The motivation for subjective well-being research rather than Gross Domestic Product (GDP) is becoming important to the roles of many governments across the globe and so identifying the strongest correlates of subjective well-being is vital as a starting point to informing policies that support subjective well-being. This thesis investigated the correlates of subjective well-being. Chapter 1 introduced the topic and has been divided into two parts: section 1 explores the motivation for subjective well-being research and section 2 presents the conceptual model of subjective well-being. Chapter 2 gave the rationale for the methodological approaches taken to investigate factors that are associated with subjective well-being. Also, the methods chapter presented limitations of the data used. Chapter 3 explored the determinants of subjective well-being in representative samples of nations; and the results obtained in chapter 3 led to three systematic reviews and meta-analyses (Chapter 4, 5 and 6). Chapter 4 conducted a systematic review and meta-analysis of the association between income inequality and subjective well-being to test the general assumption that people's subjective well-being can be increased by tackling income inequality and investigated inconsistencies of previous studies reporting a negative, positive or no association between income inequality and subjective well-being. Chapter 5 carried out a systematic review and meta-analysis of the association between health status and subjective well-being because the results of the empirical study conducted in chapter 3 suggest that health status is positively associated with subjective well-being. Chapter 6 conducted a systematic review and meta-analysis of the association between financial satisfaction and subjective well-being as the results of the empirical study conducted in chapter 3 suggest that financial satisfaction is positively associated with subjective well-being. Chapter 7 discussed the results, highlighted the need for further studies and policy directions and concluded. Taken altogether these studies suggest that: (1) subjective well-being is important to informing policies that support subjective well-being, (2) they might be circumstances where income inequality may not be associated with people's subjective well-being, (3) health status and financial satisfaction are positively associated with subjective well-being and the magnitude of the association is affected by key operational and methodological factors, (4) life satisfaction might be preferred to happiness as a measure of subjective well-being because it may better captures the influence of health status and financial satisfaction, (5) government policies that support subjective well-being measures should consider using self-reported health status and financial satisfaction amongst factors that are correlated with people's subjective well-being, (6) the association between health status and subjective well-being and the link between financial satisfaction and subjective well-being are medium and further research is required to identify other strongest correlates of subjective well-being.

Submitted by LIANA SOUSA COELHO null (lianascoelho@gmail.com) on 2016-03-04T12:42:34Z No. of bitstreams: 1 Liana S Coelho Tese doutorado.pdf: 4949880 bytes, checksum: 8a00b19396b78d2b3710b90868709838 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-03-04T17:42:42Z (GMT) No. of bitstreams: 1 coelho_ls_dr_bot.pdf: 4949880 bytes, checksum: 8a00b19396b78d2b3710b90868709838 (MD5) / Made available in DSpace on 2016-03-04T17:42:42Z (GMT). No. of bitstreams: 1 coelho_ls_dr_bot.pdf: 4949880 bytes, checksum: 8a00b19396b78d2b3710b90868709838 (MD5) Previous issue date: 2016-02-26 / A associação entre Doença Pulmonar Obstrutiva Crônica (DPOC) e Doença Arterial Coronariana (DAC) é importante causa de morbidade e mortalidade em pacientes com DPOC. Dados da literatura mostram que essa associação ocorre independente de fatores de risco comuns – tabagismo, idade e gênero e que o processo inflamatório pode ser o elo entre essas doenças. Além disso, a presença de comorbidades pode alterar de forma significativa a gravidade da DPOC e/ou DAC. O presente estudo tem como objetivos avaliar a prevalência da associação entre DPOC e DAC em pacientes com diagnóstico primário de uma das doenças e avaliar as características gerais dos pacientes com DPOC, DAC e ambas as doenças. Além disso, avaliar intensidade da dispneia, tolerância ao exercício, qualidade de vida, estado inflamatório e achados ecocardiográficos em cada grupo de pacientes. Foram avaliados 95 pacientes, de ambos os gêneros e idade ≥ 40 anos. Destes, 43 foram diagnosticados com DPOC, 47 com DAC e 5 com ambas as doenças. Todos foram submetidos a avaliação clínica, eletrocardiograma, ecocardiograma, radiograma de tórax, avaliação da composição corporal, teste de caminhada de 6 minutos (DP6), exames laboratoriais, espirometria e responderam aos questionários de qualidade de vida. A prevalência de DAC em DPOC foi de 10,4%, enquanto que no grupo de pacientes com DAC a prevalência de DPOC foi de 9,6% e, quando avaliados DAC tabagistas, foi de 17,2%. O grupo DPOC apresentou maior percepção de dispneia (p<0,001), menor DP6 (p=0,037), pior qualidade de vida, avaliada pelo SF-36 (p<0,001) e aumento da proteína C-reativa (PCR) (p=0,020) em comparação com grupo DAC. Regressão linear não identificou correlação entre o estado inflamatório avaliada por PCR e IL-6 à presença de DAC (p=0,992 e p=0,978, respectivamente). Em nosso estudo, a prevalência de DAC em DPOC assemelhou-se aos menores valores encontrados na literatura. Pacientes com ambas as doenças apresentaram maior intensidade