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Young, Jeff C. "Determinants of 2000 meter rowing ergometer performance." PDXScholar, 1990. https://pdxscholar.library.pdx.edu/open_access_etds/4122.
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Lean body weight and aerobic and anaerobic factors have long been recognized as important determinants of performance in the 2000 met:E!r (M) 1 ace distance for rowing. Current research with noninvasive techniques has important implications for training and performance but is inconclusive. The purpose of this study was to investigate the relationship between a 2000 M rowing ergometer performance test (PT) and lean body weight (LBW), velocity at heart rate deflection (Vd), and anaerobic capacity (AC) in experienced rowers. Vd was used as an estimate of aerobic function. Thirteen trained male rowers (mean age 38.5 ± 8 years) were studied. Hydrostatic weighing at residual lung volume was used to estimate LBW. Each subject performed five exercise tests on a Concept II rowing ergometer: one 2000 M PT, two sub maximal step wise progressive tests to determine Vd (s/500 M), and two maximal 40-s anaerobic tests to determine AC. Intraclass correlation coefficients for the test/retest trials of Vd and AC were R = 0.740 and R = 0.863, respectively. Stepwise multiple linear regression analysis was used to explain variance in PT. The order of entry of each independent variable (and associated multiple R2 at each step) in the analysis was (1) Vd, 0.589; (2) LBW, 0.709; (3) AC, 0.720. The regression equation was PT (s) = 375.66 + 1.093 (Vd) - 0.820 (LBW) - 0.0007 (AC); S.E.E. = 10.01. It was concluded that performance in a 2000 M rowing ergometer PT is primarily dependent on aerobic metabolism and available lean body weight with anaerobic factors contributing to a lesser degree. These results have implications for specific training and team selection.
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Borges, Ana Rita Galrinho. "Catastrophic health care expenditures in Portugal between 2000-2010: Assessing impoverishment, determinants and policy implications." Master's thesis, NSBE - UNL, 2013. http://hdl.handle.net/10362/11592.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and EconomicsObjectives: This work assesses the extent and evolution of catastrophic health care expenditures (CHE) in Portugal in the years of 2000, 2005 and 2010, to reveal household factors predicting this outcome, and simulates changes in 2010 CHE levels’ following recent reforms in user charges and prices of pharmaceutical products. Methods: The main contribution of this paper is the calculus and analysis of statistical measures to capture CHE incidence, intensity, income distribution and impoverishment effects on households using INE Household Budget Surveys. A logistic model to determine statistical significance and economic effects of 38 variables on the incidence of CHE is also estimated. Finally, a scenario analysis is presented to analyse reforms concerning user charges and prices of pharmaceuticals. Results: Incidence and intensity of CHE decreased between 2000 and 2010, from 5,005% to 2,439% and 4,693% to 0,334%, respectively. During the period, CHE were concentrated amongst the poorer income quintiles. Statistical significance in CHE prediction for all analysed years was observed for households’ income, smoking and drinking habits, area of the house and secondary education of the household head. Scenario analysis shows that the new levels of user charges in 2012, even if mitigated by the new and enlarged economic exemptions, would increase CHE incidence of 2010 to 3,529%. On the other hand, the reduction in the price of ambulatory pharmaceuticals in 2011 and 2012 is effective in reducing CHE incidence, for price demand elasticities equal or smaller (in absolute value) than 0,4. When the two effects are combined, CHE incidence increases, meaning that reductions in the price of pharmaceuticals are not sufficient to countervail the changes in user charges, even with enlarged economic exemptions.
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Cao, Yan, Katie L. Callahan, Sreenivas P. Veeranki, Yang Chen, Ying Liu, and Shimin Zheng. "Vitamin D Status and Demographic and Lifestyle Determinants Among Adults in the United States (NHANES 2001-2006)." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/130.
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This study looked at risk factors associated with vitamin D levels in the body among a representative sample of adults in the U.S., NHANES III (2001-2006) data were used to assess the relationship between several demographic and health risk factors and vitamin D levels in the body. The Baseline-Category Logit Model was used to test the association between vitamin D level and the potential risk factors age, education, ethnicity, poverty status, physical activity, smoking, alcohol, obesity, diabetes and total cholesterol with both genders. Vitamin D insufficiency and deficiency were significantly associated with age, race, education, physical activity, obesity, diabetes and total cholesterol level for both genders. Almost half of the adults sampled in these data had vitamin D levels lower than the recommended limits, with the highest frequency among the younger groups. Determining an individual’s vitamin D level is very difficult without proper clinical testing. Many of those who have low vitamin D levels are unaware. With such a high prevalence of individuals with low vitamin D levels in the U.S. and a better understanding of characteristics associated with these lower levels, increased education and prevention efforts should be focused toward those with higher risk characteristics.
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Melo, Francisco RogerlÃndio Martins de. "Mortalidade relacionada Ãs doenÃas tropicais negligenciadas no Brasil, 2000-2011: magnitude, padrÃes espaÃo-temporais e fatores associados." Universidade Federal do CearÃ, 2015. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=16018.
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nÃo hÃO Brasil à responsÃvel pela maior parte da carga de doenÃa relacionada Ãs DoenÃas Tropicais Negligenciadas (DTNs) na AmÃrica Latina. Foram analisadas as tendÃncias temporais, padrÃes espaÃo-temporais e fatores associados à mortalidade relacionada Ãs DTNs no Brasil. Foi realizada uma sÃrie de estudos ecolÃgicos baseados em dados secundÃrios de mortalidade provenientes do Sistema de InformaÃÃes sobre Mortalidade. Foram incluÃdos todos os Ãbitos relacionados Ãs DTNs registrados no Brasil no perÃodo de 2000 a 2011. A tese foi organizada em sete eixos temÃticos de acordo com suas especificidades metodolÃgicas e doenÃas analisadas: tendÃncias temporais e padrÃes espaÃo-temporais da mortalidade relacionada ao grupo de DTNs (Eixo 1) e DTNs especÃficas com elevado impacto de mortalidade no Brasil (esquistossomose, hansenÃase, neurocisticercose, leishmaniose visceral e coinfecÃÃo leishmaniose visceral e HIV/aids) (Eixos 2 a 6); anÃlise dos fatores socioeconÃmicos, demogrÃficos, ambientais/climÃticos e de assistÃncia à saÃde associados à mortalidade relacionada Ãs DTNs em nÃvel municipal no Brasil, utilizando modelos de regressÃo linear multivariada e regressÃo espacial local (Eixo 7). No perÃodo de estudo, 12.491.280 Ãbitos foram registrados no Brasil. Foram identificadas 100.814 (0,81%) declaraÃÃes de Ãbitos em que pelo menos uma causa de morte relacionada Ãs DTNs foi mencionada. A doenÃa de Chagas foi a DTN mais mencionada (72.827; 72,0%), seguido pela esquistossomose (8.756; 8,7%) e hansenÃase (7.732; 7,6%). O coeficiente mÃdio padronizado de mortalidade foi de 5,67 Ãbitos/100.000 habitantes (intervalo de confianÃa de 95% [IC 95%]: 5,56-5,77). Os maiores coeficientes de mortalidade foram observados em pessoas do sexo masculino, com ≥70 anos de idade, raÃa/cor preta e residente na regiÃo Centro-Oeste. Os coeficientes de mortalidade apresentaram tendÃncia de declÃnio significativo em nÃvel nacional no perÃodo (variaÃÃo percentual anual [APC]: -2,1%; IC 95%: -2,8; -1,3), com diminuiÃÃo da mortalidade nas regiÃes Sudeste, Sul e Centro-Oeste, aumento na regiÃo Norte e estabilidade na regiÃo Nordeste. Foram identificados clusters de alto risco em todas as regiÃes brasileiras, destacando-se um cluster que abrange uma ampla Ãrea geogrÃfica na regiÃo central do Brasil. A anÃlise de regressÃo linear multivariada mostrou uma associaÃÃo global positiva entre a mortalidade relacionada Ãs DTNs e a taxa de urbanizaÃÃo, migraÃÃo, Ãndice de Gini, taxa de desemprego, saneamento inadequado, populaÃÃo de raÃa/cor preta, cobertura do Programa Bolsa FamÃlia e temperatura, enquanto houve uma relaÃÃo negativa com a renda domiciliar, densidade de mÃdicos, extrema pobreza, densidade domiciliar, umidade e precipitaÃÃo. Os resultados da RegressÃo Geograficamente Ponderada (GWR) indicaram variaÃÃes espaciais significativas em todas as associaÃÃes entre as variÃveis explicativas e a mortalidade por DTNs ao longo de todo o paÃs, em que cada fator ecolÃgico teve efeito diferente sobre a mortalidade em diferentes regiÃes brasileiras. As DTNs continuam sendo importantes causas de morte prevenÃveis e um problema de saÃde pÃblica no Brasil. A sobreposiÃÃo geogrÃfica e as Ãreas de alto risco para Ãbitos relacionados Ãs DTNs chamam atenÃÃo para implementaÃÃo de medidas integradas de controle nas Ãreas com maior morbidade e mortalidade. A distribuiÃÃo espacial da mortalidade relacionada Ãs DTNs nos municÃpios brasileiros està correlacionada com indicadores socioeconÃmicos, demogrÃficos e ambientais/climÃticos, com variaÃÃes geogrÃficas significativas. EstratÃgias locais abrangentes e medidas de prevenÃÃo e controle para DTNs devem ser formuladas de acordo com essas caracterÃsticas nas regiÃes endÃmicas brasileiras.
