Dissertations / Theses on the topic 'Lifestyle and health'

Nowadays our life is getting more and more tense. People live under the press of different problems, such as social, ecological, economic and others. They constantly suffer from stress, noise and dust in big cities, diseases and instability. A person should be strong and healthy in order to overcome all difficulties.

Research focused on health behaviors of online graduate students is sparse. Health psychology graduate training prepares individuals to share health information with others; the information may be more credible if they present a healthy appearance. The present study tested concepts from social cognitive theory (general perceived self-efficacy) and self-determination theory (autonomy, competence, and relatedness basic needs) to determine predictive value for graduate students’ engaging in health behaviors. Participants were 121 (29 health psychology group, 92 other programs group) online graduate students who lived in the United States and attended the same online university, recruited from multiple social media sources. The study used a static comparison quasi-experimental design to examine data from an online survey. Data were analyzed using Pearson correlation, chi-square tests for independence, independent samples t-tests, ANOVA, MANOVA, and binary logistic regression. The health behaviors did not differ between the two graduate student groups. General perceived self-efficacy, autonomy, relatedness, and competency mean scores did not predict engaging in health behaviors. A significant negative correlation for the total sample was found between autonomy and body mass index. Positive social change may result from research focused on the best means to encourage health psychologists to regularly engage in health behaviors to the extent of Centers for Disease Control and Prevention recommended levels. By internalizing and modeling good health, health psychologists will add credibility to their message and help to mitigate the connection between premature death from chronic disease due to lack of engaging in a voluntary healthy lifestyle.

Type 2 diabetes is the fastest growing health threat to the UK, with prevalence rising 60% over the past decade. Those with Type 2 diabetes carry twice the risk of developing cardiovascular disease, a condition which claims the lives of the majority of adults in the UK. A significant proportion of cardio-metabolic disease could be prevented through improvements in lifestyle. Technological advancements, motorised transport and an increase in desk based work, have paved the way for physical inactivity to be norm in modern society. Clinical and government strategies to target unhealthy lifestyles are currently lacking. The aim of this thesis was to explore lifestyle related behaviours in cardio-metabolic disease, with a view to improving clinical care. A UK population based study (n=502,664) demonstrates that those with cardio-metabolic disease are characterised by low physical activity, sedentary behaviour and poor sleep. Combining all three behaviours exposes individuals to greater cardio-metabolic risk. A cross-sectional study (n=57) indicates that there are significant cardiac abnormalities in those with metabolic disease in the absence of overt heart disease. Finally, a randomised controlled trial (n=28) provides evidence that exercise can be used as a therapeutic strategy to improve cardiac structure and function in adults with Type 2 diabetes, and thereby moderate cardiac risk in this patient group. This thesis delivers two clear messages; 1) lifestyle behaviours remain significant unaddressed risk factors and 2) physical activity and exercise strategies should be used as therapies to reduce risk and improve cardio-metabolic health. Looking ahead, the results from the this study highlight the need for lifestyle behaviours to be part of the prevention and management strategies for cardio-metabolic health, and support the NHS’s 5 year plan to encourage healthier lifestyles as a priority.

Breast cancer is a leading cause of cancer and the second leading cause of cancer death among women in the US. Although many risk factors for breast cancer are known, few are modifiable and little is known about ways to prevent its incidence. Early-life body size is inversely associated with both premenopausal and postmenopausal breast cancer risk, suggesting an excess risk in lean girls. In a prospective analysis within the Nurses’ Health Study (NHS) II, Chapter 1 examines whether adolescent physical activity mitigates the excess risk of breast cancer associated with early-life body leanness. Lean girls were at higher risk of breast cancer, regardless of the level of adolescent physical activity; however, the association was slightly, though not significantly, attenuated among the most active girls. Breast cancer is hormone-related cancer; estrogen metabolites (EM) are both estrogenic and genotoxic, suggesting factors that alter the pattern of estrogen metabolism may contribute to breast carcinogenesis. With the application of advanced technology that measures 15 different individual estrogens and EM in urine, Chapter 2 examines the associations of dietary fiber and macronutrients intake with detailed estrogen metabolism in a cross-sectional analysis within the NHSII. Few significant associations were identified: a positive association between total fiber intake and 4-methoxyestradiol, an inverse association between total fiber intake and 17-epiestriol, and inverse associations for polyunsaturated and trans-fat intakes with 17-epiestriol. The tissue-specific responsiveness to potentially carcinogenic hormones, estrogen and progesterone, is partially regulated by the tissue expression of receptors that bind these hormones. Using benign breast biopsy samples collected in a nested case-control study within the NHS and NHSII, Chapter 3 assesses estrogen receptor (ER), progesterone receptor (PR), and proliferative marker Ki67 expression in normal breast tissue in relation to subsequent breast cancer risk. In this case-control analysis, PR expression in normal breast tissue was significantly positively associated with breast cancer risk in premenopausal women. ER and Ki67 expression was not significantly associated with breast cancer risk; however, our power was limited. Results of this dissertation help elucidate the underlying biologic mechanisms of breast cancer and enhance our understanding of the link between risk factors and breast cancer risk.

Mental toughness (MT) originated within elite sport and was identified as an attribute of success. MT has emerged as being important for enhancing health-related lifestyle factors (HRLF; e.g., physical activity). Investigating the healthiness of one’s lifestyle appears a timely area to research given the current health status of the population. Therefore, the aim of this thesis was to investigate MT in relation to HRLF and weight loss. Study One investigated MT and HRLF in university students (n = 167). Self-reported MT, physical activity, exercise barriers, dietary behaviour, and psychological wellbeing were recorded. MT was significantly different between regular exercisers (M = 3.43 ± .42) and non-regular exercisers (M = 3.24 ± .54, p < .05). Components of eating identity, exercise barriers, and psychological wellbeing, were significantly correlated with MT. Study Two longitudinally investigated weight loss progress, and adherence to a weight loss support group, in slimming club members who were pursuing a weight loss goal (n = 132). MT and eating identity were assessed at baseline, three-months, and six-months, and weight was recorded at weekly meetings. Overall MT was not significantly related to weight loss (r = -.15, p > 0.05) or adherence to the service (r = .03, p > 0.05). Study Three sampled individuals who held a weight loss goal, but were not attending a weight loss support club (n = 78). Overall MT was not significantly related to weight loss (r = -.21, p > 0.05). MT was not significantly different between weight loss goal achievers (M = 3.62 ± .49) and non-goal achievers (M =3.42 ± .38, p > 0.05). Thus, irrespective of whether structured support is received, overall MT was not related to weight loss progress. II Study Four investigated the experiences of high (n = 9) and low (n = 7) mentally tough individuals pursing a weight loss goal. High and low MT individuals, identified using the MTQ48, were interviewed. Thematic analysis revealed that amongst the high mentally tough individuals, those who prioritised leading a healthy lifestyle reported weight loss success compared to those who prioritised other goals. Strategies to overcome low levels of MT (e.g., control), as well as receive additional support, appeared crucial for successful weight loss in low MT individuals. Study Five further investigated the low MT individuals’ (n = 7) perceptions, experiences, and attitudes, towards weight loss. Low MT individuals were sampled based on their MT score assessed via the MTQ48. Vignette based interviews extended the findings in Study Four. Thematic analysis revealed key findings, including the potential to change low MT individuals’ perceptions to enhance behaviour change. Overall, this thesis expanded the understanding of MT; the processes that one experiences when trying to lose weight appears to differentiate between high and low MT individuals, which offers an explanation as to why MT did not appear to play a significant role in weight loss outcomes. These findings challenged the predominant contemporary understanding of MT and demonstrated that MT was not associated with behaviour change to achieve weight loss.

Ballet dancing is a rigorous activity, the requisite skill acquisition for which begins at an early age. For girls, the activity requires a clearly defined body shape and composition, the attainment of which may result in low body weight and BNH, the development of eating disorders, menstrual dysfunction, and poor nutrient intake. The combination of the high levels of exercise for both sexes and the sylph-like figure required by females may have an effect upon growth and development, injury and repair, and long-term health. No evidence could be found in the literature of investigations on retired ballet dancers and the potential effects of their career upon their long-term health. Therefore, a retrospective study was carried out on sixty-three male and female dancers by means of a 'health' questionnaire. Although the results from the retrospective study showed that no serious health effects had occurred in the sample investigated, there was nevertheless a high incidence of injury amongst both sexes. During their career, the retired females were found to have had: low body weights, with many of them having been on slimming diets; a lack of knowledge concerning food and fluid intake; and poor menstrual status, including delays in menarche. It was concluded that many of the injuries sustained by the males could be attributed to their role of partnering and therefore constantly physically supporting and lifting the female dancers. No definitive work could be found on nutrient intakes of ballet dancers and no prospective studies appeared to have been carried out on the overall injury status of currently active female ballet dancers. None of the studies had concurrently assessed nutrient intake and injury status and factors which may affect this, as well as assessing their general wellbeing. Thus, thirty-eight pre-professional female ballet dancers were recruited to the prospective study. All types of injury from minor to major were recorded over a period of ten weeks, concurrent with life events and menstrual patterns. During this period, nutrient intake was also estimated over seven consecutive days using the weighed inventory method. The dancers completed a general background questionnaire; EAT-26 and BIT'E - two screening questionnaires clinically used to assess for the symptoms of anorexia and bulimia nervosa; and, a nutritional quiz compiled by the author and largely based on what the students had been taught. The dancers had significantly lower dietary intakes of energy, carbohydrate, fat, iron, and NSP than their relative DRV's. Low intakes of energy and particularly carbohydrate could reduce muscle glycogen concentrations, and thus promote fatigue. The dancers had busy schedulesw hich restrictedt heir ability to eat well and the majority of them had poor nutritional knowledge. The injury rates of the majority of the dancers were found to be high and a statistically significant correlation was found between these injury rates and fatigue. These findings suggest that the dancers needed to receive a more fruitful method of nutrition education and have less hectic schedules, a combination of which could well result in the dancers having greater opportunity to eat well and rest sufficiently to reduce their overall levels of fatigue, enhance their overall feeling of wellbeing, and thus, possibly, reduce the risk of injury.