de dispneia, pior qualidade de vida e maior estado inflamatório que os outros grupos. Não encontramos relação entre o estado inflamatório e a prevalência de DAC em DPOC; esta associação parece dever-se à alta prevalência dos fatores de risco clássicos para DAC nos pacientes com DPOC. / The association between Chronic Obstructive Pulmonary Disease (COPD) and coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with COPD. Published data show that this association is independent of common risk factors - smoking, age and gender, and that the inflammatory process may be a link between these diseases. Furthermore, the comorbidities can significantly alter the severity of COPD and/or CAD. This study aims to evaluate the prevalence of the association between COPD and CAD in patients with a primary diagnosis of a disease and assessing the general characteristics of patients with COPD, CAD and both diseases. Also, to assess the severity of dyspnea, exercise tolerance, health status, inflammatory status, echocardiographic findings in each group of patients. We evaluated 95 patients of both genders and age ≥ 40 years-old. Of these, 43 were diagnosed with COPD, 47 with CAD and 5 with both diseases. All patients underwent clinical evaluation, electrocardiogram, echocardiogram, chest X-ray, assessment of body composition, 6-minute walk test, laboratory tests, spirometry and answered all health status’ questionnaires. The prevalence of CAD in COPD was 10.4% while in patients with CAD, the prevalence of COPD was 9.6%, and in DAC with smoking history, the prevalence was 17.2%. The COPD group had a higher perception of dyspnea (p<0.001), lower 6-minute walking distance (6MWD) (p=0.037), worse health status assessed by the SF-36 (p<0.001) and increased C-reactive protein (CRP) (p=0.020) compared to CAD group. Linear regression did not identify correlation between inflammatory status, assessed neither by CRP nor by IL-6, and the presence of CAD (p 0.992 and p 0.978, respectively). In our study, the prevalence of CAD in COPD resembles the lower values found in the literature. Patients with both diseases presented more intense dyspnea, lower exercise tolerance, worse health status and higher inflammatory status than other groups. There was no relationship between inflammatory status and the prevalence of CAD in COPD; this association is probably due to the high prevalence of classic risk factors for CAD in patients with COPD.

Orientador: Irma de Godoy / Resumo: A associação entre Doença Pulmonar Obstrutiva Crônica (DPOC) e Doença Arterial Coronariana (DAC) é importante causa de morbidade e mortalidade em pacientes com DPOC. Dados da literatura mostram que essa associação ocorre independente de fatores de risco comuns – tabagismo, idade e gênero e que o processo inflamatório pode ser o elo entre essas doenças. Além disso, a presença de comorbidades pode alterar de forma significativa a gravidade da DPOC e/ou DAC. O presente estudo tem como objetivos avaliar a prevalência da associação entre DPOC e DAC em pacientes com diagnóstico primário de uma das doenças e avaliar as características gerais dos pacientes com DPOC, DAC e ambas as doenças. Além disso, avaliar intensidade da dispneia, tolerância ao exercício, qualidade de vida, estado inflamatório e achados ecocardiográficos em cada grupo de pacientes. Foram avaliados 95 pacientes, de ambos os gêneros e idade ≥ 40 anos. Destes, 43 foram diagnosticados com DPOC, 47 com DAC e 5 com ambas as doenças. Todos foram submetidos a avaliação clínica, eletrocardiograma, ecocardiograma, radiograma de tórax, avaliação da composição corporal, teste de caminhada de 6 minutos (DP6), exames laboratoriais, espirometria e responderam aos questionários de qualidade de vida. A prevalência de DAC em DPOC foi de 10,4%, enquanto que no grupo de pacientes com DAC a prevalência de DPOC foi de 9,6% e, quando avaliados DAC tabagistas, foi de 17,2%. O grupo DPOC apresentou maior percepção de dispneia (p<0,001), m... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The association between Chronic Obstructive Pulmonary Disease (COPD) and coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with COPD. Published data show that this association is independent of common risk factors - smoking, age and gender, and that the inflammatory process may be a link between these diseases. Furthermore, the comorbidities can significantly alter the severity of COPD and/or CAD. This study aims to evaluate the prevalence of the association between COPD and CAD in patients with a primary diagnosis of a disease and assessing the general characteristics of patients with COPD, CAD and both diseases. Also, to assess the severity of dyspnea, exercise tolerance, health status, inflammatory status, echocardiographic findings in each group of patients. We evaluated 95 patients of both genders and age ≥ 40 years-old. Of these, 43 were diagnosed with COPD, 47 with CAD and 5 with both diseases. All patients underwent clinical evaluation, electrocardiogram, echocardiogram, chest X-ray, assessment of body composition, 6-minute walk test, laboratory tests, spirometry and answered all health status’ questionnaires. The prevalence of CAD in COPD was 10.4% while in patients with CAD, the prevalence of COPD was 9.6%, and in DAC with smoking history, the prevalence was 17.2%. The COPD group had a higher perception of dyspnea (p<0.001), lower 6-minute walking distance (6MWD) (p=0.037), worse health status assessed by the SF-36 (p<0.001) ... (Complete abstract click electronic access below) / Doutor

