Letteratura scientifica selezionata sul tema "Health Studies"

Aquesta tesi està formada per dues parts relacionades amb l'estudi de la salut d'una regió geogràfica dividida en un conjunt de zones (àrees petites). La primera part es basa en un estudi amb informació de salut agregada per cadascuna de les àrees que formen la regió d'estudi. En concret, es tracta d'una aplicació de mapes de salut (disease mapping), que utilitza mètodes Bayesians empírics per generar un Atles de mortalitat en àrees petites de Catalunya en el període 1984-1998. La segona part utilitza una nova perspectiva basada en la integració de les dades agregades i individuals de salut per cadascuna de les zones que formen la regió d'estudi, mitjançant equacions d'estimació (estimating equations). Aquesta nova perspectiva és una extensió de la regressió geogràfica.
L'elaboració de la primera part d'aquesta tesi està justificada per diferents raons. En primer lloc, els atles de salut i en general els mapes d'indicadors de salut, ens han mostrat la seva gran utilitat per identificar les localitzacions geogràfiques de les malalties, formular hipòtesis sobre les causes de la malaltia i monitoritzar intervencions en salut pública. En segon lloc, els atles de mortalitat en àrees petites presenten la distribució del risc relatiu per les causes de mortalitat més importants utilitzant mapes amb un alt nivell de resolució geogràfica.
El primer objectiu d'aquesta tesi va ser construir un atles de mortalitat en 289 àrees petites (municipis o municipis agregats) de la Comunitat Autònoma de Catalunya i 66 àrees bàsiques de salut de la ciutat de Barcelona (l'àrea petita analitzada amb una major població) per al període 1984-1998. Per obtenir els indicadors de salut en àrees petites s'han utilitzat mètodes Bayesians. Aquests mapes presenten, en un format de doble pàgina, els riscs relatius ajustats per edat, les àrees significatives d'alt i baix risc, el risc relatiu de la ciutat de Barcelona respecte a Catalunya i internament respecte a Barcelona, el risc relatiu per grups d'edat (0-64 i 65) i addicionalment l'evolució temporal del risc relatiu en cada àrea resumida en un únic mapa. En concret, per estudiar l'evolució del risc relatiu de mortalitat s'inclou: 1) l'evolució del risc relatiu en el període d'estudi de cada àrea comparada amb la tendència global de Catalunya i 2) l'evolució absoluta del risc relatiu a cada àrea. Segons el nostre coneixement, aquesta és la primera vegada que aquests dos tipus d'informació es combinen en un únic mapa. A més, aquest és el primer Atles que presenta informació sobre la distribució geogràfica de zones que formen àrees petites de gran població, com ciutats d'un país, i inclou l'esperança de vida obtinguda amb mètodes Bayesians empírics.
La segona part d'aquesta tesi és útil per estudis epidemiològics on s'inclouen variables d'exposició i confusió que poden tenir diferents fonts de variabilitat (variabilitat dins les poblacions i entre les poblacions). Específicament, els anàlisis individuals que valoren la relació entre la malaltia i l'exposició dins d'una població són útils quan l'exposició presenta variabilitat dins la població. Quan aquesta variabilitat és limitada, la força dels anàlisis individuals es debilita. En aquesta situació, un anàlisis de dades agregades de la malaltia entre poblacions, amb una mostra de dades individuals d'exposició, pot ser eficaç en l'estimació de l'efecte d'exposició si aquest presenta gran variabilitat entre poblacions. No obstant, encara que es pugui conèixer quina de les dues variacions domina en la variable d'exposició, es poden considerar conjuntament variables d'exposició i/o confusió amb diferents tipus de variació. El segon objectiu d'aquesta tesi va ser considerar una nova perspectiva, combinació dels anàlisis de dades individuals i agregades, basat en equacions d'estimació (perspectiva population-based estimating equation (PBEE)). En funció de la variabilitat que domina en la exposició, la anàlisis proposada pren força de la perspectiva basada en dades individuals i agrades de salut, per estimar els efectes d'exposició. Es van realitzar estudis de simulació en diferents escenaris per a mostrar el poder de la perspectiva proposada en l'estimació dels efectes d'exposició d'interès.
Finalment, esperem que els mètodes i els diferents aspectes utilitzats en aquesta tesi puguin ser d'utilitat per a aquells investigadors que vulguin millorar l'estudi de la salut a l'espai i temps.
