Made available in DSpace on 2015-07-22T20:50:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-30 / Introducao: O envelhecimento bem sucedido e considerado o novo paradigma da gerontologia. A aptidao funcional e imprescindivel ao modelo de envelhecimento bem sucedido. Objetivo: Investigar as condicoes socioeconomicas e de saude e a relacao entre a aptidao funcional pelo American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) e o envelhecimento bem sucedido em idosas inscritas no Programa Saude da Familia, em Maceio, entre 2008 e 2009. Metodo: O estudo aconteceu em Unidades Basicas de Saude com o Programa Saude da Familia, entre julho de 2008 e fevereiro de 2009. A populacao foi constituida por uma amostra aleatoria de mulheres com idades entre 60 ate 79 anos, inscritas no Programa Saude da Familia de Maceio. As variaveis estudadas foram: socioeconomicas, percepcao da saude, flexibilidade, agilidade e equilibrio dinamico e coordenacao (AAHPERD); morbidades autorreferidas, estado nutricional (indice de massa corporal e circunferencia da cintura); depressao (escala de depressao geriatrica .GDS- com 30 itens); nivel de aptidao fisica (International Physical Activity Questionnaire - IPAQ) e capacidade funcional (escala de Lawton). O tratamento de dados deu-se por estatistica descritiva, teste Qui-Quadrado, teste Exato de Fisher, teste t nao pareado de Student, coeficiente de correlacao gr h de Pearson, sendo considerados com nivel de significancia os valores de p<0,05. Resultados: Foram estudadas 268 idosas, com media de 66,68 anos de idade (DP+/-5,77). Houve maior proporcao de idosas na faixa de 60-69 anos (70,5%). Das comorbidades, a hipertensao arterial foi a mais prevalente (84,0%), seguida por artrite/reumatismo/artrose (56,7%) e diabetes mellitus (31,3%). Tinham sintomas de depressao leve ou moderada (escala de depressao geriatrica.11) 41,0%, foram classificadas com dependencia funcional 12,7% e foram consideradas sedentarias ou insuficientemente ativas 50,7% das idosas. Nos testes da AAHPERD tiveram avaliacao boa/muito boa em relacao a flexibilidade 76,1% da amostra, agilidade e equilibrio dinamico 34,7% e coordenacao 6,0%. Registrou-se 30,6% da amostra com aptidao funcional boa/muito boa. A aptidao funcional correlacionou-se com idade, anos de estudo, capacidade funcional e nivel de atividade fisica. Foram consideradas com envelhecimento bem sucedido 16,4% das idosas. A associacao entre ter envelhecimento bem sucedido e ausencia de hipertensao, diabetes, doencas do coracao e artrite/reumatismo/artrose foi significante. Conclusao: As idosas estudadas possuiam baixa escolaridade, baixa renda, com percepcao de saude regular a ruim. Houve elevado numero de morbidades autorreferidas, sendo a hipertensao arterial, artrite/reumatismo/artrose e diabetes mellitus as mais frequentes. Os componentes da aptidao funcional estudados correlacionaram-se com idade, escolaridade, capacidade funcional e nivel de atividade fisica e podem servir como parametro de avaliacao e seguimento na promocao do envelhecimento bem sucedido. / Introduction: The successful aging is considered the new gerontology paradigm. The functional fitness is imperative to the successful aging. Objective: investigate the socioeconomic and health conditions and the relation between the functional fitness by American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) and successful aging in elderly female registered in the Family Health Program of Maceio, from 2008 to 2009. Method: The study took place in Primary Care Settings with Family Health Program, from July, 2008 to February, 2009. The population was a random sample of women from 60 until 79 years-old, registered in the Family Health Program of Maceio. The variables studied were: socioeconomic and health perception conditions, flexibility, agility and balance, coordination (AAHPERD), self-referred morbidities, nutritional status (body mass index and waist circumference); depression (geriatric depression scale-30); international physical activity questionnaire (IPAQ) and functional capacity (Lawton scale). The data were analyzed by descriptive statistics, qui-Square test, Fisher fs exact test, non-pared t-test, correlation coefficient of Pearson, being considered of significant level the values of p<0.05. Results: 268 elderly women were analyzed with a mean of 66.68 years (DP+/-5.77). There were a higher proportion of women from 60 to 69 years (70.5%). Hypertension was more prevalent (84%), followed by arthritis/rheumatism/artrosis (56.7%) and diabetes (31.3%). Of the women, 41% have mild to moderate depression (Geriatric Depression Scale.11), 12.7% were classified with functional dependency and 50.7% were considered as sedentary or insufficiently actives. In the AAHPERD tests, 76.1% had good/very good evaluation related to flexibility, 34.7% for agility and dynamic balance and 6% for coordination. Of the sample, 30.6% were shown with good/very good functional fitness. This functional fitness was correlated to age, years of education, functional capacity and physical activity. 16.4% of the sample was considered for the successful aging model. The association among successful aging and lack of hypertension, diabetes, heart diseases and arthritis/rheumatism/artrosis were significant. Conclusion: The evaluated elderly female had low educational level, low income and had a regular to bad perception of health. There was a high level of self-referred morbidities, being the hypertension, arthritis/rheumatism/artrosis and diabetes as more frequent. The functional fitness measured by AAHPERD were related to age, educational level, functional capacity and level of physical activity and may work as a evaluation parameter and follow-up for successful aging. / TEDE / BV UNIFESP: Teses e dissertações