O Ministério da Saúde preconiza que o cuidado pré-natal deva ser realizado de forma regular e completa, com o número mínimo de seis consultas. Considerando esse aspecto, a análise da distribuição de indicador de cobertura pré-natal, segundo áreas geográficas, é um instrumento valioso na pesquisa em saúde materno-infantil por contribuir para o entendimento dos processos envolvidos na determinação das condições de saúde da mulher e do recém-nascido. O objetivo do estudo foi analisar a distribuição espacial da cobertura pré-natal em relação as características maternas em São Luís/MA. Trata-se de uma pesquisa do tipo ecológico realizada em São Luís/MA com uma amostra aleatória de 2.019 mulheres. A coleta de dados de nascimentos, ocorridos em 2012, foi no período de julho a outubro de 2013, na Secretaria Municipal de Saúde de São Luís, por meio do Sistema de Informação de Nascidos Vivos. Os endereços da amostra foram corrigidos com a utilização do Google Earth, versão 7.1.2.2041, e a busca das coordenadas latitude e longitude pelo site http://batchgeo.com/ para serem georreferenciadas pelo programa TerraView, versão 4.2.2. As coordenadas geográficas do município foram obtidas pela projeção lat/long e datum WGS-84 e foram convertidas para SIRGAS 2000/UTM. Foram obtidos padrões de densidade espaciais por meio de análise estatística espacial, segundo a técnica de alisamento de Kernel e elaboração dos mapas no ArcGis, versão 10.1. Os resultados demonstraram que a maioria das mães estava na fase adulta (85,29%), 96,53% tinham mais de 9 anos de estudo, 65,77% possuíam companheiro, 80,14% não tiveram filhos mortos, 51,42% eram primíparas, 97,67% com gravidez única, 56,76% realizaram parto cesáreo e 67,27% foram a termo. Quanto às consultas prénatais, 13,72% realizaram o número de consultas insuficientes, 38,24% foram regulares e 48,04%, suficientes. Observou-se uma associação estatisticamente significativa. Observou-se uma associação estatisticamente significativa entre idade materna (p<0,0000), anos de estudo (p<0,0000), paridade (p<0,0000), idade gestacional (p<0,0000) e tipo de parto com a cobertura pré-natal (p<0,0000), como também situação conjugal (p=0,0007) e nascidos mortos (p=0,0319). Quanto à condição da cobertura pré-natal por Distritos Sanitários, observou-se que as consultas pré-natais suficientes foram em maior porcentagem nos Distritos Cohab (56,9%), Vila Esperança (54,5%) e Bequimão (51,6%); as consultas pré-natais regulares foram mais expressivas nos Distritos Centro (51,3%) e Itaqui- Bacanga (42,4%); e as consultas insuficientes variaram entre 11,5% e 17,6% em todos os Distritos. Os resultados evidenciam uma forte concentração da cobertura pré-natal suficiente nos distritos Tirirical e Cohab, demostrando a necessidade de vigilância contínua nos outros distritos que apresentaram concentração da cobertura regular a insuficiente / The Ministry of Health recommends that prenatal care should be performed regularly and completely, with the minimum number of six visits. Considering this aspect, the analysis of the distribution of indicator prenatal coverage, according to geographical areas, is a valuable tool for research in maternal and child health by contributing to the understanding of the processes involved in determining the health of women and newborns. The objective of the study was to analyze the spatial distribution of antenatal coverage compared maternal characteristics in São Luís/MA. This is a research of the ecological type carried out in São Luís/MA with a random sample of 2,019. The data collection of births occurred in 2012, was the period from July to October 2013, the Municipal Health Secretary of São Luís, throught the Live Birth Information System. The sample`s addresses were corrected with the use of Google Earth, version 7.1.2.2041, and the pursuit of latitude and longitude coordinates for http://batchgeo.com/ site to be georeferenced by terraView, version 4.2.2 program. The geographic coordinates of the city were obtained by projecting lat/long and datum WGS-84 and were converted to SIRGAS 2000/UTM. Patterns of spatial density using spatial statistical analysis were obtained using the technique of kernel smoothing and preparation of maps in ArcGIS, version 10.1. The results showed that most mothers were in adulthood (85,29%), 96,53% had more than 9 years of education, 65,77% had a partner, 80,14% had children dead, 51,42 % were primiparous, 97,67% with single pregnancy, 56,76% underwent cesarean delivery and 67,27% were full-term. As for antenatal visits, 13,72% had insufficient number of queries, 38,24% were regular and 48,04% were sufficient. There was a significant association of maternal age (p<0,0000), years of education (p<0,0000), parity (p<0,0000), gestational age (p<0,0000) and mode of delivery with prenatal coverage (p <0.0000), as well as marital status (p=0,0007) and stillbirths (p=0,0319). As the condition of prenatal coverage by health districts, it was observed that sufficient prenatal visits were done in the Districts Cohab with the highest percentage (56,9%), Vila Esperança (54,5%) and Bequimão (51,6 %); regular antenatal visits were more expressive in Center Districts (51,3%) and Itaqui-Bacanga (42,4%); and insufficient consultations ranged between 11,5% and 1,.6% in all Districts. The results show a strong concentration of sufficient prenatal coverage in Tirirical and Cohab districts, demonstrating the need for continued vigilance in other districts who presented concentration of regular coverage until insufficient

