Thesis (M.Sc. (Tropical Medicine))--Mahidol University, 2007. / LICL has E-Thesis 0024 ; please contact computer services. LIRV has E-Thesis 0024 ; please contact circulation services.

By facilitating timely diagnosis and treatment initiation, population-wide newborn screening programs have led to important reductions in morbidity and mortality for many rare diseases, including medium-chain acyl-CoA dehydrogenase (MCAD) deficiency and very-long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. Newborn screening has also expanded the spectrum of disease severity for MCAD and VLCAD deficiencies to include a higher proportion of milder cases, raising questions about appropriate disease management. To date there has been no systematic attempt to characterize best management practices in terms of the guidance that is available to those who provide care for MCAD and VCLAD deficiencies; nor has there been an attempt to understand the extent to which current practices align with such currently available guidance. The two projects that are part of this thesis sought to address these research gaps with a particular focus on two key disease-specific management practices we identified in advance as priorities: the use of carnitine supplementation and the recommended duration of fasting. The objective of the first project was to systematically review the quality and content of clinical practice guidelines and/or recommendations for the diagnosis and management of both MCAD and VLCAD deficiencies. Two independent reviewers assessed the eligibility of citations retrieved from a comprehensive search of the peer-reviewed and grey literature. We appraised the quality of the reviewed guidance and extracted information on the content of recommendations. From the 25 guidance documents that met our inclusion criteria, only 7 incorporated evidence reviews, indicating that guidance in this field does not generally meet established methodological standards for the rigorous development of clinical practice guidelines. With respect to content, we identified unclear and inconsistent recommendations regarding fasting times and the use of carnitine supplementation. Further empirical evidence in these areas is necessary to inform the development of future rigorous guidelines. The objective of the second project was to identify actual practices in the management of MCAD deficiency. We conducted a scoping review of published literature on treatment practices around the world and a secondary analysis of data documenting treatments received by participants in a Canadian pediatric cohort study. For the scoping review, citations retrieved from our comprehensive search strategy were screened by two independent reviewers. We extracted information on study characteristics and disease management. Our secondary analysis included longitudinal data for Canadian children with MCAD deficiency, born between 2006 and 2015 and enrolled in a cohort study at one of 13 centres. For both project components, we described carnitine supplementation and fasting times, overall and according to potential indicators of disease severity (genotype, biochemical phenotype). We identified 5 relevant publications in the scoping review and analyzed data for 107 children participating in the Canadian cohort. Management practices related to carnitine supplementation and fasting times for MCAD deficiency were highly variable based on both data sources. There was some evidence of an association between genotype and carnitine use, which, based on the scoping review, may be due to a relationship between genotype and carnitine deficiency. While actual practice was in some ways aligned with the guidance we reviewed in the first project, these results underscore the need for further evidence to address areas of uncertainty that have been prioritized by patients and families, clinicians, and health researchers, including questions regarding the potential to tailor treatment to predicted disease severity and an emphasis on controversial therapies such as carnitine supplementation.