Abstract Oral diseases are, to a notable extent, behavioral diseases. The concept of lifestyle makes it possible to study behavior in a broad sense. The aim was to study the association of lifestyle with oral health and dental health behavior. All of the 1,012 55-year-old citizens of Oulu were invited to a clinical examination, and 780 of them participated. A lifestyle variable to measure health orientation was constructed. Smoking, alcohol consumption, dietary habits and physical activity were used as indicators of lifestyle. The association of lifestyle with dental caries, periodontal health, denture stomatitis and dental health behavior was studied with a cross-sectional design. An unhealthy lifestyle was associated with a higher number of dental decay, periodontal pockets and a higher prevalence of denture stomatitis. Lifestyle accounted for a large part of the differences between socioeconomic groups and between men and women in number of dental decay and periodontal pockets. An unhealthy lifestyle was associated with an increased prevalence of denture stomatitis in yeast carriers. A higher toothbrushing frequency and the use of extra cleaning methods were related to healthier lifestyle. Socioeconomic status was more important than lifestyle as a determinant of dental visits. Smoking was associated with higher lactobacillus counts and the presence of yeasts in saliva. Lifestyle explained a great part of the differences between the socioeconomic groups and between men and women in oral health. It seems that part of the association between oral and general health can be explained by lifestyle. It is important to control for general lifestyle when the biological connections between oral and general health are studied.

BACKGROUND. Unhealthy lifestyle behaviours such as physical inactivity are global risk factors for chronic disease. Despite this, a substantial proportion of the UK population fail to achieve the recommended levels of physical activity. This may partly be because the health messages presently disseminated are not sufficiently potent to evoke behaviour change. There has been an exponential growth in the availability of digital health technologies within the consumer marketplace. This influx of technology has allowed people to self-monitor a plethora of health indices, such as their physical activity, in real-time. However, changing movement behaviours is difficult and often predicated on the assumption that individuals are willing to change their lifestyles today to reduce the risk of developing disease years or even decades later. One approach that may help overcome this challenge is to present physiological feedback in parallel with physical activity feedback. In combination, this approach may help people to observe the acute health benefits of being more physically active and subsequently translate that insight into a more physically active lifestyle. AIMS. Study One aimed to review existing studies employing fMRI to examine neurological responses to health messages pertaining to physical activity, sedentary behaviour, smoking, diet and alcohol consumption to assess the capacity for fMRI to assist in evaluating health behaviours. Study Two aimed to use fMRI to evaluate physical activity, sedentary behaviour and glucose feedback obtained through wearable digital health technologies and to explore associations between activated brain regions and subsequent changes in behaviour. Study Three aimed to explore engagement of people at risk of type 2 diabetes using digital health technologies to monitor physical activity and glucose levels. METHODS. Study One was a systematic review of published studies investigating health messages relating to physical activity, sedentary behaviour, diet, smoking or alcohol consumption using fMRI. Study Two asked adults aged 30-60 years to undergo fMRI whilst presented personalised feedback on their physical activity, sedentary behaviour and glucose levels, following a 14-day wear protocol of an accelerometer, inclinometer and flash glucose monitor. Study Three was a six-week, three-armed randomised feasibility trial for individuals at moderate-to-high risk of developing type 2 diabetes. The study used commercially available wearable physical activity (Fitbit Charge 2) and flash glucose (Freestyle Libre) technologies. Group 1 were offered glucose feedback for 4 weeks followed by glucose plus physical activity feedback for 2 weeks (G4GPA2). Group 2 were offered physical activity feedback for 4 weeks followed by glucose plus physical activity feedback for 2 weeks (PA4GPA2). Group 3 were offered glucose plus physical activity feedback for six weeks (GPA6). The primary outcome for the study was engagement, measured objectively by time spent on the Fitbit app, LibreLink app (companion app for the Freestyle Libre) as well as the frequency of scanning the Freestyle Libre and syncing the Fitbit. RESULTS. For Study One, 18 studies were included in the systematic review and of those, 15 examined neurological responses to smoking related health messages. The remaining three studies examined health messages about diet (k=2) and physical activity (k=1). Areas of the prefrontal cortex and amygdala were most commonly activated with increased activation of the ventromedial prefrontal cortex predicting subsequent behaviour (e.g. smoking cessation). Study Two identified that presenting people with personalised feedback relating to interstitial glucose levels resulted in significantly more brain activation when compared with feedback on personalised movement behaviours (P < .001). Activations within regions of the prefrontal cortex were significantly greater for glucose feedback compared with feedback on personalised movement behaviours. Activation in the subgyral area was correlated with moderate-to-vigorous physical activity at follow-up (r=.392, P=.043). In Study Three, time spent on the LibreLink app significantly reduced for G4GPA2 and GPA6 (week 1: 20.2±20 versus week 6: 9.4±14.6min/day, p=.007) and significantly fewer glucose scans were recorded (week 1: 9.2±5.1 versus week 6: 5.9±3.4 scans/day, p=.016). Similarly, Fitbit app usage significantly reduced (week 1: 7.1±3.8 versus week 6: 3.8±2.9min/day p=.003). The number of Fitbit syncs did not change significantly (week 1: 6.9±7.8 versus week 6: 6.5±10.2 syncs/day, p=.752). CONCLUSIONS. Study One highlighted the fact that thus far the field has focused on examining neurological responses to health messages using fMRI for smoking with important knowledge gaps in the neurological evaluation of health messages for other lifestyle behaviours. The prefrontal cortex and amygdala were most commonly activated in response to health messages. Using fMRI, Study Two was able to contribute to the knowledge gaps identified in Study One, with personalised glucose feedback resulting in a greater neurological response than personalised feedback on physical activity and sedentary behaviour. From this, Study Three found that individuals at risk of developing type 2 diabetes were able to engage with digital health technologies offering real-time feedback on behaviour and physiology, with engagement diminishing over time. Overall, this thesis demonstrates the potential for digital health technologies to play a key role in feedback paradigms relating to chronic disease prevention.

A basic health and lifestyle questionnaire was given to a convenience sample of 103 Ute elders, age 50 and older. Fifty-three percent reported being diagnosed with diabetes. The mean BMI (body mass index) was 33.31 (SD=8.72). For descriptive purposes, BMI was divided into three categories: less than 25, 25-29.99, 30 or above. Eleven percent were in the BMI category of less than 25. Thirty percent of Ute elders reported a BMI between 25-29.99. Fifty two percent had a BMI of 30 or above. Diabetes rates among this Ute elder sample were significantly lower with a lower income, lower education level, older age, higher BMI, and having a family history of diabetes. A binary logistic regression revealed family history (Exp [B]=3.06; p Based on this survey, the Ute Tribe should focus future wellness programs on prevention and control of diabetes and obesity among their tribe. Prevention for these chronic diseases needs to begin with the youth as well as with the older members of the tribe. Currently, the Ute tribe has two programs to treat and prevent diabetes among their tribe. The Diabetes Prevention and Control Program is a clinic to provide intervention for those Ute members with diabetes. It also provides a small gym furnished with exercise equipment for members of the tribe to use at no cost to them. The other program for the youth of the tribe teaches about the importance of nutrition and exercise in their lifestyles. Future programs should expand upon existing programs in attempts to reach the whole tribe.

Current prevention recommendations for ovarian cancer are limited, and the underlying etiology is not fully elucidated. The associations of common modifiable factors, such as psychosocial and lifestyle factors, with ovarian cancer risk need to be more fully evaluated. Thus, I examined the association of ovarian cancer with depression, physical activity, hypertension, and antihypertensive medication use among participants from two prospective cohort studies: the Nurses' Health Study and Nurses' Health Study II. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for these associations. Depression was associated with about 30% increased risk of ovarian cancer (HR = 1.30, 95% CI 1.05-1.60). Higher risk was also observed among women with persistent positive depression status than women intermittently positive or persistently negative for depression. Contrary to the hypothesis that physical activity may lower ovarian cancer risk, we observed that both low and high physical activity was associated with a modest increase in ovarian cancer risk (HR for ≥27 [approximately equivalent to 1 hr/day of brisk walking] versus 3-9 MET-hrs/week = 1.26, 95% CI 1.02, 1.55; HR for <3 versus 3-9 MET-hrs/week = 1.19, 95% CI 0.94, 1.52). However, these associations were only restricted to premenopausal physical activity, and postmenopausal activity was not associated with ovarian cancer risk. While hypertension was not associated with risk (HR = 1.03, 95% CI 0.87, 1.21), use of thiazide diuretics was associated with an increased risk of ovarian cancer (HR = 1.35, 95% CI 1.04, 1.74), and use of calcium channel blockers was associated with a suggestively lower risk (HR = 0.73, 95% CI 0.53, 1.01). Our results need to be confirmed by other studies, but suggest that these common modifiable factors may have a moderate impact on ovarian cancer risk. This represents an opportunity to broaden our understanding of ovarian cancer etiology and potentially improve prevention strategies for ovarian cancer.
Epidemiology

Lifestyle medicine is the use of lifestyle interventions in the prevention, treatment and management of disease. A faith-based community, which is the subject of much health lifestyle research, is the focus of this study. The Seventh-day Adventist church has promoted a healthy lifestyle, including a plant-based diet, since its foundation in 1863. Research shows that Adventists are much healthier and live significantly longer than the general population. Adventist vegetarians are even more healthy, and live about five years longer than non-vegetarians. The present study was designed to investigate how church leaders relate to the Adventist health lifestyle, and to what extent information about the benefits of adopting this lifestyle is communicated to church members in Sweden. Survey interviews with specific health-related lifestyle questions were used to collect the data. 60% of the respondents reported being vegetarian or vegan. Many agreed that pastors should be health educators as much as gospel preachers, but a majority did not have any academic or other education on health. Only a minority stated that they often preach or share the Adventist health message, but most respondents agreed that every church should be a school of health. The educational program for pastors and other church leaders should include adequate training and experience in health and lifestyle medicine from a faith-based perspective. Seventh-day Adventists should be the first to take full advantage of an evidence-based healthy lifestyle and live as examples to others.

