The first chapter assesses the impact of the cohort size on labour market outcomes. Using exogenous variation and micro-level data for France, the UK and the US, we study the effect of supply shocks measured at different ages on unemployment rates and wages during a cohort's life cycle. The results from an IV estimation show that the largest magnitude of the effects is found when the cohort size is measured at age 25. The impact of both wages and unemployment rates are temporary, however, both decreasing with time. The second chapter analyses the effects of large inflows of foreign students on English undergraduates. Our results confirm previous findings that there is no overall effect, but we identify changes in the distribution of natives. We find that top performing English students are crowded in by foreign students. It is also mainly English-born males, natives who do not have English as their mother tongue and those of Asian ethnic origins that are crowded in by foreign students. In chapter three, we aim to understand the short-term effects of changes in the level of the tuition fees charged by English universities on students' geographic mobility. Our results suggest that the increase in tuition fees in 2006/07 charged by English universities led students to enrol into universities that are closer to home, with a larger effect experienced by men and White students. Moreover, we find that students are less likely to move to universities located in rich areas.

O impacto positivo do aleitamento materno (AM) na saúde de mulheres e crianças em curto e longo prazo, tanto em países de média e baixa renda como em países de alta renda, é amplamente reconhecido. Apesar disso, os índices de AM estão longe de ser considerados bons, tanto em nível mundial quanto no Brasil. Com base em alguns estudos, mães adolescentes são consideradas população de risco para não amamentação ou interrupção precoce dessa prática, configurando-se em um grupo prioritário para a promoção, proteção e apoio ao AM. Nesse sentido, estratégias devem levar em consideração as peculiaridades da amamentação em mães adolescentes, bem como os determinantes do abandono precoce ou da manutenção da amamentação por diferentes períodos nesse grupo. No entanto, faltam estudos abordando esse tema, o que justifica a realização do presente estudo, que teve como objetivo identificar os fatores associados à manutenção do AM por 6, 12 e 24 meses em uma coorte de mães adolescentes. Trata-se de um estudo de coorte aninhado em um ensaio clínico randomizado realizado com 323 mães adolescentes residentes no município de Porto Alegre (RS), que deram à luz no Hospital de Clínicas de Porto Alegre, e cujo recém-nascido era saudável, com peso superior a 2.500 g. Informações sobre vários aspectos da alimentação da criança foram obtidas mensalmente nos primeiros 6 meses e bimestralmente dos 6 aos 12 meses, por contato telefônico ou visita domiciliar. Quando as crianças tinham entre 4 e 7 anos de vida, as mães foram novamente entrevistadas. Os fatores associados com a manutenção do AM por 6, 12 e 24 meses foram avaliados por meio de regressão multivariável de Poisson com variância robusta, seguindo uma abordagem hierarquizada. A manutenção do AM por no mínimo 6, 12 ou 24 meses ocorreu em 68,4, 47,3 e 31,9% da amostra, respectivamente. Apenas um fator se associou à manutenção da amamentação nos três períodos estudados: o fato de a criança não usar chupeta aumentou a probabilidade de manutenção do AM por 6, 12 e 24 meses. Apoio da avó materna e duração do AME mostraram-se associados com a manutenção do AM por 6 e 12 meses. Os demais fatores se associaram à manutenção do AM por apenas um dos períodos: por 6 meses ou mais, cor da pele da mãe parda ou negra; por 12 meses ou mais, criança do sexo feminino e apoio do companheiro; e por 24 meses ou mais, maior idade paterna e multiparidade. Conclui-se que os fatores associados com a manutenção do AM podem variar dependendo da duração considerada, com destaque para não uso de chupeta, apoio da avó materna e duração do AME. Os achados deste estudo podem contribuir para o desafio de aumentar a duração do AM em mães adolescentes por meio de estratégias que contemplem os fatores aqui identificados. / The positive impact of breastfeeding (BF) on child and maternal health, in both the short and long terms, and in both developing and developed countries, is widely recognized. Nevertheless, BF practices in international and Brazilian settings are far from reaching optimal levels. Previous studies have demonstrated that adolescent mothers present a higher risk of not BF, or of interrupting BF early, and therefore these mothers should be prioritized in interventions aiming to promote, protect, and support BF. In this sense, interventions should take into consideration the peculiarities of BF among adolescent mothers and also the determining factors of early BF interruption or BF maintenance for different periods of time in this group. However, few studies