In Healthy People 2010, mental health is listed as a major public health concern as evidenced by an alarming increase in the number of individuals who suffer from mental disorders. Mental disorders are a treatable public health condition. However, health disparities in the treatment of mental disorders are evident. The purpose of this study was to examine factors that affected health outcomes of persons with mental disorders. Two specific aims were addressed: Aim 1: to examine the relationships of population characteristics (predisposing factors and enabling resources), health behaviors (health services use and health practice); and health outcomes (physical health status and mental health status); Aim 2: to determine the differences in the usual source of care and health outcomes between individuals with self-reported mental disorders and individuals without mental disorders. This study was a secondary analysis of existing data collected from 2006 Medical Expenditure Panel Survey Household Component Consolidated file. A sample of U.S. civilian non-institutionalized adults (N=622) was grouped according to three self-reported health conditions: mental disorders (MD), physical illnesses (PI) and co-morbid mental disorders and physical illnesses (CM). This sample was predominantly male, White non-Hispanic and married; had a high school diploma, middle to high income, and private insurance; and preferred office-based clinics as the usual source of care, F(2,29)=5.94, p = .007. No statistically significant differences between groups in usual source of care (p=.069) and physical health status (p=.490) but there was a significant difference in mental health status (p=.001). Participants with CM had a poorer mental health status than those with PI and MD, F (2,619) =21.8, p= .000. The mental health status of individuals with PI was significantly better than that of participants with MD. Awareness of disparities in the usual source of care, health services use, and health outcomes among individuals with mental health conditions is imperative if barriers to care are to be eliminated. Innovative interventions pertinent to decreasing barriers to accessing health care and improving the health outcomes among individuals with MD must be tested. Advocating for mental health care policies that reduce health care services disparities among individuals with self-reported MD must be encouraged.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O Brasil é um dos maiores consumidores per capita de açúcar e estudos têm mostrado um papel específico do consumo excessivo de açúcar no ganho de peso. Com o aumento do ganho de peso observado em vários países, e também no Brasil, é importante testar quais mensagens, estratégias e propostas de intervenção seriam eficazes na prevenção dessa epidemia. Os dados reportados são referentes a um ensaio randomizado por conglomerado, controlado, conduzido em 20 escolas municipais na cidade metropolitana de Niterói no Estado de Rio de Janeiro, de março a dezembro de 2007, que testou a eficácia de orientações para merendeiras objetivando reduzir a disponibilidade de açúcar e de alimentos fontes de açúcar na alimentação escolar e no consumo delas. A intervenção consistiu em um programa de educação nutricional nas escolas usando mensagens, atividades e material educativo que encorajassem a redução da adição de açúcar na alimentação escolar pelas merendeiras e no consumo delas. A redução da disponibilidade per capita de açúcar pelas escolas foi analisada através de planilhas com dados da utilização dos itens do estoque. O consumo individual das merendeiras foi avaliado através de questionário de freqüência de consumo alimentar. As medidas antropométricas e bioquímicas foram realizadas de acordo com técnicas padronizadas. As escolas de intervenção apresentaram maior redução da disponibilidade per capita de açúcar quando comparadas às escolas controle (-6,0 kg vs. 3,4 kg), mas sem diferença estatisticamente significante. Houve redução no consumo de doces e bebidas açucaradas nas merendeiras dos dois grupos, mas o consumo de açúcar não apresentou diferenças estatisticamente significativas entre eles. Houve redução do consumo de energia total nos dois grupos, mas sem diferença entre eles, e sem modificação dos percentuais de adequação dos macronutrientes em relação ao consumo de energia. Ao final do estudo somente as merendeiras do grupo de intervenção conseguiram manter a perda de peso, porém sem diferença estatisticamente significante. A estratégia de redução da disponibilidade e do consumo de açúcar por merendeiras de escolas públicas não atingiu o principal objetivo de redução de adição de açúcar. Uma análise secundária dos dados avaliou a associação entre a auto-percepção da saúde e da qualidade da alimentação com o excesso de peso e concentração elevada de colesterol sérico das merendeiras na linha de base. As perguntas de auto-percepção foram coletadas por entrevista. Dentre as que consideraram a sua alimentação como saudável, 40% apresentavam colesterol elevado e 61% apresentavam excesso de peso vs. 68% e 74%, respectivamente, para as que consideraram a sua alimentação como não-saudável. Dentre as que consideraram a sua saúde como boa, 41% apresentavam colesterol elevado e 59% apresentavam excesso de peso vs. 71% e 81%, respectivamente, para as que consideraram a sua saúde como ruim. A maioria das mulheres que relatou ter alimentação saudável apresentou maior frequência de consumo de frutas, verduras e legumes, feijão, leite e derivados e menor freqüência de consumo de refrigerante. Conclui-se que perguntas únicas e simples como as utilizadas para a auto-avaliação da saúde podem também ter importância na avaliação da alimentação. / Brazil is one of the largest per capita consumers of sugar and several studies have shown a specific