This cross-sectional study investigated the use of health benefits in relation to the self-rated health of employees at two medium-sized industrial enterprises in Hälsingland. The method used to investigate this was through a self-designed questionnaire consisting 19 questions about health, lifestyle and health benefits at the workplace. A total of 100 questionnaires were distributed in the two companies, hence 50 surveys at each workplace. The response rate was measured to 88 % and 74 %, which means a loss of 6 persons and 13 persons. The results showed that Company nr 1 offers its employees a health benefits consisting of free access to gym in the company premises after working hours and financial contributions to training-cards. These benefits are used regularly by 29% of respondents. Company nr 2 currently offered no health benefits for their employees. The results also showed that 66% of the respondents at Company nr 1 rated their physical health as Excellent or Good and 79% consider their mental health as Excellent or Good. At Company nr 2, 65 % of the participants responded that they consider their physical health as Excellent or Good and 84% consider their mental health as Excellent or Good. The study also found that more than half of the participants in the two companies had a BMI (Body Mass Index) greater than 26. The conclusion from this is that the health benefits offered at Company nr 1 is used sparingly and that more than half of the participants at both companies consider their physical and mental health as Excellent or Good.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A autoavaliação do estado de saúde (AAS) é um indicador de saúde amplamente utilizado e influenciado por uma grande variedade de fatores. Em particular, existem evidências crescentes de que a discriminação racial é um importante fator de risco para eventos mórbidos em saúde e seu impacto na saúde da população brasileira ainda é pouco explorado. No primeiro artigo, o objetivo principal é investigar a associação entre AAS e fatores sociodemográficos, comportamentais e de morbidade. No segundo artigo, o objetivo é estimar a associação entre discriminação racial e diferentes desfechos em saúde, a saber, AAS, morbidade física e depressão ajustando por variáveis sociodemográficas, comportamentos relacionados à saúde e Índice de Massa Corporal, na população de pretos e pardos. O presente estudo possui delineamento seccional, baseado nos dados do inquérito de abrangência nacional Pesquisa Dimensão Social das Desigualdades. Os entrevistados responderam a questionários estruturados e suas medidas antropométricas foram aferidas. No primeiro artigo, foram avaliados 12.324 indivíduos, entre chefes de família e cônjuges, com idade maior ou igual a 20 anos. No segundo artigo, foram avaliados 3.863 chefes de família que responderam a pergunta sobre discriminação racial e que se classificaram como pretos e pardos. AAS foi avaliada por meio de pergunta obtida do instrumento de qualidade de vida SF-36 e, para o primeiro artigo, foi analisada de forma dicotômica em AAS boa (categorias de resposta excelente, muito boa e boa) e AAS ruim (categorias de resposta razoável e ruim). No segundo artigo, esse desfecho foi analisado utilizando-se as 5 categorias de resposta. As análises foram realizadas utilizando-se modelos de regressão logística uni e multivariados, para dados binários (artigo 1) ou ordinais (artigo 2). Os resultados foram apresentados na forma de Odds Ratios com os respectivos intervalos de 95% de confiança. Maior faixa etária, analfabetismo, tabagismo, obesidade e doenças crônicas estiveram associados a maior chance de AAS ruim. Para cada incremento na faixa de renda, observou-se uma redução de 20% na chance de relatar AAS ruim. Atividade física esteve associada a menor chance de AAS ruim. No segundo artigo, exposição à discriminação racial esteve associada com aumento na chance de relato de pior AAS, de morbidade física e de depressão. O presente estudo identificou a influência de diversos fatores sociais, demográficos, comportamentos relacionados à saúde e morbidade física na AAS. O estudo demonstrou ainda que a discriminação racial está associada negativamente aos três desfechos em saúde avaliados (AAS, morbidade física e depressão). Esses resultados podem traçar um perfil de subgrupos populacionais mais vulneráveis, ou seja, com maior risco de contrair doenças ou de procurar o serviço de saúde por uma doença já existente, auxiliando na definição de populações-alvo para o adequado planejamento de políticas e de programas de promoção de saúde. / Self-rated health (SRH) is a health indicator widely used in surveys and affected by many