Made available in DSpace on 2014-07-29T15:29:19Z (GMT). No. of bitstreams: 1 RENATA.pdf: 841954 bytes, checksum: 22a19d48bb00070603bf3c14a16b8ab8 (MD5) Previous issue date: 2009-11-25 / OBJECTIVES: To compare the prevalence of shoulder-arm morbidity, quality of life (QOL) and satisfaction with surgical treatment in women submitted to quadrantectomy with those submitted to modified radical mastectomy (MRM) with immediate breast reconstruction (IBR). METHODS: A cross-sectional study was performed on women with breast cancer who had been submitted to quadrantectomy or to MRM+IBR with a transverse rectus abdominis myocutaneous (TRAM) flap, who had completed treatment at least six months previously. A total of 44 women submitted to quadrantectomy and 26 submitted to MRM+IBR were included in the study. RESULTS: Prevalence of lymphedema was 12% in the MRM+IBR group and 18% in the quadrantectomy group (OR: 0.51; 95%CI: 0.02-10.1; p=0.66). There was a greater prevalence of restricted inner shoulder rotation in the women submitted to quadrantectomy (OR: 7.23; 95%CI: 1.28-17.1; p=0.03). There was no difference in QOL scores or satisfaction with surgery. When the participants were questioned whether they would have opted for a different surgical technique, 25% of women in the MRM+IBR group and 12% in the quadrantectomy group reported that they would have made a different choice (adjusted analysis, OR: 7.4; 95%CI: 0.7- 73.3; p=0.09). CONCLUSIONS: The present findings suggest that the type of surgery does not affect the occurrence of lymphedema. Quadrantectomy increased the likelihood of restricted shoulder movement. In addition, the two surgical techniques evaluated were found to exert a similar effect on QOL and on the woman s satisfaction with surgery. / OBJETIVOS: Comparar a prevalência da morbidade no complexo ombro-braço, satisfação com o tratamento cirúrgico e a qualidade de vida (QV) de mulheres submetidas à quadrantectomia às daquelas submetidas à mastectomia radical modificada (MRM) com reconstrução imediata (RI) da mama. MÉTODOS: Conduziu-se um estudo de corte transversal incluindo mulheres com câncer de mama, que haviam se submetido à quadrantectomia ou à MRM+RI com retalho miocutâneo transverso do músculo reto abdominal, que apresentavam pelo menos seis meses de término do tratamento. Foram incluídas 44 mulheres submetidas à quadrantectomia e 26 à MRM+RI. RESULTADOS: A prevalência de linfedema foi de 12% no grupo de MRM+RI e 18% na quadrantectomia (OR: 0,51; IC 95%: 0,02-10,1; p=0,66). As mulheres submetidas à quadrantectomia apresentaram maior prevalência de restrição do movimento de rotação interna do ombro (OR: 7,23; IC 95%; 1,28-17,1; p=0,03). Não houve diferença nos escores de QV e da satisfação com a cirurgia. Quando as participantes foram questionadas se optariam por outra técnica cirúrgica, 25% no grupo de MRM+RI e 12% no grupo de quadrantectomia referiram que fariam uma escolha diferente (análise ajustada, OR: 7,4; IC 95%: 0,7-73,3; p=0,09). CONCLUSÕES: Nossos dados sugerem que o tipo de cirurgia não influenciou a ocorrência de linfedema. A quadrantectomia aumentou a chance de restrição do movimento do ombro. Observou-se ainda que a técnica cirúrgica apresentou impacto semelhante na QV e na satisfação da mulher com a cirurgia.