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Made available in DSpace on 2014-07-29T15:23:41Z (GMT). No. of bitstreams: 1 Dissertacao Ana Paula dos Santos Rodrigues.pdf: 2331692 bytes, checksum: a04c9bd6d87780a5ad1d63e1d023287c (MD5) Previous issue date: 2011-03-31 / Objective: To evaluate the profile of patients with severe obesity and effectiveness of a treatment protocol developed for nutritional care of these patients in referral hospital in Goiânia-GO. Methods: Data were collected from 79 patients treated between October 2007 and October 2009. Were excluded 26 patients in the nutritional intervention, the other 53 obese grade II and III were divided into intervention group A (IA) (n = 26), without use of anti-obesity drug, and intervention group B (IB) (n = 27), using anti-obesity drup, and followed by nine consultations. Results: Average body mass index was 48,3 ± 6,9 kg/m2. Prevailed women (91,1%), age group of 30 to 49 years (60,7%), 49.3% studied over nine years, over 75,0% had family income lower than one minimum wage. Most prevalent comorbidities were hypertension (58,2%) and dyslipidemias (55,7%), 70,9% were sedentary, 50.0% had binge eating disorder (BED). We found a low consumption of dairy products, fruits and vegetable B and high consumption of sugar and soft drinks. Age and hypertension were associated with higher education (&#8805; 9 years). Family income per capita (3rd and 4th quartiles) was associated with the onset of weight gain, daily consumption of vegetable A and daily consumption of sweets, while prior use of anti-obesity drugs was associated with low family incomes (1st and 2nd quartiles). The nutritional intervention resulted in significant reduction in weight and BMI for both groups. Comparing the average weight for each consultation, IA values were lower than IB in the last three visits. There was a qualitative improvement in food consumption. IB group showed adherence to physical activity. Conclusions: It was noted worrying and inadequate health and nutritional conditions and inadequate, with income and education associated with some of these conditions in severe obesity. The nutritional treatment protocol was effective in reducing weight and BMI, promoted improvement in the dietary pattern of patients and improved practice of physical activity for IB. / Objetivo: Avaliar o perfil de pacientes obesos graves e a efetividade de um protocolo de tratamento nutricional desenvolvido para atendimento destes pacientes em Hospital de referência de Goiânia-GO. Métodos: Foram coletados dados de 79 pacientes atendidos no período de outubro de 2007 a outubro de 2009. Na intervenção nutricional foram excluídos 26 pacientes, os outros 53 obesos graus II e III foram divididos em grupo intervenção A (IA) (n=26), sem uso de medicamentos anti-obesidade e grupo intervenção B (IB) (n=27), em uso de medicamentos anti-obesidade, com seguimento por nove consultas. Resultados: Índice de Massa Corporal médio foi de 48,3±6,9 kg/m2. Predominaram mulheres (91,1%), faixa etária 30-49 anos (60,7%), 49,3% estudou mais de 9 anos, mais de 75,0% com renda familiar per capita menor que 1 salário. Comorbidades mais prevalentes foram hipertensão arterial (58,2%) e dislipidemias (55,7%), 70,9% eram sedentários, 50,0% apresentaram compulsão alimentar periódica (CAP). Observou-se baixo consumo de leite e derivados, frutas e vegetal B e alto consumo de açúcar e refrigerantes. Idade e hipertensão arterial associaram-se à maior escolaridade (&#8805; 9 anos). Renda familiar per capita (3° e 4° quartis) associou-se ao início do ganho de peso, consumo diário de vegetal A e consumo diário de doces, enquanto menor renda (1° e 2° quartis) associou-se a uso anterior de medicamentos anti-obesidade. Quanto à intervenção nutricional, houve redução significativa do peso e IMC para ambos os grupos. Na comparação da média de peso a cada consulta IA apresentou valores menores que IB nas últimas três consultas. Houve melhora qualitativa no consumo alimentar. O grupo IB apresentou adesão à prática de atividade física. Conclusões: Notaram-se condições de saúde e nutrição inadequadas e preocupantes, sendo a renda e a escolaridade associadas a algumas dessas condições em obesos graves. O protocolo de tratamento nutricional foi efetivo na redução de peso e IMC, promoveu melhora no padrão de consumo alimentar dos pacientes e na prática de atividade física para IB.