Brazil accounts for most of the disease burden related to Neglected Tropical Diseases (NTDs) in Latin America. We analyzed temporal trends, spatiotemporal patterns and associated factors to NTD-related mortality in Brazil. We performed a series of ecological studies based on secondary mortality data from the Mortality Information System. We included all NTD-related deaths recorded in Brazil from 2000 to 2011. The thesis is organized into seven Thematic Axes according to their methodological characteristics and diseases analyzed: Time trends and spatiotemporal patterns of mortality related to NTDsâ group (Axis 1) and specific NTDs with high mortality impact in Brazil (schistosomiasis, leprosy, neurocysticercosis, visceral leishmaniasis, and visceral leishmaniasis and HIV/AIDS co-infection) (Axes 2 to 6); analysis of socioeconomic, demographic, environmental and health care ecological factors associated with the NTD-related mortality at municipal level in Brazil, using multivariate linear regression and local spatial regression models (Axis 7). During the study period, 12,491,280 deaths were recorded in Brazil. We identified 100,814 (0.81%) death certificates in which at least one cause of death related to NTDs was mentioned. Chagas disease was the most commonly mentioned NTD (72,827; 72.0%), followed by schistosomiasis (8,756, 8.7%) and leprosy (7,732; 7.6%). The average annual age-adjusted mortality rate was 5.67 deaths/100.000 inhabitants (95% confidence interval [95% CI]: 5.56-5.77). The highest mortality rates were observed in males, age group ≥70 years, black race/color and residents in the Central-West region. The mortality rates presented a significant decreasing trend at national level during the period (annual percentage change [APC]: -2.1%; 95% CI: -2.8; -1.3), with decreasing mortality in the Southeast, South and Central-West regions, increase in the North region and stability in the Northeast region. We identified high-risk clusters in all Brazilian regions, highlighting a major cluster covering a wide geographical area in central Brazil. The multivariate linear regression analysis indicated a global positive relationship between NTD-related mortality rates and urbanization, migration, Gini index, unemployment, inadequate sanitation, black population, Bolsa FamÃlia Program coverage and temperature, while there was a negative relationship with household income, density of physicians, extreme poverty, household density, humidity and precipitation. The results of the Geographically Weighted Regression (GWR) models indicated significant spatial variations in all associations between the explanatory variables and NTD-related mortality throughout the country; each ecological factor had a different effect on mortality in the different regions. NTDs remain important causes of preventable death and a public health problem in Brazil. The geographical overlap and areas of high-risk for NTD-related deaths identified call attention to implementation of integrated measures of control in areas with higher morbidity and mortality. The spatial distribution of NTD-related mortality in Brazilian municipalities is correlated with socioeconomic, demographic and environmental/climate factors, with significant geographic variations. Comprehensive local strategies and control and prevention measures for NTDs should be planned according to these characteristics in Brazilian endemic regions.
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Alvarado, Ramírez Gaddy Guillermo, and Guerra Cynthia Paola Mendoza. "Determinantes sociales y desigualdades en la prevalencia de desnutrición crónica infantil en menores de 5 años entre el 2000 y el 2015 en América Latina y el Caribe." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2021. http://hdl.handle.net/10757/655143.
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OBJETIVOS: Determinar la desigualdad de la prevalencia de desnutrición crónica infantil en función a algunos determinantes sociales en países de América Latina y el Caribe (ALC)
MÉTODOS: Se realizó un estudio ecológico con los indicadores de desarrollo de la base de datos del Banco Mundial. Se analizaron los indicadores de 19 países (acceso a electricidad y servicios básicos de agua en población rural, PBI per cápita, gasto en salud per cápita). La desigualdad absoluta y relativa se determinó mediante el Índice de Kuznets absoluto, y relativo, la gradiente de la desigualdad a través de índice de las gradientes de la desigualdad, y para la desigualdad proporcional se usó el (índice de concentración de salud) ICS y la curva de concentración.
RESULTADOS: la brecha de las desigualdades en la prevalencia de desnutrición crónica infantil entre los países de ALC se mantuvo prácticamente sin cambios significativos a lo largo del periodo estudiado. El 20% de los países con mayor desventaja concentran el 40% de la prevalencia de desnutrición crónica mientras que el 20% de los países con mayor ventaja solo el 7-8%, medido a través del ICS.
CONCLUSIONES: A pesar de que en los Objetivos de Desarrollo del Milenio se encontraban eliminar la desnutrición, ésta permanece. La brecha de desigualdad ha disminuido respecto a la gradiente de desigualdad (desigualdad absoluta), sin embargo, la desigualdad proporcional se ha mantenido igual. Para eliminar esta brecha en ALC se deben generar políticas para distribuir de forma más eficiente y equitativa los recursos destinados al gasto en salud y los sectores relacionados, para de esa forma enfocarse en los determinantes sociales debidos.OBJECTIVES: determinate the inequality of the prevalence of chronic childhood malnutrition according to some social stratifiers in the countries of Latin America and the Caribbean (LAC) METHODS: An ecological study was carried out at the country level with the development indicators of the World Bank database. The indicators of 19 countries will be analyzed (access to electricity and basic water services in rural areas, GDP per capita, health expenditure per capita). The absolute and relative inequality was determined by the absolute and relative Kuznets index, gradient of the inequality through the graduation index of the inequality, in addition, the proportional inequality was calculated through the index of concentration in health and the curve of concentration. RESULTS: the gap of inequalities in the prevalence of chronic child malnutrition in the LAC countries, remained practically without significant changes throughout the period studied. In addition, 20% of the countries with the greatest disadvantage accounted for 40% of the prevalence of chronic malnutrition compared to 20% of the countries with the greatest advantage, which presented 7-8% of the prevalence through the index of concentration on health. CONCLUSIONS: Although the Millennium Development Goals were to eliminate malnutrition, it was not possible to do so. However, the inequality gap has partially decreased. To eliminate it In LAC, wealth should be distributed more efficiently, and equitable resources allocated to health spending and related sectors. As well as generating Policies to address inequalities in and between countries.
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Blanco-Perez, Cristina. "Socioeconomic Determinants of Health." Doctoral thesis, Universitat Autònoma de Barcelona, 2013. http://hdl.handle.net/10803/113489.
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Aquesta tesi doctoral consisteix en tres articles que analitzen l’efecte de les variables socioeconòmiques en el nivell de salut dels individus.
El primer article estudia per primera vegada l’efecte de la polarització de la renda en el nivell de salut dels individus. Aquest treball proposa que la polarització de la renda capta millor alguns dels mecanismes que relacionen la salut i les diferències en renda, com ara la tensió i el conflicte social. Aquests han estat tradicionalment associats a la desigualtat de la renda. Aquesta hipòtesi s’ha testat utilitzant dades de panell per a Espanya. Els principals resultats mostren que la polarització de la renda té un efecte negatiu sobre la salut dels individus. En aquest estudi s’ha considerat no només la polarització entre regions, si no també entre grups de referència, és a dir, que els individus no només es comparen amb altres individus de la mateixa regió, sino també amb individus amb característiques similars. En aquest cas la polarització de la renda només és rellevant quan es considera el grup de referència. Aquests resultats q¨uestionen el què tradicionalment s’ha assumit en la literatura prèvia, on la regió és determinant per a establir grups de referència.