Introdução: No contexto do envelhecimento populacional, uma questão fundamental é avaliar se as estratégias de prevenção de doenças crônicas poderiam contribuir para o aumento dos anos vividos em boas condições de saúde, pela população idosa. Objetivo: Avaliar se a eliminação de determinadas doenças crônicas é capaz de levar à compressão da morbidade em indivíduos idosos. Métodos: Estudo transversal analítico, de base populacional, utilizando dados oficiais secundários para o Município de São Paulo, em 2000, e dados obtidos a partir do estudo SABE. O método de Sullivan foi utilizado para o cálculo de expectativas de vida livre de incapacidade (E.V.L.I.). O impacto da eliminação de uma doença na prevalência de incapacidade foi estimado com um modelo de regressão logística múltipla. Tábuas de vida de eliminação de causas foram utilizadas para calcular as probabilidades de morte com a eliminação de doenças. O efeito da eliminação das doenças crônicas foi avaliado, considerando a teoria de riscos competitivos e a abordagem proposta por Nusselder e colaboradores. Resultados: Os maiores ganhos em E.V.L.I., com a eliminação de doenças crônicas, ocorreram no sexo feminino, levando a um processo de compressão absoluta da morbidade. Nos indivíduos de idade mais avançada, os ganhos em E.V.L.I., ocorreram em função de um processo de compressão relativa da morbidade. Nos homens com idade de 75 anos, todas as doenças estudadas, com exceção da doença cardíaca e da hipertensão arterial sistêmica, levaram a um processo de expansão absoluta da morbidade, mas simultaneamente a um processo de compressão relativa da morbidade, ao serem eliminadas. A doença cardíaca apresentou-se como aquela que mais promoveria a compressão da morbidade, caso fosse eliminada, em ambos os sexos. Conclusão: A eliminação de doenças crônicas na população idosa poderia levar a uma compressão da morbidade em homens e mulheres, tanto na idade de 60 anos, quanto na de 75 anos / Introduction: In the context of the aging process, a key issue is to assess whether strategies to prevent chronic diseases may contribute to the increase in years lived in good health among elderly individuals. Objective: To evaluate whether elimination of certain chronic diseases can lead to the compression of morbidity, in the elderly. Methods: Analytical cross-sectional survey, based on official data for the city of São Paulo, in 2000, and data obtained from the SABE study. Sullivans method was used for the calculation of disability-free life expectancy (DFLE). Cause-deleted disability prevalence was estimated using multiple logistic regression model. Cause-deleted probabilities of dying were derived with the cause-elimination life-table technique, considering the independence of the causes of based on the approach proposed by Nusselder and co-workers. Results: The greatest gains in DFLE, with the elimination of chronic diseases, occurred in women, leading to a process of absolute compression of morbidity. Among individuals of a more advanced age, gains in DFLE occurred due to a relative compression of morbidity process. Among men aged 75 years, all diseases eliminated, except heart disease and hypertension, led to a process of absolute expansion of morbidity, but simultaneously, to a relative compression of morbidity. If eliminated, heart disease was the condition that would most lead to the compression of morbidity in both genders. Conclusion: The elimination of chronic diseases in the elderly population could lead to the compression of morbidity in men and women at both 60 years of age and in 75 years of age or older

Utilizou-se de um inquérito domiciliar de saúde, realizado em dois distritos administrativos de São Paulo (compreendendo uma população de 190 mil habitantes) em 2001, para se analisar o possível impacto do \"Programa de Saúde da Família\" (PSF) - QUALIS na morbidade referida e estilo de vida dos maiores de 14 anos. Utilizando-se de análise uni e multivariada, com diversas variáveis sócio-econômicas, mostrou-se que há diferenças na morbidade crônica entre as populações cobertas ou não pelo PSF. Esse fato deve-se, possivelmente, a um maior acesso à Atenção Primária por parte das populações cobertas por essa nova estratégia. Praticamente não houve diferenças em relação a estilo de vida. / A health survey, held in 2001 in two administrative districts of the city of Sao Paulo (inhabited by 190,000 people) was used to measure the impact of the \"Family Health Program\" - QUALIS in referred morbidity and lifestyle for those 15 and older. Through univariate and multivariate analysis, using several socioeconomic measures, we came to the conclusion that there are differences in chronicle morbidity between the populations attended or not by the program. It is so, possibly, due to a larger access to Primary Health System with this new strategy. There is basically no difference concerning lifestyle.