PROBLÉMATIQUE La violence collective, à travers les guerres civiles et autres conflits politiques violents, constitue un lourd fardeau pour la santé publique. Plus de la moitié des décès causés par l’ensemble des conflits dans le monde entier se trouvent en Afrique. L’une des conséquences est le déplacement massif des populations qui se réfugient vers l’extérieur du pays, mais aussi de plus en plus à l’intérieur des frontières nationales. Ceux qui ne traversent pas sont appelés déplacés internes. Leur état de santé est au moins aussi vulnérable que celui de réfugiés, mais est très peu documenté. De 1993 à 2005, le Burundi a plongé dans une crise politico-sociale sans précédent. En 2001, environ 10 % de la population vivaient dans des camps de déplacés. OBJECTIF Documenter l’état de santé des personnes déplacées par la guerre au Burundi et identifier ses déterminants. CADRE CONCEPTUEL Le cadre conceptuel est basé sur la modélisation de l’association entre les événements traumatiques, les facteurs de l’environnement post-traumatique et l’état de santé des déplacés internes burundais. MÉTHODE Une enquête transversale a été menée dans deux camps de déplacés au Burundi. Les données ont été obtenues de façon rétrospective sur l’exposition aux événements traumatiques et de manière transversale pour l’état de santé et les facteurs de l’environnement post-traumatique. Les participants ont été interrogés sur les événements traumatiques vécus personnellement ou par leurs proches selon une courte échelle élaborée à cet effet. De même, les facteurs de l’environnement post-traumatique ont été documentés. Pour la mesure de l’état de santé, un questionnaire comportant certains des 17 items du profil de santé de Duke a été utilisé. Deux traductions ont été réalisées et plusieurs items ont été adaptés. RÉSULTATS Les événements traumatiques vécus par les déplacés internes burundais sont négativement associés à l’état de santé physique, à l’état de santé sociale, à l’état de santé perçu et, positivement, avec l’incapacité. De même, plusieurs facteurs de l’environnement post-traumatique sont associés à l’état de santé. Par contre, certaines associations sont à interpréter selon leurs interactions avec les événements traumatiques. Celles-ci agissent parfois comme modificateurs d’effet, en amortissant ou en amplifiant le lien associatif initial entre certains événements traumatiques et l’état de santé des déplacés. CONCLUSION : Les résultats font ressortir un effet différentiel associé d’une part aux événements traumatiques vécus précédemment et d’autre part, en interaction avec ces derniers, à l’environnement post-traumatique. Notre thèse en arrive à la conclusion que les facteurs de l’environnement post-traumatique constituent des déterminants importants de l’état de santé des déplacés de guerre. / INTRODUCTION Collective violence in the form of civil war and other violent political conflict places a heavy burden on public health. More than half of all deaths caused by conflicts around the globe occur in Africa. One of the consequences of such conflict is the massive displacement of populations seeking refuge either outside their country or, increasingly, within their country’s borders. Those who remain within their country are called internally displaced persons. Although little documented, the health of these people is every bit as vulnerable as that of refugees. From 1993 to 2005, Burundi was plunged into a socio-political crisis of unprecedented proportions. In 2001, approximately 10% of the population was living in displaced person camps. OBJECTIVE To document the health status of persons displaced by the war in Burundi and identify its determinants. CONCEPTUAL FRAMEWORK The conceptual framework is based on a modelling of the association between traumatic events, factors in the post-trauma environment and the health status of internally displaced Burundians. METHOD This cross-sectional study was carried out in two displaced persons camps in Burundi. It uses retrospective data on exposure to traumatic events and cross-sectional data on health status and factors in the post-trauma environment. Using a short scale especially designed for this study, the participants answered questions about the traumatic events that they or those close to them had experienced. Factors in the post-trauma environment were also documented. To measure health status, a questionnaire containing some of the 17 items of the Duke Health Profile was used. Two translations were made, and several of the items were adapted to the particular context. RESULTS The traumatic events experienced by displaced persons in Burundi are negatively associated with physical health, social health and perceived health, and positively associated with disability. A number of factors in the post-trauma environment were also associated with health status. However, some of these associations are difficult to interpret because of their interactions with traumatic events. These interactions sometimes act as effect modifiers by diminishing or amplifying the initial association between certain traumatic events and the health status of displaced persons. CONCLUSION The results reveal a differential response associated with, on the one hand, previously experienced traumatic events and, on the other hand, the post-trauma environment in interaction with these traumatic events. This thesis concludes that factors in the post-trauma environment constitute important determinants of the health of persons displaced by war.

PROBLÉMATIQUE La violence collective, à travers les guerres civiles et autres conflits politiques violents, constitue un lourd fardeau pour la santé publique. Plus de la moitié des décès causés par l’ensemble des conflits dans le monde entier se trouvent en Afrique. L’une des conséquences est le déplacement massif des populations qui se réfugient vers l’extérieur du pays, mais aussi de plus en plus à l’intérieur des frontières nationales. Ceux qui ne traversent pas sont appelés déplacés internes. Leur état de santé est au moins aussi vulnérable que celui de réfugiés, mais est très peu documenté. De 1993 à 2005, le Burundi a plongé dans une crise politico-sociale sans précédent. En 2001, environ 10 % de la population vivaient dans des camps de déplacés. OBJECTIF Documenter l’état de santé des personnes déplacées par la guerre au Burundi et identifier ses déterminants. CADRE CONCEPTUEL Le cadre conceptuel est basé sur la modélisation de l’association entre les événements traumatiques, les facteurs de l’environnement post-traumatique et l’état de santé des déplacés internes burundais. MÉTHODE Une enquête transversale a été menée dans deux camps de déplacés au Burundi. Les données ont été obtenues de façon rétrospective sur l’exposition aux événements traumatiques et de manière transversale pour l’état de santé et les facteurs de l’environnement post-traumatique. Les participants ont été interrogés sur les événements traumatiques vécus personnellement ou par leurs proches selon une courte échelle élaborée à cet effet. De même, les facteurs de l’environnement post-traumatique ont été documentés. Pour la mesure de l’état de santé, un questionnaire comportant certains des 17 items du profil de santé de Duke a été utilisé. Deux traductions ont été réalisées et plusieurs items ont été adaptés. RÉSULTATS Les événements traumatiques vécus par les déplacés internes burundais sont négativement associés à l’état de santé physique, à l’état de santé sociale, à l’état de santé perçu et, positivement, avec l’incapacité. De même, plusieurs facteurs de l’environnement post-traumatique sont associés à l’état de santé. Par contre, certaines associations sont à interpréter selon leurs interactions avec les événements traumatiques. Celles-ci agissent parfois comme modificateurs d’effet, en amortissant ou en amplifiant le lien associatif initial entre certains événements traumatiques et l’état de santé des déplacés. CONCLUSION : Les résultats font ressortir un effet différentiel associé d’une part aux événements traumatiques vécus précédemment et d’autre part, en interaction avec ces derniers, à l’environnement post-traumatique. Notre thèse en arrive à la conclusion que les facteurs de l’environnement post-traumatique constituent des déterminants importants de l’état de santé des déplacés de guerre. / INTRODUCTION Collective violence in the form of civil war and other violent political conflict places a heavy burden on public health. More than half of all deaths caused by conflicts around the globe occur in Africa. One of the consequences of such conflict is the massive displacement of populations seeking refuge either outside their country or, increasingly, within their country’s borders. Those who remain within their country are called internally displaced persons. Although little documented, the health of these people is every bit as vulnerable as that of refugees. From 1993 to 2005, Burundi was plunged into a socio-political crisis of unprecedented proportions. In 2001, approximately 10% of the population was living in displaced person camps. OBJECTIVE To document the health status of persons displaced by the war in Burundi and identify its determinants. CONCEPTUAL FRAMEWORK The conceptual framework is based on a modelling of the association between traumatic events, factors in the post-trauma environment and the health status of internally displaced Burundians. METHOD This cross-sectional study was carried out in two displaced persons camps in Burundi. It uses retrospective data on exposure to traumatic events and cross-sectional data on health status and factors in the post-trauma environment. Using a short scale especially designed for this study, the participants answered questions about the traumatic events that they or those close to them had experienced. Factors in the post-trauma environment were also documented. To measure health status, a questionnaire containing some of the 17 items of the Duke Health Profile was used. Two translations were made, and several of the items were adapted to the particular context. RESULTS The traumatic events experienced by displaced persons in Burundi are negatively associated with physical health, social health and perceived health, and positively associated with disability. A number of factors in the post-trauma environment were also associated with health status. However, some of these associations are difficult to interpret because of their interactions with traumatic events. These interactions sometimes act as effect modifiers by diminishing or amplifying the initial association between certain traumatic events and the health status of displaced persons. CONCLUSION The results reveal a differential response associated with, on the one hand, previously experienced traumatic events and, on the other hand, the post-trauma environment in interaction with these traumatic events. This thesis concludes that factors in the post-trauma environment constitute important determinants of the health of persons displaced by war.