Esta tesis esta formada por dos partes relacionadas con el estudio de la salud en una región geográfica dividida en un conjunto de zonas (áreas pequeñas). La primera parte considera un estudio con información de salud agregada para cada una de las áreas que forman la región analizada. En concreto, se trata de una aplicación de mapas de salud (disease mapping), consistente en el uso de métodos Bayesianos empíricos para generar un Atlas de mortalidad en áreas pequeñas de Cataluña en el periodo 1984-1998. La segunda parte considera un nuevo enfoque que realiza una integración de los datos agregados e individuales de salud para cada una de las zonas que forman la región en estudio, mediante ecuaciones de estimación (estimating equations). Se considera que este nuevo enfoque es una extensión de la regresión geográfica.
La elaboración de la primera parte de esta tesis esta justificada por diferentes razones. Primero, los atlas de salud y en general los mapas de indicadores de salud, han mostrado su gran utilidad para identificar localizaciones geográficas de las enfermedades, formular hipótesis sobre las causas de la enfermedad y monitorizar intervenciones en salud pública. En segundo lugar, los atlas de mortalidad en áreas pequeñas presentan la distribución del riesgo relativo para las causas de mortalidad más importantes usando mapas con un alto nivel de resolución geográfica.
El primer objetivo de esta tesis fue construir un atlas de mortalidad en 289 áreas pequeñas (municipios o municipios agregados) de la Comunidad Autónoma de Cataluña y 66 áreas básicas de salud de la ciudad de Barcelona (el área pequeña analizada con mayor población) para el periodo 1984-1998. Para obtener los indicadores de salud en las áreas pequeñas se han aplicado métodos Bayesianos. Estos mapas presentan, en un formato de página doble, los riesgos relativos ajustados por edad, las áreas significativas de alto y bajo riesgo, el riesgo relativo de la ciudad de Barcelona con respecto a Cataluña e internamente con respecto a Barcelona, el riesgo relativo por grupos de edad (0-64 y 65) y adicionalmente la evolución temporal del riesgo relativo en cada área resumida en un único mapa. En concreto, para estudiar la evolución del riesgo relativo de mortalidad se incluye: 1) la evolución del riesgo relativo en el periodo de estudio de cada área comparada con la tendencia global de Cataluña y 2) la evolución absoluta del riesgo relativo en cada área. Según nuestro conocimiento, esta es la primera vez que ambos tipos de información se combinan en un único mapa. Además, este es el primer Atlas que presenta información sobre la distribución geográfica de zonas que forman áreas pequeñas de gran población, como ciudades de un país, e incluye la esperanza de vida obtenida mediante métodos Bayesianos empíricos.
La segunda parte de esta tesis es útil en estudios epidemiológicos donde se incluyen variables de exposición y confusión que pueden tener diferentes fuentes de variabilidad (variabilidad dentro de las poblaciones y entre poblaciones). Específicamente, los análisis individuales que valoran la relación entre enfermedad y exposición dentro de una población son útiles cuando la exposición presenta variabilidad dentro de la población. Cuando dicha variabilidad es limitada el poder de los análisis individuales se reduce. En esta situación, un análisis de datos agregados de enfermedad entre poblaciones, con una muestra de datos individuales de exposición, puede ser eficaz en la estimación del efecto de exposición si este presenta gran variabilidad entre poblaciones. No obstante, aunque se pueda conocer cual de las dos variaciones domina en la variable de exposición, se pueden considerar conjuntamente variables de exposición y/o confusión con diferentes tipos de variación. El segundo objetivo de esta tesis fue considerar un nuevo enfoque, combinación de los análisis de datos individuales y agregados, basado en ecuaciones de estimación (enfoque population-based estimating equation (PBEE)). Dependiendo de la variabilidad que domina en dicha exposición, el análisis propuesto toma fuerza de los enfoques basados en datos individuales y agregados de salud, para estimar los efectos de exposición. Estudios de simulación bajo diferentes escenarios fueron realizados para mostrar el poder del enfoque propuesto en la estimación de los efectos de exposición de interés.
Finalmente, esperamos que los métodos y diferentes aspectos empleados en esta tesis puedan ser de utilidad para aquellos investigadores que quieran mejorar el estudio de la salud en el espacio y en el tiempo.