Desde o início do século passado, estudos na literatura médica documentaram uma significativa associação entre poluição atmosférica decorrente da emissão de combustíveis fósseis e morbimortalidade na raça humana, inclusive para níveis de poluentes no ar considerado como seguro para a saúde da população exposta. Na década de 70, durante a crise do petróleo o governo brasileiro implementou um programa chamado Proálcool com o objetivo de produzir um combustível alternativo, renovável, e não poluente: o etanol, derivado da cana-de-açúcar. Esse programa culminou com uma grande produção de veículos movidos a álcool a partir da década de 80, e um grande incremento da cultura da cana-de-açúcar na região central do Estado de São Paulo. Com a crescente utilização do álcool como combustível em veículos automotores houve uma melhora na qualidade do ar nos grandes centros urbanos. Existe, porém, o contraponto: a cana-de-açúcar é uma cultura agrícola singular, uma vez que, por razões de produtividade e de segurança, a colheita é realizada após a queima dos canaviais, o que gera uma grande quantidade de elemento particulado negro denominado "fuligem da cana". Esse material particulado modifica as características do meio ambiente nas regiões onde a cana-de-açúcar é cultivada, colhida e industrializada. A queima da biomassa é a maior fonte de emissão de material particulado e de gases tóxicos no planeta, e não havia na literatura médica qualquer trabalho, que relacionasse a poluição atmosférica em conseqüência da queima desse tipo especifico de biomassa, com a saúde humana. Esse estudo epidemiológico de séries temporais avalia a associação entre o material particulado coletado durante a queima de plantações de cana-de-açúcar e um indicador de morbidade respiratória em Araraquara (SP). Entre 26 de maio e 31 de agosto de 1995, o número diário de pacientes que necessitaram inalações em um dos principais hospitais da cidade foi quantificado, e utilizado para estimar a morbidade respiratória. Para estimar o nível da poluição do ar foi quantificado diariamente o peso do sedimento do material particulado proveniente da fuligem da cana-de-açúcar, obtido por sedimentação simples, em dois pontos da cidade, um localizado no centro e o segundo na zona rural. A associação entre o peso do sedimento e o número de pacientes que necessitaram de terapia inalatória, foi avaliada pelo modelo aditivo generalizado da regressão de Poisson com controle para sazonalidade, temperatura e dias da semana. Encontrou-se uma associação positiva significante e dose dependente entre o número de terapia inalatória e o peso do sedimento. Um aumento de 10 mg no peso do sedimento está associado a um risco relativo de terapêutica inalatória de 1,09 (1-1,19). Nos dias mais poluídos o risco relativo de terapêutica inalatória é de 1,20 (1,03-1,39). Esses resultados indicam que a queima das plantações da cana-de-açúcar pode causar efeitos deletérios à saúde da população exposta. / This times series epidemiological study was designed to evaluate the association between particulate matter collected during sugar cane plantation burning and an indicator of morbidity respiratory in Araraquara, São Paulo State, Brazil. From May 26th to August 31st, 1995, the daily number of patients that received inhalation therapy in one of the main hospitals of the city was recorded and used as a morbidity respiratory estimation. In order to estimate air pollution levels the daily sediment weight from sugar cane particulate matter was measured after collected by simple sedimentation process, in two strategic points of the city: one in a central area and the other in a peripheral area. The association between the sediment weight and the number of patients who received inhalation therapy was evaluated by means of generalized additive Poisson regression models controlled for seasonality, temperature and days of the week. A positive significant and dose-dependent relationship was found between the number of inhalation therapy and the sediment weight. The relative risk of inhalation therapy associated with an increase of 10 mg in the sediment weight was 1.09 (1 - 1.19), and the relative risk of an inhalation therapy was 1.20 (1.03 -1.39) in the most polluted days. These results indicate that sugar cane plantations burning may cause deleterious health effects in the exposed population.

