In den vorliegenden Untersuchungen wurde das Ziel verfolgt die Nutzbarkeit des Milchinhaltsstoffes Laktose als praxistaugliche Managementhilfe zu prüfen. Die Primärdaten stammen aus drei israelischen Hochleistungsherden, über mehrere Laktationen erhoben. Der Parameter Laktosegehalt wurde in der Datenaufbereitung dahingehend geprüft, ob dieser zur Gesundheits- und Leistungsvorhersage ausreicht oder welche zusätzlichen Merkmale für die Verwendung in einem Prognose-Modell von Bedeutung sein könnten. Als leistungs- bzw. gesundheitsrelevante Ereignisse (Events) wurden Brunst, Diarrhoe, Endometritis, Fieber, Infektionen, Klauenerkrankungen, Mastitis, Stress, Stoffwechselstörungen sowie Verletzungen zugeordnet. Die Bewertung der Nützlichkeit einzelner Merkmale für die Prädiktion erfolgte anhand der Erkennungsraten. Zwei- und dreistufige Entscheidungsbäume wurden entwickelt, um diese Events zu identifizieren. Ein einzelnes Merkmal ist oft nicht ausreichend, weshalb verschiedene Kombinationen von Variablen analysiert wurden. Die wichtigste Erkenntnis der vorliegenden Arbeit besteht darin, dass der Abfall der Laktosekonzentration und Laktosemenge immer ein kritisches Ereignis darstellt. Das Hauptziel eines Gesundheitsmonitorings im Milchkuhbestand sollte deshalb darin bestehen, frühzeitig eine Stoffwechselüberlastung "sichtbar" oder "erkennbar" zu machen. Unabhängig davon, welche Erkrankung sich anbahnt, muss das Herdenmanagement darauf hinwirken, die Glukoseversorgungssituation des Einzeltieres zu verbessern. Aus der Analyse für die einzelnen Herden und Laktationen kann grundlegend abgeleitet werden, dass die Ergebnisse der Milchkontrolldaten, die im Zuge der datengestützten Herdenüberwachung erhoben wurden, sich verwenden lassen, um den Leistungs- und Gesundheitsstatus der Kühe im Laktationsverlauf einzuschätzen und zu prognostizieren. Die Verwendung von Informationen zum Laktosegehalt des Gemelks verbesserten in jedem Fall die Erkennungsraten. / The aim of the current studies was to investigate whether the milk ingredient lactose can be used as a practical support management. The primary data comes from three Israeli high-performance herds, collected over several lactations. In the data preparation, the parameter "lactose content" was examined to see whether it is sufficient for a health and performance prediction or whether additional features may be of importance for usage in a forecasting model. Oestrus, diarrhea, endometritis, fever, infections, hoof diseases, mastitis, stress, metabolic disorders, and injuries have been assigned to the performance- and/or health-affecting events. The usefulness of individual features for the prediction was evaluated on the basis of the recognition rates. Thus two- and three-level decision trees have been developed to identify these events. As one single feature is often insufficient, different combinations of variables were analyzed. The most important finding of this study is that the drop in the lactose concentration and lactose quantity always represents a critical event. The main objective of a health monitoring in the dairy herd should therefore be to make a metabolic overload "visible" or "recognisable" at an early stage. Whichever disease begins to take shape, the herd management must work on improving the glucose supply situation of the individual animal. In conclusion from the analysis of the individual herds and lactations it can be inferred that the results of the milk control data collected in the course of the data-based herd monitoring can be used in order to assess and to predict the performance and health status of the cows in the course of lactation. The use of information on the lactose content of the milk improved in any case the recognition rates.