El segon article es centra en la relació existent entre la renda relativa i la salut. Tradicionalment les comparacions de la renda entre individus s’han considerat determinants per al nivell de salut individual. Tot i així, els estudis previs s’han basat principalment en les comparacions de la renda “cap amunt”, sense tenir en compte les comparacions amb els individus més pobres. En aquest treball s’utilitza una definició de renda relativa més àmplia per a testar simultàniament l’efecte de les comparacions de la renda “cap a munt” i “cap avall” en la salut dels individus. Aquestes comparacions s’han calculat a través d’un índex de privació i de satisfacció respectivament. L’estudi es basa en les dades del German Socio-Economic Panel data (SOEP) i s’han utilitzat models de dades de panell per a corregir la possible endogeneitat de la renda deguda a variables omeses. Els resultats mostren que la privació de la renda té un efecte positiu, mentre que l’índex de satisfacció té un efecte negatiu sobre el nivell de salut. Aquests resultats són robustos inclús corregint per l’heterogeneïtat no observada i utilitzant mesures de salut “quasi-objectives”.
Finalment, el tercer article estudia el poder explicatiu de l’“state depen-dence” en el nivell de salut auto-percebuda per a Espanya durant els anys 1994-2001. Amb aquest objectiu en ment s’han estimat una sèrie de models economètrics, incloent el model de selecció de Heckman on la condició inicial s’ha estimat per primera vegada utilitzant un ordered probit. Els resultats sug-gereixen que l’“state dependence” i la heterogeneïtat no observada expliquen la major part de la probabilitat de presentar un determinat nivell de salut. Al considerar els dos factors anteriors la significativitat de l’heterogeneïtat obser¬vada mesurada a través de les variables socioeconòmiques disminueix. Tot i així, l’“state dependence” perd importància una vegada es millora l’estructura de l’error de les estimacions.The core of this dissertation consists of three essays that contribute to the understanding of the eect of socioeconomic variables on individual’s health. The rst essay examines the eect of income polarisation on individual health. I argue that polarisation captures much better the social tension and conict that underlie some of the pathways linking income disparities and indi- vidual health, and which have been traditionally proxied by inequality. These premises are tested with panel data for Spain. The main ndings show that polarisation has a detrimental eect on health. Besides dening polarisation between regions, the paper introduces polarisation between reference groups. That is, the relevant comparison group may not be the region but individuals with similar characteristics. In this case polarisation is only relevant between reference groups and not between regions. Thus, these results challenge what has been traditionally assumed in the literature, i.e. that it is regions that matters. The second essay focus on the association between relative income and health. Income comparisons have been found to be important for individual health. However, the literature has so far looked solely at upward compari- sons, disregarding the eects of comparisons with worse-o individuals. In this paper, I use a broad denition of relative income to test simultaneously for the eect of \upward” and \downward” income comparisons on health. Relative deprivation and relative satisfaction indexes are used to summarise upward and downward comparisons. Panel data models are used to correct for income en- dogeneity bias due to omitted variables. Using German Socio-Economic Panel data (SOEP), results show that relative deprivation has a positive eect, while relative satisfaction has a deleterious impact on health. These ndings hold after correcting for unobserved heterogeneity and are robust to using quasi- objective health measures. Finally, the last essay studies the importance of the contribution of state dependence to the explanation of self-assessed health dynamics in Spain for 1994-2001. With this objective in mind, a series of econometric models are estimated including a new proposal for a Heckman selection model with an initial conditions equation run as an ordered probit. Evidence suggests that state dependence and unobserved heterogeneity account for much of the prob- ability of reporting a specic health status while the signicance of observed heterogeneity measured by socioeconomic variables vanishes when controlling for both. Only gender, education and labour status seem to be relevant in explaining health status. However, state dependence looses importance once the error structure of the estimations is improved.
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Wood, David L. "Social Determinants of Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5168.
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Trumble-Waddell, Jan Elizabeth. "Mapping determinants of health behaviours." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0023/NQ32892.pdf.
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Jaishankar, Gayatri. "Social Determinants of Health Screening." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/8873.
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Wood, David L. "New Models of Health and Social Determinants of Health." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5180.
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Weierbach, Florence M. "Determinants of Health for Rural Caregivers." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7374.
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Nuno, Velia Leybas. "Determinants of Early Adolescent Girls' Health." Diss., The University of Arizona, 2012. http://hdl.handle.net/10150/265813.
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Adolescence is a period of development when health-related behaviors can become rooted and subsequently contributes to leading causes of adult morbidity and mortality. The dissertation is based on three studies. The first is a cohort study (n=577) of sixth grade students followed for 2.5 years to assess changes in smoking susceptibility measured by intention to smoke. The second study applies a pre-post design to evaluate the outcomes of a 13-week after-school program and three-day, in-residence University camp on personal and familial factors among 37 sixth grade girls, most of whom were Mexican American. The third study is a cross-sectional study of depression among 80 sixth grade girls, the majority of whom were Mexican American. A survey measured depression severity and familial and individual factors that influence depression. Results showed smoking intention increased nearly six-fold from sixth grade to eighth grade (OR=5.8, 95% CI: 1.19, 3.05). The intervention study resulted in changes from pre to post test in familial and personal factors. The prevalence of depression was 50% among participants in the third study, 38% of girls reported moderate to severe levels. In sum, the greater prevalence of smoking intention over time suggests a norm of acceptance occurring as students' progress through middle school. Protective factors from such attitudes differ by gender and are influenced by the relationships surrounding the adolescent. Similarly, relationships were protective in the study of depression. The father's relationship with his daughter guards against depression as does positive peer relationships. These relationships can be strengthened through interventions as was suggested in the intervention study. Study findings emphasize the protective influence familial and peer relationships have on the developing adolescent.
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Buck, Jacalyn S. "Determinants of Early Adolescents' Health Promoting and Health Risk Behaviors." Connect to resource, 2000. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1211999027.
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Friedman, Nicole Lisa. "Impactful Care: Addressing Social Determinants of Health Across Health Systems." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/5073.
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There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse.
The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.
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McDevitt, Helen. "Early life determinants of infant bone health." Thesis, University of Glasgow, 2010. http://theses.gla.ac.uk/1835/.
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This thesis consists of a series of studies utilising quantitative ultrasound (Sunlight Omnisense 7000P) to assess bone health of infants. Preterm infants are at risk of osteopenia of prematurity (OP) which can result in fractures in the short term and may have an impact on growth in infancy and childhood. OP has a multifactorial aetiology including factors such as poor mineral intake and immobility. There is an increasing number of ex-preterm survivors therefore morbidity becomes more important. There is also increasing evidence from epidemiological studies that growth in infancy can have an effect on adult diseases such as osteoporosis. The first study was a cross-sectional study of bone quantitative ultrasound measurements in 110 term and preterm infants shortly after birth. Speed of sound (SOS) was measured at the tibial and the radius. This validated the technique showing reproducible measurements with low inter and intra-observer error, and also showed no benefit to measuring multiple sites. Preterm infants were found to have a significantly lower SOS than term infants. There was a positive correlation between tibial SOS and gestation, with birthweight being a less significant factor than gestation. The second study followed 18 preterm infants longitudinally from birth to hospital discharge or term corrected gestational age (CGA). SOS fell significantly with time in all infants. The most preterm infants had the greatest fall in SOS. SOS at the end of the study period was negatively associated with peak serum alkaline phosphatase and severity of illness score. SOS was significantly lower in the infants who required total parenteral nutrition for longer than 3 weeks. These results show that the neonatal course has a significant impact on SOS trajectory. When preterm infants were followed up in the out-patient clinic over the first two years of life the SOS measurements taken as the next part of this study showed a catch up phenomenon. In the majority of infants, but not all infants, SOS moved into the normal range by 6 months CGA. In the subgroup of infants followed longitudinally those with the lowest SOS at hospital discharge/term corrected age had the greatest increase in SOS over time. An interventional study of passive exercise was performed to explore its role in influencing the bone health of preterm infants. Thirty one infants born at less than 33 weeks gestation were randomised to receive range of motion flexion and extension exercises once daily for 5 days each week starting ‘early’(n=15) or ‘late’ (when on 100kcal/kg/day enteral feeds, n=16) and continuing until term corrected gestational age (CGA) or discharge from hospital. Tibial SOS declined significantly from birth to end of physical activity in both ‘early’ and ‘late’ groups, and this was similar to the decrease seen in a group of historical controls from the earlier longitudinal study. Weight gain and head growth did not show a significant difference between groups or between study infants and controls. No infant was reported to have sustained a fracture, and length of hospital stay was not significantly different between groups. There was no significant increase in sepsis rate, retinopathy of prematurity or chronic lung disease in study infants but numbers were small. On longer term follow-up the intervention was not associated with any adverse effects. To investigate the possibility that the maternal environment plays an important role in influencing infants’ bone health we also studied SOS changes in 188 pregnant women and their offspring. Most women had SOS in the normal range antenatally, and there was no significant change in SOS across pregnancy in the group as a whole. There was a significant negative correlation with SOS SDS and BMI in early pregnancy. Women who smoked cigarettes had lower SOS throughout pregnancy and so did their infants. Serum bone biochemistry was measured in the women antenatally and after delivery, and umbilical cord blood was also taken where possible. Vitamin D deficiency was found to be common at the end of pregnancy. Women of Asian origin had significantly lower vitamin D levels at all stages of pregnancy. There was no significant relationship between maternal and infant SOS, or between maternal vitamin D status and infant SOS. The work of this thesis establishes quantitative ultrasound as a useful technique in the assessment of infant bone health. It is a radiation free tool which provides precise and reproducible measurements in both term and preterm infants. In agreement with a small number of other studies we found that preterm infants have a lower speed of sound at birth compared to term infants; speed of sound increases with increasing gestation while in utero. By including infants who were both appropriately grown and small for gestational age we found maturity to be a more important factor in bone strength than birthweight. Despite the apparent self limiting nature of osteopenia of prematurity an intervention to improve neonatal bone health is still desirable, to prevent fractures. Our results do not substantiate conclusions from previous studies that physical activity alone can improve neonatal bone health. .Findings are however limited by the small sample size. Further studies are needed which investigate alternative exercise regimens, taking into account mineral and nutrient supply. Vitamin D deficiency, smoking and obesity may adversely affect bone health of women and their offspring. In the west of Scotland vitamin D deficiency is common in pregnancy: women of south asian origin are at particularly high risk, and should be supplemented with Vitamin D.
