The stroke rate in Virginia is above the national rate. Stroke results in poor quality health, morbidity, and mortality. This quantitative epidemiological study was conducted to investigate whether a significant association exists between stroke and (a) socioeconomic and (b) neighborhood factors among people who were admitted to Virginia hospitals between 2010 and 2015. An ecological design, including ecosocial theory, was used to examine associations between environmental factors and stroke. Data (746 census output areas) were acquired using patients' billing zip codes from the Virginia Health Information System in combination with socioeconomic and neighborhood data by Zip Code Tabulation Area from the U.S. Census Bureau and the U.S. Food and Drug Administration. Results of linear regression analysis showed a significant association between stroke hospitalization rate and educational attainment, per capita income, and Gini coefficient for income distribution. Also, a significant association emerged between stroke and neighborhood risk factors such as food access, Walkability Index, and population density. Findings from a one-way ANOVA showed a significant geographic difference in stroke hospitalization rate with the highest stroke rate in eastern Virginia and the lowest stroke rate in northern Virginia. Results may help stakeholders, policymakers, and public health agencies design, prioritize, and implement community-based prevention programs to reduce stroke rates in Virginia.

In Nigeria, childhood tuberculosis (TB), a debilitating and deadly disease, is highly prevalent and case reporting is poor due to weak health systems. Globally, children account for at least 10 percent of the TB burden, yet they remain neglected in TB prevention and control efforts. Research studies integrating family and community-centered strategies have been recommended by stakeholders to address the paucity of current local prevention and management strategies for childhood TB. This observational cross-sectional study explored the relationship between caregivers' quality of life (QOL), gender, and socioeconomic status (SES) and the incidence of TB in children aged 0-14 years. Using the abbreviated version of World Health Organization's (WHO) QOL tool, the WHOQOL-BREF, data were collected individually in a face-to-face setting from caregivers (n = 47) whose children had been diagnosed with TB in Bauchi State, Northeastern Nigeria, over a 5-year period. Data were collected in the same manner from another set of caregivers of children without TB (n = 47) within the same period and setting. Results from logistic regression indicated a statistically significant relationship (p < .001) between the caregivers' QOL and the occurrence childhood TB. However, the caregivers' gender and SES were not significantly related to the incidence of childhood TB. This finding underscores the need to identify the factors that positively impact the QOL of caregivers of childhood TB cases. It also reflects the importance of integrating QOL interventions as part of TB control programs seeking to improve childhood TB reporting. This can mitigate the disease burden in vulnerable age-groups living in resource limited settings, thereby contributing to positive social change in the society.

According to the CDC, young people, aged 15-24 years, share the greatest risk of new sexually transmitted diseases (STD) and the negative impact of alcohol and drug use. The purpose of this quantitative study, based on the theory of social-psychological problem-behavior, was to analyze the 2013 YRBSS secondary data and document if a relationship existed between race/ethnicity and youth sexual behavior, alcohol consumption, and drug use for the 13,583 survey participants. A Kolmogorov-Smirnov test and Chi-Square were conducted to answer the research questions. Results indicated that American Indian/Alaskan Natives were most likely to report first sexual activity before 11 years old (7.5%), while Asians were most likely to report never having sex (76.6%). Race/ethnicity also impacted all other variables, such as drugs, with a mixture of results. Hispanic/Latinos were most likely to report higher alcohol consumption (15.12%) compared to Multiple Hispanic (5.12%), while, Multiple Non-Hispanic were more likely to report use of drugs before sexual activity (9.7%) compared to Hispanic Latinos (7.99%). Social change implication of the study called for developed and effective sustainable interventions to help youth with behavior, and it required full integration of race/ethnicity as prerequisites in alleviation strategy. Dissemination plans involved use of public health campaigns, school workshops, and churches to fight the negative impact on youth.

The current study sought to explore the relationship between four parent variables and children's Early Screening Inventory-Kindergarten (ESI-K) scores among families from low socioeconomic status backgrounds. The four parent variables were 1) parents' perceptions of school readiness, 2) parents' education, and 3) parents' attitudes towards their child's school, 4) the child's early development. The participants were 63 parents and their kindergarten children from three schools in Hillsborough County Florida. Results showed that parents are relatively good predictors of their children's readiness for school, with that variable alone accounting for 18% of the variance in ESI-K scores. The four variables together explained 41% of the variance in children's ESI-K scores. Implications for educators with regard to helping low-income families prepare their children for formal schooling are discussed.