This thesis consists of two related parts based on the study of health in a geographical region divided in a set of zones (small areas). The first part considers studies based on health information aggregated for each area into which the region under study has been divided. Specifically, it is a disease mapping application, based on generation of an Atlas of mortality in small areas of Catalonia over the period 1984-1998, using empirical Bayes methods. The second part considers an innovative approach, based on an integration of aggregated and individual health data in each of the zones of the region under study, using an estimating equation approach. Specifically, we consider this new approach as an extension of geographical regression.
The elaboration of the first part of this thesis is justified for different reasons. First, health atlases and the mapping of health indicators in general, has demonstrated its great utility in identifying geographical localizations of health problems, in formulation of hypotheses about disease causes, and in monitoring public health interventions. Second, most atlases of mortality at the small area level present patterns of relative mortality risk for the most important causes of death using maps with a high level of geographical resolution. The first goal of this thesis was to construct a mortality Atlas involving a decomposition of the Autonomous Community of Catalonia into 289 small areas (municipalities or aggregates thereof) and 66 primary health areas of Barcelona city (being a small area but with a large population) for the period 1984-1998. For Catalonia as a whole, these maps presented, using a double-page format, the age adjusted relative risk, significantly high and low relative risk areas, relative risk in Barcelona City with respect to Catalonia and internally with respect to Barcelona, relative risk by age group (0-64 and 65) and additionally the relative risk evolution over time in each area summarized in an single map, using spatial and temporal information modeled through Bayesian methods. Specifically, the atlas uses a strategy to include both: 1) relative risk evolution throughout the study period of each area compared to the average trend for all Catalonia and 2) the absolute relative risk evolution of each area. To our knowledge, this is the first time that both types of information have been combined in a single map. In addition, this is the first Atlas that presents information about geographical patterns in zones within small areas having a large population such as the cities of a country and includes life expectancy obtained with an empirical Bayes approach.
The second part of this thesis can be useful in epidemiological studies where we include exposure and confounding variables that may have different sources of within and between-population variability. Specifically, analyses of individual disease-exposure data within a population are useful when exposure of interest varies sufficiently within the population. When the within-population variance of exposure is limited power of the individual-data analysis within a population is reduced. In such situations, aggregated-data analyses of disease data across populations, with a sample of individual exposure data from populations, can be powerful in estimating the exposure effect if between-population variation of exposure is large. However, although we may have knowledge of which variations dominate in each variable, exposure and/or confounding variables with different types of variation can be considered jointly. The second goal of this thesis was to consider a new analytical framework that is a combination of the individual- and aggregated-data analyses, based on an estimating equation approach ("population-based estimating equation" (PBEE) approach). The proposed analysis utilizes strengths from individual and aggregated health data approaches in the estimation of the exposure effect of interest, depending on which of the exposure variations (within- vs. between-population) dominates. Simulation studies under different scenarios were performed to show the strengths of the proposed approach in the estimation of the exposure effects of interest.
Finally, we hope that some of the methods and topics employed may be of use to researchers who want to improve the study of health in space and time.

This study examines the association between immigrant women's self-reported health and their employment status and occupation using data on 859 immigrant women aged 20--64 from the 1994--95 National Population Health Survey. Of this group, 502 were in paid employment, 107 assessed their global health as poor, and 158 reported one or more disability days in the previous two weeks. Distress scores ranged from 0--21 (mean 3.85). Logistic and multiple linear regression showed being employed (vs. not being in paid employment) was associated with better self-assessed global health when age, education, income, marital status, country of birth and time since immigration were controlled and women's care-giving role was accounted for. However, this protective association was weaker in women who also reported caring for their family as a main activity. Significant associations between work and disability days or mental distress did not occur. Among 476 immigrant women currently employed in their main occupation, manual workers had poorer self-reported health and higher mental distress scores than others.