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Farrants, Linda Kristin Ostlund. "Recommodification of the social determinants of health." Thesis, Durham University, 2016. http://etheses.dur.ac.uk/11375/.
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Background Decommodification is the extent to which living standard is independent of market position. In recent decades, some states have embarked on a process of recommodification, restricting the alternatives to participating in the market. This study has investigated how recommodification of unemployment healthcare and pensions are correlated with health inequalities. Methods Using Health Survey for England and the Swedish Living Conditions Survey, this study computes the magnitude of health inequalities in Sweden and England and correlates the magnitude of inequalities with measures of recommodification. In stage 1, the odds ratio of Not good health/having visited a doctor was computed using logistic regression for each year, using the employed and the high educated as the reference categories. In stage 2, the log (odds ratios) of poor health or doctor visits computed in stage 1 were correlated with the net replacement rate/price of primary care using linear regression. Results Health inequalities between the employed and the unemployed were significantly higher in both England and Sweden in 2011 than in 1991, a period during which unemployment benefit was recommodified in both countries. The association between health inequality and net replacement rate was much stronger in Sweden. Health inequalities increased slightly among English pensioners, while those of the Swedish sample remained steady. This is not what we would expect from the development of recommodification in the two countries: Sweden recommodified while England did not. 3 For groups with similar needs, the higher educated are more likely to seek healthcare. There were no trends in inequality in access to healthcare in Sweden. Conclusion This study has shown that recommodification is associated with health inequalities, especially in Sweden, and that inequalities in replacement rates are associated with health. However, the links between recommodification and health are context-dependent.
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Muir, Jonathan A. "Societal Shocks as Social Determinants of Health." The Ohio State University, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=osu1615597384677722.
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Hopkins, Nicola Dominique. "Determinants of vascular health in young people." Thesis, Liverpool John Moores University, 2010. http://researchonline.ljmu.ac.uk/5971/.
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In recent years the prevalence of obesity, physical inactivity, sedentary behaviour and low cardiorespiratory fitness in Western countries has increased rapidly. These variables are independently associated with cardiovascular disease risk and/or mortality. Atherosclerosis begins in childhood and endothelial dysfunction is its earliest detectable manifestation. Endothelial dys/function can be quantified using flow mediated dilation (FMD). The primary aim of this thesis was to investigate childhood associations between endothelial function and a range of modifiable and non-modifiable CV risk factors. We sought to provide novel information regarding relationships between physical activity, sedentary behaviour, body composition, cardiorespiratory fitness and the heritability of endothelial function. In addition, we sought to explore the issue of the scaling of vascular outcomes for body size and composition. Study one (Chapter 4) addressed the question of scaling, by evaluating the efficacy of scaling vascular dimensions and FMD for different body composition variables using allometric and ratio procedures, with the aim of producing size independent vascular indices. Our data indicate that, if between-group comparisons of baseline brachial artery diameter are to be undertaken, appropriate, allometric scaling for measures of lean or total mass may need to be adopted. The application of such scaling to FMD data is debatable as the associations between FMD and body composition variables were very weak. We therefore concluded that the adoption of scaling FMD for body composition variables cannot be advocated until further research has been undertaken. Studies 2 and 4 (Chapters 5 and 7) assessed cross-sectional relationships between FMD and modifiable CV risk factors in young people. We examined associations between FMD and objective measurements of body composition, cardiorespiratory fitness, physical activity levels and sedentary behaviour. We observed a weak association between percentage body fat and FMD and no further relationships across cohort. However, depressed endothelial function was significantly related to, and predicted by high intensity physical activity. The relationship between FMD and high intensity PA was further reinforced by the findings from studies 3 and 4 (Chapters 6 and 7), which aimed to address the issue of seasonal variation in FMD and determine its predictors. The studies demonstrated that seasonal decline in vascular function was associated with, and predicted by, a change in high intensity PA but no other variables. These findings demonstrate, for the first time, that high-intensity PA may be an important determinant of vascular dys/function in children. The ramifications of these findings are that interventions aimed at improving vascular health in children may need to be refocused to bring about a progressive increase in physical activity, specifically high intensity physical activity, rather than reducing obesity or sedentary time per se. Finally, studies 5 and 6 (Chapters 8 and 9) utilised a classic twin study design to explore the role of genetics in the modulation of FMD. Through the comparison of intra-twin pair differences in mono- and di-zygotic twins, we were able to provide information relating to the genetic influence on FMD and calculate a heritability estimate. We concluded that, although a one-off measurement of endothelial function is under some level of genetic control, environmental factors may have a larger influence in the determination of FMD in young people (study 5).In study 6, twins undertook 8 weeks of aerobic exercise training. In this study, intra-twin differences in the adaptation of FMD were compared to changes in other variables. The results highlighted a greater similarity between MZ twins than DZ twins in the change in FMD, suggesting that exercise-induced improvements in FMD may be highly genetically determined. Taken together, the findings of this thesis infer that, whilst a genetic predisposition to endothelial dysfunction may exist, interventions that aim to increase high intensity physical activity have the potential to enhance vascular health in young people at risk of endothelial impairment and future development of atherosclerotic diseases.
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Franklin, Wanda J. "Social Determinants of Health in Appalachian Populations." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8369.
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Ng, Jessica. "Determinants of High Deductible Health Plan Choice." Scholarship @ Claremont, 2017. http://scholarship.claremont.edu/cmc_theses/1629.
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This paper analyzes the role that demographics, health services utilization, and knowledge play in determining the choice of insurance plan. Using data from a 2014 National Opinion Research Center (NORC) report and by estimating a probit model, I examine the effect of the three variable categories on the probability of selecting a High Deductible Health Plan (HDHP). While many of the results align with the existing literature, I contribute to prior insurance studies by finding that confusion over health services and plan benefits is the largest driver in HDHP choice, as it increases the probability that an individual enrolls in an HDHP by over 15 percentage points. This result provides evidence to policymakers that insurance education should be more widely available to ensure that individuals are choosing a plan that best fits their needs.
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Nuhu, Kaamel M. "DETERMINANTS OF HEALTH-SEEKING BEHAVIOR IN GHANA." OpenSIUC, 2018. https://opensiuc.lib.siu.edu/dissertations/1539.
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Health can be described as both a product and a process of life, and is necessary for human wellbeing, overall quality of life and productivity. While health is generally desirable, many factors affect health and health outcomes of individuals and populations the world over. Virtually all individuals will be faced with one health problem or another during their lifetime, that requires some form of health care intervention. Whatever their reasons for seeking care, all health care consumers share a common interest – a desire to get better. In a pluralistic health care environment where different avenues exist for seeking and receiving health care, differential choice of care may be influenced by sociodemographic and related factors. To the extent that the available avenues for seeking and receiving health care do not offer the same opportunities for improving health, significantly different health outcomes may be realized for comparable conditions for which different types and volume of health care are sought and received. Understanding the factors that influence health-seeking behaviors among various populations may therefore, be an important first step in designing intervention programs that nudge health consumers toward better health-seeking behaviors with the goal to improving health and health outcomes among these populations. The purpose of this research was to develop a research instrument for studying health-seeking behaviors based on the Health Belief Model, and to use the instrument to study the factors that influence/predict health-seeking behaviors among Ghanaians. Using a convenience sample of 504 participants recruited from the Greater Accra, Ashanti, Volta and Northern Regions, analyses of the data showed that different sociodemographic characteristics such as age group, gender and health insurance status as well as selected modified constructs of the Health Belief Model such as Perceived Barriers to mainstream care, variously and collectively influence health-seeking behaviors at government and private health facilities, self-medication with herbal and pharmaceutical drugs, faith healing and care from traditional/herbal practitioners. Based on the findings of this study, the author concludes that health-seeking behaviors in Ghana are influenced by a multiplicity of factors including sociodemographic characteristics. Subsequently, recommendations for a more extensive study with a complementary qualitative enquiry are made in order to gain a more wholistic insight of the drivers of health-seeking behaviors in Ghana.
