The purpose of this study is to augment the existing literature concerning the relationship between marital status, gender, social networks, and cohort effect on dimensions of subjective well-being for women. Multiple dimensions of subjective well-being are examined. Multiple regression and logistic regression are employed to examine the effects of marital status, social networks, and cohort effects on the dependent variables that tap the dimensions of subjective well-being. The analysis controls for age, race, education, income, religious attendance and region of residence. The findings report some inconsistency in regards to the current literature. Social networks and support are found to be the most constant independent predictor of subjective well-being. While the effects of being divorced and separated, as well as cohort membership, are not as consistent, the findings are notable and should be addressed in future research addressing subjective well-being.

This study explored the phenomenon of first year students who lived in a nursing living learning community and their experiences during their first year. The researcher utilized a qualitative research methodology to investigate the social and academic aspects that influenced these students as they worked to prepare to apply to the nursing program on their way to becoming nurses. Of the 68 students who lived in the community in the first two years, 12 were interviewed in a face-to-face setting. The researcher used Tuckman’s Stages of Group Development as the framework for this study, recognizing that groups go through several stages depending on the length of time that the group is together. The participants’ experiences were examined on a group and individual level, in order to fully understand their experiences in the community, including their persistence through applying to and enrolling in the nursing program. This study brought voice to the experiences of the students, helping to understand why they came together, how the community developed, and what lessons the students took away from living in this community. It was made clear during the interviews that the students chose to live in the community where they would be surrounded by students with the same goals. They also felt very strongly about academics taking a priority over social events, and believed that the community should have a second semester common course to keep the students working together throughout the duration of the first year.

This thesis is divided in three chapters: (i) introduction to organ donation, (ii) rationale, implementation and design of a pilot observational study currently underway and (iii) justification for use of a waived consent model for observational research studies on organ donor care. Organ donation is a complex event that remains a mystery to most health care providers. The first chapter reports knowledge gaps in clinical management of deceased organ donors across Canada and summarizes ongoing trials in organ donor care. The persistent deficit in transplantable organs along with the limited scientific evidence to guide the clinical management of the organ donor justify the need for a national research program in organ donor care. There are logistical and methodological challenges unique to the design and conduct of research on deceased donors. To identify potential stakeholders involved in the process of organ donation and to provide an accurate description of usual management of deceased donor and assess its variability, we developed and initiated a prospective observational study called DONATE. The second chapter of this thesis described the pilot phase of this study. It contains the following sections: i) objectives of the study ii) the screening process, iii) data collection, iv) clinical outcomes, v) methods of measurement, vi) analysis plan and vii) strategies used to minimize the biases inherent to observational studies. The normative goal of obtaining informed consent from participants may not be appropriate for an observational study in organ donor care. The third chapter summarizes the justification for use of a waived consent model for observational studies of organ donation medicine. In this chapter, I discuss regulatory, ethical and logistical issues relevant to use of a waived consent model in organ donation research. / Thesis / Master of Science (MSc) / Organ donation saves lives and it is the most effective therapy available to treat end stage organ failure of a number of organs. Unfortunately, there is a growing gap between the number of donors and the number of patients waiting for transplantation. This thesis summarizes the foundational work of a national research program in deceased donor management. It describes the study design of a 4 centre prospective observational study in deceased donor management with outcome assessment on corresponding organ-recipients. This thesis also contains a justification for waiving the procurement of consent to research on organ donor management. Finally, it will inform investigators of future national multicentre observational studies on design and implementation issues related to donor management, in order to improve care provided to donors and outcomes of recipients while reducing the gap between transplant needs and organ supply.

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No description available.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24093号 / 社医博第124号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 古川 壽亮, 教授 村井 俊哉, 教授 中川 一路 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

The Falconbridge study was a historical prospective mortality study conducted at a nickel company in Sudbury Ontario. The study included all the men that worked there for at least 6 months between 1950 and 1976 with an update in 1984. Nearly 11500 subjects were included in the cohort. From here all the subjects identified with lung cancer were selected and matched with different number of healthy subjects (1:1, 1:2, 1:4, 1:6, 1:8, 1:10). Information was generated of the time-intensity of different contaminants normally found in the mining atmosphere and eight of such contaminants were evaluated for the different sets of case:control. Given the fact that some contaminants present a time delay effect, an assessment of this factor was also made using the subject initial and final time of exposure to each contaminant. Finally a variable selection was performed for the three data sets generated in the project. The results showed that some of the postulated contaminants did have an effect in the final outcome, however, because of the complex effect between the different chemical compounds a definite conclusion is not given. / Thesis / Master of Science (MSc)

Introduction Postoperative medical complications are often preceded by a period with hypotension. Postoperative hypotension is poorly described in the literature. Data are needed to determine the incidence and risk factors for the development of postoperative clinically important hypotension after noncardiac surgery. Methods The incidence of postoperative clinically important hypotension was examined in a cohort of 40,004 patients enrolled in the VISION (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation) Study. Eligible patients were ≥45 years of age, underwent an in-patient noncardiac surgery procedure, and required a general or regional anesthetic. I undertook a multivariable logistic regression model to determine the predictors for postoperative clinically important hypotension. Model validation was performed using calibration and discrimination. Results Of the 40,004 patients included, 20,442 patients were selected for the derivation cohort, and 19,562 patients were selected for the validation cohort. The incidence of clinically important hypotension in the entire cohort was 12.4% (4,959 patients) [95% confidence interval 12.1-12.8]. Using 41 variables related to baseline characteristics, preoperative hemodynamics, laboratory characteristics, and type of surgery, I developed a model to predict the risk of clinically important postoperative hypotension (bias-corrected C-statistics: 0.73) The prediction model was slightly improved by adding intraoperative variables (bias-corrected C-statistics: 0.75). A simplified prediction model using the following variables: high-risk surgery, preoperative systolic blood pressure <130 mm Hg, preoperative heart rate >100 beats per minute, and open surgery, also predicted clinically important hypotension, albeit with less accuracy (bias-corrected C-statistics 0.68). Conclusion Our clinical prediction model can accurately predict patients’ risk of postoperative clinically important hypotension after noncardiac surgery. This model can help identify which patients should have enhanced monitoring after surgery and patients to include in clinical trials evaluating interventions to prevent postoperative clinically important hypotension. / Thesis / Master of Science (MSc) / In patients undergoing noncardiac surgery, numerous patients will develop postoperative clinically important hypotension. This may lead to complications including death, stroke, and myocardial infarction. I performed a large observational study to examine which risk factors would predict clinically important postoperative hypotension. Once we have identified these risk factors, we will use them to conduct randomized trials in patients at risk of clinically important hypotension to determine if we can prevent major postoperative complications.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25182号 / 医博第5068号 / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 西浦 博, 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

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第25207号 / 社医博第134号 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 森田 智視, 教授 永井 洋士, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM