Dissertations / Theses on the topic 'Life years lost'

Made available in DSpace on 2016-12-12T17:32:59Z (GMT). No. of bitstreams: 1 RESUMO KADINE.pdf: 15853 bytes, checksum: bfa11d3fee681ef7c30a44a0738800d9 (MD5) Previous issue date: 2015-12-10<br>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior<br>Os estudos de Carga Global da Doença (GBD) alertam que idosos com doenças crônicas irão viver mais, porém com incapacidades como é o caso das amputações de membros inferiores atribuíveis ao diabetes mellitus (DM). O objetivo deste estudo foi estimar a GBD para as amputações de membros inferiores atribuíveis ao DM no Estado de Santa Catarina, no período de 2008 a 2013. Realizou-se um estudo epidemiológico descritivo de base hospitalar, utilizando o cálculo de DALY (disability adjusted life years). A partir das Autorizações de Internação Hospitalar no período de 2008 a 2013, foram incluídas pessoas submetidas à cirurgia de amputação nos hospitais públicos do Estado de Santa Catarina e a prevalência do óbito por DM registrados no sistema de informação de mortalidade nesse período. Ocorreram 1.183 amputações de membros inferiores em pessoas com DM nos últimos 6 anos considerando-se todas as microrregiões do Estado de Santa Catarina. A carga revelou-se elevada e a morbidade foi a principal responsável por mais de 8 mil anos de vida sadia perdidos (93% do DALY), em homens e mulheres acima de 60 anos de idade com maior impacto na expectativa de vida de homens. Estimamos a GBD de uma população majoritariamente idosa que envelhecerá com a amputação de membro Inferior. Assim, há necessidade de assistência planejada a partir de intervenções reabilitadoras em tempo real, levando em consideração que as distribuições das taxas de DALY nas 20 microrregiões do estado não mostraram distribuição homogênea. Alerta-se para a criação de equipes multidisciplinares para a identificação precoce do pé diabético, além da necessidade de capacitação das equipes na atenção especializada e ampliação da atuação do fisioterapeuta na reabilitação pré e pós-protetização.

Climate change is expected to be one of the biggest global health threats in the 21st century. In response to changes in climate and associated extreme events, public health adaptation has become imperative. This thesis examined several key issues in this emerging research field. The thesis aimed to identify the climate-health (particularly temperature-health) relationships, then develop quantitative models that can be used to project future health impacts of climate change, and therefore help formulate adaptation strategies for dealing with climate-related health risks and reducing vulnerability. The research questions addressed by this thesis were: (1) What are the barriers to public health adaptation to climate change? What are the research priorities in this emerging field? (2) What models and frameworks can be used to project future temperature-related mortality under different climate change scenarios? (3) What is the actual burden of temperature-related mortality? What are the impacts of climate change on future burden of disease? and (4) Can we develop public health adaptation strategies to manage the health effects of temperature in response to climate change? Using a literature review, I discussed how public health organisations should implement and manage the process of planned adaptation. This review showed that public health adaptation can operate at two levels: building adaptive capacity and implementing adaptation actions. However, there are constraints and barriers to adaptation arising from uncertainty, cost, technologic limits, institutional arrangements, deficits of social capital, and individual perception of risks. The opportunities for planning and implementing public health adaptation are reliant on effective strategies to overcome likely barriers. I proposed that high priorities should be given to multidisciplinary research on the assessment of potential health effects of climate change, projections of future health impacts under different climate and socio-economic scenarios, identification of health cobenefits of climate change policies, and evaluation of cost-effective public health adaptation options. Heat-related mortality is the most direct and highly-significant potential climate change impact on human health. I thus conducted a systematic review of research and methods for projecting future heat-related mortality under different climate change scenarios. The review showed that climate change is likely to result in a substantial increase in heatrelated mortality. Projecting heat-related mortality requires understanding of historical temperature-mortality relationships, and consideration of future changes in climate, population and acclimatisation. Further research is needed to provide a stronger theoretical framework for mortality projections, including a better understanding of socioeconomic development, adaptation strategies, land-use patterns, air pollution and mortality displacement. Most previous studies were designed to examine temperature-related excess deaths or mortality risks. However, if most temperature-related deaths occur in the very elderly who had only a short life expectancy, then the burden of temperature on mortality would have less public health importance. To guide