Foram analisados os resultados retrospectivos do transplante de medula óssea alogênico em 100 pacientes portadores de leucemia mielóide crônica, divididos em dois grupos: Grupo I, de 49 pacientes que recebeu alta hospitalar após a pega medular, e grupo II, de 51 pacientes, que recebeu alta precocemente, antes da pega medular, para acompanhamento ambulatorial. Foram comparados os dias de ocupação de leitos hospitalares, a morbidade e a mortalidade entre os grupos de alta até o dia 100 pós transplante. Verificou-se que, no grupo de alta precoce, houve, significativamente, menos dias de ocupação de leitos hospitalares, sem aumento da morbidade e da mortalidade / We analyzed the results of a retrospective study of 100 patients with chronic myelogenous leukemia submitted to allogeneic stem cell transplantation in one of two settings: Group I, with 49 patients, transplanted in the traditional inpatient and group II, with 51 patients, in partial outpatient. We compared the median number of days spent in hospital, morbidity and mortality within 100 after bone marrow transplantation. We concluded that there was a significant reduction in the median of hospital length of stay in the partial outpatient group, without increasing morbidity and mortality

Abstract Morbid obesity is the most rapidly increasing health threat of developed countries, and the costs caused by it are already higher than those of smoking. In an increasing number of developing countries both starvation and morbid obesity are increasing simultaneously. Obesity in children and adolescents is also increasing rapidly. Conservative treatment almost invariably fails when treating morbid obesity. Results of pharmacotherapy have been disappointing after great expectations. Laparoscopic gastric banding has been used in the treatment of morbid obesity since 1993. The method was first used mostly in Europe. In the USA either an open or laparoscopic gastric bypass have been the most common methods of surgery. The aim of this study was to investigate the operation results of 280 patients operated in Vaasa Central Hospital during the 11 years after March 1996. Of these patients, 123 have been followed at least 5 years. The results have been analyzed with BAROS that measures the quality of life. Quality of life was measured prospectively 1 year after surgery with the 15D questionnaire that is validated in the Finnish population. The effect of gastric banding in esophageal motility and reflux was studied prospectively in 31 patients. Late results were analyzed in 123 patients 11 years after the first operation. Mean excess weight loss (EWL) was 56% in patients who had their band in place 7 years after surgery, and 46% in all patients. There was no mortality related to the operation, and there was only one serious complication. Disease-specific quality of life improved in 78.8% of the patients in 28 months of follow-up. Health-related quality of life was significantly improved 12 months after surgery, but improvement was not connected to the amount of weight loss. The band inhibited reflux 19 months after surgery. Complications, failures, and reoperations increase with longer follow-up. Weight loss is moderate 9 years after a gastric banding operation, and in carefully selected patients this operation is still a good option in the treatment of morbid obesity.

Cette thèse se donne pour objectif de contribuer à la compréhension des tendances démographiques en Afrique subsaharienne par l’examen de l’influence de la mortalité infantile sur les comportements de fécondité. Dans le premier chapitre, j’examine la relation entre mortalité infantile et fécondité à l’échelle micro-économique. Des modèles de données de comptage sont utilisés pour analyser les déterminants de la fécondité complète de femmes d’une communauté rurale sénégalaise. Je montre que l’effet global de la mortalité infantile est positif tant sur la fécondité totale que sur la fécondité nette. De plus, j’identifie une relation en U inversé entre mortalité infantile et fécondité nette. Dans le second chapitre, j’analyse les effets de la mortalité infantile sur les comportements reproductifs dans un modèle de fécondité endogène où la survie infantile est stochastique. J’adopte une forme fonctionnelle de coût des enfants englobant quatre scénarios différents, chacun représentant un contexte socio-économique distinct. Mon modèle peut prédire des réponses positives et négatives de la fécondité, selon que les enfants sont respectivement “intensifs en temps” ou “pourvoyeurs en temps”. Finalement, le troisième chapitre analyse les effets de la mortalité et de la morbidité infantiles sur le processus de décision de fécondité des femmes rurales sénégalaises. J’estime des modèles dynamiques non linéaires de données de panel. Je montre que la mortalité et la morbidité palustres à l’échelle de la communauté, ont un effet positif sur les décisions ultérieures de fécondité. Cet effet est d’autant plus fort que la maladie est létale pour les enfants infectés. / This dissertation attempts to contribute to the understanding of current demographic trends in sub-Saharan Africa by examining the role of child mortality in shaping fertility behavior. In the first chapter of this dissertation, I examine the relationship between child mortality and fertility at the micro level. Count data models are employed to investigate the determinants of completed fertility of women from a Senegalese rural community. The global effect of child mortality on total and net fertility is found to be positive. I also identify an inverted-U shaped relationship between child mortality and net fertility. In the second chapter of this dissertation, I analyze the effects of child mortality changes on fertility behaviors in an endogenous fertility model where child survival is stochastic. I adopt a functional form for the cost of children that allows for four different scenarios, each of which is representative of a particular socio-economic setting. My model can predict both positive and negative fertility responses to child mortality depending on whether children are “time-intensive” or “time-supplying”, respectively. Finally, the third chapter analyzes the effects of childhood mortality and morbidity on the fertility decision-making process among rural Senegalese women. I estimate nonlinear dynamic panel data models of fertility behavior. I find that community child mortality and morbidity attributable to malaria exert a joint influence on fertility behaviors. Community-level malaria incidence among children has a positive effect on subsequent fertility choices, and this positive effect is stronger the more the disease is fatal to children who are infected.