A ocorrência de doença cardiovascular não pode ser explicada somente pelo estilo de vida do adulto. Estudos ecológicos e epidemiológicos dos últimos vinte anos demonstraram maior incidência de doenças crônicas não transmissíveis em indivíduos que nasceram com baixo peso e tiveram um ganho de peso inadequado nos dois primeiros anos de vida. A hipótese aceita atualmente é a de que agravos, principalmente nutricionais, ocorridos durante a gestação alteram a programação de órgãos e sistemas para preservar, principalmente, o desenvolvimento cerebral, levando ao sacrifício metabólico de vários órgãos, como rins, fígado, coração, pâncreas, que ao serem solicitados na vida adulta, teriam menor capacidade funcional. Esta teoria foi chamada Hipótese de Barker ou do Fenótipo Poupador. Este trabalho tem como objetivo avaliar o peso de nascimento e do primeiro ano de vida de adultos usuários do Centro de Saúde-Escola Prof. Samuel B. Pessoa, que foram matriculados quando lactentes e que estão atualmente em seguimento nesta unidade de saúde, correlacionando com a sua condição de saúde atual, para tentar demonstrar a teoria das origens desenvolvimentistas da saúde e da doença em nosso meio. A anamnese clínica, medidas da cintura abdominal, cintura quadril, pressão arterial, freqüência cardíaca, e exames laboratoriais, tais como colesterol total e frações, triglicérides, glicemia de jejum foram estudados. Constituiu-se um grupo de 298 usuários, com média de idade de 25 anos, sendo 212 mulheres e 86 homens. Após a execução do estudo observamos que não houve diferença estatisticamente significante em relação a anamnese e aos exames laboratoriais alterados dos adultos, quando se compararam aos grupos com baixo peso de nascimento, nem quando comparados aos grupos com peso baixo com um ano de idade. O acompanhamento destes de adultos, por duas a três décadas, poderá trazer dados que venham a ajudar a comprovar a teoria das origens desenvolvimentistas da saúde e da doença em nosso meio. A prevenção primordial, isto é, antes do nascimento, das doenças crônicas não transmissíveis será o objetivo futuro da Pediatria Preventiva / The appearance of a cardiovascular disease cannot be explained only by the adults lifestyle. Ecological and epidemiological studies from the last twenty years show a more frequent incidence of non-communicable chronic diseases in individuals that were born under the ideal weight and had an inadequate gain of weight during their first two years. The hypothesis initially accepted is that certain deficiencies, mainly nutritional, that occurred during pregnancy alter the programming of organs and systems in order to preserve the cerebral development. This process may lead to metabolic sacrifice of many organs, including liver, kidneys, heart and pancreas, which will have a worse functional capacity when necessary in adult life. This theory was called Barker Hypothesis or Thrifty Phenotype Hypothesis. This research project has for objective the comparation of the weight at birth and during the first year of life from adults whose health is followed at Health Center School Prof. Samuel B. Pessoa. This group of adults was subscripted when its members were infants. A correlation between their present health and their health conditions when infants was made during this study in order to try to demonstrate in our environment the Developmental Origins of Health and Disease. The basis of the study was the clinical anamneses, the measures of the abdominal waist, hip, arterial pressure, cardiac frequency and some laboratorial examinations, such as total and fractional cholesterol, triglycerides, fasting glucose levels. A group of 298 patients was formed, with an average age of 25 years-old members. 212 of them were women and 86 were men. After this study, it was concluded that the underweight at birth and underweight during the first year of life do not lead to alterations statistically relevant in the anamneses and in the laboratorial examinations. The following of these adults during two or three decades may bring data that might help to prove the developmental origins of health and disease theory in our environment. The primordial prevention (before the child is born) of non-communicable chronic diseases will be the future target of Preventive Pediatrics

JUSTIFICATIVA E OBJETIVOS: Condições adversas no ambiente pré-natal e primeiros anos de vida são independentemente associados com risco aumentado de doença cardiovascular. A hipótese aceita atualmente para essa associação é a de que agravos, principalmente nutricionais, ocorridos durante a gestação alteram a organização de órgãos e sistemas, que ao serem solicitados na vida adulta, teriam menor capacidade funcional. Com base nessa premissa, o trabalho tem o objetivo de estudar a relação entre o peso ao nascer, crescimento no primeiro ano de vida e fatores de risco para doença cardiovascular e aterosclerose subclínica em adultos do Centro de Saúde-Escola (CSE) \"Prof. Samuel B. Pessoa\" da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: Em 2009, 88 adultos jovens com idade entre 20-31 anos, seguidos desde o início da vida no CSE, foram submetidos ao diagnóstico de aterosclerose subclínica. Informações relacionadas às características sociodemográficas, dados antropométricos, medidas da pressão arterial, perfil metabólico, e avaliação da aterosclerose subclínica pela ultrassonografia