvolvimento de um processo educativo em saúde e meio ambiente voltado para uma reflexão crítica da realidade e a sua transformação, reforçando práticas saudáveis que possam contribuir para a melhoria da qualidade de vida da população. O método da pesquisa-ação mostrou-se extremamente adequado em um processo que objetiva a busca de soluções para determinada problemática de forma participativa e dialógica e a melhoria das condições de vida da população. / The increase in population concentration and the changes in the traditional way of life of the indigenous community of the District of Iauaretê, City of São Gabriel da Cachoeira/AM, in Alto Rio Negro Indigenous Land, have been producing negative consequences for the general health of the population. This is mainly due to the lack of basic sanitation. The objective of the research was to identify the major sanitation and socio-environmental problems that directly interfere in the health and living standards of the inhabitants of Iauaretê, in order to improve such conditions. The research methodology used is known as action-research, by means of different techniques used during the community meetings, such as questionnaires, interviews, talking-maps, photography panels and active observation. Despite the indigenous population's awareness of the causes and effects of certain situations which were potentially hazardous to their health, they were as yet unable to incorporate that knowledge to their daily life. The inhabitants who interacted with the research were keen to improve sanitation. However, it was clear that infra-structural improvements will not be enough to guarantee their health, nor break the cycle of disease transmission. It is also necessary to develop environmental and heath education processes which bring about a critical understanding of reality and its transformations, thus reinforcing healthy habits which might contribute to an improvement in their quality of life. Action-research proved itself as an extremely adequate methodology for processes which aim at finding solutions to a given problem through participation and dialogue, as well as improving the general standard of living.

Contexte : Un accès adéquat aux aliments sains dans les environnements résidentiels peut contribuer aux saines habitudes alimentaires. Un tel accès est d’autant plus important pour les personnes âgées, où les changements associés au vieillissement peuvent accentuer leur dépendance aux ressources disponibles dans le voisinage. Cependant, cette relation n’a pas encore été établie chez les aînés. Objectifs : La présente thèse vise à quantifier les associations entre l’environnement alimentaire local et les habitudes alimentaires de personnes âgées vivant à domicile en milieu urbain. La thèse s’est insérée dans un projet plus large qui a apparié les données provenant d’une cohorte d’aînés québécois vivant dans la région métropolitaine montréalaise avec des données provenant d’un système d’information géographique. Trois études répondent aux objectifs spécifiques suivants : (1) développer des indices relatifs de mixité alimentaire pour qualifier l’offre d’aliments sains dans les magasins d’alimentation et l’offre de restaurants situés dans les quartiers faisant partie du territoire à l’étude et en examiner la validité; (2) quantifier les associations entre la disponibilité relative de magasins d’alimentation et de restaurants près du domicile et les habitudes alimentaires des aînés; (3) examiner l’influence des connaissances subjectives en nutrition dans la relation entre l’environnement alimentaire près du domicile et les habitudes alimentaires chez les hommes et les femmes âgés. Méthodes : Le devis consiste en une analyse secondaire de données transversales provenant de trois sources : les données du cycle 1 pour 848 participants de l’Étude longitudinale québécoise « La nutrition comme déterminant d’un vieillissement réussi » (2003-2008), le Recensement de 2001 de Statistique Canada et un registre privé de commerces et services (2005), ces derniers regroupés dans un système d’information géographique nommé Mégaphone. Des analyses bivariées non paramétriques ont été appliquées pour répondre à l’objectif 1. Les associations entre l’exposition aux commerces alimentaires dans le voisinage et les habitudes alimentaires (objectif 2), ainsi que l’influence des connaissances subjectives en nutrition dans cette relation (objectif 3), ont été vérifiées au moyen d’analyses de régression linéaires. Résultats : Les analyses ont révélé trois résultats importants. Premièrement, l’utilisation d’indices relatifs pour caractériser l’offre alimentaire s’avère pertinente pour l’étude des habitudes alimentaires, plus particulièrement pour l’offre de restaurants-minute. Deuxièmement, l’omniprésence d’aspects défavorables dans l’environnement, caractérisé par une offre relativement plus élevée de restaurants-minute, semble nuire davantage aux saines habitudes alimentaires que la présence d’opportunités d’achats d’aliments sains dans les magasins d’alimentation. Troisièmement, un environnement alimentaire plus favorable aux saines habitudes pourrait réduire les écarts quant à la qualité de l’alimentation chez les femmes ayant de plus faibles connaissances subjectives en nutrition par rapport aux femmes mieux informées. Conclusion : Ces résultats mettent en relief la complexité des liens entre l’environnement local et l’alimentation. Dans l’éventualité où ces résultats seraient reproduits dans des recherches futures, des stratégies populationnelles visant à résoudre un déséquilibre entre l’accès aux sources d’aliments sains par rapport aux aliments peu nutritifs semblent prometteuses. / Context: Adequate access to healthful foods in residential environments may contribute to healthful dietary practices. Such access is important for older adults where changes associated with aging may accentuate their dependence on resources available in their residential neighborhood. However, this relationship has not been established for seniors. Objectives: This thesis aims to quantify associations between the local food environment and dietary patterns of independent urban-dwelling older adults. The thesis is part of a larger project involving the linkage of data from a cohort of Québec seniors living in the Montréal metropolitan area and data from a geographic information system. Three studies addressed the following specific objectives: (1) to develop relative indices of local-area food sources outlets to qualify stores potentially selling healthful foods and supply of restaurants in neighborhoods that were part of the study area, (2) to quantify associations between the relative availability of food stores and restaurants in residential area and dietary patterns of members of the cohort, (3) to examine the influence of subjective nutrition knowledge in the relationship between the residential food environment and dietary patterns among older men and women. Methods: Cross-sectional analysis of data from three different sources was performed: (1) person-level data on 848 participants from cycle 1 of the Québec Longitudinal Study on Nutrition and Successful Aging , (2) 2001 Census data from Statistics Canada and (3) data from private businesses and services registry (2005), these two gathered in a geographic information system called Megaphone. Nonparametric bivariate analyses were applied to address objective 1. Associations between exposure to residential-area food sources and dietary patterns (objective 2), as well as moderating effect of nutrition knowledge (objective 3), were tested using linear regression analyses. Results: Analyses revealed three important results. First, the use of relative indices to characterize availability of local-area food sources is relevant to the study of dietary patterns, particularly regarding the supply of fast food restaurants. Second, the ubiquity of unfavorable aspects in the food environment, characterized by relatively higher fast food restaurants offer seem more detrimental to healthful eating habits that the presence of opportunities to buy healthful foods in food stores. Third, a residential food environment more favorable to healthful dietary patterns could reduce disparities in diet quality between women with low nutrition knowledge compared to women more knowledgeable. Conclusion: These results highlight the complex links between local environment and diet. If findings can be replicated in future research, population-based strategies to address an imbalance between accessibility to healthful food sources relative to unhealthful food sources, would be promising.