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-07-15T18:28:24Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Edson - Finalizada - 29.01.16 - Imprimir capa dura.pdf: 2261811 bytes, checksum: 5635ed9118d8dd3a6e3535878c994b1a (MD5) / Made available in DSpace on 2016-07-15T18:28:24Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Edson - Finalizada - 29.01.16 - Imprimir capa dura.pdf: 2261811 bytes, checksum: 5635ed9118d8dd3a6e3535878c994b1a (MD5) Previous issue date: 2016-02-26 / Objetivo: avaliar os fatores associados que interferem na prática da atividade física em idosos longevos assistidos na atenção básica de saúde. Método: trata-se de um estudo analítico, quantitativo e de corte transversal. A amostra foi constituída por 98 idosos de 80 anos ou mais comunitários assistidos pela Estratégia de Saúde da Família da cidade de Recife-PE. O registro das informações efetuou-se utilizando um roteiro de entrevista estruturado com questões fechadas e organizadas em blocos, incluindo: identificação do participante, dados sociodemográficos, condições de saúde, e escalas que avaliaram comprometimento cognitivo (MEEM), sintomatologia depressiva (GDS), risco nutricional (MAN), e nível de atividade física (IPAQ). Foi realizada análise dos dados utilizando técnicas de estatística descritiva e inferencial. As técnicas de estatística descritiva envolveram a obtenção de distribuições absolutas bivariadas. Para estatística inferencial bivariada foi utilizado o teste Qui-Quadrado de Pearson. Na análise multivariada foi gerada uma árvore de decisão utilizando o algoritmo “Exhaustive CHAID” que se baseia em testes de associação Qui-quadrado sucessivos a partir de uma lista de possíveis desfechos, reduzindo uma decisão complexa a um número finito de elementos simples com relação a variável dependente. Resultados: predominância de idosos com idade entre 80 e 85 anos (53,1%); sexo feminino (77,6%); viúvos (63,3%); com escolaridade de 1 a 4 anos de estudo (45,9%); com renda de 1 a 2 salários mínimos (76,5%); aposentados (72,4%); hipertensos (76,6%); sem sintomatologia depressiva (63,3%); e bom estado nutricional (48,0%). No que se refere ao nível de atividade física. A maioria dos idosos (60,2%) foram classificados como muito ativos, destacando-se o domínio para as atividades físicas domésticas (42,9%). Ainda na análise por domínios do IPAQ, destacam-se os resultados para a atividade física de lazer, na qual 91,8% dos entrevistados foram classificados como inativos. Na análise bivariada o nível de atividade física apresentou associação estatisticamente significativa com a escolaridade (p=0,010) e com a presença de doenças cardiovasculares (p=0,017). Na análise multivariada, os idosos sem escolaridade formal (analfabetos) que corresponderam em torno de 31% da amostra foram classificados como insuficientemente ativos, com prevalência observada de 63,3% para a categoria. Considerações Finais: Os resultados aqui obtidos reforçam a importância de estratégias e programas destinados aos mais velhos que favoreçam a prática regular da atividade física em seus diversos domínios de análise, com vistas ao envelhecimento bem sucedido e redução das incapacidades. Para tal, se faz necessário a organização do ambiente social e comunitário em que esses idosos vivem, a fim de uma melhor aptidão funcional e melhor qualidade de vida. / Objective: To evaluate the associated factors that interfere with the practice of physical activity in the oldest old assisted in basic health care. Method: this is an analytical study, quantitative and cross-sectional. The sample consisted of 98 elderly aged 80 years or more assisted by Community Health Strategy Family for the Recife-PE City. The recording of information made up using an interview script structured with closed questions and organized into blocks, including: participant identification, demographic data, health status, and scales that assessed cognitive impairment (MEEM), depressive symptoms (GDS) nutritional risk (MAN), and level of physical activity (IPAQ). Data analysis using techniques of descriptive and inferential statistics were performed. The descriptive statistical techniques involved obtaining absolute bivariate distributions. For bivariate inferential statistics we used the chi-square test of Pearson. In the multivariate analysis it was generated a decision tree using the algorithm "Exhaustive CHAID" which is based on tests of association Chi-square successive from a list of possible outcomes, reducing a complex decision to a finite number of simple elements regarding dependent variable. Results: prevalence of elderly people aged between 80 and 85 years (53.1%); females (77.6%); widows (63.3%); schooling with 1-4 years of education (45.9%); earning 1-2 minimum wages (76.5%); retired (72.4%); hypertensive (76.6%); no depressive symptoms (63.3%); and good nutritional status (48.0%). With regard to the level of physical activity. Most of the elderly (60.2%) were classified as very active, highlighting the area for domestic physical activity (42.9%). Still in the analysis by IPAQ domains, it highlights the results for the leisure physical activity, in which 91.8% of respondents were classified as inactive. In bivariate analysis the level of physical activity were significantly associated with schooling (p = 0.010) and the presence of cardiovascular disease (p = 0.017). In the multivariate analysis, older people without formal education (illiterate) which accounted for around 31% of the sample were classified as insufficiently active, with observed prevalence of 63.3% for the category. Final Thoughts: The results obtained reinforce the importance of strategies and programs for older that favor regular physical activity in their various fields of analysis, with a view to successful aging and reduction of disabilities. To this end, it is necessary to the organization of social and community environment in which these elderly people live in order to better functional ability and quality of life.