e métodos gráficos foram obtidas dos adultos, e estudadas de acordo com 2 pontos de corte em relação ao peso de nascimento (< 2.500 gramas; e, > 3.500 gramas) e ganho de peso no primeiro ano de vida. Os pesos foram obtidos dos registros de prontuários. Os achados atuais dos adultos foram analisados em relação às condições de nascimento e ao ganho de peso no primeiro ano de vida. Para realização das análises estatísticas foram realizadas regressões multivariadas. RESULTADOS: Baixo peso ao nascer, menor de 2.500 gramas (g) foi negativamente correlacionado com a relação cintura-quadril (RCQ) elevada, segundo coeficiente de regressão (CR) igual a -0,323, IC 95% [-0,571, -0,075] p < 0,05, níveis de pressão arterial diastólica (CR=-4,744, IC 95% [-9,017,-0,470] p < 0,05), HDL-colesterol reduzido (CR=-0,272, IC 95% [-0,516, -0,029] p < 0,05), e frequência da espessura da média-íntima (EMI) média da carótida esquerda (CE) acima do p75 (CR=-0,242, IC 95% [-0,476,-0,008] p < 0,05). Peso ao nascer maior do que 3.500 g foi positivamente associado com IMC (CR=2,832, IC 95% [0,433, 5,233] p < 0,05), IMC >= 25,0 kg/m2, (CR=0,317, IC 95% [0,782, 0,557] p < 0.05), cintura abdominal elevada (CR=0,284, IC 95% [0,054, 0,513] p < 0,05), RCQ elevada (CR=0,280, IC 95% [0,054, 0,505] p < 0,05), glicemia de jejum (CR=3,808, IC 95% [0,558, 7,058] p < 0,05), MEGA mínima (CR=4,354, IC 95% [0,821, 7,888] p < 0,05), MEGA máxima (CR=7,095, IC 95% [0,608, 13,583] p < 0,05), tamanho do lobo direito do fígado (CR=6,896, IC 95% [1,946, 11,847] p < 0,01), e com a frequência do lobo direito do fígado acima do p75 (CR=0,361, IC 95% [0,169, 0,552] p < 0,01). Ganho de peso no primeiro ano de vida menor que: a diferença entre o peso com 12 meses de idade e o peso de nascimento no p50 das curvas da Organização Mundial da Saúde, foi considerado inadequado, sendo negativamente correlacionado com EMI média da CE (CR=-0,046, IC 95% [-0,086, -0,006] p < 0,05), frequência da EMI média da CE acima do p75 (CR=-0,253, IC 95% [-0,487, -0,018] p < 0,05), EMI da (CE+CD)/2, com CR=-0,038, IC 95% [-0,073, -0,002] p < 0,05, e com a frequência da EMI (CE+CD)/2 acima do p75 (CR=-0,241, IC 95% [-0,442, -0,041] p < 0,05). CONCLUSÕES: Adultos com pesos de nascimento menores do que 2.500 g. e maiores do que 3.500 g. e com ganho de peso insuficiente no primeiro ano de vida apresentaram diferentes fenótipos metabólicos, mas todos relacionados com fatores de risco aumentados para doença cardiovascular e aterosclerose subclínica, quando comparados com aqueles que nasceram com peso adequado e com ganho de peso suficiente no primeiro ano de vida / BACKGROUND AND OBJECTIVES: Adverse conditions in the prenatal environment and in the first years of life are independently associated with increased risk for cardiovascular disease. The currently accepted hypothesis for this association is the one that states that alterations occurred during pregnancy, mainly nutritional ones, affect the organization of organs and systems that would have a lower functional capacity when needed during adult life. This paper aims to study the relationship between weight at birth, growth in the first year of life and risk factors for cardiovascular disease and subclinical atherosclerosis subclinical atherosclerosis in adults of the \"Prof. Samuel B. Pessoa\" Health Center-School (CSE) from the Medical School of the University of São Paulo. METHODS: In the year of 2009, 88 young adults aged between 20 and 31, followed since the beginning of their lives in the CSE, were submitted to the diagnosis of subclinical atherosclerosis. Their sociodemographic qualities, anthropometric data, blood pressure measurements, metabolic profile, evaluation of subclinical atherosclerosis by ultrasound and graphical methods were collected. These pieces of information were later studied according to their birth weight (< 2,500 grams and > 3,500 grams) and to the gain of weight during their first year of life. Weights were obtained from the registrations of their medical records. The current findings in the adults were analysed in relation to their conditions of birth and weight gain in the first year of life. Multivariate regressions were performed in order to obtain the statistical analyses. RESULTS: Low birth weight, less than 2,500 grams (g) was negatively correlated with higher waist-to-hip ratio (WHR), according to regression coefficient (RC) equal to -0.323, 95% CI [-0.571, -0.075] p < 0.05, diastolic blood pressure (RC=-4.744, 95% CI [-9.017, -0.470] p < 0.05), reduced HDL cholesterol (RC=-0.272, 95% CI [-0.516, - 0.029] p < 0.05), and the frequency of the intima-media thickness (IMT) of the left carotid artery average above 75th p (RC=-0.242 95% CI [-0.476, -0.008] p < 0.05). Birth weight greater than 3,500g was positively associated with BMI (RC=2.832, 95% CI [0.433, 5.233] p < 0.05), BMI >= 25.0 kg/m2, (RC=0.317, 95% CI [0.782, 0.557] p < 0.05), waist circumference elevated (RC=0.284, 95% CI [0.054, 0.513] p < 0.05), WHR elevated (RC=0.280, 95% CI [0.054, 0.505] p < 0.05), fasting glucose (RC=3.809, 95% CI [0.559, 7.058] p < 0.05), minimum subcutaneous adipose tissue (SAT) with RC=4.354, 95% CI [0.821, 7.888] p < 0.05), maximum SAT (RC=7.095, 95% CI [0.608, 13.583] p < 0.05), size right lobe of the liver (RC=6.896, 95% CI [1.946, 11.847] p < 0.01), and the frequency of the right lobe of the liver above the 75th percentile (RC=0.361, 