[pt] Este trabalho apresenta os dados de desilgualdade, entre as famílias, da renda, dos rendimentos do trabalho e do consumo de bens não duráveis, a partir dos microdados da PNAD [Pesquisa Nacional por Amostra de Domicílios] (Brasil, de 1976 a 1997) e da POF [Pesquisa de Orçamentos Familiares] (regiões metropolitanas 1987-88 e 1995-96). Para os dados da PNAD obtêm-se, a cada ano, índices de theíl da renda e da renda do trabalho para grupos de famílias com chefes nascidos ao mesmo ano e com a mesma escolaridade. Para a POF, obtêm-se esses índices para essas duas variáveis e para consumo, para famílias nascidas na mesma década e com a mesma escolaridade. Com os dados da POF, analisa-se a evolução temporal da desigualdade de consumo, a qual tende a ser um indicador bem mais fiel, do que a desigualdade de renda, da disparidade permanente de recursos disponíveis e de bem estar entre famílias. Segundo a hipótese de renda permanente, espera-se que a desigualdade de consumo para uma mesma coorte cresça com o tempo. Caso haja impedimentos à validade dessa hipótese, tais como consumidores prudentes (motivo precaução para a poupança), ou restrição de crédito, a desigualdade de consumo passa a depender da evolução da distribuição de rende e de rendimentos do trabalho, podendo, então, crescer ou não com o tempo. / [en] This thesis presents income, earnings and consumption inequality data among Brazilian families. Those data were generated from two different sources: PNDA’s (National Household Survey) micro data for Brazil from 1976 to 1997 and POF’s (Household Expenditures Survey) micro data for the Brazilian metropolitan areas in 1987/88 and 1995/96. Theil’s indexes for family income and earnings among families headed by individuals with same age and educational level were calculated from the PNAD’s data for each year. The same procedure was used for POF’s data, but measures of consumption inequality were also done. From PNAD’s data, one can identify the part of inequality that is explained by age, cohorts, and time effects. The same sort of hypothesis tha Deaton and Paxson (1994) used to identify those three different effects was applied in this current work. In general, the consumption inequality tends to be a more accurate estimator of the permanent disparity of resources and of well being among families than the income inequality is. Therefore, calculations of consumption inequality were held using POF’s data. According to the permanent income hypothesis (PIH), one should expect that the consumption inequality among families of the same cohort grows as time evolves. In the case that there are some constraints to the PIH, as prudent consumers or credit constraints, the consumption inequality stars depending on the temporal evolution of income and earnings distribution, which allows that consumption inequality does not grow with time.

This study tested if intergenerational differences in attitudes toward immigration in Sweden exist due to different early life socialization experiences across generations with cohort analysis. Also, if shock effects which are defined as large scale shifts in society affected different age-groups differently? As socioeconomic status was positively related to both proimmigration attitudes and age, age could be excluded from the model assuming aging affected attitudes only indirectly due to increased financial security, this avoided collinearity between age, period and cohort. Assuming that aging does not affect attitudes toward immigration the conclusion was made that intergenerational differences in attitudes exist due to a difference in early life socialization across generations. Observing the trends of different age-groups between 2002 and 2016 a pattern emerged where shock effects like the refugee crisis in 2015 seemed to affect all cohorts with similar force contrary to prior research and the impressionable years and later-life decline models.

This study focuses on the nature of the school advisor's roles within a collaborative educational setting, specifically, a partnership involving a school district, university and teachers association referred to as the Richmond Teacher Education Project. The study investigates how school advisors view their roles and responsibilities within a cohort group. School advisors describe their experiences according to role, motivations, preparation and training, improvements to the program and professional/ethical considerations. Findings from the study indicate that the role development of school advisors is dependent on the amount of time spent as a member of the Richmond Practicum Project and on the relationship-building process between the student teachers and other members of the cohort grouping. All subjects mention some difficulty in their role as the primary evaluator and believed that the faculty advisor should share this role. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

Bibliography: pages 85-87. / A simplified cohort survival analysis was used to investigate the academic progression of first-time entering undergraduate students within four large bachelors' degree programmes at the University of Cape Town. The rates of graduation, academic exclusion and voluntary drop-out were quantified in relation to the matriculation authorities and prior matriculation performance of the students within each of the four cohorts. The results of the analyses served to identify specific areas of concern with regard to the internal efficiencies in student progression through each of the four degree programmes, and it is suggested that the availability of information of this type will be essential in the attainment of the institutional transformation goals set out in the 1997 White Paper on the transformation of higher education in South Africa. Significant relationships between the matriculation criteria and the final academic outcomes of students within each cohort were detected using log-near modelling. By means of multiple discriminant analysis, significant predictor variables of the final undergraduate academic outcomes within each cohort were identified. However, the relatively weak discriminatory powers of the multiple discriminant models and the poor predictive accuracy of the associated classification functions suggest the variables included in these analyses did not adequately explain the variability in the final undergraduate academic outcomes of students within the selected cohorts. The extent of the voluntary drop-out phenomenon within each of the cohorts was quantified in relation to matriculation criteria, and further analysis of the cohorts indicated that factors other than academic difficulty appeared to have prompted the greater proportion of the voluntary withdrawals. Those students who had dropped out voluntarily were therefore not included in either the log-linear models or the multiple discriminant analyses.