The Kingdom of Swaziland is a small African nation with an HIV prevalence rate of 27.4% in adults and up to 39% in pregnant women (Global Health Observatory, 2014). In 2012, life expectancy for a woman in Swaziland was 55-years (World Health Organization, 2014). Health entails more than the absence of disease. Although considered a lower middle-income country, 69% of Swazi citizens live in poverty and nearly one-third live in extremely poor circumstances. The degree to which upstream factors such as social conditions and the cultural environment impact individuals tends to be minimized in Westernized models of health behavior. The purpose of this study was to examine the sociocultural factors that impact self-care and health maintenance of women in Swaziland. The goals related to this were to uncover the salient cultural values, beliefs and attitudes that affect the health of Swazi women, and to develop a deeper understanding of how strongly embedded cultural values are a determinant of health outcomes. Using Carspecken’s methodology of critical ethnography, which incorporates both observational and narrative methods, this study focused intensively on the life stories of four rural African women. The findings richly illustrate how social issues such as poverty and food insecurity impact the health of women and their children; and how traditional customs and practices both support and threaten the health of women and families. Women in this study experienced a loss of husband or extended family due to death or abandonment that resulted in losses in supports and resources. Additionally, they worried about the health and education of their children before personal health needs. They also reported chronic employment problems and mistrust in existing governmental agencies including the healthcare system. Application of the culturally sensitive Person-Environment-Neighborhood (PEN-3) model highlights areas of resilience, strengths, and resource targets and identifies the community as an appropriate entry level for health interventions.

Increasing interest in productivity, safety and environmental issues have highlighted the area of maintenance and reliability. The increasing cost of maintenance covers both preservation and sustainable exploitation of resources and awareness in maintaining equipment in a way to ensure return on investment both in the short and long run. The information obtained from condition monitoring of existing turbine, plant, rails and pumps can provide an important basis for dimensioning of future systems and components. The main objective of this research work is to develop and apply methods for efficient condition monitoring, and hence reduce maintenance costs and provide a framework for development and implementation of computer based decision tools. Furthermore, methods enabling existing process data and cost effective transducers to be used together with modern data analysis and diagnostic tools for condition monitoring of complex mechanical systems have been examined and prototypes developed. The areas of investigation covered in this work are hydropower turbines, rails and the main cooling pumps in a nuclear power-plant. The interest in diagnostics for hydropower turbines was driven by the obvious risk of contamination of water by oil leaks and expensive refurbishments caused by wear of the Kaplan turbine vane bearings. The intrest in risk analysis was motivated by Vattenfall's intrest in gaining knowledge about the state of all turbines in the company. The aim of this project was to develop a generic model of hydropower turbine behavior using physics-based models based on material properties, load tolerances, etc.. An important question was whether it was possible to predict the wear rate and plan predictive replacement or maintenance. A systematic approach to find failure modes, their effects, their causes and consequences in combination with Fault Tree Analysis was needed. The objective of this project was to examine a systematic approach to map failure modes and their causes in an hydropower turbine. We have restricted the study to turbine units of the Kaplan, Francis and tube types. The objective of the study concerning rail track was to develop methods and equipment for detection of surface damage in rail track rail in addition to the present system of practice of visual examination. The equipment developed has to be used to obtain objective statistical data for evaluating maintenance methods and efforts. We have restricted the study to spalling and headchecks on the rail head surface and running edge. The method developed enables measurements of different types of surface damage such as spalling and shelling to be made with inductive transducers sensitive to the distance to the measured object. The assumption here is that the damage being detected is characterized by the absence of material from rail surface. The main object of condition monitoring of the cooling pumps was to be able to detect bearing wear in order to be able to plan and carry out restoration well ahead of breakdown or bearing seizure. The study was restricted to the main cooling pump motor and its main bearings. Condition monitoring of the pumps was done using a method based on current measurements. Analysis of the currents on the main cooling pump of the power plant proved that it is possible to monitor the condition of the pump in spite of the presence of electronic frequency converters which distorts the signal.

Godkänd; 2002; 20070222 (ysko)

Review question / Objective: This study aimed to systemically analyze previous studies that used the PRECEDE-PROCEED model and performed to examine the effectiveness and usefulness of health promotion intervention across different settings and populations. Condition being studied: The eligibility criteria for studies were as follows: (a) studies containing participants of all ages, healthy people, and people with diseases in community and hospital settings; (b) intervention studies using the PRECEDE-PROCEED model, excluding those that used only the PRECEDE model and observational studies; and (c) studies containing health-related outcomes, with behavior, cognitive and physiological health, and quality of life as primary outcomes, as well as other predisposing factors for effective intervention based on the PRECEDE-PROCEED model.