Orientador: Luciane Miranda Guerra / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-25T14:49:06Z (GMT). No. of bitstreams: 1 Nambu_MauricioMassayuki_M.pdf: 6110256 bytes, checksum: fb5c5c2f84a8fc982cb54524cde90aef (MD5) Previous issue date: 2014 / Resumo: A proposição do presente estudo foi avaliar as Assistências Farmacêuticas Básicas municipais das cidades que compõem a Comissão Intergestores Regional de Saúde (CIR) de Ourinhos-São Paulo, através de indicadores de estrutura, processo e resultado, e propor, de forma compartilhada e participativa, ações na perspectiva de impactar mudanças positivas nos indicadores verificados e na prática dos serviços. Trata-se de um estudo transversal descritivo, baseado em indicadores do manual prático de acompanhamento de políticas nacionais de medicamentos da Organização Mundial de Saúde (OMS), perfazendo neste estudo, um total de treze indicadores, caracterizados pela utilidade, descrição, padrão, fonte, metodologia de coleta, cálculo e limitações. Foram realizadas observações diretas em medicamentos, cadastros, relatórios e/ou documentos, entrevistas com os responsáveis pelas Assistências Farmacêuticas Municipais e visitas às unidades de saúde que dispensavam medicamentos para a atenção básica, perfazendo um número total censitário de doze municípios, 41 unidades de saúde e três Centrais de Abastecimento Farmacêutico, não anexas às unidades dispensadoras de medicamentos (farmácias). Em uma segunda etapa, foi realizada uma oficina temática direcionada a todos os municípios participantes do estudo. Verificou-se que 63,89% das unidades de saúde e 75% das centrais de abastecimento farmacêutico possuíam controle de estoque e 68,33% e 70%, cumpriam as boas práticas de armazenamento, respectivamente. Nas unidades de saúde foram encontrados, em média, 0,85 farmacêuticos por unidade; 14,79% de trabalhadores capacitados, 2,44% de listas de padronização afixadas nas farmácias, presença de 88,91% de medicamentos marcadores, 3,77% de medicamentos fora do prazo de validade, 1,99 medicamentos por prescrição, 63,98% de medicamentos prescritos, pertencentes à Atenção Básica, 80,21% de medicamentos prescritos pela denominação genérica, 74,94% de medicamentos prescritos e atendidos, sendo 73,57% na íntegra e 79,59% de medicamentos pertencentes ao Componente Básico da Assistência Farmacêutica dispensados. Na oficina temática, das doze cidades estudadas, sete responsáveis pelas Assistências Farmacêuticas municipais compareceram. Nesta, foram analisados os dados situacionais e elaboradas propostas para melhoria dos indicadores apurados, sendo as mesmas encaminhadas aos gestores e farmacêuticos responsáveis pelas respectivas Assistências Farmacêuticas dos doze municípios da CIR Ourinhos-São Paulo. Apesar dos índices não serem totalmente insatisfatórios, em sua maioria, os valores dos indicadores ficaram abaixo dos padrões estabelecidos pela literatura, demonstrando a necessidade de adequações na infraestrutura e da realização de capacitações para as Assistências Farmacêuticas municipais, visando maior qualidade de atenção aos usuários do sistema de saúde / Abstract: The proposition of this study was to evaluate the Municipal Basic Pharmaceutical Assistance of towns compounding the Intermanagerial Regional Health Commission (IRC) of Ourinhos-Sao Paulo, through indicators of structure, process and result, and propose, in a shared and participatory manner, actions to cause positive changes in the verified indicators and practice of services. It is a cross-sectional descriptive study, based on the attendance of Practical Manual Indicators of National Medicine Policies of the World Health Organization (WHO), totalizing thirteen indicators, characterized by utility, description, standard, source, collection methodology, calculation and limitations. Direct observations were made on medications, records, reports and/or documents, interviews with those responsible for Municipal Pharmaceutical Assistance, and visits to health facilities dispensing drugs for primary care, with total census number of twelve municipalities, forty one health units and three pharmaceutical supply centers, not attached to the units dispensing medications (pharmacies). In a second stage, a thematic workshop was directed to all municipalities participating in the study. It was found that 63.89% of health units and 75% of the pharmaceutical supply centers had stock control, 68.33% and 70% of them respectively, met the good storage practices. In the health units were found, on average, 0.85 pharmacists per unit; 14.79% skilled workers, 2.44% of standardization lists posted in pharmacies, the presence of 88.91% tracer drugs, 3.77% of drugs with expiry