Nutritional factors have been intensively studied as important determinants of many diseases. Food frequency questionnaires (FFQ), dietary records, 24-hour dietary recalls, nutrient biomarkers are important dietary assessment methods, and are subject to various sources of measurement error. Given the limitations of these methods, much effort has been devoted to refining them and evaluating their ability to measure diet. This dissertation focused on evaluating the performance of a semi-quantitative FFQ (SFFQ), multiple web-based automated-self-administered 24-hour recalls (ASA24), 7-day dietary records (7DDR) and biochemical indicators in assessing nutrient intakes among women. Intraclass correlation coefficient, Spearman correlation coefficient, and validity coefficient calculated by method of triads were used to evaluate the reproducibility and validity of each dietary method. The first paper evaluated the performance of a 152-item SFFQ comparing intakes of nutrients estimated by SFFQ with those measured by the average of two 7DDR, and of four ASA24s kept over a one-year period. The study SFFQ performed consistently well when compared with multiple diet records, and that modifications to the questionnaire over time have adequately taken into account the changes in the food supply and eating patterns that have occurred since 1980. Multiple ASA24s can provide similar estimates of validity as dietary records if day-to-day variation is taken into account. The second paper explored the validity of long-term intakes of energy, protein, sodium and potassium assessed by SFFQ and ASA24s using recovery biomarkers and 7DDR as standards. The study SFFQ and averaged ASA24’s are reasonably valid measurements for energy-adjusted protein, sodium and potassium compared to multiple recovery biomarkers or dietary records. Recovery biomarkers should not be considered to be without error, including systematic within-person error. Finally, the third paper further evaluated the validity of nutrient assessed by SFFQ and ASA24 compared with intakes by the 7DDR and plasma levels of fatty acids, carotenoids, retinol, tocopherols and folate. Again, the study SFFQ provides reasonably valid measurements for specific fatty acid, most carotenoids, alpha-tocopherol and folate compared to concentration biomarkers or dietary records. Compared to SFFQ, almost all nutrients estimated by averaged ASA24s had relatively low correlations with biomarkers, 7DDRs and estimated ‘true’ underlying intakes.
Nutrition

Thesis (Ed. D.)--West Virginia University, 2001.
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Mitochondria are membrane-bound organelles found in the cytoplasm of almost all eukaryotic cells. Their main functions include energy metabolism, free radical production, calcium homeostasis and apoptosis. Located closely to the source of reactive oxidative stress (ROS) production, Mitochondrial DNA (mtDNA) is extremely susceptible to oxidative damage due to its absence of protective histones, the lack of introns and a scarcity of the efficient DNA repair mechanisms. Associations between leukocyte mtDNA copy number (mtCN) and various oxidative stress related health outcomes have been demonstrated in multiple prospective studies. MtCN has also been suggested to be a contributor to many cancer types. These pieces of evidence suggest that mtCN in leukocytes may serve as a candidate biomarker for oxidative stress related general health outcomes. In this work, we determined associations between mtCN and skin cancer as well as lung cancer risk by case-control studies nested within the Nurses’ Health Study (NHS) and the Health Professional Follow-Up Study (HPFS). Furthermore, we examined relationships between various oxidative stress generating factors (age, smoking, physical activity, body anthropometric indices, weight change and alcohol consumption) and mtCN among women using controls from the previous two studies. Relative mtCN in peripheral blood leukocytes (PBL) was measured by quantitative PCR (qPCR)-based assay and covariates were collected by biannually updated questionnaires. Our results indicate that obesity and weight gain are associated with lower mtCN. Moreover, mtCN may be more sensitive to obesity, while telomere length reflects aging better. In terms of cancer risks, women with low mtCN are more likely to develop skin cancer and the increased melanoma risk associated with low mtCN is more apparent among women with low constitutional risk or high UV exposure history. Although mtCN was not significantly associated with lung cancer risk, current smokers might be more susceptible for the disease when mtCN first starts to decrease.
Epidemiology