95% CI [0.169, 0.552] p < 0.01). Weight gain in the first year of life was considered inadequate when it was lower than the difference between the weight at 12 months of age and birth weight at the 50th percentile curves of the World Health Organization (WHO), and negatively correlated with media IMT of left carotid (RC=-0.046, 95% CI [-0.086, -0.006] p < 0.05, frequency of media IMT of left carotid above the 75th percentile (RC=-0.253, 95% CI [-0.487, -0.018] p < 0.05), media IMT(left carotid + right carotid)/2 com RC=-0.038, 95% CI [-0.073, -0.002] p < 0.05, and the frequency of the media IMT (left carotid + right carotid)/2 above the 75th percentile (RC=-0.241, 95% CI [-0.442,-0.041] p < 0.05). CONCLUSIONS: Adults with weight at birth lower than 2,500 g and higher than 3,500 g and with insufficient weight gain in the first year of life have showed different metabolic phenotypes, but all related to increased risk factors for cardiovascular disease and subclinical atherosclerosis when compared to those who were born with appropriate weight and who have gained enough weight during the first year of life

A ocorrência de doença cardiovascular não pode ser explicada somente pelo estilo de vida do adulto. Estudos ecológicos e epidemiológicos dos últimos vinte anos demonstraram maior incidência de doenças crônicas não transmissíveis em indivíduos que nasceram com baixo peso e tiveram um ganho de peso inadequado nos dois primeiros anos de vida. A hipótese aceita atualmente é a de que agravos, principalmente nutricionais, ocorridos durante a gestação alteram a programação de órgãos e sistemas para preservar, principalmente, o desenvolvimento cerebral, levando ao sacrifício metabólico de vários órgãos, como rins, fígado, coração, pâncreas, que ao serem solicitados na vida adulta, teriam menor capacidade funcional. Esta teoria foi chamada Hipótese de Barker ou do Fenótipo Poupador. Este trabalho tem como objetivo avaliar o peso de nascimento e do primeiro ano de vida de adultos usuários do Centro de Saúde-Escola Prof. Samuel B. Pessoa, que foram matriculados quando lactentes e que estão atualmente em seguimento nesta unidade de saúde, correlacionando com a sua condição de saúde atual, para tentar demonstrar a teoria das origens desenvolvimentistas da saúde e da doença em nosso meio. A anamnese clínica, medidas da cintura abdominal, cintura quadril, pressão arterial, freqüência cardíaca, e exames laboratoriais, tais como colesterol total e frações, triglicérides, glicemia de jejum foram estudados. Constituiu-se um grupo de 298 usuários, com média de idade de 25 anos, sendo 212 mulheres e 86 homens. Após a execução do estudo observamos que não houve diferença estatisticamente significante em relação a anamnese e aos exames laboratoriais alterados dos adultos, quando se compararam aos grupos com baixo peso de nascimento, nem quando comparados aos grupos com peso baixo com um ano de idade. O acompanhamento destes de adultos, por duas a três décadas, poderá trazer dados que venham a ajudar a comprovar a teoria das origens desenvolvimentistas da saúde e da doença em nosso meio. A prevenção primordial, isto é, antes do nascimento, das doenças crônicas não transmissíveis será o objetivo futuro da Pediatria Preventiva / The appearance of a cardiovascular disease cannot be explained only by the adults lifestyle. Ecological and epidemiological studies from the last twenty years show a more frequent incidence of non-communicable chronic diseases in individuals that were born under the ideal weight and had an inadequate gain of weight during their first two years. The hypothesis initially accepted is that certain deficiencies, mainly nutritional, that occurred during pregnancy alter the programming of organs and systems in order to preserve the cerebral development. This process may lead to metabolic sacrifice of many organs, including liver, kidneys, heart and pancreas, which will have a worse functional capacity when necessary in adult life. This theory was called Barker Hypothesis or Thrifty Phenotype Hypothesis. This research project has for objective the comparation of the weight at birth and during the first year of life from adults whose health is followed at Health Center School Prof. Samuel B. Pessoa. This group of adults was subscripted when its members were infants. A correlation between their present health and their health conditions when infants was made during this study in order to try to demonstrate in our environment the Developmental Origins of Health and Disease. The basis of the study was the clinical anamneses, the measures of the abdominal waist, hip, arterial pressure, cardiac frequency and some laboratorial examinations, such as total and fractional cholesterol, triglycerides, fasting glucose levels. A group of 298 patients was formed, with an average age of 25 years-old members. 212 of them were women and 86 were men. After this study, it was concluded that the underweight at birth and underweight during the first year of life do not lead to alterations statistically relevant in the anamneses and in the laboratorial examinations. The following of these adults during two or three decades may bring data that might help to prove the developmental origins of health and disease theory in our environment. The primordial prevention (before the child is born) of non-communicable chronic diseases will be the future target of Preventive Pediatrics