É reconhecida a importância da atividade física e do estilo de vida na prevenção das doenças cardiovasculares. Programas corporativos de condicionamento físico têm sido utilizados por empresas na tentativa de melhorar a saúde de seus funcionários. O objetivo deste trabalho foi verificar se existe relação entre atividade física e morbidade cardiovascular referidas por gerentes e diretores de uma indústria automobilística. Como objetivos secundários avaliar a associação entre atividade física e outras variáveis relacionadas com o estilo de vida, com a utilização de serviços de saúde, absenteísmo e presenteísmo. Por último, avaliar se a participação em um programa de condicionamento físico supervisionado influenciou a atividade física habitual dessa população. Para tanto, foram estudados 376 indivíduos ativos ou inativos, participantes ou não do programa de condicionamento físico. A atividade física habitual, que foi avaliada por meio do Escore de Baecke, e outras variáveis relacionadas com o estilo de vida, como consumo alimentar de gorduras, frutas e vegetais, hábito de fumar e consumo de bebidas alcoólicas foram levantadas por meio de questionário. O escore de atividade física apresentou associação negativa tanto com relação ao absenteísmo como quanto em relação ao indivíduo que executa trabalho quando doente. Não houve associação estatisticamente significativa com morbidade cardiovascular referida, procura por atendimento médico e presenteísmo. Os indivíduos que relataram morbidade cardiovascular apresentam média de idade mais alta e índice de massa corpórea mais elevada. O presenteísmo se associou positivamente com o maior consumo de frutas e vegetais . E o inverso foi observado nos indivíduos com maior absenteísmo, que consumiram menor quantidade de frutas e vegetais. Verificou-se que os participantes regulares do programa de condicionamento físico supervisionado, por um lado, apresentaram escore mais elevado de atividade física, e por outro referiram maior proporção de morbidade cardiovascular. Esta última característica também foi observada entre os que procuraram e participaram do programa mas não foram aderentes. / There is no doubt that the fitness activity together with a sound life style has a strong impact on preventing cardiovascular diseases. Corporate fitness programs have been utilized by most companies in an attempt to improve the overall health of their employees. The primary objective of this study was to verify if there is any relation between physical activity and cardiovascular morbidity as referred by a group of managers and directors of automotive industry. As a secondary objective we intended to evaluate the relationship between physical activity and other variants directly related to some issues, such as life style, utilization of health services, absenteeism and presenteeism. At last, evaluate if the attendance to a under supervision physical activity program has influenced the habitual physical activity of this mentioned population. In order to accomplish that, we have studied 376 individuals, actives or not, attending or not to a physical activity program. The habitual physical activity, which has been evaluated by the \"Escore de Baecke\" and some other variants related to life style, such as intake of fat, fruits and vegetables, smoking habits as well as alcohol intake. These data have collected by the application of a questionnaire. The physical activity score has shown a negative association either with regards to absenteeism or with regards to the individual who performs his or her job when sick. There has not been any significant statistic association among the referred cardiovascular morbidity, search for medical assistance and presenteeism. The individuals who reported cardiovascular morbidity showed a higher age average and also higher body mass. The presenteeism was positively associated with the higher intake of fruits and vegetables. And the opposite was also observed in individuals with higher absenteeism with a less intake of fruits and vegetables. It was also observed that the regular attendees of under supervision physical activity program, at one side, show higher physical activity score and by the other side showed a higher proportion of cardiovascular morbidity. This last characteristic was also observed among those individuals who looked for and participated in a physical activity program but did not have the opportunity to attend it.

