SOCIOECONOMIC FACTORS AND THE 2014-16 EBOLA VIRUS DISEASE OUTBREAK IN GUINEA, LIBERIA, AND SIERRA LEONE INTRODUCTION: Ebola virus disease (EVD) is an infectious disease transmitted by close contact with an estimated case fatality rate fluctuating around 50%. The most affected countries by the 2013-16 West African Ebola outbreak were Guinea, Liberia, and Sierra Leone. These countries reported a total of 28616 probable, suspected and confirmed cases. However, we are still learning about the sociodemographic factors that contributed to the outbreak characteristics at the subnational level. METHODS: Data were collected from the World Health Organization, Demographic Health Surveys, and Global Data Lab for 37 districts (8 for Guinea, 15 for Liberia, and 14 for Sierra Leone). The outcome of interest was epidemic size at the district level for Guinea, Liberia, and Sierra Leone (cumulative number of EVD patient confirmed and probable cases). Socio-demographic predictors included household density, sanitation level, mobility, and wealth status. We also controlled for the timing of the start of the outbreak across districts. Pearson’s correlation and multiple linear regression were employed in our analyses. Model building was informed by a review of the relevant literature. Sensitivity analyses were conducted to assess the impact of potential outliers. RESULTS: In the final multivariable regression model, wealth status and household density were positively associated with the epidemic size while sanitation level and the difference in the outbreak start dates were negatively associated with the outcome. These results did not change in the sensitivity analyses. The regression model explained 57% of the variance in epidemic size (Adj R-Sq=0.57), with the largest contribution from the international wealth index (semi-partial R-square=0.22). CONCLUSION: District sociodemographic characteristics such as household density, wealth and sanitation levels contributed to the EVD outbreak in Guinea, Liberia, and Sierra Leone, which is in agreement with recent studies. However, further research should consider other sociodemographic indicators as well as the role of migration and connectivity among regions.

The purpose of this thesis is to look at the preferred use and management of public lands in the state of Utah. The data used in this study was collected through a statewide, random survey measuring the respondent’s preferred use and management of public lands along with social and demographic information. Several quantitative tests were conducted on the variables used to illustrate the following: a snapshot of what the survey population looks like, how each independent variable interacts with the dependent variable, and finally, the combined interaction of all of the independent variables on the dependent variable. The primary goal of this thesis is to add more information to the growing body of literature on public land uses and preferences. Specifically, this research hopes to shed some light on how people in Utah feel about the use and management of public lands that exist within the borders. A secondary purpose in this study is to provide agencies and individuals that have a say in the use and management of public lands with information that will help them to manage public lands to more closely resemble the desires of the state residents. If a characteristic (or set of characteristics) is identified as a reliable predictor of preferences, those people and agencies who have the power to decide how public lands will be used will have a better indicator as to how well their decision will go over based on the characteristics of the population in that area.