date, 1.99 medicine per prescription, 63,98% of prescribed drugs belonging to primary care, 80.21% of drugs prescribed by the generic denomination, 74.94% of the drugs prescribed and received, being 73.57% in full and 79.59% of drugs belonging to the dispensed Basic Pharmaceutical Component Assistance. In thematic workshop of the twelve cities studied, seven responsible for Municipal Pharmaceutical Assistance attended. It was analyzed the data situation and proposals for improvement were prepared for the checked indicators. The proposals were forwarded to managers and pharmacists responsible for their respective Pharmaceutical Assistance of the twelve municipalities of IRC Ourinhos-Sao Paulo. Despite the indices not being totally unsatisfactory, mostly the indicator values were below the standards established by the literature, demonstrating the need for adjustments in infrastructure and conducting training for the Municipal Pharmaceutical Assistance, improving the quality of care to the health system users / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

Les diagnostics d’hypominéralisations molaire-incisive (HMI) et de colorations post-mortem de l’émail sont peu fiables et reproductibles dans des séries archéologiques. Notre guide de diagnostic a permis de distinguer les hypominéralisations de l’émail des colorations taphonomiques. L'émail hypominéralisé est caractérisé par des taux de β-carbonate plus élevés et une densité minérale plus faible. Les colorations taphonomiques présentent une concentration plus élevée en manganèse, en fer, en cuivre et en plomb, mises en évidences par des analyses en fluorescence X. Les dentures d’individus immatures issus de 21 séries archéologiques ont été examinés et comprenaient : 4 séries françaises, Sains-en-Gohelle (Pas-de-Calais), Cognac-Saint-Martin (Charente), Beauvais (Oise) et Jau-Dignac-et-Loirac (Gironde) provenant de cimetières médiévaux et post-médiévaux et 17 séries anglaises (Londres) provenant de cimetières romains, médiévaux et post-médiévaux. Nous avons dénombré 555 individus dont l’âge au décès est compris entre 5 et 19 ans et dont la datation chronologique s’étale sur une période allant du 1er au 19ème siècle. Au total, sur les 290 individus avec au moins une première molaire permanente (PMP) présente, 42 avaient au moins une opacité délimitée de l’émail sur une PMP (soit 14,5%). Parmi les 17 individus dont les dents ont été analysées, les tests statistiques n’ont mis en évidence que 9 cas de HMI, soit 52,9% de l’effectif. Une prévalence de 9,3% de HMI a été estimée dans nos séries archéologiques ce qui avoisine les prévalences connues à l’heure actuelle dans les populations du vivant en Europe. Les défauts du développement de d'émail sont souvent utilisés comme indicateurs de la santé générale dans les populations archéologiques passées. La possibilité de trouver des HMI dans des populations anciennes minimise l’importance de certaines hypothèses étiologiques contemporaines (par exemple les dérivés de dioxines, les bisphénols ou les antibiotiques) sans exclure l'aspect multifactoriel possible de l'anomalie. / Developmental enamel defects are often used as indicators of general health in past archaeological populations. It can be difficult to macroscopically distinguish subtle hypomineralised enamel opacities such as Molar Incisor Hypomineralisation (MIH) from post-mortem staining. The diagnostic guide developed enables the differentiation of developmental hypomineralisation of enamel from taphonomic discolorations. Hypomineralised enamel had higher β-carbonate rates and lower mineral density. Taphonomic discoloration had higher concentration of manganese, iron, copper and lead, determined by means of X-ray fluorescence analyses. Sub adults from 21 archaeological series were examined and included: 4 French series, Sains-en-Gohelle (Pas-de-Calais), Cognac-Saint-Martin (Charente), Beauvais (Oise) and Jau-Dignac-et-Loirac (Gironde) from medieval and post-medieval cemeteries and 17 English series (London) from Roman, medieval and post-medieval cemeteries. We recorded 555 individuals aged between 5-19 years dating from 1st to 19th century. Among 290 specimens with at least one first permanent molar (FPM) present, 42 showed at least one FPM opacity (14.5%). Among the 17 individuals whose teeth were analysed, statistics highlighted 9 cases of MIH (52.9%). MIH prevalence of 9.3% was estimated among the archaeological series which is close to prevalence in living populations in Europe. The identification of MIH among past populations downplays contemporary aetiological hypotheses (e.g. dioxins, bisphenols, antibiotics) without excluding multifactorial aetiology of this pathology.