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Lu, Xiaomei. "Determinants of health care expenditure in Sweden." Thesis, Umeå universitet, Nationalekonomi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-161097.
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Sweden faces increasing pressures on health funding. Total expenditure on health care currently accounts for about 10.92% of GDP, which suggests an increase of about twofold over the last five decades. This paper examines the short-run and long-run relationship between income and health care expenditure in Sweden during the period 1980–2017. The study focused on the differences between short- and long-term elasticities. Consistent with the conventional findings, the income elasticity for health care is found to be greater than one, suggesting that health care is a luxury good in Sweden. Additionally, the age structure variable is found to have a significant positive impact on health care expenditure. Finally, the importance of another non-income variable, relative price, is also confirmed, an increase in relative price is associated with lower quantity of health care expenditure.
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Omotoso, Kehinde Oluwaseun. "Assessing changes in the social determinants of health and health inequality." Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/65505.
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This thesis broadly investigates the relative changes in socio-economic related health inequalities over the second decade of post-apartheid South Africa. This period is characterised by di erent policies and reforms, aimed at reducing socio-economic inequalities that pervaded all aspects of life before 1994. By extension, these policies and reforms have also been applied to the health care system. Speci cally, policy interventions such as scal redistribution directed at key sectors, abolition of user fees for primary health care, and the ongoing discussions related to universal health coverage through yet-to-be-implemented national health insurance have targeted reductions in socio-economic related health inequality. However, evidence from the academic and policy-oriented literature suggests that not much has changed. Health inequality which is strongly linked to inequalities in its social determinants, persist, despite notable policies targeting socio-economic factors. Moreover, existing literature has not identi ed drivers of change, and, therefore, presents a narrow perspective of health inequality. Hence, it is important to analyse changes in social determinants of health and health inequality over the current post-apartheid period. This thesis uses data from the nationally representative General Household Surveys (GHS), which started in 2002. After scrutinising the data for consistency and comparability across the years, the thesis pro les trends in health outcomes across a spectrum of socio-demographic factors, using the GHS data covering the years 2004 - 2014. The health variables considered are ill-health status, medical aid coverage, and preference for public or private health care. As there are few obvious patterns in the raw health variables' time series, the analysis, which is descriptive in nature, relies upon both parametric and non-parametric techniques to smooth the time series in order to outline a few general trends. It is found that medical aid coverage and the general population's preference for public health care decreased by 0.2% and 0.1%, per year, respectively, while reports of ill-health status increased by 0.4%, annually. Moreover, the probability that an individual, who is covered by a medical aid scheme, would utilize public health care decreased by about 44%. Having established changes in the health indicators, the thesis further explores some key socio-economic drivers of these changes. Speci cally, the thesis uses information collected on social determinants of health (SDH), and a variety of health indicators in the 2004 and 2014 GHS data, to explain how changes in the SDH have impacted health inequalities over that decade. Using the Oaxaca-Blinder decomposition of change in a concentration index, the thesis nds that rising inequalities in ill-health are largely explained by changes in the composition of those residing in urban areas and in relatively richer provinces. Meanwhile, rising inequality in medical aid coverage and the utilisation of private health care are attributable to changes in educational attainment and racial composition. On the other hand, changing elasticities in SDH, rather than increasing inequalities, are found to explain a widening preference for private health care in the event of illness. Finally, the thesis investigates socio-economic factors driving health inequality at a fairly disaggregated level, by examining the relative contributions of SDH to changes in gendered health di erentials between 2005 and 2014. Using di erences-in-decompositions, the thesis nds that the gender gap in health narrowed by approximately 2% between 2005 and 2014, and the narrowing of that gap can be attributed to changes in educational attainment and social grant receipt. Speci cally, the relative increase in social grant receipt by females explains approximately 28% of the reduction, while the relative increase in the receipt of formal education by females explains about 1.11%.Thesis (PhD)--University of Pretoria, 2017.
Economics
PhD
Unrestricted
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Vitale, Caitlin McManus. "TheRole of the Social Determinants of Health in Rural Health Equity:." Thesis, Boston College, 2020. http://hdl.handle.net/2345/bc-ir:109012.
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Thesis advisor: Karen S. LyonsBackground: Health equity is a complex phenomenon that embodies both the social determinants of health (structural and intermediary) and external factors, such as the health system. As a well-researched phenomenon, it is known that certain populations are more vulnerable than others to experiencing health inequities; specifically, those of low socioeconomic status, racial/ethnic minorities, older adults, and rural residents. However, gaps in knowledge exist in understanding why certain populations remain at higher risk of experiencing health inequities during a time of improved health insurance coverage and technological advances in health care. The purpose of this manuscript dissertation was to identify and address influential factors that serve as road blocks in achieving health equity, guided by the World Health Organization’s Conceptual Framework on the Social Determinants of Health. Methods: First, an integrative review was performed in order to determine current scope of practice restrictions and patient outcomes across the continuum of licensure for advanced practice registered nurses (APRNs), especially certified registered nurse anesthetists (CRNAs). Next, a secondary analysis of large national data set was done to identify the social determinants and risk factors for poor health effect among a national sample at high risk for poor health. And finally, a survey methodology study was completed to determine the roles that satisfaction with health care and physical function have on the perceived health status for rural, older adults in Massachusetts, and to explore the willingness of rural, older adults to use non-physicians for their health care needs. Results: The integrative review revealed the inconsistent use of APRNs at their full licensure. Nationally, APRNs had better geographic distribution in rural areas compared to physicians; yet many states continue to restrict APRN SOP. Second, across the U.S., older adults at the highest risk for poor health live in rural areas, are of lower socioeconomic status, and identify as racial/ethnic minorities. Third, both satisfaction with health care and the physical function of a small sample of older rural adults were significantly associated with physical health. And finally this body of work found that among a small sample of older rural adults, most were willing to use APRNs to meet their health care needs. Conclusions: With the ultimate goal of health equity it is necessary to empower those experiencing health inequities to be both aware of the problems as well as informed enough to push for change. Understanding why the experience of health differs among some individuals more than others helps to target change. The fusion of findings from this body of research has revealed a gap in health care that can be easily filled with simple policy change. APRNs at full SOP can generate means for high quality preventative, cost-saving care, and can better access the most vulnerable populations at a lower cost than physician counterparts
Thesis (PhD) — Boston College, 2020
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Holcombe, Andrea Lee. "Selected health implications of low body mass: determinants and health outcomes." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6592.
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While the role of obesity in health outcomes has been well described, the role of low body mass index (BMI), body weight relative to height, has largely been ignored. Those with low BMI are commonly excluded completely or combined with the normal BMI category in BMI studies. However, there have been some studies indicating poorer health outcomes among those with lower BMI, particularly that of increased risk of mortality. The purpose of this study is to explore the role of low BMI throughout the lifespan.
Data from the Health and Retirement Study was used to evaluate 1) the association between childhood health and socioeconomic status (SES) exposures and low BMI in midlife adulthood, 2) the association between low BMI and health related outcomes in midlife adulthood (ages 50 to 65), and 3) the association between low BMI in midlife and health related outcomes, including mortality, over a longer follow-up (maximum of 20 years). To increase sample size, two low BMI definitions were used: the traditional
Few significant results were found. Low BMI status was consistently associated with older age and female gender as well as current smoking status. Childhood exposure of respiratory disease and greater SES disadvantages was more common among those with low BMI in adulthood. In midlife adulthood, low BMI status was associated with increased difficulties with activities of daily living with either definition of low BMI. Increased risk of fracture was associated with a low BMI definition of <18.5. Increased risk of lung disease and decreased risk of high blood pressure was associated with a low BMI definition of ≤20. An analysis of those 30 years old or older found low BMI to be associated with increased risk of mortality and decreased risk of diabetes regardless of low BMI definition. When low BMI was defined as <18.5, those with low BMI were also more likely to experience difficulty with one or more activities of daily living. When low BMI was defined as ≤20, low BMI status was associated with greater risk of lung disease and decreased risk of high blood pressure.