The central theme of this study is that because of the changing life styles and the macro-events which occurred after World War I these years were a watershed. The women born in the three five-year cohorts from 1910 through 1924 were at different stages of maturity and awareness as particular economic and political events occurred. The social and political climates were different for each of these cohorts of women. Therefore there would be discernible differences in attitudes and opinions among the cohorts. A literature review indicated three models for the formation of social attitudes and political opinions. The "Personality Types" is based on the premise that attitudes formed early in life remain fixed. The "Aging/Conservative" model considers that attitudes become increasingly conservative as the person ages. This study, however, was based on the "Historical Change" model. Beliefs and attitudes may change in response to personal experiences throughout the life course. Four research questions were developed. 1. How have macro-events affected the life experiences of women in these cohorts? 2. How have social pressures affected their experiencing of employment, matrimony, and motherhood? 3. How do the opinions of women in these three cohorts with regard to social and political issues differ and change? 4. Can differences of opinions among the women of the three cohorts be traced to dissimilarities in life experiences? Census data literature was researched to provide background documentation on technological and demographic changes in the United States during the 20th century. Questions for cohort comparisons were selected from the National Opinion Research Council Surveys of 1972 through 1989. These considered individual and family demographics, labor force participation, social attitudes, and political orientation. For the 2,814 respondents analysis was done by five-year cohorts to determine differences and by six-year periods to point out trends. Both ANOVA and Chi-square were used to verify statistical significance. Focus group sessions, with 41 participants, met at senior centers and housing units in the Portland metropolitan area. A questionnaire completed by each participant confirmed that the focus group demographics corresponded to those of the national sample. Individual life experience time lines provided material for opening the discussion. Other discussion topics were based on differences noted among the three cohorts in the NORC data analysis. These were in the areas of education, work experience, family life patterns, political orientation, and attitudes toward societal changes. A brief finding for each research question follows. 1. NORC data indicated that each successive cohort held increasingly liberal sociopolitical opinions, and that women of all three cohorts became less conservative over the years. The focus group participants related these changes to specific macro-events in their life experiences. 2. Focus group discussions disclosed that the 1910-1914 cohort realized later in life that societal pressure had limited their educational achievement. Women of the 1915-19 cohort came to understand that their acceptance of the homemaker role was somewhat based on societal expectations. The 1920-24 cohort were aware that discrimination in the work arena was based on societal norms of the time. 3. Analysis of both NORC data and opinions expressed in the focus groups indicated that each successive cohort was increasingly broadminded and tolerant. 4. The women participating in the focus groups exhibited an awareness of the differential effects of life experiences. They specified the effects of macro-events (chiefly the Great Depression), education, mobility, and workforce participation. This research has tentatively confirmed that a generational watershed occurred for women born before World War I and those born after. As the women of the 1910 through 1924 cohorts matured they experienced differing social and political climates. This resulted in cohort differences. Further investigation may reveal more precise cohort boundaries for the 1910 through 1924 years. It should be remembered also that cohort boundaries for men may not coincide with those of women.