have addressed this topic, thus justifying the conduction of the present study, whose aim was to identify factors associated with the maintenance of BF for 6, 12, and 24 months in a cohort of adolescent mothers. This cohort study is nested in a randomized clinical trial that involved 323 adolescent mothers residing in the city of Porto Alegre, state of Rio Grande do Sul. Mothers were recruited at the maternity ward of a teaching hospital (Hospital de Clínicas de Porto Alegre) and were included if they gave birth to a healthy infant weighing 2,500 g or more. Data on different aspects of infant feeding were collected monthly in the first 6 months via telephone interviews, and bimonthly between 6 and 12 months via either telephone interviews or home visits. When the children were 4-7 years old, the mothers were interviewed again in person. Factors associated with BF maintenance at 6, 12, and 24 months were assessed using multivariate Poisson regression analysis with a hierarchical approach. BF maintenance for at least 6, 12, and 24 months was observed in 68.4, 47.3, and 31.9% of the sample, respectively. Only one factor was associated with BF maintenance at all three time points assessed: infant not using a pacifier increased the chance of BF maintenance for 6, 12 and 24 months. Support from the infant’s maternal grandmother and exclusive BF duration were associated with maintenance of BF for 6 and 12 months. Other factors evaluated were associated with BF maintenance at only one of the time points assessed: at 6 months, non-white maternal skin color; at 12 months, female infant and partner’s support of BF; and at 24 months, older paternal age and multiparity. In conclusion, the factors associated with BF maintenance may vary according to the time period assessed, with emphasis on not using a pacifier, having the support of the infant’s maternal grandmother, and exclusive BF duration. The present findings can contribute to the challenge of increasing BF duration among adolescent mothers via the implementation of strategies that take into consideration the associated factors here identified.

One purpose of the thesis is to find the role of the cohort effect in changes in the wage structure of urban China. We construct synthetic cohort data from the repeated cross-sections of Urban Household Survey (UHS) 1988-2002, and get a series of interesting results on wages. Our analysis is not only the first study in cohort patterns of wage structure in economic transition, but also the first study that systematically discusses the winners and losers during economic transition in urban China. Besides, our study makes contributions in the further discussion of factors influencing cohort effect. Furthermore, the thesis provides the first study in the role of cohort effect in estimating returns to education and age premium. Lastly, this thesis decomposes factors affecting the growth of wage and wage inequality, and finds that the cohort effect is mainly responsible for the rapid wage growth and inequality increase in urban China. / The last twenty years have witnessed an economic transition for many countries, including the former Soviet Union, Central and Eastern Europe, as well as China. Different from other countries, China has been experiencing a gradual and partial economic transition since the late 1970s. The consequences of the economic transition in all these countries are also quite different. Other transitional economies have recorded abrupt recessions, as reflected in negative GDP growth, a decline in wage, and an increase in unemployment. As a stark contrast, China has experienced a smooth and rapid economic growth in the last two and a half decades of economic transition. Its GDP growth has kept on a leading level with that of the whole world. Besides, the wage level, as well as wage inequality, has risen substantially. / The other purpose of this thesis is to find the role of the cohort effect in the dramatically declining labor force participation of urban China. Our study reveals that the cohort effect explains much of the decline in the labor force participation. This is the first study in analyzing labor participation in economic transition using synthetic cohort data, and we find that estimation of cross-section analysis of life-cycle participation is quite misleading. Besides, our study presents the first analysis of the wage structure effect on participation after separating the cohort effect from the age effect. Will higher inequality cause incentive effect or disincentive effect? Will results differ for men and women? This thesis provides a thorough analysis, and makes important contributions to the literature. / This thesis conducts research on wage structure and labor force participation during economic transition in urban China. One major contribution of this thesis is to separate the cohort effect from the age effect in analyzing labor market behavior in economic transition. Given the dramatic changes to the Chinese economy and society in the past half century, cohort quality, cohort size, cohort preference, and even labor market opportunities for each cohort will be very different. Therefore, inter-cohort differentials in labor market behaviors may be quite significant. However, previous studies usually employed cross-section analysis, and have ignored the cohort effect, which mixed up cohort effect and age effect and might cause the serious problem of bias in estimation. Our analysis avoids this problem. / Han Jun. / "September 2006." / Advisers: Juncen Zhang; Hongbin Li. / Source: Dissertation Abstracts International, Volume: 68-03, Section: A, page: 1109. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 196-223). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Background Multimorbidity, the co-existence of multiple health conditions in an individual, is a significant Public Health challenge. However, it has no consensus definition or measure, and its determinants and outcomes are not fully understood. Resilience may be a mechanism by which the experience of multimorbidity can be improved but there has been little study of this. Aim To define and measure the prevalence of multimorbidity and resilience to multimorbidity, to assess the role of mental health and childhood socio-economic status (SES) and to investigate the long-term outcomes. Objectives 1. To determine how multimorbidity and resilience to multimorbidity should be defined and measured in Public Health research 2. To assess the prevalence of multimorbidity and resilience to multimorbidity using the measures identified in objective one 3. To assess the role of mental health conditions and childhood SES in the occurrence of multimorbidity and resilience to multimorbidity 4. To assess the impact of multimorbidity and resilience to multimorbidity on long-term outcomes Method Systematic reviews of the literature were conducted to address objective one. The analysis of two contrasting study populations was used to address objectives two to four. These were the Australian cross-sectional Diamond study and the Aberdeen Children of the 1950s cohort study. Results Multimorbidity was defined as the presence of two or more conditions and was measured by patient self-report and healthcare administrative data. Resilience was the presence of good self-reported outcomes despite multimorbidity. Multimorbidity prevalence ranged from 3% to 38%. Mental health conditions led to an increased burden of multimorbidity and a reduced prevalence of resilience. Childhood SES and other SES factors were associated with multimorbidity. Childhood SES and other SES factors were associated with multimorbidity. Multimorbidity was associated with poorer outcomes. Conclusion The findings in this thesis can be used to improve consensus approaches to studying multimorbidity and resilience, and to develop interventions to tackle these.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-11T20:58:32Z No. of bitstreams: 1 AndreAlmeida.pdf: 1209602 bytes, checksum: 5e9d024317045cd5c5e47ebea29cf505 (MD5) / Made available in DSpace on 2017-05-11T20:58:32Z (GMT). No. of bitstreams: 1 AndreAlmeida.pdf: 1209602 bytes, checksum: 5e9d024317045cd5c5e47ebea29cf505 (MD5) Previous issue date: 2016-06-10 / Respiratory symptoms are an important cause of mothers seeking health services; We can characterize them according to the presence of one or more symptoms, such as coughing, wheezing, difficulty breathing, runny nose; the study aimed to examine the respiratory symptoms and related factors in children and 36 months. Crosssectional study a nested cohort "etiological factorsof preterm birth and perinatal factors consequences in child health: birth cohorts in two Brazilian cities" – BRISA (Brasilian Birth Cohort Studies) the sample used were the information of the second moment of the cohort, conducted with mothers and children, these 1 to 3 years, with total 3306. The results showed the mother's other children (50.03%), lives with up to 4 people at home (68.43%), have an income less than minimum salary (26.76%), do not have adequate schooling to the age (35.30%), children were breastfed exclusively until the sixth month of life (59.09%), were born of natural childbirth (51.16%), respiratory symptoms (46.52%), father/mother or brothers with a history of asthma (15.48%) parent or sibling with a history for rhinitis (30.01%). The relationship between the independente and dependent variables was estimated in univariate analysis Chi-square test with a significance level of 5%. There was statistical significance between the variable respiratory symptoms and the presence of other children (57.41%) p=0.0001, economic class C(53.39%) p=0.007, children born of natural childbirth p=0.005, asthma and family history (61.72%) p=0.0001, family history for rhinitis (57.42%) p=0.003, smokers in the home (58.29%) p=0.041 and adequate schooling mother (50.67%) p=< 0.0001. The study showed that the assessment of respiratory symptoms