The U.S. healthcare system is a complex segment of our society that is constantly evolving with changes to various areas such as education, financing, safety, and health. There continues to be a critical examination of how healthcare professionals are trained and utilized as healthcare demands increase. One category of healthcare professionals that has evolved over time to address societal needs is pharmacists. Pharmacists have kept their traditional function of dispensing medications while expanding into multiple areas of expertise and training from patient counseling and drug therapy, to being part of multidisciplinary teams treating acute care patients. According to the National Association of Boards of Pharmacy (NABP) in 2009 there were approximately 265,000 licensed pharmacists in the U.S. (NABP, 2010). The Health Resources and Services Administration (HRSA) reported the settings with the largest number of positions are chain pharmacies (77,300), hospitals (49,200), and independent pharmacies (36,200) (DHHS, 2008). The ratio of pharmacists per 100,000 population is expected to increase from 68.9 pharmacists per 100,000 population to 76.7 per 100,000 between 1995 and 2020 (Gershon, Cultice, & Knapp, 2000). This increase in the pharmacist to population ratio is consistent with a growth rate of 13% during this time period of time. Until 1998, the supply of pharmacists in the U.S. appeared to be in reasonable balance with demand. Market forces gradually upset the delicate balance between the supply of pharmacists and the demand for their services between 1998 and 2009. In particular, a precipitous increase in the volume of prescription written and filled during this time period contributed to upsetting this delicate balance between the supply of pharmacists and demand (Cooksey, Walton, Stankewicz, & Knapp, 2003). Researchers have noted a number of environmental factors affecting the pharmacist supply in the U. S. This inquiry explores these factors within the context of the population ecology theoretical framework. In addition to the volume of prescriptions, additional environmental factors believed to have a discernible impact on the pharmacist supply include, the number of physicians, size of the business industry and insurance coverage. Previous studies on pharmacists supply have pointed to income, physician population, and population among other variables that predict the demand for pharmacists (Walton, Cooksey, Knapp, Quist, & Miller, 2004; Cherry, D.K., Woodwell, D.A., & Rechtsteiner 2007; Walton, Knapp, Miller, & Schumock 2007). U. S. physicians wrote over 4 billion prescriptions in 2007 (Medical Expenditure Panel Survey, 2008). Physicians are the primary healthcare providers that generate prescriptions to be filled. Consequently, the number of physicians is believed to be a significant environmental factor affecting the supply of pharmacists. There were approximately 940,000 physicians in the U. S. in 2008. Projections call for continuous growth of the number of physicians well into the future (Smart, 2010). Another important environmental factor potentially impacting the demand for pharmacists is the size of the business industry. In 2006, the health plan offer rate for large or medium organizations (50 or more employees) was 96.7% compared to 61.2% for small organizations (50 or less employees) (Sommers & Crimmel, 2008; Crimmel & Sommers, 2008). Insurance cov¬erage has the potential to have a positive impact on the demand for pharmacists because it provides the opportunity to obtain required prescriptions (Ranji, Wyn, Salganicoff, & Yu, 2007; Weinick, Byron, & Bierman, 2005). The population ecology theoretical framework has been used in the study of restaurants, newspapers, and physicians and their interactions with their surrounding environments. The theoretical framework proved to be beneficial in the exploration of the pharmacist supply vis-á-vis the environment. The primary constructs in the population ecology theory are carrying capacity and density. Carrying capacity consists of two sub-constructs: munificence and concentration. Density points to the current pharmacists supply and its impact on the future pharmacist supply. Numerous variables have been used in previous empirical studies of the pharmacist supply. Among the indicators of munificence in previous studies in the extant literature on pharmacist supply are total population, elderly population, hospitals, and median household income. In the present inquiry, total population was found to be a statistically significant environmental factor affecting the pharmacist supply. This was hypothesized that there is a positive linear relationship between total population and the pharmacist supply. The number of hospitals with pharmacies was also found to be a statistically significant environmental factor affecting the pharmacist supply. Hospital pharmacies are important venues wherein pharmacists can demonstrate their unique expertise and make discernible contributions to desirable health care outcomes when pharmaceutical interventions are required. In light of this empirical finding, it seems reasonable that a growth in hospital pharmacies corresponds with an increased demand for pharmacists (Kaboli, Hoth, McClimon, & Schnipper, 2006). Measures of the concentration dimension included the number of hospital beds per 100,000 population, employer volume and size and the number of insured. The only putative indicator of concentration that was found to be statistically significant in this inquiry was the number of employers with 20 or more employees. Previous pharmacist supply was found to be a significant environmental factor affecting the pharmacist supply in the future. Thus, density is a significant environmental factor affecting the pharmacist supply. Five of the 13 hypotheses tested in this inquiry were accepted. These findings are consistent with related findings in the extant literature on the pharmacist supply. Empirical findings from this inquiry are believed to make significant contributions to the literature on the pharmacist supply. The population ecology theoretical framework appears to be a suitable tool for exploring environmental factors affecting the pharmacist supply. Recommendations for future research are presented in the final chapter.

This study described the hospital morbidity of 194,persons with Fetal Alcohol Syndrome (FAS), born between 1973-1992, who were identified through a major referral center for Saskatchewan children with disabling conditions. Computerized provincial hospital separation data were obtained for 84% of 101 males and 77% of 93 females. Complete hospitalization histories were obtained for 128 patients, and partial histories for 29 patients. This data provided information on 1,556 hospitalizations from January 1, 1973 to November 30, 1992. At least 54% of study group members experienced morbidity as newborns, and 83% of all females and 91% of all males had experienced at least one other hospitalization (excluding the newborn stay) during their life (based on provincial data combined with information from patient follow-up and record reviews). By November 1992 (provincial data only), the mean number of hospitalizations (SD) for males and females age 15-19 years was 8.4 (7.0) and 10.2 (8.1), respectively. For children <5 years the mean (SD) was 6.0 (5.8) for males and 3.1 (4.7) for females. Age and sex-specific hospital separation rates for the FAS group (based only on provincial data pooled from fiscal years 1987-91) were compared to the 1989-90 Saskatchewan rates. The 95% confidence intervals for the rate ratios indicated significantly higher rates for both males and females with FAS <1 year, 1-4 years and 5-14 years of age, relative to children in general. Comparisons were made using Saskatchewan Registered Indian rates, since 88% of the study group was Aboriginal. The 95% confidence intervals indicated significantly higher rate ratios for males with FAS in all age groups, and for females with FAS age 5-14 years, relative to Registered Indians. The rate ratios for females <1 year and 1-4 years may not have achieved significance because of a possible bias toward underestimation, given the higher proportions of missing data in these groups. The results suggest the high rates of hospitalization in children with FAS are not explicable solely by factors associated with racial identity or ethnicity.