factors. There is increasing evidence showing that racial discrimination is an important risk factor for morbid events on health and its impact on health of the Brazilian population is still poorly understood. In the first paper, the main purpose is to investigate the association between SRH and social and demographic factors, health behaviors and morbidity. In the second paper, the main purpose is to estimate the association between racial discrimination and different health outcomes, such as: SRH, physical morbidity and depression, controlling for social and demographic variables, health behaviors and Body Mass Index, in the population of blacks and mullatoes. This study has a cross-sectional design and is based on data obtained from the national survey Research for Social Dimension of Inequalities. The interviewees answered to a structured questionnaire and had their anthropometric measures collected. In the first paper, 12,324 household chiefs and their spouses, aged 20 years or older, were evaluated. In the second paper, the study population was composed of 3,863 family chiefs who answered to the question about racial discrimination and who classified themselves as blacks or mullatoes. The measurement of SRH was based on the question obtained from the SF-36 quality-of-life questionnaire. For the first paper, SRH was treated as a dichotomous variable: Good (categories: Excellent, Very Good and Good) and Poor (Regular and Bad). For the second paper, the five original categories were considered. Analysis will be developed using univariate and multivariate logistic regression models for binary (paper 1) and ordinal data (paper 2). Results were presented in the form of Odds Ratios and respective 95% confidence intervals. Older age, illiteracy, smoking habits, obesity and chronic diseases were associated to higher chances of having poor SRH. As income increased, it was observed a reduction of 20% in the chance of having poor SRH. Physical activity was associated to a lower chance of having poor SRH. In the second paper, racial discrimination was associated to a higher chance of having: poor SRH, physical morbidity and depression. The present study identified the influence of several social and demographic factors, health behaviors, and physical morbidity in SRH. Individuals with poor SRH will compose the health services demand. It also showed that racial discrimination was negatively associated to the three evaluated health outcomes (SRH, physical morbidity and depression). These results may trace profiles of vulnerable population subgroups, that is, people with higher risks of becoming ill or of searching for health services because of an existent disease. This find may help in the definitions of target populations for the adequate establishment of health planning and programs

This thesis presents five standalone essays that demonstrate the feasibility and utility of employing advanced analytic techniques to cross-sectional data from Indonesia in order to deal with some technical challenges typically encountered either in the estimation of social gradient in health or in the monitoring and evaluation of well-being as a multidimensional construct. The first essay estimates the causal effect of poverty on mental health by exploiting a natural experiment induced by weather variability across 440 districts in the Indonesian archipelago. The second essay applies parametric anchoring vignette methodology to investigate the extent to which the estimates of demographic and socio-economic inequalities in self-rated health are biased by survey respondents' differential reporting behaviour. The third essay formally assesses the existence and identifies the social determinants of the double burden of malnutrition in Indonesia using a variant of a generalised linear mixed model. The fourth essay maps the social and spatial distributions of malaria in 27 districts in Indonesian Papua using a probabilistic disease mapping technique that is capable of accounting for the complex dependency structure of spatially-correlated multilevel data. The fifth essay examines the extent and patterns of multidimensional poverty in Indonesia over the last decade using a novel poverty measurement method that is sensitive to both the incidence and intensity of multiple deprivations in income, health and education domains. Together, these essays show that although health and social researchers in the developing world have little choice but to conduct cross-sectional studies, new insights can sometimes be gained if one is willing to look at existing data through a new lens. In all five cases presented here, this approach is proved to be useful in shaping practical policy-making.