Orientador: Heleno Rodrigues Corrêa Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T23:35:36Z (GMT). No. of bitstreams: 1 Miquilin_IsabelladeOliveiraCampos_D.pdf: 3441205 bytes, checksum: 7ee4d37959e9a09f5bf14453c81ebc28 (MD5) Previous issue date: 2015 / Resumo: O universo do trabalho na sociedade capitalista encerra crianças e adolescentes marginalmente inseridos no mercado de trabalho e que enfrentam situações laborais que impõem riscos à saúde. Ponto de estagnação ao desenvolvimento social e humano, a persistência do trabalho infantil (TI) reflete desigualdades sociais e fere princípios fundamentais dos direitos da pessoa humana. O objetivo do estudo foi descrever gradientes de desigualdades no trabalho de crianças e adolescentes e construir indicadores de saúde de crianças e adolescentes em condições de trabalho. Os objetivos específicos foram: investigar desigualdades socioeconômicas e de saúde entre crianças e adolescentes trabalhadores (trabalhavam ou estavam em busca de emprego) e não trabalhadores (Artigo1); analisar desigualdades socioeconômicas e de saúde segundo violência referida sofrida por crianças e adolescentes (Artigo 2); descrever o perfil dos acidentes de trabalho (ATs) notificados entre menores de 18 anos e propor indicadores para análise dos riscos do TI no País (Artigo 3). Para análise do primeiro objetivo, foram selecionadas do banco de dados da Pesquisa Nacional por Amostra de Domicílios (PNAD/2008) pessoas de 5 a 17 anos de ambos os sexos (n=91.377). Realizada análise descritiva das características do trabalho principal (n=9.104) bem como das variáveis socioeconômicas e de saúde entre trabalhadores (n=11.002) e não trabalhadores (n=80.375). Estimadas razões de prevalência (RP) ajustadas das características de saúde utilizando regressão de Poisson, sendo `não trabalhadores¿ categoria de referência. Para análise das desigualdades segundo violência referida foram selecionadas da PNAD/2008 meninos e meninas de 5 a 17 anos. Estimadas prevalências de violência sofrida nos 12 últimos meses segundo variáveis socioeconômicas, morbidade referida e ocupação, além de RP de violência ajustadas. A análise descritiva dos ATs ocorridos entre menores de 18 anos (n=896) foi realizada a partir dos registros de acidente de trabalho grave do Sistema de Informação de Agravos de Notificação (SINAN/2008). Foram elaborados indicadores de prevalência relatada de TI e incidência de AT a partir da PNAD/2008 e do SINAN/2008, incluindo ficha de qualificação dos indicadores. A prevalência estimada de TI foi de 12%. Comparados aos não trabalhadores, crianças e adolescentes que trabalhavam ou buscavam emprego tiveram maior proporção de meninos; adolescentes de 14 a 17 anos; pretos e pardos; menor frequência escolar e piores condições de moradia. O TI esteve associado, principalmente, a pior saúde autorreferida (RP=1,18 p-valor<0,05) e depressão (RP=1,37 p-valor<0,05). A prevalência estimada de violência foi de 13,5/1.000 habitantes, sendo depressão (RP=4,11 p-valor<0,05), pior saúde autorreferida (RP=1,63 p-valor<0,05) e TI (RP=1,41 p-valor<0,05) as principais variáveis associadas. Quanto às vítimas de AT na infância destacam-se os meninos; maiores de 13 anos; atendentes de lanchonete e trabalhadores do setor de comércio. Os indicadores de saúde avaliaram a magnitude e riscos do TI, apontando limites e possibilidades das bases de dados utilizadas. O trabalho infantil é um desafio a ser enfrentado pelo Estado e sociedade que devem reconhecer os fatores de ordem social e econômica que predispõem sua ocorrência. Espera-se que os indicadores contribuam para análise da dimensão socioeconômica e de saúde do TI auxiliando a Vigilância em Saúde do Trabalhador do País / Abstract: The labor universe in capitalist society contains children and adolescents marginally inserted in the job market and facing work situations that impose risk to their health. The persistence of child labor is a stagnation point to the social and human development. It reflects social inequalities and violates the human rights. The aims of this study were to describe inequalities gradients in the work of children and adolescents and build health indicators of children and adolescents in working conditions. The specific aims were: to investigate socioeconomic and health inequalities between children and adolescents workers (or looking for a job) and non-workers (Article1); to analyze health, work and socioeconomic inequalities according to the reported violence suffered by children and adolescents (Article 2); to describe the profile of occupational accidents (OA) that were notified among children under 18 years of age and propose indicators for analysis of child labor risks (Article 3). To the first objective, children and adolescents aged 5-17 years in both sexes (n=91,377) were selected from the National Household Sample Survey (PNAD/ 2008). Descriptive analysis of job characteristics were performed (n=9.104), and a descriptive analysis of socioeconomic, housing conditions and morbidity characteristics among workers (n=11.002) and non-workers (n=80, 375) was done as well. Adjusted prevalence ratios (PR) of health characteristics were estimated using Poisson regression, and `non-workers' were the reference category. Children and adolescents aged 5-17 years were selected from PNAD/2008 for the analysis of inequalities according to violence referred. Prevalence of reported violence suffered in the last 12 months were estimated according to socioeconomic variables, reported morbidity and work, as well adjusted PR of violence. The descriptive analysis of OA occurred among children aged less than 18 years old (n = 896) was performed using the serious work accident records from the Reportable Diseases Information System (SINAN/2008). Indicators of prevalence of child labor and incidence of OA were developed from the PNAD/2008 and SINAN/2008, including the indicators qualifying record. The estimated prevalence of child labor was 12%. Compared with non-workers, children and adolescents workers (or looking for a job) had higher proportion of boys; girls and boys aged 14-17 years; black and brown; lower school attendance and worse housing