The present study examined whether external (out-of-school) suspensions are applied equitably to students of different ethnic backgrounds who commit violent and nonviolent offenses. The hypotheses presented in this study were addressed through secondary analysis of disciplinary records from a large metropolitan school district in Florida. The results indicate that, for the group of 1,667 tenth grade students included in this analysis, racial equity was related to the type of offense, as well as to the student's socioeconomic status. Racial differences were found when SES was not considered, with African American students more likely to be suspended from school for status offenses and violent offenses. The same degree of racial disproportionality was not found among low SES students. However, middle and higher SES students appeared to account for much of the racial disproportionality seen in the sample, with African American students in this group more likely to be suspended for both violent and status offenses.

Research Doctorate - Doctor of Philosophy (PhD) / In this dissertation, Van Davy makes a case for a cohesive system of schools which can serve the public — both the national interest and individual interests — while directly addressing the current national schooling system’s failure: * to replace, for the entire student cohort...high levels of student boredom with high interest and engaging curriculum and pedagogy; * to replace, for low SES and indigenous students...low levels of learning outcomes, low enrolment levels in senior schooling, and only brief experience of curriculum choice with a curriculum paradigm providing intrinsic value, understanding of pathways from disempowerment to empowerment, curriculum choice from the earliest years, and schooling outcomes which, over time, equal those of the national cohort of students * to replace a citizenry divided in its support for public, church-based, and exclusionary schools with a community united in its support for a socially agreed set of social purposes for schooling and a new curriculum paradigm, one half of which is generated by this set of social purposes * to address a major political issue: social cohesion The proposed new and cohesive system of schools is envisaged to meet the needs - both Common Good and Individual Good - of the citizenry. It will grow from an earlier and pre-requisite national social agreement around a set of political goals which together sketch a preferred future society - these political goals in the hands of education specialists will generate an "essential" curriculum as one of two elements in a new two-tiered curriculum to be followed from the earliest until the latest years of schooling. The second element, occupying the other half of the curriculum from the earliest to the latest years of schooling, will be an elective curriculum designed to encourage all students to pursue their own interests in as much depth as desired. Studies of sectarian studies will be included in the elective curriculum. Davy’s analysis ranges across a number of disciplines, fusing together a number of viewpoints: historical, political theory, educational performance, and educational theory. It searches Australia’s schooling outcomes, identifies low SES and Aboriginal outcomes as major areas of failure, and challenges a number of widely accepted schooling practices. In the process, Davy discovers OECD and ACER data, but little official interest or analysis, concerning widespread boredom amongst Australia’s students. He argues that, in respect of both low SES students and student boredom, system responsibilities such as the nature of Australia’s curriculum, could be just as implicated as concerns for “teacher quality.” Davy’s interest extends beyond the purely educational. He examines the purposes that public and non-public school authorities articulate, as well as reasons parents give for enrolling their children in schools. From this research Davy identifies several issues and suggests that very considerable “choice” in schooling could be found in a different curriculum paradigm, and that both public and non-public schools are deficient when measured against widely-accepted concerns for religious freedom, social cohesion, and fundamental democratic principles. For Davy, a major political issue confronting Australia is the national imperative of “social cohesion.” He searches Australia’s schooling history for evidence of any social agreement around the social purposes of schooling, including more recent attempts to formulate “essential" and “new basics” and “national” curriculum. He concludes that while many educators, and the OECD, refer to the need for a pre-requisite set of social purposes that outline a preferred future society, the politics of schooling has not permitted this to eventuate and, given the absence of this management fundamental, “it is not surprising that schooling systems are shaped by internal logics (ideologies, religions, personalities, internal politics, quest for advantage and/or privilege) rather than wider concerns for the shape of the globe’s and nation’s future, and the advancement of the twins: Common Good and Individual Good.” With these problems laid bare — low SES and indigenous outcomes, student boredom, and social cohesion — Davy addresses all three simultaneously. He draws confidence from contemporary political theorists proposing political processes which engage the public in a “deliberative democracy.” He constructs a surrogate “foundation of agreed principles” which, he deduces, the processes of deliberative democracy might lead the Australian people to construct, then outlines a step-by-step means by which these principles can generate an essential curriculum for all Australian children, while encouraging a full range of choice within an elective stream. The political processes of open collaboration throughout civil society which produces the social agreement may produce a new political context. This new, less adversarial and more trusting political context is seen to be fertile ground for the replacement of Australia’s fractured schooling system with a cohesive schooling system for the Australian public — an Australian schooling system — to be managed nationally.

