Corporal punishment is a controversial form of discipline. To inform the debate on corporal punishment, one of the objectives of the current dissertation was to characterize parental use of this disciplinary strategy and to examine its long-term developmental outcomes. The dissertation drew on data from the National Longitudinal Survey of Children and Youth (NLSCY) to understand potential social change in corporal punishment and to characterize parents who continue to use this strategy. Over a 14-year period (1994-1995 to 2008-2009), results revealed a significant decrease in the use of corporal punishment and other negative strategies (e.g., psychological aggression), as well as a significant increase in the use of positive strategies (e.g., reward/praise and explain/teach). Nevertheless, approximately 25% of Canadian parents still use corporal punishment with children aged 2–11 years; therefore, it remains an issue that merits continued attention. While several socio-demographic factors significantly distinguished parents who use corporal punishment, other more dynamic variables may be important to consider, such as parental stress and their attitudes toward corporal punishment. For the outcomes associated with corporal punishment, NLSCY data revealed that experiences of corporal punishment at 2-3 years are associated with increased externalizing behaviours at 8-9 years. Results also indicated that, within a certain disciplinary context (more hostile and punitive parenting), early corporal punishment is associated with increased externalizing behaviours at 14-15 years, increased internalizing behaviours at 8-9 and 14-15 years, and reduced prosocial behaviours at 8-9 and 14-15 years. Overall, results confirmed that corporal punishment represents a small but non-trivial risk factor for child development. The second objective of the current dissertation was to address one of the central limitations of the existing literature on corporal punishment by clarifying what parents self-label as corporal punishment. Using a sample of 338 Canadian caregivers, the study assessed the relation between responses to a general question on corporal punishment and responses to questions on specific physical disciplinary strategies. Predictors (e.g., cultural norms, attitudes toward and childhood experiences of corporal punishment) of this relation were then investigated. Results suggested that questions such as the one used in the NLSCY may reflect parental use of milder forms of corporal punishment. Results also revealed that some caregivers remain undetected by general questions on corporal punishment. Factors such as attitudes toward corporal punishment can help identify those caregivers who use physically punitive strategies but who do not endorse corporal punishment. Results from the current dissertation offers support for the anti-corporal punishment perspective and calls for the de-legitimatization of this disciplinary strategy across society.

This work deals with an analysis of the Healthy Life Expectancy indicator for the Czech Republic. At the beginning, this work describes different European organizations that are focused on the development of this indicator and also describes selected European harmonized surveys which can be a data source for the calculation of the indicator. Then it includes an analysis of risk factors affecting health and health conditions and outlines the problem of the aging population of the Czech Republic. Healthy Life Expectancy indicator is calculated here by Sullivan method. Healthy Life Expectancy indicator is calculated on the basis of three different definitions of health, which were used in the sample survey EU-SILC. This paper analyzes the prevalence rates found by different definitions of health and then also analyzes indicators of Healthy Life Expectancy in 2007, separately for men and women. Then the paper compares the indicators between the years 2005 and 2007. Variability is calculated at the end as well as testing of hypothesis about the equality of Healthy Life Expectancy indicators (calculated according to subjective health prevalence rates) between men and women in 2007.

Aim: To assess if there is an association between sitting time and obesity among adult Peruvian population, using three different anthropometric measurements. Methods: A secondary analysis using data from a population-based study, the National Household Survey (ENAHO, in Spanish), was conducted enrolling adults aged ≥18 years from the 25 regions of Peru using a multistage random sampling technique. The outcome of interest was obesity, determined by body mass index (BMI > 30 kg/m2), waist circumference (WC > 80 and >90 cm in women and men, respectively) and waist to height ratio (WHR > 0.5); while the exposure was sitting time, measured using the last domain of the International Physical Activity Questionnaire and then categorised in <4 hours/day, 4 to <8 hours/day and 8+ hours/day. Associations were estimated using Poisson regression models, reporting prevalence ratios (PRs) and their respective 95% CI. Results: Data from 8587 subjects were analysed; mean age was 38.4 (SD: 13.5) and 53.6% were females. The prevalence of obesity was 16.3% (95% CI: 15.2–17.5%) by BMI, 58.5% (95% CI: 56.9–60.0%) by WC, and 78.0% (95% CI: 76.5–79.3%) by WHR. In the multivariable model, subjects reporting a sitting time of 8+ hours/day were more likely to be obese than those reporting <4 hours/day according to BMI (PR: 1.38; 95% CI: 1.15–1.65), WC (PR: 1.20; 95% CI: 1.12–1.28) and WHR (PR: 1.05; 95% CI: 1.01–1.10). Conclusions: Subjects with greater sitting time were more likely to be obese, and this association was evident with three different anthropometric indicators. Findings suggest the need of generating public health actions to reduce sedentary behaviour. / Revisión por pares / Revisión por pares