A la croisée de l’anthropologie de la maladie et de l’anthropologie de la santé, cette thèse explore la diversité des savoirs et des pratiques de soins dédiés à la prévention ainsi qu’au traitement des problèmes de santé considérés comme spécifiquement féminins en France rurale. L’ethnographie a été menée sur la presqu’île du Médoc, territoire où l’imaginaire lié à la nature fait naître des représentations sur la population entre fantasmes et stigmates, et où se pose régulièrement la question de la désertification médicale, à l’instar d’autres campagnes françaises. Dans ce contexte, des observations et des entretiens qualitatifs ont été réalisés auprès d’une soixantaine de femmes et d’une quarantaine d’acteurs du soin aux profils variés, afin de dessiner les contours et les dynamiques du pluralisme thérapeutique local consacré aux « maux de femmes ». Cette catégorie opératoire regroupe l’ensemble des malaises, mal-être et maladies, souvent sensibles et tabous, qui m’ont été confiés par mes interlocutrices. La thèse éclaire les diverses logiques de recours aux soins qu’elles développent au cours de ces itinéraires thérapeutiques particuliers, constitués de soins biomédicaux, spécialisés ou non dans le domaine de la « santé sexuelle et reproductive », de soins non conventionnels et de soins domestiques. La réflexion globale porte sur la complémentarité des soins façonnée par les usagères du pluralisme thérapeutique au fil de leurs quêtes de soins efficaces, en même temps qu’elle questionne les quêtes de soi suscitées chez les femmes selon que les soins normalisent ou non leurs conduites, les rendent ou non actrices de leur santé, ou qu’ils réifient ou réinventent les normes de genre. / This thesis in medical anthropology explores the diversity of knowledge and care practices dedicated to prevention and treatment of health problems considered as specifically feminine in rural France. The ethnography was conducted in the Medoc peninsula, an area where nature related imaginary leads to representations between fantasy and stigmas from the local population. It is also an area discussed for its medical desertification alike other French rural areas. In this context, observations and qualitative interviews were conducted with about sixty women and forty care actors with various profiles in order to understand and present the contours and dynamics of local therapeutic pluralism dedicated to “women health issues”. This operational category stands for all illness, sickness and diseases, often sensitive, taboo and revealed to me in confidence. This thesis enlightens women’s diverse uses of healthcare in their singular therapeutic itineraries, made of biomedical care, specialized or not in the sexual and reproductive health sector, of non-conventional or alternative medicines and of domestic cares. The overall reflection addresses the complementarity of treatments developed by users of therapeutic pluralism in their quest for health, and questions women’s personal quest according to the way treatments normalize or not their practices, make them actor of their own health or not, or re-invent or re-conduct gender norms.

<p>Dijabetes melitus je metaboliĉki poremećaj koji karakteri&scaron;e hroniĉna hiperglikemija i predstavlja veoma ozbiljan javno-zdravstveni problem u celom svetu. Najveći potencijal za pobolj&scaron;anje zdravlja obolelih leţi u postizanju i odrţavanju optimalne glikoregulacije. Podaci iz literature pokazuju da se sprovođenjem strukturiranih edukativnih programa o tipu 2 dijabetesa postiţu pozitivni efekti na zdravstveno pona&scaron;anje i glikoregulaciju kod obolelih koji su pohađali edukaciju. Cilj ovog istraţivanja bio je da se proceni efekat strukturirane edukacije o tipu 2 dijabetesa u primarnoj zdravstvenoj za&scaron;titi na promenu nivoa znanja, zdravstveno pona&scaron;anje, antropometrijske i biohemijske parametre glikoregulacije pacijenata. Istraživanje je sprovedeno u vidu prospektivne studije od februara do avgusta 2018. godine u Savetovali&scaron;tu za dijabetes Doma zdravlja Subotica. Ispitivanje je obuhvatilo 91 pacijenta sa dijagnostikovanim tipom 2 dijabetesa. Ispitanici su pohađali strukturirani &scaron;estonedeljni grupni edukativni program, kreiran za potrebe ovog istraţivanja. U cilju procene efekata edukativnog programa, na poĉetku i ĉetiri meseca nakon edukacije, prikupljeni su podaci o: zdravstvenom pona&scaron;anju, nivou znanja o dijabetesu (Diabetes Knowledge Test), o aktivnostima samonege u prethodnih sedam dana (The Summary of Diabetes Self-Care Activities) i o aktivnostima samonege prethodnih osam nedelja (The Diabetes Self-Management Questionnaire), određeni