Further research is needed to fully characterize the role of low BMI on health outcomes as well as the role of SES on low BMI. Additionally, there is a need for greater understanding of the potential biological mechanisms of low BMI for health outcomes. Currently, there are few studies evaluating health outcomes and SES of low BMI. Limiting studies to the extreme upper end of the BMI spectrum limits the overall understanding of the role of BMI in health and may overlook unique characteristics and challenges those with low BMI may face.
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Denton, Kacie Hoyle, and Claire Gleadhill. "Social Determinants of Health in Belize Free Clinic." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/205.
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Abstract: Social Determinants of Health in Belize Free Clinic
Introduction: To determine the most appropriate ways to serve patients in rural Belize through medical mission work, it is important to assess social determinants of health (SDOH). It has long been agreed that a variety of factors affect health, including environment, community and social context, access to healthcare, stress, income, mental health, education, and transportation. Many people in Roaring Creek, Belize, a village with a population of approximately 2,000, use Body and Soul Ministries, a nonprofit that invites medical teams from all over to deliver medical care, as their primary source of healthcare. During one of these trips, a medical team from East Tennessee State University (ETSU) provided medical care and employed the TeamCare survey, already used in several clinics in east Tennessee to assess the SDOH needs of the patient population in Roaring Creek. The purpose of this study was to use a survey that assesses several SDOH to determine better ways to address health needs in the community of Roaring Creek as well as connect patients with resources to meet those needs.
Methods: A team of ETSU medical students, a resident, and five physicians served in a free clinic in Roaring Creek, Belize in October 2017. The team saw approximately 500 patients. Some patients were randomly selected to take the TeamCare survey to assess for six SDOH, including literacy, financial needs, drug use, abuse, transportation, and mental health. Based on the results of the survey, patients were connected with their local community health worker to assist in locating resources for patients. Using SPSS, results from the survey were arranged for frequencies and measures of central tendency.
Results: Overall, a total of 106 patients responded to the TeamCare survey. Based on the survey results, 83.2% of patients responded “yes” to at least one question regarding needs related to SDOH. In fact, 7.9% of patients answered “yes” to five questions. Of note, 53.5% of patients responded positively for financial need, 46.5% positive for mental health needs, 37.6% positive for environmental alcohol or drug abuse, and 32.7% positive for transportation needs. More women stated positively for physical or verbal abuse compared to men (-1.48, p=0.001).
Discussion and Conclusion:
Roaring Creek, Belize is a rural community that illustrates how SDOH can impact health outcomes. There has been a recent effort for clinicians to address SDOH, especially in rural areas, but perhaps not enough globally. One way this can be done is by surveying for SDOH at clinic visits and then linking patients with relevant community resources. However, resources are not always readily available in Roaring Creek, Belize. Many patients are positive for SDOH, but with an overall lack of resources, it is important to do more research to determine how global health efforts can best serve these populations. Perhaps the best way for SDOH needs to be addressed is for Body and Soul to collaborate with community health workers and mission teams to establish ongoing programs and longstanding resources for the community.
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Wu, Juan. "Dietary Determinants of Age-Related Macular Degeneration." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27201715.
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Age-related macular degeneration (AMD) is the most common cause of irreversible blindness in older Americans. There has been a long standing interest in the role of diet in the development of AMD. As early as the first National Health and Nutrition Examination Survey in the 1970s, higher intakes of fruits and vegetables were inversely correlated with the prevalence of AMD. Carotenoids and omega3 fatty acids are the most studied dietary factors due to strong biological plausibility. However, evidence from epidemiologic studies and clinical trials on the relations has been inconsistent.
Chapter I prospectively examined the intakes of lutein/zeaxanthin and other common carotenoids in relation to the risk of AMD over more than two decades of follow-up among two large US cohorts, the Nurses’ Health Study and Health Professionals Follow-Up Study. We assessed nutrient intakes by repeated food frequency questionnaires. We also computed bioavailable plasma carotenoid scores directly from food intake using validated regression models. Cox proportional hazards models were used to compute the associations. Higher intakes of bioavailable carotenoids (except lycopene) were inversely associated with advanced AMD but not intermediate AMD. Analyses based on bioavailable intakes resulted in stronger associations than conventional nutrient intakes.
Chapter II prospectively evaluated the marine long-chain omega3 fatty acids. We found that long-chain omega3 fatty acids were inversely associated with visually significant intermediate AMD. There was no association with advanced AMD; however, the totality of current evidence for advanced AMD is also discordant.
Chapter III further investigated the plant-derived omega3 fatty acids, α-linolenic acid (ALA). We found that higher intake of ALA was associated with intermediate AMD before 2002 but not after. This coincides with the same time period when trans ALA was found in our participants’ blood and in mayonnaise, a primary food source of ALA. Whether trans ALA mediates this positive association warrants further studies.
Although randomized trials are usually believed as the “gold standard”, dietary factors are hard to be adequately studied by randomized trials due to the complexities of diet and disease relations. Thus, findings in this thesis from large long-term prospective cohort studies provide the next best form of evidence.
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Harry, Ethan. "Determinants of Caloric Intake." Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/cmc_theses/485.
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In the summer of 2003, David Cutler, Edward Glaeser, and Jesse Shapiro published the paper, “Why Have Americans Become More Obese?”1 In the paper, the authors explore changing trends in American weight and caloric intake over time and hypothesize as to the potential causes of these changes. In performing our tests, we hope to both replicate their results and update any analysis for the present.
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Laporte, Audrey. "Essays on the socioeconomic determinants of population health." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ56292.pdf.
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Shirely, Kaitlyn, Margaret Smith, Kacie Denton, Blair Brandt, Ivy A. Click, and Joseph Gravel. "Social Determinants of Health in Rural Tennessee Clinics." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6383.
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Mirbaha-Hashemi, Fariba. "Determinants of Mental Health Problems Among College Students." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc33227/.
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Many college students have reported struggling with mental health problems while dealing with challenging demands of college. The initial theoretical framework for this research was Pearlin's stress process model (SPM). Building on the SPM, the three additional mediating variables of perceived control, meaninglessness, and financial worries were added to create a composite model for the research. Mental health outcomes in the model were measured by a comprehensive range of factors, which included: psychological distress, suicide, substance abuse, and anger. Data were collected from a non-probability convenience sample of 463 undergraduate students attending a large state supported university in the southwestern region of the United States. Among the social status variables measured, being married, female, and white were significant predictors of poor mental health in the sampled college students. Poor self-image, feeling of meaninglessness, and worrying about current and future finances were significant mediating variables. Poor mental health could make individuals overwhelmed and discouraged. This is a formula for failure in college. The results of this study contribute to a better understanding of the correlates of mental health problems among college students. A greater understanding means that families and college administrations will have better ideas about how to intervene to reduce the stress of students and to focus the available and often limited resources to help young adults in their college experience.
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Chang, Ting-Huan. "Determinants of hospital affiliation with health care networks." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2007. https://www.mhsl.uab.edu/dt/2008r/chang.pdf.
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Boundy, Ellen O'Neal. "Determinants of Global Maternal and Neonatal Morbidity and Mortality." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121139.
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In 2013, approximately 289,000 women died from pregnancy-related causes and 2.8 million newborns died within the first 28 days of life. The vast majority of these deaths occur in resource-limited settings. This work examines risk and protective factors for the development of several perinatal complications that put mothers and their infants at risk for adverse health outcomes. We explored determinants of preeclampsia and gestational hypertension among women in Dar es Salaam, Tanzania. We also examined the effects of pregnancy spacing intervals on perinatal outcomes in that group of women. We used log binomial regression to obtain risk ratios and 95% confidence intervals for the development of the adverse pregnancy outcomes of interest. We also looked at the efficacy of an intervention aimed at improving neonatal outcomes by conducting a systematic review and meta-analysis of the effects of kangaroo mother care on neonatal morbidity and mortality.
We found that nulliparity, history of hypertension, urinary tract infection, low calcium intake, history of preeclampsia, and history of preterm birth were associated with an increased risk of developing preeclampsia among women in Dar es Salaam. Risk factors for gestational hypertension included a history of diabetes, elevated blood pressure at study enrollment, increased mid-upper arm circumference, high hematocrit, low mean corpuscular volume, a history of miscarriage or stillbirth, and older age at first pregnancy. Twin gestation and increased body mass index were risk factors for both types of hypertensive disorders of pregnancy among women in Tanzania. After a live birth, inter-pregnancy intervals less than six months were associated with an increased the risk of having a low birth weight baby in the next pregnancy; while after a stillbirth, short inter-pregnancy intervals were associated with increased risk of stillbirth and perinatal death. Providing kangaroo mother care to infants after birth was associated with decreased neonatal morbidity and mortality and increased likelihood of exclusive breastfeeding when compared to conventional care.