Background: Dyslipidemia is a modifiable risk factor for cardiovascular disease (CVD). We investigated the prevalence and associated risk factors of dyslipidemia- raised total cholesterol (TC), raised triglycerides (TG), raised low-density lipoprotein (LDL-C), low high-density lipoprotein (HDL-C), and raised non-high-density lipoprotein (non-HDL-C) in rural and urban China. Methods: We analyzed data from 136,945 participants aged 40-100 years of the CNSSPP project for 2014. Dyslipidemia was defined by the NCEP-ATP III and the 2016 Chinese guidelines for the management of dyslipidemia in adults. Complete data on demographic, metabolic and lifestyle characteristics were used. Chi-square tests and multivariable logistic regression were used to obtain age- and sex-adjusted prevalence and risk factors for dyslipidemia among participants. Results: A total of 53.1% participants lived in rural areas. The prevalence of dyslipidemia was similar among rural and urban participants (43.2% vs. 43.3%). Regarding the components of dyslipidemia: urban compared with rural participants had a higher prevalence of low HDL-C (20.8% vs. 19.2%), whereas the prevalence of raised LDL-C (7.8% vs. 8.3%), raised TC (10.9% vs.11.8%) and raised non-HDL-C (10.0% vs. 10.9%) were lower in urban residents, (all p < 0.001). Women were more likely to have raised TC than men (adjusted OR [AOR] =1.83, 95% confidence interval [CI]:1.75-1.91), raised LDL-C (AOR = 1.55, 95% CI: 1.47-1.63) and high non-HDL-C (AOR = 1.52 95% CI: 1.45-1.59) (all p < 0.001). Compared with rural, urban participants had higher odds of dyslipidemia: low HDL-C (AOR = 1.04, 95% CI: 1.01-1.07), and raised TG (AOR = 1.06, 95% CI: 1.04-1.09). Hypertension and current drinker were less likely to get low HDL-C with AOR 0.93 (95% CI: 0.90-0.96) and AOR 0.73 (95% CI: 0.70-75), respectively. Overweight, obesity, central obesity and diabetes had higher odds of all dyslipidemias (p < 0.001). Conclusions: Low HDL-C was higher in urban areas, whereas the remaining dyslipidemia types were more common in rural areas. Dyslipidemia was more common in women in both areas of residence. Overweight, obesity, central obesity and diabetes were associated with dyslipidemias. The need to intensify intervention programs to manage dyslipidemia and risk factors should be prioritized.

Context: Although the overall prevalence of tuberculosis (TB) in the United States is declining, correctional facilities continue to encounter a higher prevalence of this disease. Despite mandatory reporting laws for active TB, data for latent TB infection (LTBI) remains sketchy because reporting it is not required. Purpose: Investigation of the period prevalence of LTBI in a rural Ohio regional jail compared with other populations in the region to determine the need and adequacy of the screening program. Methods: Data collected on inmates was compared with data collected on hospital employees within the same geographic region. Findings: Between January 2006 and July 2007, staff at the jail tested 1274 inmates for TB using the Mantoux purified protein derivative (PPD) method. Ten inmates (6 in 2006 and 4 in 2007) tested positive. All 10 cases were followed with a negative chest radiograph, leading to the diagnosis of LTBI. The overall incidence for the jail for LTBI was 0.8%, with 0% active cases. However, 85 inmates (6.7% of the population) were released before a PPD interpretation could be completed. In the comparative population, 651 hospital employees were tested for TB. Of these, 32 employees tested positive (LTBI prevalence of 4.9%). There were no cases of active TB reported. Conclusion: The prevalence of LTBI in a rural jail (0.8%) is lower than the comparative sample population at a local hospital (4.9%). The rapid release of inmates (6.7%) indicates that TB data is incomplete and that potential cases of LTBI could have been unreported because of missed opportunity for interpretation of skin tests.

Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in pressure ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting pressure ulcer prevalence and incidence studies. The group's main findings are summarised in this paper.