policy decisions and resource allocation, it is desirable to know the actual burden of temperature-related mortality. To achieve this, I used years of life lost to provide a new measure of health effects of temperature. I conducted a time-series analysis to estimate years of life lost associated with changes in season and temperature in Brisbane, Australia. I also projected the future temperaturerelated years of life lost attributable to climate change. This study showed that the association between temperature and years of life lost was U-shaped, with increased years of life lost on cold and hot days. The temperature-related years of life lost will worsen greatly if future climate change goes beyond a 2 °C increase and without any adaptation to higher temperatures. The excess mortality during prolonged extreme temperatures is often greater than the predicted using smoothed temperature-mortality association. This is because sustained period of extreme temperatures produce an extra effect beyond that predicted by daily temperatures. To better estimate the burden of extreme temperatures, I estimated their effects on years of life lost due to cardiovascular disease using data from Brisbane, Australia. The results showed that the association between daily mean temperature and years of life lost due to cardiovascular disease was U-shaped, with the lowest years of life lost at 24 °C (the 75th percentile of daily mean temperature in Brisbane), rising progressively as temperatures become hotter or colder. There were significant added effects of heat waves, but no added effects of cold spells. Finally, public health adaptation to hot weather is necessary and pressing. I discussed how to manage the health effects of temperature, especially with the context of climate change. Strategies to minimise the health effects of high temperatures and climate change can fall into two categories: reducing the heat exposure and managing the health effects of high temperatures. However, policy decisions need information on specific adaptations, together with their expected costs and benefits. Therefore, more research is needed to evaluate cost-effective adaptation options. In summary, this thesis adds to the large body of literature on the impacts of temperature and climate change on human health. It improves our understanding of the temperaturehealth relationship, and how this relationship will change as temperatures increase. Although the research is limited to one city, which restricts the generalisability of the findings, the methods and approaches developed in this thesis will be useful to other researchers studying temperature-health relationships and climate change impacts. The results may be helpful for decision-makers who develop public health adaptation strategies to minimise the health effects of extreme temperatures and climate change.

Ainda que limitadas enquanto expressão dos eventos ligados à saúde e apesar das deficiências em relação à cobertura e à qualidade dos dados, as estatísticas de mortalidade constituem um dos mais importantes subsídios para o planejamento e avaliação dos serviços de saúde. Tradicionalmente, a mortalidade de uma determinada população tem sido aferida por meio das taxas brutas e específicas de mortalidade. Porém, esses índices consideram apenas a magnitude das causas de óbito, sem qualificar o peso resultante dessas mortes para a sociedade. Neste sentido, tem-se enfatizado cada vez mais a importância da mortalidade prematura enquanto expressão social do valor da morte, pois esta, quando ocorre numa idade de altas criatividade e produtividade não só afeta o indivíduo e o grupo social que convive diretamente com ele, mas a sociedade como um todo, que é privada do seu potencial econômico e intelectual (REICHENHEIM; WERNECK, 1994). \"O indicador Anos Potenciais de Vida Perdidos (APVP), ao combinar a magnitude das mortes com a idade em que ocorreram os óbitos, qualifica essas mortes\" (KERR-PONTES; ROUQUAYROL, 1999 apud SAUER; WAGNER, 2003, p. 1520). Este estudo pretendeu avaliar a evolução dos APVPs nos municípios e regionais de saúde do Estado de São Paulo, no período de 2003 a 2013, para a população total. Pretendeu, também, analisar a evolução retrospectiva das 15 causas de óbito com as maiores taxas de APVP em 2013, para a população total do Estado de São Paulo. Para tanto, foi elaborada uma base de dados a partir dos óbitos de residentes do Estado de São Paulo ocorridos no período de 2003 a 2013 e processados pelo SIM (Sistema de Informação sobre Mortalidade), sendo as causas de morte classificadas de acordo com a Décima Revisão da Classificação Internacional de Doenças (CID 10). O cálculo dos APVPs foi realizado com base numa proposta feita por Romeder e McWhinnie (1988) e, após elaborados os dados, foram confeccionados cartogramas utilizando o programa Tabwin para visualização da evolução dos APVPs nas regionais de saúde do Estado. Foram construídos gráficos de linha para a observação da evolução das 15 causas de óbito com as maiores taxas de APVP de 2003 a 2013. Posteriormente, foram analisadas as Taxa de Mortalidade Geral (TMG), Taxa de Mortalidade Infantil (TMI) e Taxa de Mortalidade Materna (TMM) para os anos de 7 2003 a 2013 para o Estado de São Paulo. E, finalmente, foram avaliados: as dimensões escolaridade, longevidade e riqueza