The aim of this PhD thesis was to expand the current knowledge of “traditional Sami” diet and lifestyle, and to test aspects of the Sami diet and lifestyle, specifically dietary pattern, macronutrient distribution and coffee consumption, in population-based epidemiological studies of mortality and incident cardiovascular disease and cancer in a general population. In Paper I, semi-structured interviews were conducted with 20 elderly Sami concerning their parent’s lifestyle and diet 50-70 years ago. Questionnaire data from 397 Sami and 1842 matched non-Sami were also analyzed, using non-parametric tests and partial least square methodology.  In Papers II-IV, mortality data and incident cancer data for participants in the Västerbotten Intervention Program (VIP) cohort were used for calculations of hazard ratios by Cox regression. In Paper II, a Sami diet score (0-8 points) was constructed by adding one point for each intake above the median for red meat, fatty fish, total fat, berries and boiled coffee, and one point for each intake below the median for vegetables, bread and fibre. In Paper III, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create a Low-Carbohydrate, High-Protein (LCHP) score (2-20 points). In Paper IV, filtered and boiled coffee consumption was studied in relation to incident cancer. In Paper V, a nested case-control study of filtered and boiled coffee consumption and acute myocardial infarction, risk estimates were calculated by conditional logistic regression. Surprisingly, fatty fish may have been more important than reindeer meat for the Sami of southern Lapland in the 1930’s to 1950’s, and it is still consumed more frequently by reindeer-herding Sami than other Sami and non-Sami. Other dietary characteristics of the Sami 50-70 years ago and present-day reindeer-herding Sami were high intakes of fat, blood, and boiled coffee, and low intakes of bread, fibre and cultivated vegetables (Paper I). Stronger adherence to a “traditional Sami” diet, i.e. a higher Sami diet score, was associated with a weak increase in all-cause mortality, particulary apparent in men (Paper II). A diet relatively low in carbohydrates and high in protein, i.e. a high LCHP score, did not predict all-cause mortality compared with low LCHP score, after accounting for saturated fat intake and established risk factors (Paper III).  Neither filtered nor boiled coffee consumption was associated with cancer for all cancer sites combined, or for prostate or colorectal cancer. For breast cancer, consumption of boiled coffee ≥4 versus <1 occasions/day was associated with a reduced risk. An increased risk of premenopausal and a reduced risk of postmenopausal breast cancer were found for both total and filtered coffee. Boiled coffee was positively associated with the risk of respiratory tract cancer, a finding limited to men (Paper IV). A positive association was found between consumption of filtered coffee and the risk of acute myocardial infarction in men (Paper V). In conclusion, the findings of Paper I, in particular the relative importance of fatty fish compared to reindeer meat in the “traditional Sami” diet of the 1930’s-1950’s, suggest that aspects of cultural importance may not always be of most objective importance. The findings of Papers II-V generally did not support health benefits for the factors studied. The relatively good health status of the Sami population is therefore probably not attributable to the studied aspects of the “traditional Sami” lifestyle, but further investigation of cohorts with more detailed information on dietary and lifestyle items relevant for “traditional Sami” culture is warranted.
Syftet med denna avhandling var att beskriva livsstil och kostvanor hos samer. Det var också att undersöka hur en ”traditionell samisk” livsstil påverkar risken att insjukna av eller dö i cancer och hjärt-/kärlsjukdom i en norrländsk normalbefolkning. En majorietsbefolkning har alltså undersökts ur ett minoritetsperspektiv. Avhandlingen belyser framför allt kostvanor, fördelning av de näringsämnen som innehåller energi (kolhydrat, protein, fett) och konsumtion av kok- och bryggkaffe. Bakgrunden till undersökningarna var att samerna, till skillnad från de flesta andra urfolk i världen, kan förvänta sig ett lika långt liv som majoritetsbefolkningen. När det gäller hjärtkärlsjukdom finns inga stora etniska skillnader, men samiska män, särskilt renskötande, har lägre risk att drabbas av cancer än icke-samer. Det finns ingen entydig förklaring till samernas relativt goda hälsa, men det kan finnas ett samband med kostvanor och livsstil. Delstudie I var en intervjustudie med äldre samer och fungerade som bakgrund för de andra delstudierna. Tjugo äldre samer intervjuades om sina föräldrars livsstil och kostvanor för 50-70 år sedan. Dessutom analyserades kostdata från 81 renskötande och 226 icke-renskötande samer och 1842 matchade icke-samer för att se vilka skillnader som fanns mellan grupperna. Intervjuerna visade överraskande att fet fisk kan ha varit viktigare än renkött för samerna i södra Lappland under 1930-1950-talen. Fet fisk äts fortfarande i högre utsträckning av renskötande samer än av andra samer och icke-samer. Saker som har hög kulturell betydelse (i detta fall renkött) behöver alltså inte alltid ha lika stor betydelse ur ett objektivt, vetenskapligt perspektiv. Andra typiska särdrag hos den samiska kosten var en hög andel av fett, blod och kokkaffe och en låg andel av bröd, fibrer och odlade grönsaker. Det dagliga livet hos samerna på 1930-1950-talen präglades också mycket mer av fysisk aktivitet än vad det gör idag. De samiska männen arbetade oftast långt hemifrån, medan kvinnorna hade ansvaret hemmavid för fiske, jordbruk och trädgårdsskötsel (som introducerades under 1930-1950-talen). Kvinnorna tog även hand om hushållsarbetet och barnen. Delstudierna II-V handlade om olika aspekter av samisk kost i relation till dödlighet och sjuklighet. Till dessa användes huvudsakligen data från Västerbottens hälsoundersökningar, men i delstudie V även från MONICA-projektet, som är en del av ett multinationell forskningsprojekt om hjärt-/kärlsjukdom.  Totalt ingick på så sätt data från mer än 80 000 unika individer från en allmän, till största delen icke-samisk, normalbefolkning. Delstudie II byggde på en modell liknande den som använts för att undersöka hälsoeffekter av så kallad Medelhavsdiet.  En poängskala från 0-8 poäng, en så kallad ”Sami diet score”, skapades för att spegla likheter med ”traditionell samisk” kost. Den hälft av deltagarna som åt mest rött kött, fet fisk, fett, bär respektive kokkaffe, fick 1 poäng var, sammanlagt maximalt 5 poäng. Den hälft av deltagarna som åt minst grönsaker, bröd respektive fibrer fick också 1 poäng var, sammanlagt maximalt 3 poäng. Stora likheter med en ”traditionell samisk” kost, det vill säga höga ”Sami diet score” poäng, var förknippade med en svagt ökad dödlighet, särskilt hos männen. Det verkar därför osannolikt att den samiska kosten i sig förklarar den relativt goda hälsan hos samer. Denna fråga är dock mycket svår att undersöka, eftersom kostvanorna kan ha skiljt sig mellan olika samegrupper och över tid. Dessutom äter dagens västerbottningar mycket mindre av vissa livsmedel, jämfört med vad samerna gjorde förr i tiden. Det gäller till exempel fet fisk och bär.  För sådana livsmedel kan det därför vara extra svårt att påvisa samband med dödlighet. Syftet med kostenkäten i Västerbottens hälsoundersökningar är inte heller att spegla en ”traditionell samisk” kost. Det finns till exempel inga frågor om renkött och vilt, utan sådant kött räknas som en del av övrigt rött kött. Det här är första gången som någon undersökt betydelsen av ett ”traditionellt samiskt” kostmönster för hälsan på detta sätt. Fler liknande undersökningar i material med mer detaljerade frågor, som bättre fångar en samisk kost, är önskvärda. Lågkolhydratdieter, som har vissa likheter med den ”traditionella samiska” kosten, är både populära och kontroversiella. Eventuella långtidseffekter för hälsan är till stor del okända. I delstudie III speglades förhållandet mellan kolhydrater och protein i kosten med hjälp av så kallade LCHP (låg-kolhydrat, hög-protein) poäng. Högsta LCHP poäng fick de deltagare som åt minst kolhydrater och mest protein. Höga LCHP poäng påverkade inte risken att dö, eller att dö i cancer eller hjärt-/kärlsjukdom, efter att statistisk hänsyn tagits till intaget av mättat fett och de vanligaste riskfaktorerna. LCHP score användes i denna studie, istället för exempelvis en LCHF (low carbohydrate, high fat) variant. På så sätt kunde betydelsen av total fettmängd och av mättat fett också vägas in i analyserna. Dessutom innehåller kolhydrater och protein samma mängd energi per gram, vilket gör det lättare att byta ut dem mot varandra i en poängskala. Fett innehåller nästan dubbelt så mycket energi per gram som proteiner och kolhydrater. Inte bara olika sorters fett, utan även olika sorters protein och kolhydrater, kan spela roll för hälsan. Det är därför mycket svårt att skilja ut effekterna av mängd och kvalitet av kolhydrater, protein och fett i kosten. I delstudierna IV och V undersöktes risken att bli sjuk i cancer eller få en akut hjärtinfarkt hos västerbottningar som dricker mer respektive mindre kok- och bryggkaffe. De som drack mycket kaffe hade varken ökad generell cancerrisk, eller ökad risk för prostata- eller tjocktarmscancer. Kvinnor som drack kokkaffe ≥ 4 ggr/dag hade minskad risk för bröstcancer jämfört med kvinnor som drack <1 gång/dag.  Både totalt kaffeintag och intag av bryggkaffe var kopplade till ökad risk för bröstcancer hos yngre kvinnor och minskad risk hos äldre. Män som drack mycket kokkaffe hade ökad risk för cancer i luftvägarna. Dessa resultat visar att de som dricker olika sorters kaffe kan ha olika stor risk att drabbas av olika sorters cancer. I tidigare studier har inga starka samband hittats mellan kaffedrickande och cancer. Denna studie var den första att undersöka hur cancerriskerna ser ut hos människor som dricker olika sorters kaffe. När det gäller hjärtinfarkt, hade män som drack mycket bryggkaffe ökad risk, medan inga entydiga resultat kunde visas bland män som drack mycket kokkaffe. Tidigare studier har visat motstridiga resultat när det gäller kaffe och hjärt-/kärlsjukdom, även om kaffekonsumtion är vedertaget förknippat med en del faktorer som kan öka risken att drabbas av hjärtinfarkt, till exempel ökade halter av blodfetter. Betydelsen av kokkaffe har aldrig undersökts tidigare i en studie där uppgifter om kaffedrickande samlats in i förväg. Delstudierna II-V är alla så kallade observationsstudier. I sådana studier följer deltagarna ingen bestämd forskningsplan, utan lever sina normala liv och jämförs sedan med varandra.  I observationsstudier är det mycket svårt att ta hänsyn till alla möjliga störande faktorer som kan finnas i omgivningen. Därför är det i princip omöjligt att bevisa direkta samband mellan orsak och verkan i en observationsstudie. Delstudierna II-V hade emellertid den starkaste design som en observationsstudie kan ha. De byggde på en representativ normalbefolkning (= en befolkningsbaserad kohort), där data samlats in från ett stort antal personer (> 80 000 unika individer) medan de ännu var friska (= en prospektiv kohort).  Resultaten av enstaka observationsstudier har störst betydelse som underlag för att planera nya liknande, eller andra typer av mer riktade undersökningar. De är med andra ord hypotesgrundande. Om däremot flera observationsstudier visar på liknande resultat brukar man utgå från att resultaten är sanna, eller åtminstone sannolika.
(Nordsamiska) Guorahallama ulbmil lea muitalit sámi biepmu ja eallinvuogi birra ja iskat got árbevirolaš sámi borranvierut, makrobiebmama juogustus ja gáffegolaheapmi  váikkuhit jámolašvuođa  ja riskka oažžut borasdávdda dehe váibmo-/ suotnadávdda dábálaš davvi-ruoŧŧelaš ássiid luhtte. Guoktelogi sámi vuorrasa ledje jearahallon daid vánhemiid eallinvuogi  ja borramuša birra 50-70 jagi áigi (Oassedutkan 1). Dasa lassin  397 sámi ja 1842 ruoŧŧelačča biebmandata guorahallojuvvo eahpe-paramehtarlaš iskamiid ja partialalaš unnimus kvadráhta metoda (PLS) mielde. Dát golbma čuovvovaš oassedutkama, gait kohortdutkamat, isket jápminsiva dehe borasdávdabuohccivuođa oaseváldiid luhtte  Västerbottenis dearvas-vuohŧaiskkademiid hárrái (64 603-77 319 iskama) ja riskkaluoitimat leat rehkenaston Cox regrešuvnna  mielde. Oassedutkamis  2  árbevirolaš sámi biebman  lea speadjalaston čuokkesskála vuostá   0 rájes gitta 8 čuoggá.  Dát bealli oaseváldiin geat leat eanemus rukses bierggu, buoiddes guoli, buoiddi, murjiid ja vuoššangáfe borran, lea ožžon 1 čuoggá juohke áidna biebmanelemeanta ovddas, oktiibuot eanemus 5 čuoggá. Vel 3 čuoggá dát bealli oaseváldiin lea ožžon geat lea unnimus šattuid, láibbi ja fiberiid borran, eanemus oktiibuot 3 čuoggá. Oassedutkamis 3 speadjalastá oktavuođa kolhydráhtaid ja proteiinnaid gaskkas  biebmamis  LCHP (vuolit-kolhydráhta, alit-proteiidna) čuoggáid bokte. Alimus LHCP čuoggát (=20) dát oasseváldit leat ožžon geat leat borran unnimus kolhydráhtaid ja eanemus proteiinnaid  ja vuolimus čuoggát (=2)  dát oasseváldit leat ožžon geat leat borran eanemus kolhydráhtaid ja unnimus proteiinnaid. Oassedutkamis 4 riska borasdávdabuohccivuođa ektui guorahallojuvvo brygg- ja vuoššangáffejuhkkiid  luhtte. Oassedutkan 5 lei goallostuvvon dárkkástus-dutkan, gos riska fáhkkatlaš healladávdda oažžut gáffejuhkkiid luhtte rehkenasto logistihkalaš eaktuduvvon regrešuvnna bokte. Sáhttá leahkit nu ahte buoiddes guolli lea rievtti mielde leamašan deaŧaleabbo sámiide go boazobiergu lulli Lapplánddas  1930-1950-logus ja badjeolbmot ain dávjábut borret dan go iežá sámiid ja ruoŧŧelaččat. Iežá sierra erenomášvuohta sámi biebmamis lei alit oassi buoiddis, mális ja vuoššangáfes ja vuolit oassi láibbis, fiberiin ja šaddaduvvon  šattuin (Oassedutkan 1). Stuora seammaláganvuođat árbevirolaš sámi biebmamiin, rievtti mielde alit Sami diet score čuoggát, ledje čatnon veahá aliduvvon jámolašvuhtii  dievdduid luhtte muhto ii fal nissoniid luhtte (Oassedutkan 2). Biebman mas vuolit oassi kolhydráhtaid ja alit oassi proteiinnat, rievtti mielde alit LHCP čuoggát, ii váikkuhan riskka jápmit, maŋŋel go lea statistihkalaččat jurddašan ahte buoiddi borrat ja mat dát leat dát sajáiduvvon riskafáktorat (Oassedutkan 3). Gáffejuhkan ii lean čatnon eaneduvvon borasdávdariskii, iige eaneduvvon riskii oažžut prostata- gassačoalleborasdávdda. Nissoniin mat juhke vuoššangáfe ≥ 4 geardde/beaivái lei geahpeduvvon riska oažžut čižžeborasdávdda go nissonat mat juhke <1 geardde/beaivái.  Ollesgáffe ja brygg-gáffe ledje čatnon eaneduvvon riskii oažžut čižžeborasdávddá nuorat nissoniid luhtte ja geahpeduvvon riskii vuorrasiin luhtte. Dievdduin mat juhke ollu vuoššangáfe lei eaneduvvon riska oažžut borasdávdda (Oassedutkan 4). Dievdduin mat juhke olu brygg-gáfe lei eaneduvvon riska oažžut healladávdda (Oassedutkan 5). Vuorrasit sámiid muitalusat man olu guoli sin vánhemat leat borran boazobierggu ektui 1930-1950-logus, čujuhit ahte bealit main alit kultuvrralaš mearkkašupmi eai dárbbaš seamma nanu objektivalš mearkkašumi atnit. Oassedutkamiid 2-5 bohtosat čujuhit ahte guorahallon bealit árbevirolaš sámi biebmamis ja eallinvuogis eai váikkut gárrasit dearvvašvuođa ja buohccivuođa dábálaš davviruoŧŧelaš ássiid luhtte.
(Lulesamiska) Dán guoradallama ájggom lij sáme biebmov ja viessomvuogev tsuojgodit, ja åtsådit gåk árbbedábak sáme bårråmdábe, stuoräládusebna juohkem ja káffajuhkam nuorttalándak álmmugin, bájnná jábmemav ja bårredávddabalov ja tsåhke-/ varravárredávddabalov. Guoktalågev sáme gatjádaláduvvin sijá äjgádij viessomvuoge ja biebmo birra 50-70 jage dán åvddåla (Oasseåtsålvis 1). Biebbmodáhtá 397 sámes ja 1842 láttes guoradaláduvvin parametragahtes gähttjalimij ja muhtem miere unnemus kvadráhta vuoge (PLS) viehkijn. Gålmmå tjuovvo oasseåtsådime, gájkka kohorttaåtsådime, vuolggin Västerbottena varresvuohtaåtsådimj oassálasstij jábmemårijs jali bårredávddaskihpudagájs (64 603-77 319). Ballamoarremerustallamav dahkin Cox regressionijn.  Oasseåtsådibme 2 spiedjildij avtaárvojt árbbedábak sáme biebmon tjuokkesmåhtajn nållå rájes gávtse tjuoggáj. Dat lahkke oassálasstijs gudi bårrin ienemus ruoppsis biergov, buojdes guolev, buojdev, muorjijt ja máleskáfav, oattjoj avtav tjuoggáv juohkka avta bårråmoases, aktan 5 tjuoggá ienemusát.  Ájn 3 tjuoggá oattjoj dat lahkke oassálasstijs mij båråj binnemus ruonudisájt, lájbijt ja fiberijt, aktan ienemusát 3 tjuoggá. Oasseåtsådibme 3 spiedjilt vidjurijt kolhydráhtaj ja proteijnaj gaskan biebmon nåv gåhtjodum LCHP (vuolle-kolhydráhta, alla-proteijna) tjuoggáj viehkijn.  Alemus LCHP tjuoggájt (=20) oadtjun oassálasste gudi binnemus kolhydráhtajt ja ienemus proteinajt bårrin ja vuolemus LCHP tjuoggájt (=2) oassálasste gudi ienemus kolhydráhtajt ja binnemus proteijnajt bårrin.  Oasseåtsådimen 4 åtsådaláduváj bårredávddaballo brygga- ja máleskáffajuhkkijn. Oasseåtsådibme 5 lij aktijdum guoradim-åtsådibme, gånnå káffajuhkkij tsåhkedávddaballo merustaláduváj aktijdam vihkemáhtsadime baktu. Vuordedahtek lij buojdes guolle ájnnasabbo gå boatsojbierggo sámijda oarjje Lapplándan 1930-1950-lågojn ja ájn vilá ällosáme guolev ienebut bårri gå ietjá sáme ja látte. Ietjá sierra merka sáme biebmon lij alep oasse buojdes, máles ja máleskáfas ja unnep oasse lájbes, fiberis ja sáddjidum ruonudisájs (Oasseåtsådibme 1). Árbbedábak sáme biebmo muoduk biebbmo, alep Sami diet score tjuoggáj, aktijaneduváj lasse jábmemijn sierraláhkáj ålmmåj hárráj (Oasseåtsådibme 2). Biebbmo vuolep kolhydráhttaåsijn ja alep proteijnnaåsijn, alla LCHP tjuoggáj, ittjij jábmembalov bájne, maŋŋel gå statistijkalattjat gehtjadam buojddebårråmijt ja ieme ballovidjurijt (Oasseåtsådibme 3).  Káffajuhkam lij tjanádum juogu de lasse gájkkásasj bårredávddaballuj, jali lasse prostáhta- bahtatjoallebårredávddaj. Kujnajn gudi máleskáfav juhkin ≥ niellji bäjvváj lij binnep njidtjebårredávddaballo gå buohtastahttá kujnaj gudi < akti bäjvváj juhkin. Ålleskáffa ja bryggakáffa tjanáduváj lasse njidtjebårredávddaballuj nuorap kujnaj hárráj ja binnep vuorrasappoj. Ålmmåjn gudi juhkin edna máleskáfav lij lasse bårredávddaballo vuojŋŋamorgánajn (Oasseåtsådibme 4). Ålmmåjn gudi juhkin edna bryggakáfav lij lasse tsåhkedávddaballo (Oasseåtsådibme 5). Vuorrasap sámij tsuojggoma äjgádij guollebårråmis gå buohtastahttá boatsojbierggobårråmijn 1930-1950-lågo, vuosedi biele alla kultuvrak sisanos e agev dárbaha sämmi nanos objektijvak sisanov adnet. Oasseåtsådimij 2-5 båhtusa vuosedi åtsådum biele árbbedábak sámebiebmos ja viessomvuoges e varresvuodav ja skihpudagáv nuorttalándak álmmuga hárráj heva bájne.
(Sydsamiska) Dan goerehtimmien ulmie lea saemien beapmoem jïh jielemevuekiem buerkiestidh jïh dotkedh guktie aerpievuekien saemien beapmoevuekieh, makrobïepmehtimmiej juekeme jïh prïhtjhjovhkeme jaemedem jïh riskem dijpieh vaajmoe-/ jïh soeneskïemtjelassen muhteste noerhtesvöörjen sïejhmi årroji luvnie. Lea göökteluhkie saemien voeresh goerehtamme daej eejtegi jielemevuekien jïh beapmoen dïehre  50-70 jaepiej juassah (Stuhtjedotkeme 1). Dïsse lissine lea beapmoedaatam goerehtamme 397 saemijste jïh 1842 laedtijste ov-parametrihken gïehtjedimmiej jïh partiellen unnemes kvadraaten vuekien mietie (PLS).  Dah golme båetien stuhtjedotkemh, gaajhkh kohortdotkemh, leah dotkeme man gaavhtan jaameme jallh mïetskeåedtjieskïemtjelassh daej luvnie gïeh meatan Västerbottenen healsoedotkemi muhteste (64 603-77 319 dotkemh) jïh riskeryøknemh  dorjeme Cox  regresjovnen viehkine. Stuhtjedotkemisnie 2 lea mohtedamme guktie aerpievuekien saemien beapmoe vaestede låhkoeraajterasse 0 raejeste 8 raajan. Daate bielie daejstie gïeh meatan gïeh jeenemes rööpses bearkoem, buajtehks gueliem, buejtiem, muerjieh jïh voessjemeprïhtjegem byöpmedamme, leah aktem låhkoem åådtjeme fïere guhte beapmoeelementen åvteste, jeenemes 5 låhkoeh. Dïsse lissine 3 låhkoeh åådtje daate bielie daejstie gïeh meatan gïeh unnemes kruanesaath, laejpiem jïh fiberh byöpmedamme, jeenemes 3 låhkoeh. Stuhtjedotkemisnie 3 daelie mohtede kolhydraath jïh proteinh beapmosne LHCP (vuelehks-kolhydraath, jïlle-proteine) låhkoej viehkine. Jillemes LHCP låhkoem åådtjeme (=20) dah gïeh meatan gïeh vaenemes kolhydraath jïh jeenemes proteinh byöpmedamme jïh vueliehkommes LHCP låhkoem (=2) åådtjeme dah gïeh meatan gïeh jeenemes kolhydraath jïh vaenemes proteinh byöpmedamme. Stuhtjedotkemisnie 4 riskem goerehtamme mietskeåedtjieskïemtjelassem åadtjodh brygg- jïh voessjemeprïhtjegejovhkiji luvnie. Stuhjtedotkeme 5 lïj tjetskeme-dotkeme gusnie riskem ryöknoe logistihken regresjovnen baaktoe jis maahta  faahketji vaajmoedåeriesmoerh åadtjodh prïhtjhjovhkiji luvnie. Buajtehks guelie meehti vihkielåbpoe årrodh båatsoesaemide goh bovtsebearkoe åarjel Lapplaantesne 1930-1950-låhkosne jïh daamhtah båatsoesaemieh daam byöpmedieh jeenebe goh jeatjah saemieh jïh laedtieh. Jeatjah sïejhmi sjïere vuekieh saemien beapmosne lea jïlle stuhtje buejteste,  maeleste jïh voessjemeprïhtjegistie jïh vuelie stuhtje laejpeste, fiberistie jïh kruanesaatijste (Stuhtjedotkeme 1). Jeenh saemien aerpievuekien beapmoe, jïlle Sami diet score låhkoeh, provhki vuesiehtidh vaenie jeananamme jaemede ålmaj gaskemsh bene ij nyjsenæjjaj gaskemsh (Stuhtjedotkeme 2). Beapmoe man vuelehks stuhtje kolhydraath jïh stoerre stuhtje proteijnh, jeenh LCHP låhkoeh, ij leah dïjpeme riskem jaemedh, dan mænggan goh lea ussjedamme statistihken muhteste man jeene buejtiem byöpmedidh jïh sijjiedahteme riskefaktovrh ussjedamme. (Stuhtjedotkeme 3). Prïhtjhjovhkeme ij leah tjoelmesovveme jeananamme mïetskeåedtjieriskese, jallh jeananamme riskese prostaate-voeresbuejtiemïetskeåedtjiem åadtjodh. Nyjsenæjjah gïeh voessjemeprïhtjegem jovhkeme ≥ 4 aejkien/biejjesne unnemes riskem utnin njammamïetskeåedtjiem åadtjodh nyjsenæjjaj muhteste gïeh jovhkeme <1 aejkien/biejjesne. Ellies prïhtjege jïh bryggeprïhtjege lea tjoelmesovveme jeananamme riskese njammamïestkeåedtjiem åadtjodh noere nyjsenæjjah luvnie jïh unniedamme riskem voeresi luvnie. Ålmah gïeh jeenh voessjemeprïhtjegem juvhkieh jeananamme riskem utnieh mïetskeåedtjiem åadtjodh girsesne (Stuhtjedotkeme 4). Ålmah gïeh jeenh bryggeprïhtjegem jovhkeme jeananamme riskem utnieh vaajmoedåeriesmoerem åadjtodh (Stuhtjedotkeme 5). Dah saemien voeresi soptsestimmieh man jeeneh gueliem daej eejtegh leah byöpmedamme bovtsebearkoem muhteste 1930-1950-låhkosne, vuesehte ahte daate bielie man vihkeles kultuvren sisvege ij eejnegen seamma objektiven sisvegem utnieh. Illeldahkh stuhtjedotkemijstie 2-5 vuesiehtieh ahte  dah bielieh mejtie lea goerehtamme saemien aerpienvuekien beapmoen jïh jielemevuekien muhteste eah healsoem jïh skïemtjelassem dïjph jeenebe goh sïejme noerhtesvöörjen årrojh.
(Umesamiska) Dahte guoreteme suptseste saamien beäpmoen jah jielemevuökien  biire jah giehtjedie guktie aarpievuökien saamien beäpmoeh, oajviebeäpmoeh jah kaavoeh mietete jaameke vahkake jah  cancerenne jah vajmoen/ virreveättennea nuorthen  allmetjeih luunie. Guökteluhke saamieih boariesh gihtjedihke lie elltie eihtegeh jielemevuökien jah beäpmoen biire dann baelie 50-70 jaapieh (Oasie 1). Jieneh beäpmoe-dataede dahkedihke lie 397 saamieiheste jah 1842 ruotseiheste dennake viehketihenne ieh parmetriske giehtjedemeh jah  partiellen unnemes kvadraten vuökien miete (PLS). Dah gullme oasieh boatien kohort- luhkemeh, allkemme lie jaamemeste jall canceremeste mieteih Västerbottenen varaasgiehtjemeih luunie (64603-77319 ollu) vahkake-tsiehkesjeme dahkedihke Cox-enne regressione. Oasienne 2 vuöjnedihke leh akte laakatjenne aarpievuökien saamien beäpmoeh vuösstede akte tsiehkesjerairoe 0 – 8. Dahte bielie deistie gieh jienemes ruöpses beärrkoede, buöjteks guöliede, buöjtiede borrein jah vuossjeme kaavoede juukein, akte tsiehkie fierte beäpmoih outeste otjoin, jienemes 5 tsiehkieh.Vielie 3 tsiehkieh dahte bielie otjoin gieh unnemes jaamoede jah urhtsede, laipiede jah fiberede borrein, jienemes 3 tsiehkeh. Oasienne 3 vuöjnedihke aktevuotta gasske kolhydrateh jah proteieneh beäpmoenne LCHP-esne (vuöleke kolhydrateh, jylloeke-proteineh) tsiehkie. Jyllemes LCHP tsiehkieh (=20) dainie mietenne unnemes kolhydrateh jah ollomes proteineh borrein jah unnemes LCHP tsiehkieh (2) dainie mietenne ollomes kolhydrateh jah unnemes proteineh borrein. Oasienne 4 giehtjedihke vahkake cancerede brygg- jah vuossjeme kaavoe juukejenne. Oasie 5 tjohkenne lin kontrolle- giehtjedeme vahkake hiehke vaajmoe-narrenne kaavoe-juukejenne tsiehkiesjdihke logistiske regressionenne. Buöjteke guölieh borretdihke mahtein vieliebe buutsebeärrkoeste saamieihesne oarrjel  saamien eätname 1930-1950 jaapienne jah vieliebe borretdihke buutsesaamieiheste guh jeätja saamieh jah ruotse-allmetjeh. Jeätja siejhme sierreme saamien beäpmoesne lin akte jylloeke oasie buöjtie-, viire-, jah vuossjeme kaavoeste jah akte vuöleke oasie laipie-, fibere-, joamoe jah urhtseste (Oasie 1). Ollu aktelaaka aarpievuökien saamien beäpmoeh, ollu Sami diet score tsiehkieh tjohkan lin vieliebe jaameme ollmaihenne sierrelaaka (oasie 2). Beäpmoihenne unne kolhydrateh jah ollu proteineh, ollu LCHP tsiehkie, ieh vahkake lasste jaamet, dann mingjelen guh statistiske ussjede valltedihke leh borremmiean gallane buöjtieste jah vihties vahkake faktoreiheste (oasie 3). Kaavoejuukeminne lin ieh vielebe aarpievuökien cancer-vahkake tjohkenne, jall vielebe vahkake prostate-kolorektale-cancere. Nyesenejah guh vuossjeme kaavoe juukein ≥4  aikieh/biejvie  unnebe vahkake nitje-cancereb lin muhteste nyesenejanneh gieh  <1 aikie/biejvie juukein. Gaihkekaavoe jah brygg-kaavoe lie tjoahkan vielebe nitje cancereb nyesenejanne jah unnebe vahkake boariesh nyesenejaihenne. Ollma guh ollu vuossjeme kaavoeb juukein cancereste gonkelmesenne vieliebe vahkake otjoin (oasie 4). Ollma guh ollu brygg-kaavoe vajmoe-narreme vieleb vahkake otjoin (oasie 5). Dah boariesh saamieh suptsestemeh man jingje guöliede elltie eihtegeh buutsebeärrkoeh borrein 1930-1950-aikie, vuösiete dahte bielie veäksekes kulture miele ieh gaihke aikie darpesjedennake veäksekes objektive miele leh. Oasie 2-5 vuösiete dah giehtjedemes dahte bielie aarpievuökien saamien beäpmoen jah jielemen vuökien ieh varaas jah skieptjeme mietete ieh nuorthen almetejeh ollu.