JUSTIFICATIVA E OBJETIVOS: As doenças cardiovasculares (DCV) constituem uma importante causa de mortalidade em todo mundo, sendo a principal causa de morte e incapacidade no Brasil, determinando um impacto social, econômico e médico de grandes proporções. O desenvolvimento das DCV está correlacionado a vários fatores de risco desde os primeiros anos de vida, com expressão na vida adulta. As sementes da aterosclerose são semeadas muitas décadas antes da manifestação dos pontos finais clínicos. A espessura da média-intimal da carótida (EMIC) é relevante na avaliação da repercussão dos fatores de risco sobre a parede arterial. As condições precursoras dos distúrbios metabólicos e das alterações vasculares relativas à aterosclerose podem ser evitadas ou interrompidas se identificados e tratados a tempo. Com base nessa premissa, o presente trabalho tem como objetivo estudar a relação entre história e condições de vida, fatores de risco cardiovascular e espessura da média-intimal da carótida em crianças escolares de 5 a 9 anos, procedentes de escolas públicas da região central da cidade de Fortaleza - Ceará - Brasil. MÉTODOS: estudo transversal observacional com dados primários colhidos por formulário aplicado a uma amostra da população escolar de instituições públicas em crianças de 5 a 9 anos da região central da cidade de Fortaleza, sorteadas aleatoriamente. Informações relacionadas às características sociodemográficas, dados antropométricos, medidas da pressão arterial, perfil metabólico, e avaliação da espessura da média-intimal da carótida pela ultrassonografia foram realizados. Para análises estatísticas, análises univariadas foram desenvolvidas por meio da comparação de proporções pelo Teste do Qui-quadrado e pela seleção de variáveis independentes, para compor os modelos de regressão logística múltipla. RESULTADOS: Foram investigadas quinhentas crianças de 5-9 anos, sendo do sexo feminino 260 crianças (52%). A medida da EMIC teve média e desvio padrão para EMIC esquerda de 0,42mm (±0,09) e para EMIC direita de 0,39mm (±0,07). Não houve diferenças significativas para os sexos. Houve associação estatisticamente significante e de forma crescente com a idade, sendo 5,02 vezes maior uma criança de 9 anos ter a EMIC aumentada (IC95% = 1,95 - 12,88; p=0,001). A EMIC esteve associada significantemente com o nível de instrução materna baixo (OR = 0,46; IC95% = 0,23 - 0,90), com hipertensão diastólica (OR = 7,61; IC95% = 2,18 - 26,53), com sobrepeso/obesidade (OR = 4,81; IC95% = 2,50 - 9,24), com hipercolesterolemia (OR = 20,8; IC95% = 10,17 - 42,92), com níveis de PCR elevados (OR = 3,03; IC95% = 1,27 - 7,21) e insulina de jejum elevados (OR = 10,4; IC95% = 3,03 - 36,24). CONCLUSÕES: A aterosclerose subclínica já pode ser detectada em crianças pré-púberes de 5 a 9 anos que contenham fatores de risco para doença cardiovascular, indicando doença cardiovascular incipiente. A medida da EMIC pode fornecer um marcador confiável para a saúde vascular, associado a outros critérios de risco, evidenciando que, especialmente no grupo etário pediátrico, a avaliação do risco cardiovascular é benéfica. Considerando a progressão das alterações vasculares ao longo da vida, parece prudente para detectar sinais subclínicos de danos arteriais e aterosclerose muito cedo, e para aliviar a carga aterosclerótica com medidas preventivas / BACKGROUND AND OBJECTIVES: Cardiovascular diseases (CVD) are a major cause of death worldwide. They are main cause of death and disability in Brazil and thus have large social, economic and medical impact. The development of CVD is correlated with several risk factors from the first years of life, with expression in adult life. The seeds of atherosclerosis are sown many decades before the manifestation of clinical symptoms. The carotid intima-media thickness (cIMT) is relevant in assessing the manifestation of risk factors on the arterial wall. The precursor conditions of metabolic disorders and vascular changes related to atherosclerosis can be avoided or disrupted if identified and treated in time. Based on this premise, the objective of this study was to study the relationship between history and life conditions, cardiovascular risk factors, and carotid intima-media thickness in public schoolchildren, aged 5 to 9, in the central region of the city of Fortaleza, Ceará, Brazil. METHODS: an observational cross-sectional study with primary data collected by a form supplied to a sample of the school population of public institutions in the central region of Fortaleza. The children were randomly selected and information related to sociodemographic characteristics, anthropometric data, blood pressure measurements, metabolic profile, and assessment of the carotid-mediated intima-media thickness were collected. For statistical analyzes, univariate analyses were developed by comparing proportions through the Chi-square test and a selection of independent variables to compose the multiple logistic regression models. RESULTS: Five hundred children aged 5-9 years were enrolled, of whom 260 (52%) were female. The cIMT measure had a mean and standard deviation for left cIMT of 0.42mm (± 0.09) and for right cIMT of 0.39mm (± 0.07). There were no significant differences for the sexes. There was a statistically significant and increasing association with age, with a 9-year-old child being 5.02 times more likely to have