These findings can help identify women and infants at increased risk for developing pregnancy-related complications and contribute to informing development of evidence-based maternal, newborn, and family planning programs and policies.Epidemiology
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Goforth, Nikkia L. "Determinants of Obesity: Racial Differences." VCU Scholars Compass, 2007. http://hdl.handle.net/10156/1389.
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Al-Haider, Abdolmohsin S. "Modeling the Determinants of Hospital Mortality." VCU Scholars Compass, 1988. https://scholarscompass.vcu.edu/etd/4329.
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This study examined hospital characteristics that affected the differential in hospital mortality, while controlling for the effect of community attributes. Analytical models for the determinants of hospital mortality were formulated and validated through an empirical examination of 243 hospitals that had higher or lower mortality rates than expected for Medicare beneficiaries. The dependent variable for this study was death rates for 1984 Medicare patients in united states hospitals released in 1986 by the Health Care Financing Administration.
Structural equation models that portray the causal relation between organizational constructs and hospital mortality rate were formulated. This causal model was empirically validated. The findings suggest that the "size" effect on hospital mortality is a spurious one. Specialization was found to be negatively related to hospital mortality when the effects of other variables were simultaneously controlled. Hospitals having a higher degree of specialization tended to have a lower mortality rate. The effect of service intensity on hospital mortality was statistically significant when control variables were added into the equation. Thus, a hypothesized positive relationship between service intensity and hospital mortality was confirmed; the greater the service intensity, the higher the mortality.
Ownership and crude death rate both had a negligible effect on hospital mortality. The only control variable that was statistically significant is "teaching status". The teaching hospitals had a lower mortality rate than nonteaching hospitals did when other organizational factors were controlled.
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Shaikh, Mujaheed Altaf [Verfasser]. "Econometric Analysis of the Determinants of Health Expenditure, Health and Health Behavior / Mujaheed Altaf Shaikh." Frankfurt am Main : Frankfurt School of Finance & Management gGmbH, 2016. http://d-nb.info/1119834821/34.
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Kraft, Jeffrey Brian Jr. "Antidepressant pharmacogenetics: Searching for genetic determinants of treatment response." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3311330.
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Rokicki, Slawa. "Improving Reproductive Health: Assessing Determinants and Measuring Policy Impacts." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493534.
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In this thesis, I investigate policies and programs to improve reproductive health. My thesis makes a substantive contribution to reproductive health policy and a methodological contribution to quasi-experimental research.
In chapter 1, I evaluate the impact of a mobile phone intervention for adolescent girls. I design and implement a randomized controlled trial in Ghana to test whether sending information via mobile phones is an effective way to improve girls’ knowledge of sexual health and to ultimately reduce teenage pregnancy. I find that mobile phone programs are effective not only in increasing knowledge, but also in decreasing risk of pregnancy among sexually active adolescents. I discuss the results in the context of sexual education policy in Ghana.
In chapter 2, I explore the complex interactions between migration and reproductive health. I reconstruct the complete migration and reproductive health histories of women residing in the urban slums of Accra, Ghana. Using individual fixed effects to reduce selection bias, I find an increased risk of pregnancy, miscarriage, and abortion in the 48 months after migration, with no significant increase in the chance of live birth during this time period. With half of abortions in Ghana classified as unsafe, these results suggest that policies which target the rapidly growing number of urban migrants by providing access to contraception and public hospital services may reduce unsafe abortion and improve maternal health outcomes.
In chapter 3, I investigate the bias of standard errors in difference-in-difference estimation, which typically evaluates the effect of a group-level intervention on individual data. Common modeling adjustments for grouped data, such as cluster-robust standard errors, are biased when the number of clusters is small. I run Monte Carlo simulations to investigate both the coverage and power of a wide variety of modeling solutions from the econometric and biostatistics fields, while varying the balance of cluster sizes, the degree of error correlation, and the proportion of treated clusters. I then apply my results to re-evaluate a recently published study on the effect of emergency contraception on adolescent sexual behavior. I find that the study’s results claiming that emergency contraception increases risky sexual behavior may be spurious once proper adjustments for grouped data are applied.Health Policy
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Krishna, Aditi. "Social and Intergenerational Determinants of Children’s Physical and Cognitive Development." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:23205171.
Full textAbstract:
Identifying the key determinants of poor developmental outcomes is critical in improving the lives of millions of children who suffer from poor physical growth and cognitive deficits. Much research suggests that early life conditions, particularly those experienced within the household, critically influence children’s development across the life course. In this dissertation exercise, I explore how three dimensions of early experiences – prenatal conditions, parental education, and household socioeconomic conditions – influence children’s physical and cognitive development. Chapter 1 finds that the influences of low birth weight, often touted as a key determinant of later health, wane over time with increasing importance of postnatal factors. Chapter 2 also counters accepted evidence that maternal education matters more for children’s physical development by finding that both parents’ education matters equally in both infancy and childhood with no mechanisms distinguishing maternal and paternal education. Chapter 3 supports the evidence that household socioeconomic status matters for children’s cognitive development and finds that household assets are the critical determinant of cognitive status. Findings from each of these chapters will not only contribute new scientific evidence but will also help inform policies and programs to improve children’s health and well-being.
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Ozanich, Matthew S. "Socioeconomic and Job-Related Determinants of Emergency Department Use." Youngstown State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1403184917.
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Kulaga, Sophie. "Determinants of incident precursor lesions of cervical cancer." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/MQ44199.pdf.
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Shobe, Bennie. "Determinants of use of Health Care by Black Males." TopSCHOLAR®, 1997. http://digitalcommons.wku.edu/theses/356.
Full textAbstract:
The purpose of this research was to find the differences in the use of medical care between black males and white males and between young black males and older black males. A combination of the conflict perspective, formal-rationality, sick roles, and social learning perspective was used to understand what black males think about using medical care. Secondary analysis was performed on data from the 1992 National Health Interview Survey. ANOVA, t tests, correlation analyses, and multiple regressions were performed to determine the differences in the use of medical care and what factors influenced visiting a doctor. Results indicate no difference in the number of doctor visits per year for black and white males. Differences in the number of doctor visits were found to be associated with place of residency and age. Education, employment, and number of conditions were the three factors that had the most influence on the number of doctor visits.
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Truong, Khoa Dang. "Essays on environmental determinants of health behaviors and outcomes." Santa Monica, CA : RAND Corporation, 2008. http://www.rand.org/pubs/rgs%5Fdissertations/RGSD228/.
Full textAbstract:
Thesis (Ph.D.)--Pardee Rand Graduate School, 2007.Title from title screen (viewed on June 13, 2008). This website links to the complete document in PDF format. Includes bibliographical references.
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Murphy, James Morgan. "Determinants of health outcomes in switching to electric bicycles." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42170.
Full textAbstract:
Electric bicycles have grown rapidly in popularity in recent years, but with little examination of their health effects. We explore their main health effects for different categories of riders in different contexts. Relative risks of mortality were calculated for people transitioning to electric bicycles from cars and bicycles, for 7.5km weekday commutes. Three health impact mechanisms were considered: collisions, air pollution, and physical exercise. Results were evaluated for women and men of different ages and riding style in urban Netherlands. The calculations were then applied to four other countries with significant contextual differences.
Changes in exercise level dominated health outcomes in most cases. Even minimal pedaling exertion during commuting brought substantial health benefits. Collision risks were important for young riders relative to the low mortality hazards they otherwise face. Air pollution impacts were small except in the worst air quality case. The combined health effects indicated that scooter-style electric bicycles (SSEBs) were harmful in all cases, especially for young males. Bicycle-style e-bikes (BSEBs) were beneficial when displacing cars but harmful when displacing conventional bicycles.
These findings lead to three public policy implications. Policy should: a) encourage e-bike types that require some pedaling, b) limit maximum speed and power of e-bikes, and c) only support modal switches to e-bikes from less active forms of transportation.
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Thomas, William. ""The social determinants of Aboriginal Health: A literature review"." School of Native Human Services, 2003. http://142.51.24.159/dspace/handle/10219/416.
Full textAbstract:
The Assembly of First Nations has identified "the need to develop an integrated, holistic,
inter-departmental and inter organizational organism to address the inequities and gaps in
health and social service delivery to First Nations" (AFN, 2002). However, there is much work to
be done in efforts to reach this goal, as there are many factors that one must
take into consideration when examining Aboriginal health from a holistic perspective. For
example, it has been reported that in British Columbia (BC) that 20% of Aboriginal people
are below the provincial average based on income, employment, and educational attainment and
housing (Kendell and Hull, 2002).