conditions. The child labor was associated mainly to worse self-reported health (PR = 1.18 p <0.05) and depression (PR=1.37 p <0.05). The estimated prevalence of violence was 13.5/1,000 inhabitants, and depression (PR=4.11 p <0.05), worse self-reported health (PR = 1.63 p <0.05) and working children (PR=1.41 p <0.05) were the main variables associated. The victims of OA in childhood were mainly boys; aged 13 years and over; fast food attendants and sales workers. The health indicators proposed assessed the magnitude and OA risk, pointing to limits and possibilities of the databases. Child labor is a challenge to the State and society that should recognize the social and economic factors that predispose its occurrence. The suggested indicators may contribute to the analysis of the socioeconomic and health dimensions of child labor, to support an Occupational Health Surveillance System in the Country / Doutorado / Epidemiologia / Doutora em Saúde Coletiva

Individuals with advance-stage illnesses frequently face illness or treatment-related adverse effects in the mouth. These adverse effects can have serious consequences. Despite that, the importance of oral care in this population is often overlooked and there are no definitive guidelines as to what kind of oral care should be provided to these individuals. Given that, our study aims were to explore and better understand the oral health-related concerns, perceived oral care needs of palliative care patients and the berries that face in accessing dental care services. We conducted a qualitative description study by recruiting a purposive sample of 11 participants with advanced stage health conditions from the outpatient palliative care services of the University of Iowa Hospitals and Clinics. Data were collected using in-depth, semi-structured interviews using an interview guide. All interviews were fully transcribed, with the data managed with Atlas.ti software to facilitate the analysis. All participants had oral concerns although they varied widely from person to person and their illness statuses. The most significant concerns were related to dry mouth, loose dentures, and eating difficulties. Among those who stated that they would seek dental care if required, they were not planning on seeking dental care even though they had treatable oral problems, suggesting a mismatch between their oral health status and their perceived needs. The frequently observed barriers that prevented them from seeking dental care were their illness and illness related priorities, finances, feeling discriminated against by the dentist, and a dislike towards the dentist. Providing information to the palliative care clinicians about the significance of oral health and its impact, incorporating a dental care provider in palliative care team, and providing timely information to individuals with advanced health conditions may enhance the understanding of their oral health problems and help them better manage their oral health and may enhance their dental care seeking behavior.

Peu de données ont été publiées sur le statut nutritionnel des personnes âgées vivant àdomicile. Le premier objectif de cette thèse était d’évaluer le statut nutritionnel de personnesâgées de 65 ans et plus vivant à domicile et les facteurs associés à cet état. Le second objectifde la thèse était d’étudier la survenue de plusieurs événements de santé en fonction du statutnutritionnel. Les données de deux cohortes prospectives incluant des personnes âgées de 65ans et plus (AMI, n=1002 et E3C, n=9294) ont été exploitées. Les résultats de cette thèsemontrent qu’une proportion non négligeable de personnes âgées vivant à domicile présente unstatut nutritionnel altéré. Les individus les plus concernés étaient les plus âgés, de genreféminin, veufs, de niveaux de revenus et scolaire faibles, déments, présentant unesymptomatologie dépressive et des incapacités aux activités de la vie quotidienne. Cesindividus avaient de moins bonnes habitudes alimentaires caractérisées par desconsommations faibles de poisson, légumes, fruits, et élevées de biscuits et viennoiseries. Unstatut nutritionnel altéré à l’inclusion était significativement associé à la survenue de diversévénements au cours des 12 ans de suivi: démence, chute, fracture, incapacités, incontinence,institutionnalisation et décès. L’ensemble de ces travaux montre qu’un état nutritionnel altéré,avant que la dénutrition ne soit installée, n’est pas rare chez les sujets âgés vivant à domicileet que cet état est associé à la survenue plus fréquente d’événements de santé graves. Cesrésultats plaident pour une détection plus active qu’actuellement de ces sujets à risque et pourune prise en charge adaptée. / Few data about the nutritional status of elderly people living at home are available. The firstaim of this work was to evaluate the nutritional status of community-dwellers aged 65 andover and the factors associated with this state. The second aim of the thesis was to study theoccurrence of several health events according to the nutritional status. The data of twoprospective cohorts including people aged 65 and over (AMI, n=1,002 and 3C, n=9294) wereanalyzed. The results of this work show that a relatively high proportion of older people livingat home have a poor nutritional status. Individuals most affected were older, of female gender,widowed, with low levels of income and education, presenting a dementia, a depressivesymptomatology and disability in activities of daily living. These individuals had poorereating habits characterized by low consumption of fish, vegetables, fruits, and highconsumption of biscuits and pastries. A poor nutritional status at baseline were significantlyassociated with the occurrence of several events during the 12 years of follow-up: dementia,falls, fractures, disability, incontinence, institutionalization and death. These results show thatpoor nutritional status is frequent in elderly living at home, before malnutrition is established,and that this state is associated with the occurrence of serious health events. These results alsoadvocate for a more active detection of these subjects and a more appropriate healthmanagement.