cIMT (95% CI = 1.95 - 12.88, p = 0.001). The cIMT was significantly associated with low maternal education (OR = 0.46, 95% CI = 0.23-0.90), with diastolic hypertension (OR = 7.61, 95% CI = 2.18-26, 53), overweight/obesity (OR = 4.81, 95% CI = 2.50-9.24), hypercholesterolemia (OR = 20.8, 95% CI = 10.17 - 42.92), high levels of CRP (OR = 3.03, 95% CI = 1.27 - 7.21), and high-fasting insulin (OR = 10.4, 95% CI = 3.03-36.24). CONCLUSIONS: Subclinical atherosclerosis can already be detected in prepubertal children aged 5 to 9 years who have risk factors for cardiovascular disease, indicating incipient cardiovascular disease. The cIMT measure can provide a reliable marker for vascular health, associated with other risk criteria. The measure shows that, especially in the pediatric age group, cardiovascular risk assessment is beneficial. Given the progression of vascular changes throughout life, it seems prudent to detect subclinical signs of arterial damage and atherosclerosis very early and to relieve atherosclerotic burden with preventative measures

<p>Старење становништва је велики изазов са којим се суочава светска популација у XXI веку. Становништво Војводине спада у веома старо становништво, а процењује се да ће до средине овог века чак свака трећа особа бити старија од 60 година. Циљ овог рада је био да се процени здравље, разлике у здрављу и коришћење здравствене заштите, као и да се идентификују предиктори&nbsp; здравља и коришћења здравствене заштите код особа старости 65 и више година на територији Војводине. Истраживање представља део Истраживања здравља становништва Србије из 2013. године које је спровело Министарство здравља Републике Србије. Истраживањем је обухваћено 886 испитаника старости 65 и више година са територије Војводине. Инструмент истраживања су били упитници конструисани у складу са упитником Европског истраживања здравља, а подаци о телесној маси, телесној висини и крвном притиску су добијени мерењем. Резултати су показали да су имали већу шансу да процене своје здравље као лошије жене (OR=2,14; 95%CI=[1,42-3,23]; p&lt;0,001), сиромашни (OR=2,92; 95%CI=[1,18-7,20]; p=0,020), испитаници са умереним до тешким ограничењима у обављању кућних активности (OR=3,33; 95%CI=[1,28-8,69]; p=0,014), са присутним јаким болом (OR=2,81; 95%CI=[1,20-6,60]; p=0,017), благим депресивним симптомима или депресивном епизодом (OR=8,90; 95%CI=[3,71-21,32]; p&lt;0,001), оболели од две или више хроничних болести (OR=13,25; 95%CI=[4,05-43,3]; p&lt;0,001) и испитаници са лошијом социјалном подршком (OR=3,00; 95%CI=[1,08-8,34]; p=0,035). Предиктори посете лекару опште медицине били су виши ниво образовања, боље материјално стање, веће издвајање из сопствених прихода за ванболничку здравствену заштиту и мултиморбидитет, док су чешће били хоспитализовани мушкарци, особе нижег нивоа образовања, испитаници који су процењивали своје здравље као лоше или веома лоше. Истраживање је потврдило да постоје значајне неједнакости у здрављу и коришћењу здравствене заштите код старих особа у Војводини, које је потребно смањити свеобухватним јавноздравственим политикама и интервенцијама.</p> / <p>Starenje stanovništva je veliki izazov sa kojim se suočava svetska populacija u XXI veku. Stanovništvo Vojvodine spada u veoma staro stanovništvo, a procenjuje se da će do sredine ovog veka čak svaka treća osoba biti starija od 60 godina. Cilj ovog rada je bio da se proceni zdravlje, razlike u zdravlju i korišćenje zdravstvene zaštite, kao i da se identifikuju prediktori&nbsp; zdravlja i korišćenja zdravstvene zaštite kod osoba starosti 65 i više godina na teritoriji Vojvodine. Istraživanje predstavlja deo Istraživanja zdravlja stanovništva Srbije iz 2013. godine koje je sprovelo Ministarstvo zdravlja Republike Srbije. Istraživanjem je obuhvaćeno 886 ispitanika starosti 65 i više godina sa teritorije Vojvodine. Instrument istraživanja su bili upitnici konstruisani u skladu sa upitnikom Evropskog istraživanja zdravlja, a podaci o telesnoj masi, telesnoj visini i krvnom pritisku su dobijeni merenjem. Rezultati su pokazali da su imali veću šansu da procene svoje zdravlje kao lošije žene (OR=2,14; 95%CI=[1,42-3,23]; p&lt;0,001), siromašni (OR=2,92; 95%CI=[1,18-7,20]; p=0,020), ispitanici sa umerenim do teškim ograničenjima u obavljanju kućnih aktivnosti (OR=3,33; 95%CI=[1,28-8,69]; p=0,014), sa prisutnim jakim bolom (OR=2,81; 95%CI=[1,20-6,60]; p=0,017), blagim depresivnim simptomima ili depresivnom epizodom (OR=8,90; 95%CI=[3,71-21,32]; p&lt;0,001), oboleli od dve ili više hroničnih bolesti (OR=13,25; 95%CI=[4,05-43,3]; p&lt;0,001) i ispitanici sa lošijom socijalnom podrškom (OR=3,00; 95%CI=[1,08-8,34]; p=0,035). Prediktori posete lekaru opšte medicine bili su viši nivo obrazovanja, bolje materijalno stanje, veće izdvajanje iz sopstvenih prihoda za vanbolničku zdravstvenu zaštitu i multimorbiditet, dok su češće bili hospitalizovani muškarci, osobe nižeg nivoa obrazovanja, ispitanici koji su procenjivali svoje zdravlje kao loše ili veoma loše. Istraživanje je potvrdilo da postoje značajne nejednakosti u zdravlju i korišćenju zdravstvene zaštite kod starih osoba u Vojvodini, koje je potrebno smanjiti sveobuhvatnim javnozdravstvenim politikama i intervencijama.