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-05-14T14:27:46Z No. of bitstreams: 1 Tese Damião Ernane Souza. 2012.pdf: 2244792 bytes, checksum: 6559b201cc7a67973a079d399248834e (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-14T14:28:09Z (GMT) No. of bitstreams: 1 Tese Damião Ernane Souza. 2012.pdf: 2244792 bytes, checksum: 6559b201cc7a67973a079d399248834e (MD5) / Made available in DSpace on 2013-05-14T14:28:09Z (GMT). No. of bitstreams: 1 Tese Damião Ernane Souza. 2012.pdf: 2244792 bytes, checksum: 6559b201cc7a67973a079d399248834e (MD5) Previous issue date: 2012 / Esta é uma revisão sistemática da literatura epidemiológica sobre saúde autorreferida precária (SAR-P), com foco em estimativas da prevalência e fatores associados. SAR-P compreende um construto conceitualmente ligado à percepção individual do estado de saúde e sintetiza várias dimensões da vida abordadas em escalas próprias de mensuração. Procedeu-se ao rastreamento eletrônico de artigos publicados de 1998 a 2010 nas seguintes bases de dados: Medline/Pubmed, BIREME, SciELO, Biomed Central Journals, New England Journal of Medicine e Scirus (Elsevier) e scholar.google (Google Acadêmico®), utilizando-se os seguintes descritores: self-rated health, self-reported health, self assessed health e perceived health. Localizados 415 artigos, 33 foram selecionados para revisão de acordo com os seguintes critérios: estudos que utilizaram SAR como medida de saúde e em cuja análise fosse utilizada a SAR-P como desfecho em grupos ou amostras da população geral. A maioria dos estudos era do tipo transversal, utilizava escalas de cinco pontos para SAR (muito ruim, ruim, boa, muito boa, excelente) e definia o caso de SAR-P a partir da fusão das duas categorias inferiores da escala (muito ruim + ruim), cuja prevalência variou de 4 a 65,1%. Nos estudos analisados, a SAR-P estava associada a vários fatores, desde níveis macrocontextuais a níveis individuais. Foram identificados fatores associados à SAR-P como sexo feminino, idade avançada e cor da pele não branca; entretanto, piores condições socioeconômicas destacaram-se como principais preditoras de SAR-P, em todos os níveis contextuais, em especial escolaridade, renda e trabalho. Os achados dessa revisão apontam para a importância da auto-avaliação da saúde como indicador capaz de refletir várias dimensões da vida, configurando-se como alternativa para mensuração da saúde individual, capaz de sintetizar as dimensões física, mental e social. / Salvador

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo desta tese é enriquecer o campo do trânsito religioso investigando a associação da religião com a saúde das pessoas e com seus hábitos de vida principalmente o cigarro. A tese foi dividida em duas partes: a primeira visa identificar a associação entre a autopercepção da saúde, a religião e o trânsito religioso. A segunda entre religião, trânsito religioso e o hábito de fumar. Para tanto, foram analisados dados transversais do Estudo Pró-Saúde realizado no Rio de Janeiro-RJ no ano de 1999. As religiões foram categorizadas de acordo com os critérios do Instituto Brasileiro de Geografia e Estatística (IBGE) e o trânsito religioso derivou da comparação entre religião de criação e religião relatada em 1999. Os resultados evidenciaram que 62% dos participantes mantiveram-se na religião de criação, 26% mudaram de religião e 12% mudaram para sem religião. O trânsito religioso foi marcado por um crescimento de kardecistas e do grupo sem religião. As pessoas que perceberam a sua saúde regular ou ruim apresentaram chance 40% mais elevada de ter mudado de religião, quando comparadas àquelas que a perceberam como boa ou muito boa (artigo 1). A maior parte das religiões apresentaram-se negativamente associadas ao consumo de cigarros quando comparados às pessoas sem religião ajustadas por variáveis sociodemográficas, relacionadas à saúde e transtorno mental comum. Os pentecostais e protestantes históricos apresentaram uma maior associação negativa com o consumo de cigarros e apenas a religião afro-brasileira apresentou uma chance mais elevada de consumo. As pessoas que mudaram de religião apresentaram uma chance 40% mais elevada de ser um ex-fumante quando comparadas a quem não mudou de religião (artigo 2). Para esclarecer as associações observadas na presente tese, é necessário a realização de estudos posteriores com emprego de outras metodologias, especialmente com o delineamento longitudinal.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A autoavaliação do estado de saúde (AAS) é um indicador de saúde amplamente utilizado e influenciado por uma grande variedade de fatores. Em particular, existem evidências crescentes de que a discriminação racial é um importante fator de risco para eventos mórbidos em saúde e seu impacto na saúde da população brasileira ainda é pouco explorado. No primeiro artigo, o objetivo principal é investigar a associação entre AAS e fatores sociodemográficos, comportamentais e de morbidade. No segundo artigo, o objetivo é estimar a associação entre discriminação racial e diferentes desfechos em saúde, a saber, AAS, morbidade física e depressão ajustando por variáveis sociodemográficas, comportamentos relacionados à saúde e Índice de Massa Corporal, na população de pretos e pardos. O presente estudo possui delineamento seccional, baseado nos dados do inquérito de abrangência nacional Pesquisa Dimensão Social das Desigualdades. Os entrevistados responderam a questionários estruturados e suas medidas antropométricas foram aferidas. No primeiro artigo, foram avaliados 12.324 indivíduos, entre chefes de família e cônjuges, com idade maior ou igual a 20 anos. No segundo artigo, foram avaliados 3.863 chefes de família que responderam a pergunta sobre discriminação racial e que se classificaram como pretos e pardos. AAS foi avaliada por meio de pergunta obtida do instrumento de qualidade de vida SF-36 e, para o primeiro artigo, foi analisada de forma dicotômica em AAS boa (categorias de resposta excelente, muito boa e boa) e AAS ruim (categorias de resposta razoável e ruim). No segundo artigo, esse desfecho foi analisado utilizando-se as 5 categorias de resposta. As análises foram realizadas utilizando-se modelos de regressão logística uni e multivariados, para dados binários (artigo 1) ou ordinais (artigo 2). Os resultados foram apresentados na forma de Odds Ratios com os respectivos intervalos de 95% de confiança. Maior faixa etária, analfabetismo, tabagismo, obesidade e doenças crônicas estiveram associados a maior chance de AAS ruim. Para cada incremento na faixa de renda, observou-se uma redução de 20% na chance de relatar AAS ruim. Atividade física esteve associada a menor chance de AAS ruim. No segundo artigo, exposição à discriminação racial esteve associada com aumento na chance de relato de pior AAS, de morbidade física e de depressão. O presente estudo identificou a influência de diversos fatores sociais, demográficos, comportamentos relacionados à saúde e morbidade física na AAS. O estudo demonstrou ainda que a discriminação racial está associada negativamente aos três desfechos em saúde avaliados (AAS, morbidade física e depressão). Esses resultados podem traçar um perfil de subgrupos populacionais mais vulneráveis, ou seja, com maior risco de contrair doenças ou de procurar o serviço de saúde por uma doença já existente, auxiliando na definição de populações-alvo para o adequado planejamento de políticas e de programas de promoção de saúde. / Self-rated health (SRH) is a health indicator widely used in surveys and affected by many factors. There is increasing evidence showing that racial discrimination is an important risk factor for morbid events on health and its impact on health of the Brazilian population is still poorly understood. In the first paper, the main purpose is to investigate the association between SRH and social and demographic factors, health behaviors and morbidity. In the second paper, the main purpose is to estimate the association between racial discrimination and different health outcomes, such as: SRH, physical morbidity and depression, controlling for social and demographic variables, health behaviors and Body Mass Index, in the population of blacks and mullatoes. This study has a cross-sectional design and is based on data obtained from the national survey Research for Social Dimension of Inequalities. The interviewees answered to a structured questionnaire and had their anthropometric measures collected. In the first paper, 12,324 household chiefs and their spouses, aged 20 years or older, were evaluated. In the second paper, the study population was composed of 3,863 family chiefs who answered to the question about racial discrimination and who classified themselves as blacks or mullatoes. The measurement of SRH was based on the question obtained from the SF-36 quality-of-life questionnaire. For the first paper, SRH was treated as a dichotomous variable: Good (categories: Excellent, Very Good and Good) and Poor (Regular and Bad). For the second paper, the five original categories were considered. Analysis will be developed using univariate and multivariate logistic regression models for binary (paper 1) and ordinal data (paper 2). Results were presented in the form of Odds Ratios and respective 95% confidence intervals. Older age, illiteracy, smoking