The aim of this thesis was to strengthen understanding of self-reported sleep in pregnancy by drawing together evidence from: previously published research; de novo analyses of existing and novel datasets; and the lived experience of pregnant women themselves. This mixed- methods approach found that: a lack of standardisation and potential flaws in the design of previous studies do not yet permit a formal meta-analysis to be performed; and previous findings remain vulnerable to error and publication bias. The three de novo quantitative analyses of self-reported sleep conducted for this thesis sought to address many of the flaws in previous research. These analyses indicate that: several pre- existing/pre-pregnant sociodemographic and health characteristics contribute to the less favourable sleep commonly reported by pregnant women (as compared to age-matched non- pregnant women); and that variation in these and (un)related lifestyle and behavioural factors during pregnancy also contribute to variation in self-reported sleep amongst pregnant women. However, the last of these analyses provides evidence that variation in a commonly experienced phenomenon (glucose intolerance and, at its extreme, gestational diabetes) is associated with less favourable sleep in what appears to be a dose-response relationship. Analysis of posts to web-based forums by women with first-hand experience of sleep in pregnancy confirm that pregnancy-specific somatic changes were experienced/understood to be the principal causes of less favourable sleep; although the advice offered to others facing similar problems tended to focus on behavioural and situational factors as suitable avenues for intervention. On the basis of this evidence, it is clear that none of the self-administered sleep instruments/items available, and used, to-date are capable of comprehensively assessing the sleep of pregnant women. Future research must develop/use a dedicated sleep instrument to improve our understanding of the range, prevalence and likely determinants of the less favourable sleep more commonly reported by pregnant women.