Research on the Arab spring has indicated that the failure of democratic consolidation in post-Arab spring countries was, in part, due to economic insecurity. A conclusion that seems to be in line with the general literature on threat and its connection to authoritarian value-shifts. Yet, scholars in the fields of collective action and political socialisation have also demonstrated how events like the Arab spring can be incredibly influential in shaping political values, primarily among younger populations. Raising the question of whether formative experience with the Arab spring could have resulted in a more democratically inclined youth-cohort that would be more resilient to the authoritarian effects of economic insecurity. To answer this question, this master's thesis conducted a cohort analysis on five countries found in at least four waves of the Arab Barometer and tested four hypotheses generated by the previous question. The thesis did not see any evidence indicating that this Arab spring youth-cohort would be any more democratic than other cohorts. Furthermore, the cohort was also not more likely than other cohorts, to stave off the authoritarian effects of economic insecurity. Contrary to previous research, this thesis did not see a correlation between economic insecurity and authoritarianism in all countries studied. Potentially, indicating how contextual the connection actually is, and demonstrating the need for future studies on the topic to be conducted in already authoritarian contexts.

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MIRTINGUMO NUO IŠORINIŲ MIRTIES PRIEŽASČIŲ TRENDAI LIETUVOS MIESTO IR KAIMO KOHORTOSE 1967 - 2006 62 puslapiai, 32 grafikai, 2 lentelės. Raktažodžiai: amžiaus - periodo - kohortos analizė, mirtingumas, trendas, savižudybės, autotransporto įvykiai. Tyrimo tikslas: Nustatyti detalius mirtingumo dinamikos nuo savižudybių ir autotransporto įvykių ypatumus 40 - ies metų laikotarpiu priklausomai nuo lyties ir gyvenamosios vietos. Uždaviniai: Apskaičiuoti pagrindinius dinamikos parametrus - amžių, periodą, kohortas ir nustatyti jų įtaką dinamikos procesui; Išanalizuoti du svarbiausius mirtingumo dinamikos faktorius kiekvienai mirties priežasčiai ir sumodeliuoti šių faktorių poveikio kartu įtaką šiam procesui pagal lytį ir gyvenamąją vietą. Nustatyti, kaip paamžiniai mirtingumo rodikliai kinta kiekviename kohortos penkmetiniame intervale, koks šių kreivių lygis įvairiose kohortose ir kaip tai skiriasi pagal lytį ir gyvenamąją vietą. Metodai: Mirčių duomenys nuo savižudybių ir autotransporto įvykių Lietuvoje nuo 1967 iki 2006 m. buvo sugrupuoti į 17 amžiaus grupių ir 8 penkmetinius periodus. Duomenų analizei panaudotas Poissono regresijos metodas pritaikytas amžiaus - periodo - kohortos modelių efektams atskirti. Rezultatai: Ir moterų ir vyrų kaimo populiacijos mirtingumo nuo savižudybių tendencija buvo ryškiai didėjanti per visą analizuojamą periodą. Miesto moterų populiacijoje mirtingumo rodikliai nuo savižudybių mažėjo, išskyrus didėjančius senyvo amžiaus grupių rodiklius. Miesto... [toliau žr. visą tekstą] / MORTALITY TRENDS FROM EXTERNAL CAUSES AMONG URBAN AND RURAL COHORTS IN LITHUANIA 1967 - 2006 62 pages, 32 graphics, 2 tables. Keywords: age – period – cohort analysis, mortality, trends, suicide, vehicle accidents. Research aim: The aim of this study was to examine particular trends of mortality from suicide and vehicle accidents during 40 years period subject to sex and place of residence. The tasks of the research work were as follows: To calculate basic parameters of mortality trends - age, period and cohorts and detect their influence to the process; To analyze two most important factors to variation for each cause of the death and to simulate this along factors' influence to the procces subject to sex and place of residence. To find out how subsequent mortality rates vary in each cohort quinquennial interval, what is the difference of these curves levels in different cohorts and how they differ between sex and place of residence. Methods: Deaths due to suicides and vehicle accidents in the period from 1967 through 2006 and the corresponding population figures were grouped into 17 age groups and 8 5-year periods. These were fitted to Poisson regression models to assess age, period, and cohort effects. Results: Both women's and men's mortality trends from suicides increased dramatically through analyzed period. Trends of urban women's suicide mortality have decreased, except increasing trends of the elderly. Urban men's population had experienced increasing trends from... [to full text]