Introduction: The COVID-19 pandemic has increased the magnitude of mental illnesses such as depression, not only in the general population, but also in healthcare personnel. However, in Peru the prevalence, and the associated factors for developing depression in healthcare personnel, are not known. The objective was to determine the prevalence and identify the factors associated with depression in healthcare personnel, in the context of the SARS-CoV-2 pandemic. Methods: An analytical cross-sectional study was carried out from May to September, 2020 in healthcare establishments. A sample of 136 health workers were included and a survey was applied to collect the data. Depression as a dependent variable was measured using the Zung self-report scale. To identify the associated factors, the bivariate and multivariate analysis was performed by logistic regression with STATA v 14. Results: The prevalence of depression was 8.8% (95%CI, 4.64-14.90). Having a family member or friend who had died from COVID-19 was associated with depression (OR = 6.78; 95%CI, 1.39-32.90; P = 0.017). Whereas the use of personal protective equipment was found to be a protective factor against developing depression (OR = 0.03; 95%CI, 0.004-0.32; P = 0.003). Conclusions: Approximately 1 in 10 healthcare professionals and technicians developed depression during the COVID-19 pandemic in this study. In addition, having relatives or friends who had died from COVID-19 was negatively associated with depression and use of personal protective equipment was identified as a protective factor. / Revisión por pares

Hepatitis is an infectious disease that affects millions of people worldwide. The current project seeks to achieve two objectives: 1) To understand how hepatitis policies affect hepatitis prevalence in prison, and 2) To understand how hepatitis prevalence in prison affects the general population. Using a content analysis of correctional policies available through each state Department of Corrections (DOC) and secondary data from the 2010 Census, Centers for Disease Control and Prevention, and Corrections Compendium; hepatitis prevalence and policies are analyzed. The content analysis employed for this study revealed that some states have more comprehensive policies than others. However, all states may benefit from modifying their policies to meet recommendations constructed by the Federal Bureau of Prisons. Findings from descriptive statistics also suggest changes in HIV prevalence and policies positively affect hepatitis C prevalence. Future research should be dedicated to examining how personal interactions in prison also affect prevalence rates.

付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 新制・課程博士 / 博士(医学) / 甲第24510号 / 医博第4952号 / 新制||医||1064(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 小杉 眞司, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Introduction Obesity is a risk factor for abnormal metabolic conditions including hypertension, high cholesterol and type 2 diabetes (T2D). The varying prevalence patterns of these metabolic conditions stratified by body mass index (BMI) among individuals lacking awareness of their disease status is poorly explored. Methods The study data was from the U.S. CDC 2013-2014 National Health and Nutrition Examination Survey and included participants aged ≥20 years who had completed examinations for blood pressure and BMI, laboratory tests for blood sugar and cholesterol, and interviews for demographics and other related health issues. Individuals lacking a formal diagnosis from a health professional were referred to as undiagnosed. The weighted prevalence and its 95% confidence interval (CI) for total T2D, hypertension, and high cholesterol and total abnormal metabolic items by BMI within each subgroup were calculated. Similar calculations were also applied to undiagnosed participants. By treating BMI < 25 as the reference, the proportional test was used to identify if significant prevalence existed in two comparisons:overweight vs. BMI < 25 and obese vs. BMI < 25. A p < 0.05 was considered statistically significant Results and Conclusions The overall weighted prevalence of diabetes, hypertension, high cholesterol and overall abnormal metabolic conditions were 16.1%, 60.3%, 57.5% and 76.3%, respectively while the prevalence of undiagnosed diabetes, hypertension, high cholesterol and abnormal metabolic condition are 8.8%, 11.3%, 16.8% and 30.2%, respectively. A higher prevalence of T2D existed in individuals with BMI25≤BMI≤30 among black adults (18.4% vs. 16.2%). Similar differences were also observed among undiagnosed black participants with BMI < 25 (12.1% vs. 7.5%). The prevalence of total and undiagnosed hypertension increased with BMI although prevalence was lower in the undiagnosed population. Our study findings reveal that while a higher proportion of obese individuals have chronic conditions, a large proportion of normal weight individuals are similarly burdened. The prevalence estimates of individuals with at least one undiagnosed abnormal metabolic condition indicates a need for expanded screening campaigns. Additionally, the higher prevalence of T2D among normal weight warrants further research to identify potential drivers. Although efforts to manage and control these conditions must continue to have a heightened focus on obese individuals, it must also broaden its scope to target normal weight individuals and develop strategies to decrease the proportion of U.S adults without awareness of their disease status.