This dissertation evaluates lifestyle strategies for the management of cardiovascular risk factors and prevention of cardiovascular disease (CVD). In Chapter 1, I systematically review and summarize the evidence of the effect of yoga, a popular mind-body practice, on cardiovascular disease and metabolic syndrome risk factors. I perform a narrative systematic review and a random-effects meta-analysis of randomized controlled trials (RCTs) of posture-based yoga practice. I find that yoga showed significant improvement in a variety of risk factors for CVD and metabolic syndrome, including body mass index, systolic blood pressure, and total cholesterol when compared to no or minimal intervention control groups. When compared to active exercise controls, yoga produced similar risk factor level reduction. Promising evidence supports yoga’s role in improving cardio-metabolic health. Findings are limited, however, by small trial sample sizes, heterogeneity, and moderate RCT quality. In Chapter 2, I evaluate the comparative effectiveness of four different lifestyle strategies for reducing 10-year CVD risk. I used published literature on risk factor reductions associated with group therapy for smoking cessation, Mediterranean diet, aerobic exercise (walking), and yoga together with the Pooled Cohort risk algorithms to calculate a personalized optimal strategy for risk reduction based on different risk profiles. I find that for smokers, successful smoking cessation is an optimal strategy for reducing risk whereas for non-smokers or for smokers who do not quit successfully, stress reduction through yoga produces the greatest risk reductions. In Chapter 3, I examine the cost-effectiveness of aerobic exercise and yoga compared to current medical practice for primary prevention of CVD in US adults. I use a subset of RCTs from Chapter 1, along with published literature on utilities, costs, and other parameters as inputs into a validated disease microsimulation model. I calculate the costs per quality-adjusted life year ($/QALY) of aerobic exercise and yoga with an exercise on prescription approach from the societal and healthcare perspective as well as if the activities were reimbursed. Results suggest that both interventions are not cost-effective using a threshold of $100,000/QALY due to high patient time costs in the societal perspective; when the activities are reimbursed and gains in quality of life are taken into account, then the activities can be cost-effective. Future research can explore patient preference and adherence and utility gains from physical activity.
Health Policy

Background: Cardiovascular disease (CVD) is the leading cause of death among all major racial and ethnic groups in the United States (US) and worldwide. Filipinos are the second largest Asian immigrant group in the US. Healthful lifestyle behaviors are cardioprotective factors, but have been under-, overestimated, or not studied among Asian American subgroups.

Objective: The purpose of this dissertation was to describe the cardiovascular health, cardiovascular mortality, cardiometabolic and lifestyle health behaviors, acculturation, and predictors associated with CVD in the Filipino American population.

Methods: A systematic review of the literature was conducted which focused on the cardiovascular mortality, disease and clinical and behavioral risks of Filipinos in the US. Two secondary analyses of the 2011-2012 California Health Interview Survey dataset were conducted which focused on the cardiovascular health, CVD, acculturation, metabolic and lifestyle health behavior of Filipino Americans (n = 555).

Results: The systematic review suggested that Filipino Americans are at high risk for developing cardiovascular disease, for having CVD-related clinical health risks, for engaging in unhealthy CVD lifestyle behaviors, and dying from CVD, as compared to White, non-Hispanic and other Asian Americans in general and by gender. The prevalence of CVD was 7.4% among Filipinos in California. Hypertension, diabetes, physical inactivity, being overweight/obese, and inadequate consumption of fruits and vegetables were prevalent among Filipinos. Multivariate logistic regression analysis indicated that only hypertension was a significant predictor of CVD, controlling for the effects of age, gender, being born in the US, and diabetes. When taking into consideration acculturation factors in chronic diseases and health behaviors, US-born Filipinos had a significantly lower proportion of chronic diseases as compared to Filipinos not born in the US. Filipinos who lacked English proficiency reported more hypertension as compared to Filipinos who reported proficiency in English. A higher proportion of several positive health behaviors were reported among Filipinos not born in the US and those who did not speak English at home ate the recommended 35 or more servings per week of fruits and vegetables compared to their counterparts.

Conclusions: Further research is needed for culturally-appropriate interventions, education, and prevention programs which focus on health behaviors and chronic diseases, such as CVD, for Filipino Americans.

The adoption of health behaviours is essential if coronary heart disease patients are to optimise their chance of survival and reduce the likelihood of recurrent coronary events. However, this behavioural change may not ensue following an acute myocardial infarction(AMI). This study on first AMI subjects sought firstly to examine the psychometric properties of five scaled instruments used for assessing health behaviours. Secondly, the study assessed the prevalence of health-enhancing behaviours at the time of the first AMI and 6 months after this event.Thirdly, the magnitude of health behavioural change was then examined. Fourthly, sociodemographic, clinical and psychosocial predictors of health-enhancing behaviours were explored.These health-enhancing behaviours included non-smoking behaviours, normal body mass index (BMI), adequate physical activity, medication adherence and low dietary fat intake. Finally, the study examined relationships between sociodemographic , psychosocial and modifiable lifestyle factors, based on Antonovsky's hypothesis on sense of coherence(SOC), stress and adaptive coping. The study highlights that some modifiable risk factors, for example, being overweight or obese and physical inactivity were more resistant to change following an AMI.This finding, and the relationship between stress and increased dietary fat suggest a need for individualised programs to support the specific needs of AMI patients to change their modifiable cardiac risk factors.
Doctor of Philosophy (PhD)(Health)

According to the salutogenic theory put forth by Antonovsky, an individual’s sense of coherence (SOC) is central for maintaining health. The present study used data from middle-aged women being part of a longitudinal research program to investigate how SOC relates to health status (in terms of self-rated health and medicine consumption) and a set of lifestyle factors (physical exercise, alcohol consumption, nicotine consumption and dietary habits). Women with a strong SOC were hypothesized to exhibit better health profiles, consume less medication, and lead a healthier lifestyle than women with a weak SOC. The findings partly confirmed the hypotheses in showing that women with a strong SOC had better self-rated overall health, better psychological well-being, fewer self-reported diseases and lower medicine consumption. Contrary to the hypothesis, women with stronger SOC had more self-reported psychological and physical symptoms. Of the lifestyle factors, only dietary habits were significantly associated with SOC. The study shows that SOC is related to differences in health and medicine consumption in a homogeneous group of middle-aged women, while the association between SOC and lifestyle was found to be less prominent.