<p>The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. </p><p>For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. </p><p>The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV).</p><p>In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants. </p>

In Sweden and elsewhere there is evidence of poorer cancer survival for patients of low socioeconomic status (SES), and in some settings differences in treatment by SES have been shown. The aim of this thesis was to explore factors which influence cancer treatment decisions, such as knowledge reaped from clinical trials, patient-related factors, and physician-related factors. In a register study of colorectal cancer, all stages, patients were stratified for SES-factors. Differences were seen with regards to clinical investigation, surgical and oncological treatment and survival, with the highly educated group being favored. Survival was better for highly educated patients in stages I, II and III but not in stage IV. In a Scandinavian cohort of newly metastasized colorectal cancer patients, recruitment to clinical trials was studied. Patients entering clinical trials had better performance status and fewer cancer symptoms than those who were treated with chemotherapy outside of a clinical trial. Median survival was 21.3 months for trial-patients and 15.2 months for those treated with chemotherapy outside a  trial. Those not treated with chemotherapy had a median survival of just 2.1 months. Patients in clinical trials are highly selected and conclusions drawn from studies cannot be applied to all patients. In the same cohort, treatment and survival were stratified for education, smoking and indicators of social structure. Highly educated patients did not have a survival advantage. Patients who lived alone were offered less combination chemotherapy and surgery of metastases than other patients and had 4 months shorter survival than those who lived with a spouse or child. In a fourth study, 20 Swedish gastrointestinal oncologists were interviewed on which factors they considered when deciding on oncological treatment. Oncologists feared chemotherapy complications due to lack of social support, and ordered less combination chemotherapy for patients living alone. Highly educated patients were seen as well-read and demanding, and giving in to these patients’ requests for treatment was regarded as a way of pleasing patients and relatives and of avoiding conflict.

The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV). In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants.

Stroke is one of the leading causes of death and disability in Sweden and in the Western world. Despite this, stroke with focus on elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. The objectives in this thesis were to analyse from a gender, age and socioeconomic perspective how women were affected by stroke compared with men. The focus was on what it meant for elderly women and men to live with stroke and to explore various gender constructions among men and women. The study also included aspects such as incidence, medical treatment and case fatality after stroke. Both quantitative and qualitative methods were used. During a two-year period (15 October 2000–14 October 2002), uniform information was collected for all cases of first-ever and recurrent (&gt;28 days) stroke occurring in people of all ages living the region of Umeå, admitted to the University Hospital. Five different registers were used to achieve maximum coverage; the Riks-Stroke (RS) register, the Hospital Discharge Register (HDR), the Cause of Death Register, the northern Sweden WHO MONICA study, and one case-finding study in nursing homes and homes for elderly performed for this thesis. For the qualitative study a maximum variation sampling procedure was used to retrieve participants for in-depth interviews in a follow-up study. Nine women and seven men were interviewed about their experiences of treatment and care after suffering a stroke, as well as about their perceptions and experiences of help from others (health care personnel, relatives and home help personnel). The first-ever incidence of stroke was higher among low-educated than high educated men and women. Our study showed that there was an education-related age-dependent difference in stroke incidence, where elderly women had the highest incidence of stroke. The 28-day case fatality was shown to be associated with low educational level in patients above 75 years, after controlling for sex, risk factors and acute care variables. The elderly stroke patients experienced subordination in their contacts with health care personnel and the medical context. The participants used different ways to negotiate in the subordinate position, and some of these negotiations were interpreted as being gendered. We have also shown how the elderly stroke patients minimized their own needs of help, strove for independence and accepted help. The men and the women differed in their perceptions and experiences of help from others. Also, the participants expressed multiple types of needs. The elderly stroke patients’ perceptions and experiences of help from others must be studied in relation to their life circumstances and expectations from society. Further analyses of the patients’ perceptions and experiences of help from others were interpreted as being different examples of constructions of masculinities and femininities. Stroke with a focus on the elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. With further community-based stroke incidence studies including elderly men and women and with the development of appropriately targeted interventions, the burden of stroke in the population could be reduced. More research is needed where both qualitative and quantitative methods are used, as this can provide a richer and perhaps more authentic description of the issue under investigation.