<p>Kvalitet vazduha u urbanim sredinama predstavlja jedan od glavnih uzroka zdravstvenih problema. Prema podacima SZO u svetu se godi&scaron;nje usled zagađenja vazduha u urbanim sredinama dogodi preko 2,7 miliona smrtnih slučajeva. Procenjuje se da najbolji indikator za procenu veličine zdravstvenog rizika od zagađenja vazduha jeste koncentracija suspendovanih čestica PM2,5 u vazduhu životne sredine. Cilj: Proceniti uticaj suspendovanih čestica PM2,5 iz vazduha životne sredine na ukupan mortalitet, kardiovaskularni i respiratorni bolnički morbiditet odraslog stanovni&scaron;tva Grada Novog Sada. Takođe, cilj istraživanja je bio da se i utvrdi koncentracija i hemijski sastav suspendovanih čestica PM2,5 u vazduhu životne sredine na teritoriji Grada Novog Sada, na dnevnom i godi&scaron;njem nivou, uzimajući u obzir i uticaj meteorolo&scaron;kih parametara. Metod: Istraživanje je sprovedeno kao prospektivna studija vremenske serije podataka o kvalitetu vazduha, meteorolo&scaron;kim parametrima i zdravstvenim ishodima, u intervalima od najmanje 30 dana tokom sva četiri godi&scaron;nja doba 2017. godine. Uzorkovanje i određivanje koncentracije i hemijskog sastava čestica PM2,5 u skladu sa propisanim standardnim metodama, je obavljeno na mernim mestima u životnoj sredini Grada Novog Sada, koja reprezentuju uticaj saobraćaja i urbanog pozadinskog područja na zagađenje vazduha životne sredine. Primenjen je Lenschow pristup za kvantifikaciju veličine doprinosa saobraćaja porastu koncentracije suspendovanih čestica PM2,5 u vazduhu životne sredine. Podaci o meteorolo&scaron;kim parametrima (temperatura vazduha, relativna vlažnost vazduha i brzina vetra), su preuzeti od Republičkog hidrometeorolo&scaron;kog zavoda Srbije. Podaci o zdravstvenim ishodima (dnevni broj umrlih i hospitalizovanih zbog kardiovaskularnih i respiratornih bolesti), za stanovni&scaron;tvo starije od 18 godina, čije mesto stanovanja pripada teritoriji Grada Novog Sada, obezbeđeni su od strane Centra za informatiku i biostatistiku u zdravstvu Instituta za javno zdravlje Vojvodine. Za procenu uticaja nezavisnih promenljivih na zavisne (ukupan mortalitet / bolnički morbiditet) primenjen je generalizovani linearni model regresione analize za vremenske serije podataka (Poason). Rezultati: Prosečna godi&scaron;nja koncentracija suspendovanih čestica PM2,5 iz vazduha životne sredine na teritoriji Grada Novog Sada je iznosila 30,27 &mu;g/m3, a srednje dnevne koncentracije 8-79&nbsp; g/m3. Približno 30% varijabilnosti srednjih dnevnih koncentracije suspendovanih čestica PM2,5 se može objasniti lokalnim meteorolo&scaron;kim uslovima. Hemijski sastav čestica na području Grada Novog Sada u najvećem procentu čini ekvivalent karbonatne frakcije čestica, zatim sekundarni neorganski aerosol i rastvorljiva organska frakcija, dok su joni rastvorljivi u vodi (kalcijum, hloridi, natrijum, kalijum i magnezijum) zastupljeni u najmanjem procentu. Prisutni izvori zagađenja vazduha životne sredine na području Grada Novog Sada su procesi sagorevanja fosilnih goriva i biomase, saobraćaj, mineralna (zemlji&scaron;na) pra&scaron;ina i sekundarno zagađenje regionalnog porekla. Doprinos saobraćaja porastu prosečne godi&scaron;nje koncentracije suspendovanih čestica PM2,5 je iznosio 40%. Masena koncentracija čestica PM2,5, kao i hemijski sastav čestica (ekvivalent karbonatne frakcije, rastvorljiva organska frakcija, joni kalijuma i kalcijuma) doprinose umiranju i oboljevanju odraslog stanovni&scaron;tva Grada Novog Sada. Na uticaj masene koncentracije i hemijskog sastava čestica PM2,5 najosetljivije su žene i stanovni&scaron;tvo starosti &ge; 65 godina, kao i mu&scaron;karci u pogledu uticaja ekvivalenta karbonatne frakcije čestica PM2,5. Zaključak: Dobijeni rezultati po prvi put opisuju zdravstveni uticaj masene koncentracije i hemijskog sastava čestica PM2,5 na području Grada Novog Sada, odnosno kvantifikuju rizik za ukupan mortalilteta i kardiovaskualrni i respiratorni morbiditet. Razumevanje uticaja suspendovanih čestica PM2,5 na oboljevanje i umiranje stanovni&scaron;tva, stratifikovanih prema starosnoj i polnoj strukturi, uz identifikaciju mogućih izvora zađenja vazduha na području Grada Novog Sada, predstavlja osnovu za razvoj javnozdravstvene politike u cilju unapređenja zdravlja stanovni&scaron;tva Grada Novog Sada.