</p> / <p>Aging is the great challenge of the XXI century. Population of Vojvodina is very old, and projections indicate that by 2050 one in three persons will be older than 60 years. The aim of this study was to evaluate health, health differences and health care utilization, as well as to indentify predictors of health and health care utilization in people aged 65 and over in Vojvodina. The study represents part of the National health survey Serbia conducted in 2013 by the Ministry of Health of Republic of Serbia. Study included 886 examinees aged 65 and over who were interviewed on the territory of Vojvodina. The instruments were questionnaires designed according to the European Health Interview Survey questionnaire, and data on body mass, body height and blood pressure were measured. Results showed that the highest odds of assessing their health as poor had women (OR=2.14; 95%CI=[1.42-3.23]; p&lt;0.001), participants who belonged to the poor class (OR=2.92; 95%CI=[1.18-7.20]; p=0.020), who had difficulties with instrumental activities of daily living (OR=3.33; 95%CI=[1.28-8.69]; p=0.014), with severe pain (OR=2.81; 95%CI=[1.20-6.60]; p=0.017), with mild depressive symptoms or depressive episode (OR=8.90; 95%CI=[3.71-21.32]; p&lt;0.001), with 2 or more chronic conditions (OR=13.25; 95%CI=[4.05-43.3]; p&lt;0.001) and with poor social support (OR=3.00; 95%CI=[1.08-8.34]; p=0.035). Predictors of visits to general practitioner were higher educational level, affiliation to advantage classes, more out of pocket payment for outpatients health care, and multimorbidity, while the highest odds of hospitalization had males, participants who had low level of education, who assessed their health as poor or very poor. This study confirmed that there are significant differences in health and health care utilization in elderly in Vojvodina, which need to be reduced by comprehensive public health policies and interventions.</p>

Génératrice depuis le VIe siècle de notre ère de crises épidémiques récurrentes en Occident, la peste a profondémentmarqué l’histoire des sociétés européennes, tant sur le plan biologique que culturel, économique et politique. Sil’histoire des épidémies qu’elle a engendrées est aujourd’hui relativement bien connue, un certain nombre de questionssur ses caractéristiques épidémiologiques passées demeurent pour partie irrésolues. En particulier, le caractère sélectifou non de la mortalité par peste à l’égard de l’âge, du sexe et de l’état de santé préexistant des individus faitactuellement débat. À partir d’une approche anthropobiologique, le présent travail se propose de contribuer à cettediscussion. Il livre les résultats de l’étude d’un corpus de 1090 squelettes provenant, d’une part, de quatre sitesd’inhumation de pestiférés de la fin du Moyen Âge et du début de l’époque moderne et, d’autre part, de deuxcimetières paroissiaux médiévaux utilisés hors contexte épidémique. Cette étude révèle en premier lieu l’existenced’une signature démographique commune aux séries en lien avec la peste. Leur composition par âge et par sexe,distincte de celle caractérisant la mortalité naturelle, est au contraire en adéquation avec la structure théorique d’unepopulation vivante préindustrielle. L’examen de divers indicateurs de stress suggèrent par ailleurs que les victimes dela peste jouissaient, à la veille de leur décès, d’un meilleur état de santé que les individus morts en temps normal. Lesrésultats obtenus concourent à démontrer que les facteurs causals de ces lésions squelettiques, d’accoutuméresponsables d’une diminution des chances de survie, n’eurent au contraire qu’une influence mineure, si ce n’est nulle,sur le risque de mourir de l’infection à Yersinia pestis. Ce travail livre in fine un faisceau d’arguments convergents quitendent à prouver que les épidémies de peste anciennes furent à l’origine d’une mortalité non sélective, la maladiefrappant indistinctement les individus des deux sexes, de tous âges et de toutes conditions sanitaires. / From the 6th century onwards, plague caused recurring mortality crises in the Western world. Such epidemics hadprofound biological, cultural, economic and political impacts on European societies. Some aspects of the history ofplague epidemics are currently well known, but many questions remain unanswered, such as the preciseepidemiological pattern of the disease in ancient times. It is unclear whether plague killed people indiscriminately orwhether this disease was selective with respect to age, sex and health. This research contributes to this debate.It consists of an anthropological and paleopathological study of skeletal remains of 1090 individuals, including plaguevictims from four medieval and post-medieval burial grounds, and individuals from two parochial cemeteries in useduring periods of normal mortality. Results from the four plague-related assemblages reveal a peculiar demographicsignature. Age and sex distribution differs clearly from what is expected in non-epidemic periods, when it is shown tocorrespond closely to the demographic structure of the living population. Moreover, the study of various non-specificskeletal stress markers shows that plague victims were in a better health before they passed away than people who diedin non-epidemic periods. The results demonstrate that individuals who suffered stress and disease had a reducedchance of survival in non-epidemic periods, whereas they were not at a higher risk to die during plague epidemics.This study provides evidence that plague was not selective, and that it killed regardless of sex, age, and pre-existing health.