role of excessive consumption of sugar on weight gain. With the increased weight gain observed in several countries, including Brazil, it is important to test which messages, strategies and proposals for intervention would be effective in preventing this epidemic. The data reported are for an intervention study that tested the efficacy of guidelines for school lunch cooks aiming to reduce the added sugar in schools meals and their sugar intake. A cluster randomized controlled trial was carried out in twenty public schools in the metropolitan city of Niterói in Rio de Janeiro, Brazil, from March to December 2007, to assess the change in the availability and consumption of sugar. The intervention consisted of a nutrition educational program in schools using messages, activities and printed educational materials that encouraged the reduction of added sugar in the schools meals by the school lunch cooks and in their consumption. The reduction in per capita sugar availability by the schools was examined through spreadsheets with data from the use of inventory items. Individual food intake of the school lunch cooks was evaluated by a Food Frequency Questionnaire. Anthropometric and biochemical measurements were performed according to standard techniques and the variation in weight change was measured throughout the study. Per capita sugar availability reduced most markedly in the intervention schools compared to the control schools (-6,0 kg vs. 3,4 kg), however this difference was not statistically significant. Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages, but the difference in sugar intake was not statistically significant. A reduction in total energy consumption was observed in both groups, but there was no difference between them. Also, there was no difference in the percentage of adequacy of nutrients in relation to energy consumption. Sweetened beverages presented the most important consumption reduction. At the end of the study, only school lunch cooks in the intervention group were able to maintain weight loss, but not statistically significant. The strategy of reducing the availability and consumption of sugar by the school lunch cooks from public schools did not achieve the main goal of reducing added sugar. A secondary analysis examined the association between self-perceived health status and diet quality with overweight and high serum cholesterol concentration of the school lunch cooks at baseline. The self-perception questions were collected by interview. Among women who reported healthy diet, 40% presented high serum cholesterol and 61% were overweight. Among women who reported unhealthy diet, 68% presented high serum cholesterol and 74% presented overweight. Most women who reported healthy diet showed a higher frequency of consumption of sweets, fruits, vegetables, beans, dairy products and lower frequency of consumption of soft drink. In conclusion, single and simple questions, such as those used for self-perceived health status may also be important in assessing the diet.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O Brasil é um dos maiores consumidores per capita de açúcar e estudos têm mostrado um papel específico do consumo excessivo de açúcar no ganho de peso. Com o aumento do ganho de peso observado em vários países, e também no Brasil, é importante testar quais mensagens, estratégias e propostas de intervenção seriam eficazes na prevenção dessa epidemia. Os dados reportados são referentes a um ensaio randomizado por conglomerado, controlado, conduzido em 20 escolas municipais na cidade metropolitana de Niterói no Estado de Rio de Janeiro, de março a dezembro de 2007, que testou a eficácia de orientações para merendeiras objetivando reduzir a disponibilidade de açúcar e de alimentos fontes de açúcar na alimentação escolar e no consumo delas. A intervenção consistiu em um programa de educação nutricional nas escolas usando mensagens, atividades e material educativo que encorajassem a redução da adição de açúcar na alimentação escolar pelas merendeiras e no consumo delas. A redução da disponibilidade per capita de açúcar pelas escolas foi analisada através de planilhas com dados da utilização dos itens do estoque. O consumo individual das merendeiras foi avaliado através de questionário de freqüência de consumo alimentar. As medidas antropométricas e bioquímicas foram realizadas de acordo com técnicas padronizadas. As escolas de intervenção apresentaram maior redução da disponibilidade per capita de açúcar quando comparadas às escolas controle (-6,0 kg vs. 3,4 kg), mas sem diferença estatisticamente significante. Houve redução no consumo de doces e bebidas açucaradas nas merendeiras dos dois grupos, mas o consumo de açúcar não apresentou diferenças estatisticamente significativas entre eles. Houve redução do consumo de energia total nos dois grupos, mas sem diferença entre eles, e sem modificação dos percentuais de adequação dos macronutrientes em relação ao consumo de energia. Ao final do estudo somente as merendeiras do grupo de intervenção conseguiram manter a perda de peso, porém sem diferença estatisticamente significante. A estratégia de redução da disponibilidade e do consumo de açúcar por merendeiras de escolas públicas não atingiu o principal objetivo de redução de adição de açúcar. Uma análise secundária dos dados avaliou a associação entre a auto-percepção da saúde e da qualidade da alimentação com o excesso de peso e concentração elevada de colesterol sérico das merendeiras na linha de base. As perguntas de auto-percepção foram coletadas por entrevista. Dentre as que consideraram a sua alimentação como saudável, 40% apresentavam colesterol elevado e 61% apresentavam excesso de peso vs. 68% e 74%, respectivamente, para as que consideraram a sua alimentação como não-saudável. Dentre as que consideraram a