su antropometrijski (telesna teţina, indeks telesne mase, obim struka i nivo arterijskog krvnog pritiska) i biohemijski parametri glikoregulacije (nivo &scaron;ećera u krvi na&scaron;te, dva sata nakon jela, nivo HbA1c) i lipidni status pacijenata. Na početku strukturirane edukacije 79% pacijenata imalo je nizak nivo znanja o dijabetesu, prosečna vrednost na DKT bila je 46,4%. Nivo samonege pacijenatna bio je nizak i prethodnih 7 dana (SDSCA 45,8%) i prethodnih 8 nedelja (DSMQ 6,75). Trećina (35%) pacijenata imala je prekomernu telesnu masu, a njih 45% bilo je gojazno (BMI 29,85&plusmn;5,47). Povi&scaron;ene vrednosti sistolnog krvnog pritiska imalo je 43%, a dijastolnog 54% pacijenata. Polovina (54,9%) pacijenata imala je idealnu glikoregulaciju (HbA1c 6,56&plusmn;0,96%). Trećina (35%) pacijenata imala je visokorizičan nivo holesterola, a 26% visokoriziĉan nivo triglicerida u krvi. Ispitivanja sprovedena ĉetiri meseca nakon strukturirane edukacije pokazuju značajno povi&scaron;en nivo znanja pacijenata o dijabetesu, tj. visok nivo sa prosečnom vredno&scaron;ću DKT 81,5%. Nivo aktivnosti samonege prethodnih 7 dana i prethodnih 8 nedelja dostigao je umeren nivo (SDSCA 57,7%; DSMQ 7,9). Utvrđeno je značajno smanjenje telesne mase pacijenata za 1,5 kg i indeksa telesne mase, BMI, za 0,58 kg/m2. Procenat gojaznih pacijenata smanjen je na 40%. Povi&scaron;ene vrednosti sistolnog krvnog pritiska imalo je 26,4% (uz proseĉno smanjenje od 4 mmHg), a dijastolnog krvnog pritiska kod 44% pacijenata (uz prosečno smanjenje od 3 mmHg). Utvrđeno je znaĉajno smanjenje nivoa HbA1c za 0,36%, idealnu glikoregulaciju postiglo je 68% pacijenata. Zabeleţeno je smanjenje nivoa ukupnog holesterola za 0,3 mmol/L i nivoa triglicerida u krvi pacijenata za 0,23 mmol/L. Broj pacijenata sa visokorizičnim nivoom holesterola smanjen je za 19,6%, a u visokoriziĉnoj kategoriji triglicerida za 12%. Rezultati studije ukazuju da su efekti strukturiranog edukativnog programa o tipu 2 dijabetesa u primarnoj zdravstvenoj za&scaron;titi značajni, povećani su nivoi znanja i aktivnosti samonege, znaĉajno je smanjena telesna masa, vrednosti arterijskog krvnog pritiska su smanjene a pobolj&scaron;ane su vrednosti pokazatelja glikoregulacije i lipidnog statusa pacijenata.</p> / <p>Diabetes Mellitus is a metabolic disorder characterised by chronic hyperglycaemia and is a very serious public health issue worldwide. Achieving and maintaining optimal glucoregulation represents major potential for the improvement of affected persons&rsquo; health. According to information available in relative literature, the implementation of restructured Type 2 diabetes education programmes, positive results on health behaviour and glucoregulation in persons who took part in the education. The objective of the research was to assess the effect of structured education on Type 2 diabetes in primary health care, on changes in the level of knowledge, health behaviour and the anthropometric and biochemical parameters of patients&rsquo; glucoregulation. The research was conducted in the form of a prospective study between February and August 2018 in the Diabetes Support Group of the Subotica Health Centre. The research included 91 patients who were diagnosed with Type 2 diabetes. Research subjects attended a structured six-week group educational programme, which was specifically developed for the purpose of this research. In order to assess the effects of this educational programme from its outset and four months following the education, data concerning the following were gathered: health behaviour, level of knowledge on diabetes (Diabetes Knowledge Test - DKT), self care activities in the past seven days (The Summary of Diabetes Self-Care Activities - SDSCA) and self care activities in the past eight weeks (The Diabetes Self-Management Questionnaire - DSMQ). These data were anthropomorphic measurements (weight, height, waist circumference and the level of arterial blood pressure) and biochemical glucoregulation parameters (blood sugar levels on an empty stomach, two hours after a meal, HbA1c levels) and patient lipid status. When the structured education first started, 79% patients had a low level of knowledge on diabetes, and the average score at the DKT was 46.4%. The level of patient self care was also low in the past seven days (SDSCA 45.8%) and past eight weeks (DSMQ 6.75%). One third (35%) of patients had excess body mass, of whom 45% were obese (Body Mass Index &ndash; BMI 29.85&plusmn;5.47). 