This study described the hospital morbidity of 194,persons with Fetal Alcohol Syndrome (FAS), born between 1973-1992, who were identified through a major referral center for Saskatchewan children with disabling conditions. Computerized provincial hospital separation data were obtained for 84% of 101 males and 77% of 93 females. Complete hospitalization histories were obtained for 128 patients, and partial histories for 29 patients. This data provided information on 1,556 hospitalizations from January 1, 1973 to November 30, 1992. At least 54% of study group members experienced morbidity as newborns, and 83% of all females and 91% of all males had experienced at least one other hospitalization (excluding the newborn stay) during their life (based on provincial data combined with information from patient follow-up and record reviews). By November 1992 (provincial data only), the mean number of hospitalizations (SD) for males and females age 15-19 years was 8.4 (7.0) and 10.2 (8.1), respectively. For children <5 years the mean (SD) was 6.0 (5.8) for males and 3.1 (4.7) for females. Age and sex-specific hospital separation rates for the FAS group (based only on provincial data pooled from fiscal years 1987-91) were compared to the 1989-90 Saskatchewan rates. The 95% confidence intervals for the rate ratios indicated significantly higher rates for both males and females with FAS <1 year, 1-4 years and 5-14 years of age, relative to children in general. Comparisons were made using Saskatchewan Registered Indian rates, since 88% of the study group was Aboriginal. The 95% confidence intervals indicated significantly higher rate ratios for males with FAS in all age groups, and for females with FAS age 5-14 years, relative to Registered Indians. The rate ratios for females <1 year and 1-4 years may not have achieved significance because of a possible bias toward underestimation, given the higher proportions of missing data in these groups. The results suggest the high rates of hospitalization in children with FAS are not explicable solely by factors associated with racial identity or ethnicity.

Background: Chronic pain is prevalent worldwide and is estimated to range from 2% to 55% in the general population. There is a limited understanding of the prevalence and incidence of chronic pain in Canada. Furthermore, our understanding of the sociodemographic predictors of chronic pain is limited; thus we are poorly positioned to identify potential populations at risk. Objectives: The primary objectives for this study included: 1) to determine the prevalence and incidence of chronic pain and pain-related interference in Canada over time and, 2) to determine the influence of sociodemographic predictors on the development of chronic pain by sex in the Canadian adult population over 12 years. Methods: Using data from the cross-sectional components of the National Population Health Survey (NPHS) (1994/95, 1996/97, 1998/99) and the Canadian Community Health Survey (2000/01, 2003, 2005, 2007/08), we examined the prevalence and interference of chronic pain. The longitudinal component of the NPHS was used to determine the incidence and sociodemographic predictors of chronic pain. Chronic pain was defined as the presence of “usual pain”. Results: The prevalence in the cross-sectional samples ranged from 15.1% to 18.9%. In the longitudinal sample, the incidence ranged from 5.4% to 7.8% and the prevalence ranged from 15.3% to 19.5%. Women, compared to men, had a higher prevalence, but not incidence of chronic pain each year. Of those individuals reporting chronic pain, the majority reported at least a few activities prevented. Women who were older, with lower education, and widowed, separated, or divorced were more likely to develop chronic pain. There were no sociodemographic risk factors for chronic pain in men. Conclusion/Implications: This population-based study supports previous research findings indicating that chronic pain affects daily activities of many Canadians. Furthermore, this is the first population-based prospective study examining the incidence and sociodemographic predictors of chronic pain in Canadians. Further study with more detailed definitions of pain and pain-related interference is warranted. Moreover, our findings suggest that older women are more likely to develop chronic pain and that men and women may have different risk factors for chronic pain, suggesting the need for gender-based preventative interventions. / Thesis (Master, Nursing) -- Queen's University, 2010-07-20 13:38:13.996