sua saúde como boa, 41% apresentavam colesterol elevado e 59% apresentavam excesso de peso vs. 71% e 81%, respectivamente, para as que consideraram a sua saúde como ruim. A maioria das mulheres que relatou ter alimentação saudável apresentou maior frequência de consumo de frutas, verduras e legumes, feijão, leite e derivados e menor freqüência de consumo de refrigerante. Conclui-se que perguntas únicas e simples como as utilizadas para a auto-avaliação da saúde podem também ter importância na avaliação da alimentação. / Brazil is one of the largest per capita consumers of sugar and several studies have shown a specific role of excessive consumption of sugar on weight gain. With the increased weight gain observed in several countries, including Brazil, it is important to test which messages, strategies and proposals for intervention would be effective in preventing this epidemic. The data reported are for an intervention study that tested the efficacy of guidelines for school lunch cooks aiming to reduce the added sugar in schools meals and their sugar intake. A cluster randomized controlled trial was carried out in twenty public schools in the metropolitan city of Niterói in Rio de Janeiro, Brazil, from March to December 2007, to assess the change in the availability and consumption of sugar. The intervention consisted of a nutrition educational program in schools using messages, activities and printed educational materials that encouraged the reduction of added sugar in the schools meals by the school lunch cooks and in their consumption. The reduction in per capita sugar availability by the schools was examined through spreadsheets with data from the use of inventory items. Individual food intake of the school lunch cooks was evaluated by a Food Frequency Questionnaire. Anthropometric and biochemical measurements were performed according to standard techniques and the variation in weight change was measured throughout the study. Per capita sugar availability reduced most markedly in the intervention schools compared to the control schools (-6,0 kg vs. 3,4 kg), however this difference was not statistically significant. Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages, but the difference in sugar intake was not statistically significant. A reduction in total energy consumption was observed in both groups, but there was no difference between them. Also, there was no difference in the percentage of adequacy of nutrients in relation to energy consumption. Sweetened beverages presented the most important consumption reduction. At the end of the study, only school lunch cooks in the intervention group were able to maintain weight loss, but not statistically significant. The strategy of reducing the availability and consumption of sugar by the school lunch cooks from public schools did not achieve the main goal of reducing added sugar. A secondary analysis examined the association between self-perceived health status and diet quality with overweight and high serum cholesterol concentration of the school lunch cooks at baseline. The self-perception questions were collected by interview. Among women who reported healthy diet, 40% presented high serum cholesterol and 61% were overweight. Among women who reported unhealthy diet, 68% presented high serum cholesterol and 74% presented overweight. Most women who reported healthy diet showed a higher frequency of consumption of sweets, fruits, vegetables, beans, dairy products and lower frequency of consumption of soft drink. In conclusion, single and simple questions, such as those used for self-perceived health status may also be important in assessing the diet.

本研究旨在探討老年人寂寞及其相關因素模式。主要目的為：一、編擬老年人寂寞量表，以測量老年人寂寞。二、瞭解我國老年人的寂寞現況並比較不同背景變項之老年人在寂寞上的差異情形。三、建立人格特質（神經質與外向性）、自覺健康狀況、社會關係數量、社會供應（情緒共同感、價值肯定、社會共同感）與寂寞（情緒性寂寞與社會性寂寞）之間的結構方程模式，以瞭解變項之間的路徑關係。 為逹以上目的，本研究採用問卷調查法，以702位老年人為研究對象，施以「人格特質量表」、「社會關係量表」、「自覺健康狀況量表」，修訂之「社會供應量表」、自編之「老年人寂寞量表」等量表，並以描述性統計分析、t考驗、單因子變異數分析、結構方程模式進行統計分析。研究發現：1.老年人寂寞量表經因素分析，可區分為情緒性寂寞與社會性寂寞。2.我國老年人的寂寞程度為中度偏低，社會性寂寞顯著高於情緒性寂寞。3.不同年齡、性別、婚姻狀況、參與社團與居住狀況的老年人在寂寞上有顯著差異。4.去除解釋力低的自覺健康狀況，人格特質、社會關係數量、社會供應與寂寞所建構之結構方程模式的適配度獲得支持，可以有效解釋相關變項間的關聯性。 最後本研究根據研究結果進行討論，並對諮商實務及未來研究提出建議。 / The purpose of this study was to develop a 「Loneliness Scale for the Elderly」 and to explore loneliness and related factors in the elderly. Moreover, this study created the structural equation model of personality traits（neuroticis / extraversion）、quantity of social relationship、self-perceived health status、social provision（emotional togetherness / reassurance of worth / social togetherness）and loneliness（emotional loneliness / social loneliness）in the elderly, which served the purpose of illustrating the linear structural relationships among the relevant variables. The participants in this study were 702 elderly people in Taiwan. Research instruments included Personality Traits Scale、Quantity of Social Relationship Scale、Self-perceived Health Status Scale、Social Provision Scale, and Loneliness Scale for the Elderly. The collected data was analyzed by descriptive statistics, t-test, ANOVA, and structural equation model. The findings were as follows: 1. Two factors were extracted from the Loneliness Scale for the Elderly by factor analysis, they were emotional loneliness and social loneliness. 2. The level of loneliness among elderly was moderate and social loneliness is significantly higher than emotional loneliness. 3. There were significant differences in loneliness among different age groups, gender, marital status, group participations, and living arrangements. 4. The structural equation model of personality traits、quantity of social relationship、social provision and loneliness in the elderly could explain the relationship among main variables. Based on these findings, some suggestions were made for practice and future research.