do Índice Paulista de Responsabilidade Social (IPRS) em cada um de seus grupos; frequência absoluta e relativa do IPRS em cada um de seus grupos; relação do IPRS segundo Redes Regionais de Atenção à Saúde (RRAS); relação IPRS segundo Grupos Populacionais; TAPVP por grupos de IPRS; TAPVP por Grupos Populacionais; TAPVP por RRAS; IPRS na sua dimensão Riqueza por TAPVP; IPRS na sua dimensão Longevidade por TAPVP; IPRS na sua dimensão Escolaridade por TAPVP; Correlação entre as dimensões do IPRS e TAPVP. Todas estas avaliações são válidas para o Estado de São Paulo para o ano de 2012 e foram obtidas utilizando-se o aplicativo Stata 9.0. A Taxa de Mortalidade Geral (TMG) para o Estado de São Paulo para o período de 2003 a 2013 em comparação com a do Brasil mostrou-se desfavorável, o mesmo acontecendo com a Taxa de Mortalidade Infantil (TMI), cujo predomínio, no Estado, foi do componente Pós-Neonatal. Já a Taxa de Mortalidade Materna (TMM) demonstrou boa assistência ao pré-natal, parto e puerpério no Estado no período citado. Observando-se a evolução das TAPVP nos cartogramas do Estado de São Paulo no período de 2003 a 2013 as RRAS onde as TAPVP foram maiores foram: 6, 7, 9, 10, 11, 12, 13 e 17. Das quinze maiores causas de óbito segundo TAPVP para o Estado no período, nove são passíveis de prevenção na atenção primária. Citou-se ainda o subregistro e a tripla carga de doenças. A maioria dos 645 municípios do Estado de São Paulo, no ano de 2012 apresentaram um IPRS de grupo 4. Houve 95% de probabilidade de que a maior TAPVP ocorreu para o IPRS 4 com um IC de 17.325,04 a 18.424,20. O Teste de Anova, com 4 gl mostrou diferença significativa (p<0,05) na TAPVP por grupos de IPRS. Com 5 graus de liberdade, o Teste de Kruskal-Wallis foi significativo (p<0,05) indicando que houve diferença entre os Grupos Populacionais quanto à TAPVP. Com 16 graus de liberdade, o Teste de Kruskal-Wallis foi significativo (p<0,05) indicando que existiu diferença entre as RRAS quanto às TAPVP. À medida que aumentou a riqueza do IPRS, diminuiu, ainda que discretamente, a TAPVP. Longevidade e TAPVP mantiveram-se estáveis. Conforme aumentou a escolaridade, aumentou a TAPVP. Por existir uma correlação positiva entre riqueza e longevidade e escolaridade, à medida que aumentou a riqueza, aumentaram a longevidade e escolaridade. Com relação a TAPVP e riqueza e longevidade, o coeficiente de correlação foi negativo, significando que à medida que aumentaram a riqueza e 8 longevidade, diminuiu a TAPVP. Porém, com relação à escolaridade, o coeficiente de correlação entre o mesmo e a TAPVP foi positivo, indicando que à medida que aumentou a escolaridade, aumentou a TAPVP. Por fim, essa dissertação poderia ser apresentada às autoridades de saúde do Estado como um projeto para redução da mortalidade prematura, com foco em melhoria da educação básica, instalação de mais serviços de saúde de qualidade e adequação dos serviços de segurança pública.<br>Although limited as an expression of health-related events and despite problems concerning the coverage and quality of available data, mortality estimates are among the most important foundations for the planning and evaluation of health services. Traditionally, mortality has been estimated according to the gross and specific mortality rates in a given population. However, these indicators consider the impact of death causes alone, without qualifying the burden resulting from deaths to society. The importance of premature mortality as a social expression of the burden of death has therefore received increasing attention, as it occurs at an age range of high creativity and productivity and affects not only the individual and his direct social group, but society as a whole, whose economic and intellectual potential is affected (REICHENHEIM; WERNECK, 1994). The estimate of potential years of life lost (PYLL) provides a more detailed assessment of mortality by combining death rates and the age when death occurs (KERR-PONTES; ROUQUAYROL, 1999 apud SAUER; WAGNER, 2003, p. 1520). Our study was aimed at assessing the evolution of PYLL rates in the total population of cities and health districts in the State of São Paulo, Brazil, between 2003 and 2013. We also assessed the retrospective evolution of the 15 death causes with the greatest PYLL rates in 2013 for the total population of the State of São Paulo. In order to achieve this, we created a database with information on deaths occurred in the state between 2003 and 2013 which were processed by the Mortality Information System (MIS), with death causes classified according to the 10th revision of the International Classification of Diseases (ICD-10). PYLL rates were calculated according to the method proposed by Romeder and McWhinnie (1988) and data charts 9 were created in TabWin to display the evolution of PYLL rates in the health districts of the state. Line graphs were created to display the evolution of the 15 death causes with the highest PYLL rates between 2003 and 2013. We further assessed the general mortality rate (GMR), child mortality rates (CMR), and mother mortality rates (MMR). Finally, we assessed the education, longevity, and wealth dimensions of the São Paulo Index of Social Responsibility (SPISR) in each of its groups; absolute and relative frequency of the SPISR in each of its groups; relationship