This study has as an objective to compare and evaluate the living conditions of two immigrant children residing in different places in Sweden. Given that immigrants often are looked upon as a social and physical vulnerable group in relation to disadvantageous socioeconomic conditions the children's lives were analyzed in relation to four public health objects. By using Runkeeper, GIS, Equipop data, time geographic material, telephone conversations and a web survey the children lives are analyzed within their activity spaces. The children formed their lives in different socioeconomic environments and adapted their lives after their conditions. The perspective on individual level can be put in contrast with studies based on society level. In relation to this the lives of these two children are observed as deviant because they showed a good health status in social and physical aspects. Some theories and hypothesis could be verified and some of these could be falsified. Keywords: Activity spaces, immigrant, socioeconomic conditions, health status.

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.

Compared to males in almost any social group in all affluent nations, Australia's Aboriginal and Torres Strait Islander men suffer from substantially more serious illnesses and early death. To date, research done by or in collaboration with Indigenous communities has revealed the extent of the problems that arise from diabetes, heart disease, hypertension, cancers, respiratory diseases, psychological disorders, accidental injuries, violence and other causes. Reproductive health, however, rarely has been studied among Indigenous men. To date, research in this field has been limited mainly to studies of sexually transmitted infections. No data has been published on Aboriginal men's symptoms of prostate disease or erectile dysfunction, nor has the clinical screening and treatment of these disorders among these men been assessed. In-depth search of the worldwide web demonstrated that little information on these issues was available from other Indigenous populations. It does appear that Indigenous men in Australia, New Zealand and North America are less likely than European-ancestry men to die from prostate cancer, or for living cases to be recorded on cancer registries. This may arise because Indigenous men genuinely have a lower risk, or because they are not captured by official statistics, or because they do not live long enough to develop severe prostate disease. We also know very little about other reproductive health problems such as sexual dysfunction and specifically erectile difficulties. One reason for our scant knowledge is that research mainly relies on self-report of sensitive information. The aim of the research study was to improve the understanding of sexual and reproductive health problems experienced by Indigenous men. This is best gathered by Aboriginal males who are inside the culture of middleaged and older Indigenous men, but until now this has not been attempted. In this study we adopted the World Health Organization (WHO) definitions for Reproductive and Sexual Health (WHO, 2001). Thus, we consider reproductive system disorders (prostate disease, erectile dysfunction) and related health care-seeking, and also men's perceptions about a "satisfying and safe sexual life". The methodology was framed within an Aboriginal and Torres Strait Islander research protocol that advocates respect for cultural, social and community customs. A mixed method design combined qualitative inquiry (4 focus groups and 18 in-depth interviews) and quantitative survey (n=301) involving men living in remote, rural and urban communities (Tiwi Islands, Darwin and north and south-east Queensland). Survey data were compared to recently published self-reports from 5990 randomly selected men aged over 40 years in Australia (Holden et al., 2005, The Lancet, 366, 218-224. The qualitative interviews revealed that most men were silent about reproductive health. They were unwilling to reveal their inner feelings to wives or partners, and they were unwilling to discuss such issues with doctors and other health care workers. Men's reaction to sexual difficulties included shame, denial, substance abuse and occasionally violence. On a positive note many men said they want to learn about it, so they understand how to cope with such problems. The Indigenous men reported symptoms of erectile dysfunction at least as much as non-Indigenous men in other Australian studies. Bivariate analysis showed that erectile dysfunction was correlated with many health and lifestyle variable. However multivariate analysis revealed that only three factors significantly predicted ED: presence of chronic disease, presence of pain when working, and living in a remote geographic location The quantitative survey data indicate that Indigenous men have more symptoms of prostate disease than non-Indigenous men. The syndrome appears to be poorly managed in clinical practice (e.g. rates of PSA testing and digital-rectal examination are only one-third the rate reported by non-Aboriginal men, despite equivalent likelihood of GP visits). The research study adds to the literature by providing better insight and depth into the issues impacting on Aboriginal and Torres Strait Islander males experiencing reproductive and sexual health difficulties. It also provides a platform to undertake comprehensive research with Aboriginal and Torres Strait Islander men to explore a wider spectrum of questions in this important but neglected area. Implications for education of primary healthcare workers and community-based awareness campaigns for Indigenous males are discussed. Most of all, this study revealed "layers" of silence around sexual and reproductive health of Indigenous men. This includes silence in the scientific establishments in health services, and in the community. It is hoped that this study puts the voices of the men forward to help to break down this silence.