</p> / <p>Urban ambient air pollution is one of the leading causes of health problems. According to WHO data, over 2.7 million deaths occur in urban areas annually due to urban air pollution. Particulate matter PM2.5 is estimated to be the best indicator for assessing the magnitude of the health risk induces by ambient air pollution. Aim: To assess the impact of PM2.5 on total mortality, cardiovascular and respiratory hospital morbidity of the adult population of the City of Novi Sad. Also, the aim of the study was to determine the concentration and chemical composition of ambient PM 2.5 particles in the territory of the City of Novi Sad, on daily and annual bases, taking into account the impact of meteorological parameters. Method: The study was conducted as a prospective, a time series study of of data on air quality, meteorological parameters and health outcomes, at intervals of at least 30 days during all four seasons of 2017. Sampling and determination of the mass concentration and chemical composition of PM2.5 particles in accordance with the prescribed standard methods, it was performed at sampling stations in the City of Novi Sad, representing the impact of traffic and urban background impact on environmental air pollution. A Lenschow approach was used to quantify the magnitude of traffic contribution to the increase of ambient PM2.5 mass concentration. Meteorological data (air temperature, relative humidity and wind velocity) were taken from the Republic Hydrometeorological Institute of Serbia. Data on health outcomes (daily number of deaths and hospitalizations due to cardiovascular and respiratory diseases) for the population older than 18, residing within the territory of the City of Novi Sad, have been provided by the Centre for Informatics and Biostatistics, Institute of Public Health of Vojvodina. To evaluate the impact of independent variables on dependent (total mortality/hospital morbidity), a generalized linear regression model for time series data (Poisson) was applied. Results: The average annual mass concentration of PM2.5 in the territory of the City of Novi Sad was 30.27&mu;g/m3, while mean daily concentrations were 8- 79&mu;g/m3. Approximately 30% of the variability in mean daily concentrations of PM2.5 particles can be explained with local meteorological conditions. The chemical composition of PM2.5 in the area of Novi Sad is to the a great extent the equivalent of the carbonate fraction of the particles, then the secondary inorganic aerosol and the soluble organic fraction, while the water-soluble ions (calcium, chlorides, sodium, potassium and magnesium) are present in the lowest percentage. The sources of ambient air pollution in the area of the City of Novi Sad were the combustion of fossil fuels and biomass, traffic, mineral (soil dust) and secondary pollution of regional origin. Contribution of traffic to the increase of the average annual mass concentrations of PM2.5 particles was 40%. PM2.5 particle mass concentration, as well as the chemical composition of the particles (carbonate fraction equivalent, soluble organic fraction, potassium and calcium ions) contribute to the deaths and diseases of the adult population of the City of Novi Sad. Women and the population aged &ge;65, were more susceptible to mass concentration and chemical composition of PM2.5 related deaths and diseases, as well as men according to the impact of the equivalents of carbonate fractions of PM2.5. Conclusion: The results obtained show for the first time the health effects of mass concentration and chemical composition of PM2.5 particles in the City of Novi Sad, i.e. they quantify the risk for total mortality and cardiovascular and respiratory morbidity. Understanding the impact of suspended particles PM2.5 on population mortality and morbidity, stratified by age and sex structure, along with identifying of possible air pollution sources is the basis for the development of public health policies aimed at improving the population health in the City of Novi Sad.</p>