habits, obesity and chronic diseases were associated to higher chances of having poor SRH. As income increased, it was observed a reduction of 20% in the chance of having poor SRH. Physical activity was associated to a lower chance of having poor SRH. In the second paper, racial discrimination was associated to a higher chance of having: poor SRH, physical morbidity and depression. The present study identified the influence of several social and demographic factors, health behaviors, and physical morbidity in SRH. Individuals with poor SRH will compose the health services demand. It also showed that racial discrimination was negatively associated to the three evaluated health outcomes (SRH, physical morbidity and depression). These results may trace profiles of vulnerable population subgroups, that is, people with higher risks of becoming ill or of searching for health services because of an existent disease. This find may help in the definitions of target populations for the adequate establishment of health planning and programs

Self-rated health is a powerful predictor of long-term health, but relatively little is known about what determines an individual’s rating of her perceived health status. Psychoneuroimmunological research has found links between immune activity and behaviour, and a relation between low-grade inflammation and poor self-rated health, primarily in women. The principal aim of this paper was to examine the relation between self-rated health and inflammation, measured by erythrocyte sedimentation rate (ESR), in young men. A secondary objective was to investigate whether self-rated health and ESR may be associated to mortality. Pearson correlation and Cox regression analyses were used to examine data collected in 1969-70 when 49,321 men underwent military conscription, together with information from the national cause of death register in 2006. Background factors (BMI, emotional control, psychiatric diagnosis and smoking) were included in multivariate analyses. The results show that self-rated health was significantly related to ESR (r=0.08, p<0.001), also after control for background factors. Furthermore, subjects with poor self-rated health had a near two-fold increased risk of mortality during 37 years of follow-up. In addition, ESR was a significant predictor of mortality (beta=0.051, p<0.002). To conclude, in this cohort of young, healthy men, the association between self-rated health and inflammation was significant but modest. Instead, low emotional control showed a stronger independent correlation to poor self-rated health (r=-0.284, p<0.001). Moreover, adding to a growing body of evidence, poor self-rated health was a strong predictor of mortality.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo desta tese é enriquecer o campo do trânsito religioso investigando a associação da religião com a saúde das pessoas e com seus hábitos de vida principalmente o cigarro. A tese foi dividida em duas partes: a primeira visa identificar a associação entre a autopercepção da saúde, a religião e o trânsito religioso. A segunda entre religião, trânsito religioso e o hábito de fumar. Para tanto, foram analisados dados transversais do Estudo Pró-Saúde realizado no Rio de Janeiro-RJ no ano de 1999. As religiões foram categorizadas de acordo com os critérios do Instituto Brasileiro de Geografia e Estatística (IBGE) e o trânsito religioso derivou da comparação entre religião de criação e religião relatada em 1999. Os resultados evidenciaram que 62% dos participantes mantiveram-se na religião de criação, 26% mudaram de religião e 12% mudaram para sem religião. O trânsito religioso foi marcado por um crescimento de kardecistas e do grupo sem religião. As pessoas que perceberam a sua saúde regular ou ruim apresentaram chance 40% mais elevada de ter mudado de religião, quando comparadas àquelas que a perceberam como boa ou muito boa (artigo 1). A maior parte das religiões apresentaram-se negativamente associadas ao consumo de cigarros quando comparados às pessoas sem religião ajustadas por variáveis sociodemográficas, relacionadas à saúde e transtorno mental comum. Os pentecostais e protestantes históricos apresentaram uma maior associação negativa com o consumo de cigarros e apenas a religião afro-brasileira apresentou uma chance mais elevada de consumo. As pessoas que mudaram de religião apresentaram uma chance 40% mais elevada de ser um ex-fumante quando comparadas a quem não mudou de religião (artigo 2). Para esclarecer as associações observadas na presente tese, é necessário a realização de estudos posteriores com emprego de outras metodologias, especialmente com o delineamento longitudinal.