The role of arts in both formal and non-formal education has been scientifically demonstrated to create positive outcomes in people to deal with all kinds of social problems in daily life. At present, there are international public and private institutions that support this view, such as the International Arts Education Week, celebrated for the first time by UNESCO on 21-27 May 2012 when not only artists participated, but also educators, researchers, NGO actors, and international associations. This provides us with a wider perspective on how arts and education can play an interdisciplinary role in society. The aim of this research is to study how arts (e.g., performative arts, literature, film) interact with and affect Nordic society; the kind of practices, contributions and challenges that exist within the cultural and educational sectors (based on three case studies) and their relationship between the government in the form of cultural policies in Denmark, Sweden and Finland in support of the well-being of the Nordic lifestyle whenever applying a wider perspective to the role of the arts in society.  This qualitative study is composed of three case studies, which explore the role of arts in three Nordic institutions (two public ones and a private one): 1) The Academy of Fine Arts in Helsinki, Finland; 2) Skissernas Museum - Museum of Artistic Process and Public Art in Lund, Sweden; and 3) Louisiana Museum of Modern Art in Humbaelek, Denmark. The empirical material collected has been done through the usage of the hermeneutics—texts, semi-structured interviews of professionals (two art educators with multidisciplinary backgrounds, two art historians, and a museum guide), publications, catalogues, and active participation in cultural/educational activities in Sweden, Denmark, and Finland. The data collected is analyzed within the framework of the reflexive methodology. “The Theory of Communicative Action” by Jürgen Habermas aims to understand the multidisciplinary relationship among the artistic/educational institutions, society, and government as support for the well-being and sustainability of Nordic society.  The results will reveal a multidisciplinary application of the arts as support to Nordic welfare, healthand lifestyle. The results will also show how arts can be included in people’s lifestyles in an organic manner, being a benefit for the well-being of the society and supporting the sustainability of Nordic welfare when people have a wider understanding of the application of the arts in their lives, for instance, through literature, concerts, performances, but also, attending to festivals, arts and crafts activities, gardens, parks, and even experiencing architecture.

Includes bibliographical references
Background: Previous research has identified health care workers (HCWs) and shift workers as having an increased risk for non-communicable diseases (NCDs). Nurses in particular have a high prevalence of obesity, poor eating habits and insufficient physical activity and are at an increased risk for NCDs. Nurses are required to work non-traditional hours, outside the parameters of traditional day shift. Furthermore, shift work is associated with obesity and lower levels of physical activity. Even though nurses' occupations require them to be active in doing ward rounds and other duties, it is possible for these professionals to be physically active, yet highly sedentary. Sedentary behaviours such as occupational sitting, leisure-time sitting and television (TV) viewing may be associated with overweight and obesity independent of physical activity. Aim: The primary aim of this mini-dissertation was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa. The mini-dissertation included two different research methods. Study 1: The main purpose of this qualitative descriptive study was to describe health concerns, health priorities and determinants of healthy lifestyle behaviours among nurses. The objectively measured and self-reported physical activity and sedentary behaviour in day and night shift nurses were compared in Study 2. Combined, the results of these studies may be used to inform the development of worksite-related interventions for South African nurses. Methods: Participants for the first study were purposively sampled from public hospitals based in Cape Town, South Africa. The participants included 103 nurses, of whom 57 worked night shift and 36 worked day-shift. Twelve focus group discussion (FGD's) were conducted with nursing staff to obtain insight into their health concerns, lifestyle behaviours and the nature of and access to worksite health promotion programmes (Whip's). Nine hospital management personnel participated in key informant interviews (KII) to gain their perspective on health promotion in the worksite. The FGDs and interviews were conducted by a trained facilitator using guided questions. These included questions such as: 'What are your main personal health concerns?' and 'How does your work affect your lifestyle behaviours and health?' Thematic analysis was used 12 to analyse the qualitative data with the assistance of (Atlas.ti Qualitative Data Analysis Software (Scientific Software Development GmbH, Berlin, Germany). In a sub-study, 64 nurses (day shift n=30 and night shift n=34) working at two of the five public hospitals volunteered to complete a socio-demographic questionnaire and wear the ActiGraph GT3x accelerometer for 7 consecutive days to measure physical activity levels. Valid data was defined as ≥ 600 minutes wear time per day, minimum of 4 days (2 shift days and 2 non-shift days). In addition, self-reported physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ). Statistical analyses included a T-test to determine differences in PA and SB between day and night shift nurses. If data were normally distributed, ANOVA (analyses of variance) was performed to determine the significant differences in continuous outcome variables between day and night shift nurses. If data were not normally distributed, such as the GPAQ data, a non-parametric comparison Mann Whitney U test was applied. Results: Study 1: Night shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. The hospital environment was perceived to have a negative influence on the nurses' lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling and advisory services, an online employee wellness programme. The Western Cape Department of Health also offered wellness days in which clinical outcomes, such as blood glucose were measured. Most nurses identified a preference for WHPPs that provided access to fitness facilities or support groups. Both nurses and management personnel frequently mentioned lack of time to prepare healthy meals and/or participate in physical activity due to being overtired from the long working hours. Furthermore, both management and nurses reported a stressful working environment. The fact that the nurses were most concerned with the problems of overweight, obesity and living with NCDs such as diabetes and hypertension indicate that there is a need and desire for WHPP's aimed at addressing these concerns. Study 2: Based on the objectively-measured results from accelerometry, all the nurses in the sub-study met the physical activity recommendations of 150 minutes or more of moderate to vigorous intensity physical activity per w eek. The day shift nurses reported more leisure-time moderate and vigorous intensity physical activity than the night shift nurses (p=0.028). Objectively-measured physical activity also showed that night shift nurses accumulated significantly more moderate intensity physical activity than the day shift nurses ( 16.6 ± 5.6 hrs/week versus 12.1 ± 13 4.5 hrs/week, respectively, p=0.001). In addition, night shift nurses accumulated more steps per day than day shift nurses (10324 ± 3414 versus 8022 ± 3245, p=0.013). Self-reported sedentary behaviour was similar for the two shifts, 3.0 ± 1.8 hours versus 4.0 ± 2.6 hours a day, for day and night shift, respectively. Objectively-measured sedentary behaviour (SB) was significantly lower (as a % of wake time) in night shift compared to day shift workers, 66% and 69%, respectively, p= 0.047. These differences between groups remained significant, even after adjusting for differences in body size and age. Furthermore, results from the Bland – Altman plots indicate that the nurses significantly underreported their sedentary time. Summary: The nurses in this study were concerned about NCDs and being overweight. They expressed an interest and willingness to participate in future hospital-based intervention programmes. The most frequently identified preference for WHPPs was access to fitness facilities or support groups. Despite the fact that all the nurses met the current public health recommendations for physical activity, objectively-measured SB was substantial, with both day and night shift nurses spending an average of 13 hours a day in SB. Findings from this study highlight the need for WHPPs that minimize sedentary behaviour and create a more supportive environment for physical activity.

Disconnection from nature puts high-rise dwellers at risk of chronic disease and poor mental health, two major healthcare budget items. Many reports in the literature state compromised mental health, partly due to the ‘grey’ landscape of many apartment buildings, particularly in low socioeconomic areas. Lifestyle is also affected by influences of floor level and sociodemographic status. In high-density cities around the world, high-rise developments (solving urban sprawl) are increasingly being built without consideration for incorporating greenspace. The sheer height of these buildings means that dwellers are physically separated from earth and potentially beneficial soil and plant microbes. Environmental biodiversity is important to human health influencing biophilic mental relationships and physical, social and microbial characteristics. Evidence indicates soil (comprising rich diversity of microbes) is an important component in maintaining immunological health. Human skin is continually exposed both to the environment and to cleaning and hygiene tasks that contribute to skin microbial composition. The study sought to answer a vital question: How do floor level and the lack of plants and soil in high rise apartments affect the health of humans living in those environments? The longitudinal intervention study (over a 12-month period), had a ‘before’ and ‘after’ component using an independent variable (real and fake indoor plants), and dependent measurable variables (the skin microbiota and lifestyle factors). The latter were derived from self-assessed questionnaires and developed to source lifestyle and health information from fifty-nine eligible respondents from Perth, Western Australia. Relationships between sociodemographic data, floor level, health and lifestyle were analysed using Principal Component Analyses. Pilot skin microbiota (16S DNA) results were analysed for ten respondents before and after the study. My comprehensive literature review revealed that existing theories have neglected to account for relationships between high-rise apartment dwellers, lifestyle, environmental and human microbial biodiversity. Survey findings dispute historical literature on high-rises, finding that floor level does not affect mental health. Analysis of a survey on nature relatedness (21-scale NRS)showed respondents’ living on lower floors were progressively more connected to nature than those on higher floor levels (particularly when compared to employed residents on upper floors). Collectively, the NRS did not predict naturistic lifestyle behaviour, which contrasted with previous studies. After the intervention, real plant recipients demonstrated a significantly higher frequency of visiting parks and consuming fruit and vegetables compared to those with fake plants. Pilot skin microbiome respondents that received real plants showed: a) greater increase in OTU richness than those receiving fake plants, significant at the p A high-rise conceptual model is presented due to overall social justice findings. Landscape architecture in conjunction with government development policies is paramount to enabling ecological justice and accessibility to nature, as well as providing the right microbial balance for high-rise apartment buildings. Encouragement of naturistic behaviour would be beneficial for residents on higher floor levels. Growing indoor plants increases naturistic behaviour and microbial species richness over time, a novel discovery that is promising for human health.