Contexte. Les premières années de vie apparaissent particulièrement propices au développement de la sensibilisation allergénique. Objectifs. Cette thèse vise à : i) décrire les profils de sensibilisation allergénique chez le nourrisson et l’enfant, ii) étudier l’association entre ces profils et la morbidité allergique et iii) identifier les facteurs de risque de cette sensibilisation. Méthodes. Dans le cadre du suivi de la cohorte prospective de naissances en population générale Pollution and Asthma Risk: an Infant Study (PARIS), la sensibilisation allergénique a été évaluée chez 1 860 nourrissons à 18 mois et 1 007 enfants à 8/9 ans par dosage des IgE spécifiques dirigées contre 16 et 19 allergènes, respectivement. Les informations concernant la santé et le cadre de vie des enfants ont été recueillies par questionnaires standardisés répétés. Des profils de sensibilisation et des profils de morbidité ont été identifiés par classification non supervisée et mis en relation par régression logistique multinomiale. Enfin, les facteurs associés à la sensibilisation allergénique chez le nourrisson ont été étudiés par régression logistique multivariée. Résultats. Dès 18 mois, 13,8% des enfants étaient sensibilisés et 6,2%, multi-sensibilisés. À 8/9 ans, ces prévalences étaient de 34,5% et 19,8%, respectivement. Les profils de sensibilisation identifiés chez le nourrisson (3) et dans l’enfance (5) différaient au regard de la morbidité allergique. L’analyse étiologique a permis de préciser le rôle des expositions précoces aux allergènes et aux microorganismes sur la sensibilisation allergénique. Conclusion. Cette thèse contribue à une meilleure compréhension de l’histoire naturelle de la sensibilisation allergénique, et ce, dès les premières années de vie. Cette connaissance est essentielle à la prévention des maladies allergiques qui en découlent. / Background. The first years of life appear to be critical for the development of allergic sensitization. Objectives. This thesis aims: i) to describe allergic sensitization profiles in infants and children, ii) to assess the link between these sensitization profiles and allergic morbidity, and iii) to identify risk factors for allergic sensitization. Methods. This work concerns children involved in the Pollution and Asthma Risk: an Infant Study (PARIS) population-based prospective birth cohort. Allergic sensitization was assessed in 1,860 18-month-old infants and 1,007 8/9-year-old children by specific IgE measurements towards 16 and 19 allergens, respectively. Lifelong health and living condition data were collected by repeated standardized questionnaires. Sensitization profiles and morbidity profiles were identified using unsupervised classification, and related to each other by multinomial logistic regression. Finally, risk factors for early allergic sensitization were assessed by multivariate logistic regression. Results. As soon as 18 months of age, 13.8% of children were sensitized and 6.2%, multi-sensitized. When 8/9 years old, corresponding prevalence was 34.5% and 19.8%, respectively. Sensitization profiles identified in infancy (3) and in childhood (5) differed in terms of allergic morbidity. Risk factor analysis allowed to clarify the role of early exposure to allergens and microorganisms on allergic sensitization. Conclusion. This thesis improves the natural history of allergic sensitization understanding, as soon as the first years of life. This knowledge is essential for subsequent disease preventing.