43% of patients had higher systolic blood pressure values while 54% had higher diastolic blood pressure values. In one half of patients (54.9%), glucoregulation was ideal (HbA1c 6.56&plusmn;0.96%). One third of patients (35%) had highly elevated cholesterol levels, with 26% who had highly elevated triglyceride blood levels. Research conducted during the four-month structured education show a significantly higher level of patient knowledge of diabetes, i.e. high level with the average DKT score of 81.5%. The level of self care activities in the past seven days and eight weeks reached a moderate level (SDCA 57.7%; DSMQ 7.9). A significant reduction in body mass by 1.5 kg as well as Body Mass Index, BMI by 0.58 kg/m2 was determined. The percentage of obese patients was reduced to 40%. 26.4% of patients had increased values of systolic blood pressure (with an average reduction of 4 mmHg), diastolic blood pressure 44% of patients (with an average reduction of 3 mmHg). A significant reduction in HbA1c level by 36% was determined, while 68% of patients achieved ideal glucoregulation. The reduction of total cholesterol level by 0.3% mmol/L as well as triglycerides level by 0.23% mmol/L was recorded. The number of patients with a high-risk cholesterol level was reduced by 19.6%, and the number of patients in high-risk category of triglycerides by 12%. The results of the study indicate that the effects of a structured educational programme on Type 2 diabetes in primary health care are significant. Knowledge levels were increased along with self care activities, body mass was significantly reduced, arterial blood pressure values were reduced and glucoregulation and lipid status values improved.</p>

BackgroundThe prompt seeking of medical care after the onset of symptoms suggestive of acute coronary syndromes (ACS)/acute myocardial infarction (AMI) is associated with the receipt of coronary reperfusion therapy, and effective cardiac medications in patients with an ACS/AMI and is crucial to reducing mortality and the risk of serious clinical complications in these patients. Despite declines in important hospital complications and short-term death rates in patients hospitalized with an ACS/AMI, several patient groups remain at increased risk for these adverse outcomes, including women and the elderly. However, recent trends in age and sex differences in extent of pre-hospital delay, hospital management practices, and short-term outcomes associated with ACS/AMI remain unexplored. The objectives of this study were to examine the overall magnitude, and changing trends therein, of age and sex differences in duration of pre-hospital delay (1986-2005), hospital management practices (1999-2007), and short-terms outcomes (1975-2005) in patients hospitalized with ACS/AMI. MethodsData from 13,663 residents of the Worcester, MA, metropolitan area hospitalized at all greater Worcester medical centers for AMI 15 biennial periods between 1975 and 2005 (Worcester Heart Attack Study), and from 50,096 patients hospitalized with an ACS in 106 medical centers in 14 countries participating in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007 were used for this investigation. Results In comparison with men years, patients in other age-sex strata exhibited significantly longer pre-hospital delay, with the exception of women < 65 years; had a significantly lower odds of receiving aspirin, angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta blockers, statins, and undergoing coronary artery bypass graft surgery (CABG) surgery or percutaneous coronary intervention (PCI), and were significantly more likely to develop atrial fibrillation, cardiogenic shock, heart failure, and to die during hospitalization and in the first 30 days after admission. There was a significant interaction between age and sex in relation to the use of several medications and the development of several of these outcomes; in patients Conclusions Our results suggest that the elderly were more likely to experience longer prehospital delay, were less likely to be treated with evidence-based treatments during hospitalization for acute coronary syndrome, and were more likely to develop adverse outcomes compared to younger persons. Younger women were less likely to be treated with effective treatments and were more likely to develop adverse outcomes compared with younger men while there was no sex difference in these outcomes. Interventions targeted at older patients, in particular, are needed to encourage these high-risk patients to seek medical care promptly to maximize the benefits of currently available treatment modalities. More targeted treatment approaches during hospitalization for ACS/AMI for younger women and older patients are needed to improve their hospital prognosis.