Although promotion of health and healthy lifestyles are accepted tasks of registered nurses, the assessment of nurses' own health and health behaviours has rarely been assessed. In this study questionnaire responses from 59 female registered nurses and interviews with ten nurses employed full-time in south-west Alberta were analyzed. The questionnaire consisted of items taken and adapted from the Canada Health Survey (Health & Welfare Canada, 1981) on subjective well-being (Affect Balance Scale and Health Opinion Survey) and certain lifestyle practices (pap test, breast examination, alcohol consumption, cigarette smoking and seat belt use). A question on leisure time physical activity was take from Godin, Jobin and Bouillon (1986). Questions assessing self-reported immune status and perception of self as a health role model for others were designed by the researcher. Data from the questionnaires were described in narrative, frequency counts and percentages. Comparisons were made among responses in various parts of the questionnaire as well as with the results of the Canada Health Survey. Interview questions designed by the researcher assessed the ways in which the nurse participants thought about health and their goals for health; transcribed interview responses were categorized according to themes; further interpretation was done on three main themes (maintenance of health as a goal, perceived lack of nurses' self-care and nurses' expectations of themselves). The nurses' scores on the Affect Balance Scale and the Health Opinion Survey place them toward the positive end of a positive-negative continuum of subjective well-being (Okun, Stock, Haring & Witter, 1984). Comparison of the participants' responses regarding lifestyle and preventive practices with the Canada Health Survey suggests that these nurses had relatively adequate health practices with the possible exception of participation in vigorous physical activity. A majority of the participants perceived themselves as role models of health, particularly non-smokers and those with post-RN education. The ten interviewed nurses generally gave maintenance of health as their primary present and future goal for health. Lack of self-care was associated by participants with nurses' and women's traditional concern for others before themselves. The participants seemed to have generally high expectations for themselves and other nurses. This descriptive and exploratory study may provide a baseline for future study of nurses' health, an indication of areas for health promotion programs for nurses and a discussion point for nurses to continue to assess their own health and the factors affecting their own health and goals for health.
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This study involved designing an instrument to estimate self care knowledge levels of post myocardial infarction patients. The instrument subscales were diet, smoking, exercise, signs and symptoms of cardiac distress, medications, stress and high blood pressure. Twenty-six subjects were tested following hospital discharge and again two weeks later. Test-retest reliability was performed to establish stability of the instrument. The preset criterion level of.70 for the total scale was not met. The medication subscale did meet the.70 criterion level. Reliability estimates were conducted to establish internal consistency of the instrument. The preset criterion level of.70 was not met for the total scale; however, the stress subscale did meet the.70 criterion level on the retest. Concurrent validity was estimated by comparing subscale knowledge scores with self report behavior. Point biserial coefficients did not meet the preset.70 criterion levels. These results suggest that reliability and validity estimates in the post myocardial infarction patient population were not statistically significant. (Abstract shortened with permission of author.)

Includes abstract.
Includes bibliographical references.
The aim of this study is to conduct a formative assessment to explore health professionals’ capacity as well as the conditions within primary health care facilities in the Western Cape Metropole that facilitate or impede the provision of lifestyle modification education and counselling to patients with chronic diseases of lifestyle in order to make recommendations for an intervention programme that utilises available resources.

Background: The association between meat consumption and breast cancer risk and the relationship between vitamin D and colorectal cancer risk have been examined in numerous studies, but questions still remain. For colorectal cancer survival, research into diet has been sparse. Methods: Chapter one is a pooled analysis of 22 prospective cohort studies examining meat and egg consumption and breast cancer risk overall and by estrogen and progesterone receptor (ER/PR) status using Cox proportional hazards models to estimate study-specific relative risks which were then pooled using random effects models. Chapter two is a pooled analysis of 17 prospective cohort studies in which the relationship between prediagnostic circulating 25-hydroxyvitamin D [25(OH)D] and colorectal cancer risk was explored using conditional logistic regression to calculate study-specific relative risks which were then pooled using random effects models. In Chapter three, the association between pre- and post-diagnosis sugar-sweetened beverage (SSB) and sugar intake and mortality among colorectal cancer patients was assessed using Cox proportional hazards models to estimate relative risks in two prospective cohort studies. Results: There were no significant associations between red and processed meat, seafood, and egg consumption and breast cancer risk, regardless of hormone receptor status. For poultry intake, there was a marginally statistically significant increased risk of ER+ and ER+PR- breast cancers only. We found that 25(OH)D concentrations were significantly inversely associated with colorectal cancer risk, with significant decreased risks for levels beyond current recommendations. These inverse associations were stronger in women than men. Pre-diagnosis total fructose, glucose, sucrose, and added sugar intakes were positively associated with mortality, but no association was observed for SSBs. In post-diagnosis analyses, there were marginally significant increases in all-cause mortality with higher intakes of fructose and glucose only. Conclusion: The results of the pooled analysis of meat and egg consumption and breast cancer risk provide some clarification on the inconsistent findings for these associations in individual studies, while the findings of the pooled analysis of 25(OH)D and colorectal cancer risk should be considered in developing public health guidelines on vitamin D. For colorectal cancer survival, future studies should explore pre- and post-diagnosis sugar intake and mortality.

Vitamin 0 is predominantly obtained from cutaneous synthesis following sun exposure, as good dietary sources are limited. Low vitamin 0 status (25-hydroxyvitamin D (25(OH)D) <80nmol/l) has been observed in countries at high latitudes, where cutaneous synthesis is insufficient for half of the year. Vitamin 0, or more specifically, the active form, 1,25- dihydroxyvitamin 0 (l,25(OHhO), plays a role in calcium homeostasis and immunomodulation, and is involved in the pathogenesis ofosteoporosis, obesity and autoimmune diseases such as multiple sclerosis (MS).This thesis examined the vitamin D intake and status ofpopulation subgroups in Northern Ireland (latitude 55~) through an intervention study (healthy adults), a case-control study (MS patients), an epidemiological study (adolescents) and a cross-sectional observational study (overweight women).

Background: Strong evidence has been provided by several researchers on the influence that structure and social factors have on health. However, there is relatively little information about the mechanisms by which the structure shapes health-related practices and the place there is for agency in this process. Therefore, this thesis explores the mechanisms through which the structure influences the space for agency that men and women from different social groups have over their health-related practices in their daily lives in a strongly neoliberal economically high-income country such as Chile. Design and objectives: Following a critical realist approach, this thesis uses mixed methods to answer the research question. The contextual analysis aims to comprehend the wider political and economic forces related to the Chilean neoliberal regime that underlie people’s health-related practices. It is based on a bibliographical review and quantitative analysis of secondary data. The extensive analysis focuses on the extension of health-related practices and their statistical association with structural variables. Finally, the intensive analysis explores the meanings and values people give to health and to their health-related practices. It is based on the analysis of fifty-seven in-depth interviews conducted with twenty-nine people living in Santiago de Chile. Results and conclusions: By combining intensive and extensive approaches with a contextual analysis of Chilean society, this thesis concludes that there are different mechanisms through which the structure influences the space for agency that people have over their health-related practices in Chile. These mechanisms affect people differently according to their socioeconomic level and gender. They are related to people’s economic, social and cultural capital, all of which are unequally distributed in Chile. The analysis shows that these mechanisms are a consequence of a structure with high levels of inequalities consolidated by the Chilean neoliberal policy regime.

The Amish are commonly known for horse-and-buggies, simple clothing, and refusal to use electricity. Less commonly known is their rate of mental illness, which is significantly lower than the non-Amish population. The literature that points to lower depression and anxiety among the Amish does not adequately explain what elements of their lifestyle contribute to this phenomenon. Depression and anxiety are a widespread problem in the United States, increasing the importance of understanding a lifestyle that can reduce these issues. The purpose of this study was to explore the Amish way of life through the words of its members. The three research questions that drove this investigation inquired how the Amish conceptualize mental illness, if and how they seek help for mental stress, and what elements of their lifestyle may protect them from higher rates of depression and anxiety. This qualitative study employed social constructionism as the conceptual framework and positive psychology as the theoretical foundation. Data collection employed a purposeful, maximum variation sample and consisted of 14 in depth, semi-structured, face-to-face interviews. Data analysis employed phenomenological techniques as outlined by Moustakas. Elements of the Amish lifestyle contributing to positive mental health include the increasing availability of Amish focused treatment centers, bishops who encourage mental health treatment, family ties, social bonds, work ethic, and the most significant to the Amish: their faith. This study contributes to positive social change by discovering elements of Amish life that may be practical to the non-Amish. If non-Amish find positive meaning from the elements of Amish life, it may lead to lower rates of depression and anxiety.

This thesis is a systematic review using realist methodology. It emerged out of an original protocol that proposed an exploration of the barriers to a healthy lifestyle in poorer peri-urban communities. The purpose of that protocol was to design more effective lifestyle interventions, and participatory action research was identified as a potentially effective methodology to encourage behaviour change in contexts where self efficacy may be low. That development itself raised questions about what exactly was meant by action research, participatory action research and community based participatory methodologies and how effective they were. Given these questions, it was decided to undertake a systematic review of published literature and it is that review that is presently submitted as a thesis.

Adverse lifestyle factors, such as cigarette smoking, poor diet, risky alcohol consumption, overweight and obesity, physical inactivity and sedentary behaviours, are associated with non-communicable diseases and premature mortality. Evidence from controlled interventions shows that workplaces are settings where employee lifestyle factors can be improved via workplace health promotion (WHP). Less clear is what happens outside of controlled trials, when organisations attempt to implement WHP underpinned by best-evidence principles. In 2009 the Tasmanian State Service invested in a four-year WHP program that targeted its entire workforce. The aims of this thesis were to investigate employee participation in, and the benefits of, the Healthy@Work project. Of particular focus were employee lifestyle factors, including sedentary behaviours, and recommended WHP implementation strategies in practice. The study used a repeated cross-sectional survey design with stratified random samples. Survey data was collected in 2010 (n=3408) and 2013 (n=3228) from Tasmanian State Service employees, and respondent characteristics were similar in both surveys. With regard to implementation, the findings indicated employee needs assessments and health risks are likely to align with employee preferences for programs. Inequitable access to WHP activities, and lower levels of participation in some at risk groups, was evident. Barriers to participation included time, health problems and location of activities. However, recommended implementation practices, and social support, were related to participation in more activities. For lifestyle factors, prolonged sitting at work was found to be associated with psychological distress. Finally, participation in activities related to health behaviours was associated with a range of employee-perceived benefits, such as being motivated or assisted to be physically active, yet population-level differences in lifestyle factors were not observed between 2010 and 2013. Despite observed intermediary benefits, Healthy@Work was either ineffective in regard to achieving measurable behaviour change, or insufficient time had elapsed to detect a population-level shift. Organisations administering WHP should establish clearly defined outcomes and appropriately match expectations, resources and time frames to realising those outcomes.