of the SPISR according to the Regional Health Care Networks (RHCN); SPISR relationship according to population groups; PYLL rates by SPISR group; PYLL rates by population groups; PYLL rates by RHCN; SPISR dimension \'wealth\' by PYLL rates; SPISR dimension \'longevity\' by PYLL rates; SPISR dimension \'education\' by PYLL rates; and correlations between SPISR dimensions and PYLL rates. All the analyses are valid for the State of São Paulo in the year of 2012 and were made using the Stata 9.0 software. The GMR in the State of São Paulo for the period of 2003-2013 was worse compared to Brazil, and so was the CMR, with a predominance of the post-neonatal component in the State. The MMR indicated the availability of adequate prenatal, delivery, and postpartum assistance in the State during the period. The data charts displaying the evolution of PYLL rates in the State of São Paulo show that the RHCNs with the highest PYLL rates were 6, 7, 9, 10, 11, 12, 13, and 17. From the main 15 death causes according to PYLL rates in the period, 9 can be prevented in primary care. Under-recording and the triple load of diseases were also detected. The SPISR of most of the 645 municipalities in the State of São Paulo in the year 2012 was 4. The probability that the highest PYLL rate was associated with a SPISR of 4 was 95%, with a confidence interval between 17325.04 and 18424.20. An ANOVA with 4 degrees of freedom showed significant differences (p<0.05) in PYLL rates by SPISR group. With 5 degrees of freedom, the test of Kruskal-Wallis provided significant results (p<0.05), indicating the existence of differences between population groups in respect to PYLL rates. With 16 degrees of freedom, the Kruskal-Wallis test indicated the existence of significant differences between the RHCNs in terms of PYLL rates. PYLL rates decreased, although subtly, with the increase of wealth in the SPISR. Longevity and PYLL rates remained stable. As education increased, PYLL rates also increased. Since there was a positive correlation between wealth, longevity, and education, increased wealth was associated 10 with increased longevity and education as well. Concerning the relationship between PYLL rates and wealth and longevity, we found a negative correlation coefficient, indicating that as wealth and longevity increased, PYLL rates decreased. In respect to education, however, the correlation with PYLL rates was positive, indicating that increases in education were associated with increases in PYLL rates. Finally, this dissertation could be presented to the health authorities of the State of São Paulo as a project to reduce early mortality, focused on improvements in basic education, expansion of high-quality health services, and improvements in public security

En un contexto de envejecimiento de la población activa y de implantación de medidas de retraso de la jubilación, la presente tesis estudia la relación entre las condiciones de empleo a través de las trayectorias laborales y la salida prematura del mercado de trabajo por incapacidad permanente (IP). La IP es un fenómeno que pone en crisis la sostenibilidad del sistema de protección social y debilita el mercado de trabajo. Los resultados, basados en el análisis de la Muestra Continua de Vidas Laborales (MCVL), muestran que factores como la ocupación y las características de las trayectorias laborales en términos de flexibilidad e inseguridad influyen en el abandono definitivo de la vida laboral activa. Las categorías de trabajadores no cualificadas (en especial las manuales) y las trayectorias laborales caracterizadas por una alta inseguridad y una alta flexibilidad, presentan en mayor medida un abandono prematuro del mercado de trabajo, medido en términos de Años Potenciales de Vida laboral perdidos (APVLP). Sin embargo, hemos observado que en términos de estos APVLP, las trayectorias caracterizadas por una alta flexibilidad, compensada con una baja inseguridad, suponen un retraso en la salida prematura del mercado de trabajo por IP. Una política de relaciones laborales que favorezca la flexiseguridad puede ayudar a retrasar la salida prematura del mercado de trabajo.<br>In a context of active population ageing and implementation of policies to postpone retirement, this thesis examines the relationship between employment conditions through labor market trajectories and early retirement due to permanent disability (PD). This phenomenon puts a strain on the sustainability of the social protection system and weakens the labor market. Results based on the Continuous Working Life Sample (CWLS) show that factors, as the occupation and labor market trajectories characteristics in terms of flexibility and insecurity, influence on the definitive cessation of active working life. Non qualified occupational categories (especially manual categories) and those labor market trajectories characterized by high insecurity and high flexibility show to a greatest extent an early retirement measured by potential years of working life lost (PYWLL). However, we have observed that in terms of these PYWLL, labor market trajectories characterized by high flexibility, compensated by low insecurity, involve a delay in the early retirement due to PD. Labor relations policies that promote flexicurity can help to delay early retirement from the labor market.