Little is known about online dating relationships, or the online dating persona that intentionally forms and develops interpersonal relationships through online matchmaking services. Online dating relationships are becoming more prevalent, especially in South Africa. However, research studies focussing on online dating relationships seems to be lacking. Hence, a scientific psychological enquiry into online dating relationships, and more specifically the online dating persona, is indicated. Focussing on 100 online dating members from DatingBuzz, this comparative research study investigated online dating relationships and the online dating persona. More specifically, this study examined, first, online dating relationships specifically within the South African context compared to online dating relationships internationally; and second, the South African online dating persona. This was done by creating a profile focussing on (a) sociodemographic characteristics, (b) personality characteristics, (c) level of emotional intelligence and, (d) life effectiveness skills. A quasi-comparative research design was used with a non-probability, non-random sample of convenience. The realised sample for this research was 100 participants (N=100), with the total sample (n=100) reporting on online dating relationships and 67 participants (n=67) reporting on the online dating persona. The online matchmaking service, DatingBuzz, consented to post an advertisement for research participation. Using an Internet-based questionnaire with preset response categories in a Likert type format, data collection continued consecutively for six months in 2005. Instruments included (a) a set of self-constructed questions assessing online dating relationships and the sociodemographic characteristics of the online dating persona, (b) Sauciers’ 40 Mini-marker Set to examine the Big Five personality traits, (c) the 33-item EIS scale to investigate emotional intelligence and, (d) the LEQ – H to examine life effectiveness skills. The data were statistically analysed using the SAS programme and included descriptive statistics and analysis of variance (ANOVA) in terms of gender, age, relationship status, geographical location and relationship type. Consistent with previous findings, this research study found comparisons between South African and international online dating relationships. Looking at the online dating persona profile, significant findings pertaining to sociodemographic traits, Big Five personality traits, level of emotional intelligence and life effectiveness skills. These preliminary findings are discussed in relations to methodological and research issues. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted

Cumulative risk models provide a convenient, parsimonious way to identify outcomes associated with multiple, highly correlated risk factors. In this paper, we explored linkages between a cumulative sociodemographic risk index, which included rurality status, and aspects of temperamental difficulty in an early school age sample of 53 school-aged children from Southcentral Appalachia. Cumulative risk was significantly predictive of temperamental difficulty, as defined by high negative affectivity and low effortful control, but post-hoc analyses revealed this association to be driven primarily by two of the eight risk indicators: rural status and income-to-needs risk. Although rurality status was highly correlated with income-to-needs risk, rurality predicted negative affectivity over and above income-to-needs risk and income-to-needs risk predicted effortful control over and above rurality status. Future models of cumulative risk may benefit from including rurality status as a risk indicator, despite high collinearity with income-to-needs risk.

No description available.

Individual growth curve (IGC) modeling evaluated longitudinal trajectories of glycemic control and diabetes care of youth with Type 1 Diabetes (T1D) over three years. IGC modeling allowed comparison of confounded sociodemographic predictors of disease outcomes that included ethnicity, SES, parent marital status, family structure, as well as disease duration, to determine the relative impact of these factors in the evolution of HbA1c and diabetes care throughout adolescence. At baseline, participants recruited from two pediatric endocrinology clinics included 198 youth, ages 9-15 (M age = 12.65, 77% Caucasian, 74% lived with married biological parents, M SES = 45.70) with average HbA1c of 8.43% and reported diabetes care behaviors consistent with ADA recommendations. Glycemic control did not deteriorate significantly, but IGC modeling detected a trend of a steady decline in HbA1c of .01% each year. Youth with married biological parents had HbA1c levels approximately 1.23% lower than youth with alternative parent marital status throughout adolescence, t = 4.03, p < .001, although an age by marital status interaction, t = -2.34, p < .05, indicated the impact of parent marital status on HbA1c decreased at age 17. Analyses revealed significant annual declines in blood glucose monitoring frequency, t = -7.61, p < .001, eating frequency, t = -9.04, p < .001, and exercise frequency, t = -7.87, p < .001. Alternatively, the consumption of carbohydrates and fats remained relatively stable throughout adolescence. Consideration of sociodemographic predictors and disease duration further clarified trajectories of disease care behaviors. Throughout adolescence, African American youth reported lower blood glucose monitoring frequency than Caucasian youth. Youth with lower SES exercised less frequently and demonstrated poorer dietary consumption than youth with higher SES. Youth from families with alternative parent marital status ate and exercised less frequently compared to youth from married biological families. However, youth from single-parent homes exercised more frequently than those from two-parent homes. Longer disease duration related to declines in blood glucose monitoring frequency, yet better dietary consumption. Results may inform development of interventions for youth at risk of poor glycemic control and diabetes management across ethnicity, SES, and parent marital status groups.