Masters of Public Health - see Magister Public Health / Dental fluorosis is an endemic condition in a number of regions of South Africa, varying in degree of affliction according to the drinking water fluoride concentration in the area. Objective: While a number of South African studies have reported on the relationship between fluorosis and fluoride concentration in the drinking water, the purpose of this study was to determine perceptions of dental fluorosis in the Central Karoo District of the Western Cape. Methods: Learners aged 12-15 years and who had been lifelong residents in their respective areas were selected from schools in Leeu Gamka, Merweville, Nelspoort and Murraysburg. All the children meeting the inclusion criteria were included realising a total sample of 189. Drinking water fluoride concentration of each town was determined and concomitant fluorosis affliction was assessed. An interviewer administered questionnaire was used to determine respondents’ self-rated perceptions of fluorosis as well as their responses to a set of statements on clinically defined fluorosis. To this end four photographs, each depicting a different degree of fluorosis: (No fluorosis; Mild fluorosis; Moderate fluorosis; Severe fluorosis) were shown to the respondents. Results: In Leeu Gamka, with the highest fluoride concentration ([F] = 1.62ppm), 82% of respondents were aware of fluorosis stains as opposed to 6%-20% awareness in Merweville ([F] = 0.68), Nelspoort ([F] = 0.70) and Murraysburg ([F] = 0.56). Two thirds of respondents in Leeu Gamka found the appearance of their teeth embarrassing compared to only 2%-10% in the other 3 areas. The majority of respondents in Leeu Gamka (82%) indicated that they would want to remove the fluorosis spots with only 4%-20% in the lower fluoride areas. Two thirds (67%) of the Leeu Gamka respondents were teased compared to 2%-6% in the other areas. Most of the respondents have not tried to do anything to the appearance of the teeth, even in the higher fluoride area of Leeu Gamka. The average response varied little for all the photographs across the geographic areas (the minimum and maximum scores varied between 4.00 and 5.00) and reflected a greater tendency towards strongly disagreeing with the statement on aesthetics-even for the photographs depicting no fluorosis and mild fluorosis. The average response varied between 1 and 2 among all four geographic regions showing a tendency to “agree” and “strongly agree” to the statement on embarrassment. The average response to the statement on neglect varied little for all the photographs across the geographic areas as the minimum and maximum average response scores varied between 1.36 and 2.39 (agree and strongly agree). The response to the statement on disadvantage varied little for all the four photographs across the geographic areas (minimum=1.00, maximum=2.07) and reflected a greater tendency toward strongly agreeing and agreeing with the statement. Conclusion: The respondents from the higher fluoride area were more aware of dental fluorosis, had a greater perception of embarrassment and the strongest desire to remove the fluorosis staining. There was little variation in the average response to the statements on clinically defined fluorosis across the geographic areas. The learners erroneously believed that dental fluorosis was due to neglect, which is an indication that many learners are not aware of the cause of dental fluorosis in their community. The general consensus of the communities was that fluorosis was judged with feelings of negativity (embarrassment and a disadvantage for the child into adulthood).

The current study is part of a broader study called the Women’s Reproductive Health Survey (WRHS) which aimed to examine various aspects of women’s life experiences. This study examined the moderating effect of rurality on several factors of healthcare in a sample of women between the ages of 18 and 50. Self-rated health (SRH) was hypothesized to predict healthcare satisfaction, healthcare adherence, and medical mistrust. Furthermore, rurality was hypothesized to weaken the relationships between SRH and healthcare satisfaction and adherence; it was further hypothesized to exacerbate the relationship between SRH and medical mistrust. A survey containing a single-item measure of SRH and rurality, a seven-item measure of medical mistrust, and an exploratory measure of both healthcare satisfaction and adherence, was uploaded to the Internet forum Redditt. Participants received informed consent and monetary compensation for their time. Bivariate correlations and moderation analysis was conducted on the resulting data. Self-rated health was found to be a significant predictor of healthcare satisfaction, healthcare adherence, and medical mistrust. Rurality was a nonsignificant moderator. Healthcare systems may consider enhancing patient portfolios with a measure of SRH. This may have implications for improved quality of care and health outcomes. Limitations within the study included the participant demographics, which were mostly White and of a high socioeconomic status, as well as the broader survey from which this study originated. Future studies may consider comparing populations from a high socioeconomic status to populations from a low socioeconomic status.