In addition to national reports, the BC Ministry of Health advocates that there is the need to
look at the broad spectrum of health and social determinants to come up with solutions that
will improve the health and well being of Aboriginal people. These determinants are comprised
of health, gender, biology, culture, coping skills, social environments, social support
networks, income and social status, employment and working conditions, education, child
development and physical environments. The determinants are interdependent, cannot be examined
individually and a holistic approach needs to be utilized when dealing with
Aboriginal health issues. It is important for non-aboriginals to observe the difference
in fundamental viewpoints of Aboriginal people in their relationship with the natural
surroundings, other races, flora and fauna (Driben and Simpson, 2000). The lack of control over
one's life plays an important factor in their well-being.
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Al-Khalidi, Mona. "The determinants of health status in Jordan, 1960-1988." Thesis, London School of Economics and Political Science (University of London), 1992. http://etheses.lse.ac.uk/1327/.
Full textAbstract:
This thesis aims to contribute to the debate surrounding the underlying medical, social, economic and political determinants of health status improvement. The Hashemite Kingdom of Jordan was chosen as the case study because of its exceptional performance as evidenced from various international comparative data studies. An added dimension which contributes to the benefit of studying a country like Jordan, is its status as an Arab society and a middle-income country. The processes affecting health in countries that fall in these categories have not been sufficiently assessed. The primary measure of health status used is the infant mortality rate, which had fallen to 35/1000 by 1987. A review of the theoretical literature and of previous case studies on the inter-sectoral determinants of health is presented. Economic performance, national and international politics, urbanization, housing, water and sanitation, nutrition, education, fertility and the availability of health services are examined to ascertain their relative impact on the overall health status of the Jordanian population. Particular emphasis is accorded to the way in which these factors affect Jordanian women and their roles in society and the economy. Separate sections of the study are allocated to each of the above-mentioned variables. In a separate section of the thesis, the same variables are examined for the Palestinian refugee population. The refugees comprise a significant proportion of the population and their needs are met almost entirely by UNRWA. The multi-sectoral elements which have led to the success of the Jordanian experience in health development are examined closely in the concluding chapter. These include regional and international favourable conditions, strong government commitment and a high level of awareness among the population. Policy recommendations for future health sector planning in Jordan and other Arab and middle income countries are outlined.
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Krizova, Katarina. "ADHD CHILDREN AND MENTAL HEALTH SERVICE USE: MATERNAL DETERMINANTS." UKnowledge, 2015. http://uknowledge.uky.edu/hes_etds/28.
Full textAbstract:
The current study investigated maternal determinants of mental health service use, namely, individual child therapy, among preadolescent children diagnosed with ADHD. The Behavioral Model of Health Care Utilization (Andersen, 2008) was used as a theoretical framework for the study. Data from the last three rounds of ECLS-K dataset were employed to test a longitudinal model using Bayesian analysis. Socio-demographic variables and maternal mental health were tested as exogenous variables and mother-child relationship variables, discipline variables, and perceived maternal concern about child’s overall behavior and child’s emotional symptoms were tested as intervening variables. Results showed that only maternal mental health remained in the model as an exogenous variable. The effect of mental health on child therapy was mediated by maternal aggravation and maternal concern about overall behavior in one path and by maternal concern about emotional symptoms in another path, suggesting that maternal mental health needs to be considered when attempting to understand help-seeking determinants. Both concern variables were found to have large direct effects on child therapy. The results of the current study showed the importance of maternal mental health and the importance of determinants related to mother-child relationship in a mother’s decision to seek therapy for a child.
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Craven, Sally. "Determinants of General Practitioner referrals to mental health services." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/determinants-of-general-practitioner-referrals-to-mental-health-services(b85990fc-11a5-4936-bd0d-4fd13fb7427e).html.
Full textAbstract:
The overall aim of the thesis is to explore the determinants of General Practitioner (GP) referrals to specialist mental health services, in particular psychological therapy. Paper 1 is intended to contribute to this literature by providing a systematic review of GP and organisational factors identified as impacting on referral in previous research. According to this literature, referral to a mental health specialist was more likely if the GP does not feel that they have the 'capacity to help' and perceives 'time constraints' on how long they can spend with the patient. Referral also appeared more likely if the GP felt they had acceptable 'access to services' and if they had a close 'consultation/liaison' relationship with specialists. The theoretical and clinical implications of these findings are discussed, and gaps in the current literature identified for further research. Paper 2 describes an empirical study aimed at exploring the determinants of GP referral for psychological interventions within Primary Care Mental Health Services (PCMHS). 132 GPs completed questionnaires, including demographic information, attitudes towards mental health and its treatment and responses to short fictional case vignettes indicating their likelihood of referral to the PCMHS. Qualitative results suggested that GPs consider a range of factors in their referral decisions, including patient preference, severity of the problem, access to services and the effectiveness of the service. Alternative options considered included signposting to other services, reviewing, medication and providing advice and support. Quantitative results suggested that younger GPs reported a higher likelihood of referral, and were more likely to refer in line with guidelines. Psychological factors were not associated with referral likelihood or referral in agreement with guidelines. In line with previous research on clinician behaviour, findings of papers 1 and 2 are considered primarily in the context of the Theory of Planned Behaviour, and the utility of this model in predicting referral behaviour is evaluated throughout. A greater understanding of predictors of referral is thought to be valuable in designing clinician and service level interventions to improve the proportion of those in need who are able to access psychological therapy. Paper 3 provides a critical evaluation of the research process as a whole, including the processes involved in the literature review and empirical study. The strengths and weaknesses of both of these elements are discussed, along with an evaluation of the overall approach taken throughout the thesis. The findings of both studies are integrated and discussed in the context of current policy and proposed changes to healthcare provision. Implications for theory, clinical practice and further research are discussed.
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Kronenberg, Christoph. "Essays on the socio-economic determinants of mental health." Thesis, University of York, 2017. http://etheses.whiterose.ac.uk/18820/.
Full textAbstract:
One in four adults in the UK experience mental health problems at some point in their life. Mental health problems are the leading cause of sickness absence in the UK since mental illness predominantly affects working age individuals. Therefore, this thesis seeks to contribute to the evidence base on socio-economic determinants of mental health with a focus on education, training and wages. Chapter 2 examines the association between education and mental health. Changes to the compulsory school leaving age in the UK are used to test the causality of the association between education and mental health. No evidence of a causal effect of education and mental health is found. Chapter 3 investigates the relationship between work-related training and mental health. The human capital - mental health literature is limited to education as a proxy of human capital. This chapter adds to the literature by analysing the relationship between training, as a proxy for human capital, and mental health and finds a strong association between training and mental health. Chapter 4 analyses the effects of wages on mental health. The introduction of the National Minimum Wage in the UK in April 1999 is used as an exogenous variation in wages. This chapter finds no evidence of an impact of the introduction of the National Minimum Wage on mental health. The results in chapter 2, seen in the context of the wider literature, point towards early childhood interventions as more promising policy avenues for improving mental health. Chapter 3 and 4 find at best modest results for the effect of work-related training and wages. At the same time, there is increasing evidence that employment is good for mental health. It appears policymakers should focus on getting and sustaining individuals with mental health problems in employment rather than adjusting wages or training regulations.
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Schuster, Kevin Robert. "The Status and Determinants of Women's Health in America." Thesis, Boston College, 2011. http://hdl.handle.net/2345/2204.
Full textAbstract:
Thesis advisor: Richard McGowanThis paper addresses the disparities in the quality of women’s health across the United States in order to determine which factors are causing these disparities and what policies and actions can be taken to improve the quality of women’s health. In order to construct a comprehensive measure of women’s health quality, a model based on Morgan and Morgan (2010) is used to assign each state an individual quality rating. Regression analysis points to a wide range of factors as being statistically significant in determining the quality of a woman’s health in America. The data suggests that exercise rates, preventive screenings, primary care coverage, the level of emotional support, and regular oral care positively influence the level of health. Factors such as the caesarian section delivery rate, the uninsured rate, unemployment rate, and pollution levels are shown to negatively influence overall health. Concrete policies and actions can be taken to positively alter the statistically significant factors. It is my hope that this paper contributes to the field of women’s health and to the work that aims to improve the quality of women’s health in the United States
Thesis (BA) — Boston College, 2011
Submitted to: Boston College. College of Arts and Sciences
Discipline: Economics Honors Program
Discipline: Economics