Made available in DSpace on 2016-08-03T16:34:49Z (GMT). No. of bitstreams: 1 Ion de Freitas.pdf: 802705 bytes, checksum: 4e00d50acf069e67f95c70b5e2f49f04 (MD5) Previous issue date: 2009-12-10 / The goal of this study was to describe the dimension levels of social support (emotional and practical) and of emotional balance, to analyze its correlations and to investigate its relations with socio-demographic variables of a group of people who participate of a program of emotional and informational support in a charity institution of São Paulo. The researched sample, chosen randomly, consisted of 95 males and females with average age of 47, 99 years (SD=12,11). The gathering data instrument was an auto fill questionnaire composed by two measures which checked the variables of the study (perception, social support, positive and negative affects), besides the socio-demographic data. Descriptive statistic analyzes were used, differences between averages were tested, and correlation rates between variables were calculated as well. The results have shown that there are no significant differences in the perception of social support (emotional and practical) and the socio-demographic variables, sex, work, study, volunteering, time at the institution, level of education and marital status. The youngest, less than 30 years old, revealed more perception of social support (emotional and practical). They also revealed that there is no significant difference of the emotional balance towards the socio-demographic variable, except for the volunteer work which echoed expressive and positively over the emotional balance. The analyses of the relations between social support (emotional and practical) and age revealed the existence of a significant correlation, low and negative, that is, with an increase in age there s a tendency to lightly describe the perception of social support. The description of the levels of social support revealed that the perceptions of emotional and practical support (tangible and appraisal support) are significantly different, though the difference between the averages is small, prevailing the perception of higher emotional support. The description of the emotional balance scores showed that around three quarters of the interviewed have registered positive emotional balance and around one fourth have registered negative emotional balance. Significant correlation between emotional balance and age were not identified. The analyses of the relations between emotional support, practical support and emotional balance reveled significant and positive correlations, that is, with an increase in perception of the social support (emotional and practical) there is a tendency to increase the emotional balance. The results of this study might contribute to the comprehension of the psychological state of the investigated individuals, as well as, raise, to the managers of institutions, reflections on the improvement of assistential program services.(AU) / O objetivo deste estudo foi descrever os níveis de dimensões de suporte social (emocional e prático) e de balanço emocional, analisar as suas correlações e investigar as suas relações com variáveis sócio demográficas de um grupo de pessoas que participam de programa de apoio emocional e informacional em uma instituição beneficente de São Paulo. A amostra pesquisada, escolhida aleatoriamente, consistiu de 95 pessoas do sexo masculino e feminino com idade média de 47,99 anos (DP=12,11). O instrumento de coleta de dados foi um questionário de auto preenchimento composto por duas medidas que aferiram as variáveis de estudo (percepção de suporte social, afetos positivos e negativos), além dos dados sócio demográficos. Foram utilizadas análises estatísticas descritivas, testadas diferenças entre médias, bem como calculados os índices de correlação entre as variáveis. Os resultados mostraram que não há diferenças significativas na percepção de suporte social (emocional e prático) e as variáveis sócio demográficas sexo, trabalho, estudo, voluntariado, permanência na instituição, escolaridade e estado civil. Os mais jovens, com menos de 30 anos, revelaram maior percepção do suporte social (emocional e prático). Revelaram também que não há diferença significativa do balanço emocional em relação às variáveis sócio demográficas, com exceção do trabalho voluntário que repercutiu expressiva e positivamente no balanço emocional. A análise das relações entre suporte social (emocional e prático) e idade revelou existir uma correlação significativa, baixa e negativa, isto é, com o aumento da idade há uma tendência a decrescer levemente a percepção de suporte social. A descrição dos níveis de suporte social revelou que as percepções de suporte emocional e prático são significativamente diferentes, embora a diferença entre as médias seja pequena, prevalece a percepção de maior suporte emocional. A descrição dos escores de balanço emocional revelou que cerca de três quartos dos entrevistados registrou balanço emocional positivo e cerca de um quarto registrou balanço emocional negativo. Não foi constatada correlação significativa entre balanço emocional e idade. As análises das relações entre suporte emocional, suporte prático e balanço emocional revelaram correlações significativas e positivas, isto é, com um acréscimo na percepção de suporte social (emocional e prático) há a tendência de acréscimo no balanço emocional. Portanto, os resultados deste estudo poderão contribuir para a compreensão do quadro psicológico dos indivíduos pesquisados, bem como, suscitar aos gestores de instituições reflexões para o aprimoramento dos serviços de programas assistenciais.(AU)

Contexte. La démence est un problème de santé publique important. Toutefois, les stratégies actuelles en matière de santé publique ne tiennent pas compte des approches visant à renforcer les facteurs de protection pour en réduire le fardeau. Cela peut s’expliquer par le fait que le renforcement des facteurs de protection est un domaine de connaissance émergent. Son vocabulaire et ses notions de base sont encore en phase d’exploration et de définition. Parmi les termes et les notions à développer, citons la « santé positive » comme résultat du renforcement des facteurs de protection et les « atouts de santé », en tant que déterminant positif de la santé. Le développement de ces termes en promotion de la santé et leur adaptation pour les études sur la santé du cerveau contribueront à une meilleure compréhension des mécanismes permettant aux aînés de préserver leur santé cognitive, et donc ouvriront les portes à de nouvelles stratégies pour réduire le fardeau associé aux démences. L’objectif. Cette thèse vise à proposer un modèle pour l’étude de la santé cognitive des personnes âgées et à le tester dans une large base de données populationnelle. Pour atteindre cet objectif, nous avons i) dérivé la signification du terme de santé positive en examinant systématiquement la façon dont le concept est défini/utilisé par différents auteurs dans des publications sur la promotion de la santé ; ii) révisé les modèles existants de déterminants « positifs » de la santé (« modèles d’atouts de santé ») et proposer un nouveau modèle d’atouts de santé ; iii) discuté l’utilité du modèle pour la recherche sur la santé cognitive des personnes âgées, et iv) évalué l’apport indépendant des atouts de santé dans la probabilité d’une santé cognitive positive chez les personnes âgées, à l’aide du model développé. Méthodes. Un examen de la portée a été effectué pour atteindre les objectifs 1 et 2 ; une revue narrative a été réalisée pour atteindre les objectifs 3. L’analyse secondaire des données de l’étude de cohorte longitudinale « Survey on Health, Aging, and Retirement in Europe », vagues 5 et 7, a été réalisée pour atteindre l’objectif 4. Dans cette étude, les déterminants positifs avaient un effet indépendant sur la santé cognitive si i) leurs variables étaient statistiquement significatives dans le modèle entièrement ajusté et ii) ces variables améliorent significativement l’ajustement de la qualité du modèle. Résultats. 1) Aucun consensus sur la définition de la santé positive n’a été trouvé dans la littérature. Parmi les définitions proposées, il y a « bien-être », « extrêmement bonne santé », « résilience » et « capacités ». Nous avons proposé de définir la santé positive comme une réserve en capacités, permettant une plus grande résistance face aux agents pathologiques/adversités et un plus grand bien-être en leur absence. 2) Dans la littérature, des déterminants de la santé positive sont regroupés autour de traits individuels ou de caractéristiques environnementales. Nous avons proposé un nouveau cadre pour les atouts de santé. Dans ce cadre, les caractéristiques individuelles, les actions (orientées vers l’autodéveloppement ou le développement communautaire), les environnements (physique and social) et le soutien social (informel et institutionnalisé) sont interconnectés. Chaque composante précédente contribue à la suivante et à une santé positive. 3) L’état actuel des connaissances sur la santé cognitive permet l’opérationnalisation de la définition de la santé positive cognitive ainsi que du modèle des atouts de la santé. 4) Les variables de trois des quatre groupes d’atouts de santé (caractéristiques individuelles, actions et environnements) démontrent une contribution indépendante à la probabilité d’une santé cognitive positive chez les personnes âgées. L’inclusion des atouts de santé améliore significativement la qualité de l’ajustement du modèle : le pseudo-R-carré a augmenté de 0,31 à 0,33 ; l’aire sous la courbe ROC a augmenté de 77,8 % à 79,5 %, p<0,0001. Cela signifie que les atouts de santé expliquent davantage la probabilité de santé cognitive positive. Conclusion. L’étude sur les facteurs renforçant la santé cognitive pourrait aux nouvelles opportunités pour la diminution du fardeau de démence. Une validation plus poussée du modèle est nécessaire. Premièrement, des indicateurs plus spécifiques d’atouts de santé doivent être trouvés. Deuxièmement, les relations entre les groupes d’atouts de santé devraient être clarifiées. / Background. Dementia is a significant public health challenge; however, current strategies on public health hardly consider the potential of reinforcing protective factors to diminish its burden. A possible reason for this is that reinforcing protective factors represent an emerging field of knowledge. Its vocabulary and basic notions are still under development. Among the terms and notions needing further discussion are “positive health” as the outcome of these reinforcing protective factors and “health assets” as positive health determinants. Advances in the development of these terms in health promotion and their further adaptation to the realm of studies on cognitive health will contribute to a better understanding of how older adults maintain it, which, in turn, could open the doors to new strategies aimed at reducing the burden of dementia. Objective. This dissertation proposes a model for studying cognitive health in older adults and testing it in a large populational database. To achieve this objective, i) we derived the meaning of the term positive health by systematically reviewing how the concept is defined/used by different authors of publications in health promotion; ii) we revised existing models of “positive” determinants of health (“health assets models”) and proposed a new model of health assets; iii) discussed the utility of the model for research on cognitive health of older adults, and iv) we assessed the independent input of health assets into the probability of positive cognitive health among older adults, using developed model. Methods. A scoping review was conducted to achieve objectives 1 and 2, and a narrative review was conducted to achieve objective 3. Secondary analyses of the longitudinal cohort data “Survey on Health, Aging, and Retirement in Europe” data, waves 5 and 7, were performed to achieve objective 4. In this study, determinants were considered as having an independent effect on cognitive health if i) their variables were statistically significant in the fully adjusted model and ii) these variables significantly improved the model’s fit quality. Results. 1) No consensus on the definition of positive health was found in the literature. Among proposed definitions, there were “well-being,” “extremely good health,” “resilience,” and “capacities.” We proposed to define positive health as a reserve in capacities, enabling higher resistance in the face of pathologic agents/adversities and increased well-being in their absence. 2) In the literature, the determinants of positive health are grouped around individual traits or environmental characteristics. We proposed a new health assets framework. In it, individual characteristics, actions (directed to self-development or community development), environments (physical and social), and social support (informal and institutionalized) are interconnected. Each component contributes to the others and positive health. 3) The current state of knowledge on cognitive health allows operationalizing the definition of cognitive positive health and the elements of the health assets model. 4) Variables of three out of four groups of health assets (individual characteristics, actions, and environments) had independent relationships with the probability of cognitive health in older adults. Including health assets significantly improves the model’s fit statistics: pseudo-R-square increased from 0.31 to 0.33; area under ROC rose from 77.8% to 79.5%, p <0.0001. It means that positive health assets bring additional information on the probability of positive cognitive health in older adults. Conclusion. Studying health assets could open the doors to strategies to reduce the burden of dementia. Further validation of the model is required. Firstly, more specific indicators of health assets need to be found. Secondly, the relationships between health asset groups should be clarified.