and related factors when are important instrument in the quest for better service the child and his family, the nurse should identify early those factors and be able to give attention and quality. / Os sintomas respiratórios constituem uma importante causa das mães procurarem os serviços de saúde, podem ser caracterizados de acordo com a presença de um ou mais sintomas, como: tosse, chiado no peito, dificuldade de respirar, coriza; o estudo teve como objetivo analisar os sintomas respiratórios e os fatores relacionados em crianças menores e 36 meses. Estudo transversal descritivo aninhado a uma coorte “Fatores etiológicos do nascimento pré-termo e consequências dos fatores perinatais na saúde da criança: coortes de nascimento em duas cidades brasileiras” - BRISA (Brasilian Birth Cohort Studies) os dados da amostra utilizada foram das informações do segundo momento da coorte, realizado com as mães e crianças, estas com idade entre 1 a 3 anos, total de 3306. Os resultados mostraram a mãe que tem outros filhos (50,03%), mora com até 4 pessoas no domicílio (68,43%), tem uma renda menor que um salário mínimo (26,76%), não apresentam escolaridade adequada para a idade (35,30%), as crianças foram amamentadas exclusivamente até o sexto mês de vida (59,09%), nasceram de parto normal (51,16%), apresentaram sintomas respiratórios (46,52%), pai/mãe ou irmãos com histórico de asma (15,48%) pai/mãe ou irmãos com histórico para rinite (30,01%). A relação entre as variáveis independentes e dependentes foi estimada na análise univariada pelo teste qui-quadrado com nível de significância de 5%. Houve significância estatistica entre a variavel sintomas respiratórios e presença de outros filhos (57,41%) p=<0,0001, classe econômica C (53,39%) p=0,007, crianças nascidas de parto normal p=0,005, histórico familiar para asma e (61,72%) p=<0,0001, histórico familiar para rinite (57,42%) p=0,003, fumantes no domicilio (58,29%) p=0,041 e a escolaridade adequada da mãe (50,67%) p=<0,0001. O estudo mostrou que a análise dos sintomas respiratórios e fatores quando relacionados são instrumento importante na busca por uma melhor atendimento a criança e sua família, o enfermeiro deve identificar precocemente esses fatores e estar capacitado para dar atenção direcionada e com qualidade

Introdução: A varfarina é um dos anticoagulantes orais (ACO) mais utilizados na atenção primária a saúde. Com janela terapêutica estreita, exibe grande variabilidade de resposta farmacológica, e maior suscetibilidade de eventos adversos, como sangramentos e tromboembolismo venoso. Entre os fatores que influenciam na variabilidade de dose destaca-se as interações tanto com medicamentos, como com a dieta e o polimorfismo genético. Objetivos: Estimar a incidência de eventos adversos relacionados ao uso de varfarina e descrever o itinerário do usuário pelo sistema público de saúde para resolução dos problemas. Métodos: trata-se de uma coorte prospectiva realizada por um período de 18 meses com usuários do serviço público de saúde, em uso de varfarina, do município de Ijuí/RS. Os dados foram coletados por entrevistas mensais nas residências e complementados com informações médicas obtidas na atenção primária e terciária. As interações medicamentosas foram checadas em bases de dados e os hábitos alimentares conforme metodologia validada. A estatística utilizada para associar sangramento e Time in Therapeutic Range (TTR) e os fatores de risco foi teste de Poison. O projeto foi aprovado no Comitê de Ética em Pesquisa da UFRGS, com parecer número 336.259/2013. Resultados: Foram entrevistados e acompanhados 69 pacientes, sendo que 64 concluíram o acompanhamento e 5 faleceram durante o estudo, 55,1% eram do sexo feminino, com idade média de 64,3 ±13,7 anos. O tempo médio de uso de varfarina foi de 5,5 anos, a dose média semanal foi de 30,69±15,19mg e o principal motivo para uso de varfarina foi prótese valvular (39,7%). A média de medicamentos utilizados por usuário foi de 9,6±4,5. Quanto aos eventos, os sangramentos tiveram incidência de 37,7/100 pacientes/ano, o tromboembolismo de 4,8/100 pacientes/ano e de óbitos de 4,8/100 pacientes/ano. Os sangramentos apresentaram associação com possuir mais que três interações medicamentosas com a varfarina (p=0,048) e com uso de medicamentos por automedicação (p=0,030). Já para o TTR houve associação com a idade inferior a 65 anos (p=0,032). E 67 usuários estavam suscetíveis a interações medicamentosasas com varfarina, com predomínio das moderadas, sendo a média de interações com este medicamento de 2,91±1,52. A maioria das interações agiam sobre o efeito anticoagulante da varfarina, aumentando a probabilidade de sangramento. Entre as interações que os usuários apresentavam, no momento do sangramento, as mais frequentes foram com: omeprazol, sinvastatina e paracetamol. A maioria dos entrevistados apresentou consumo baixo de vitamina K. Verificou-se que sangramentos e tromboembolismos venosos foram mais frequentes nos pacientes em início de tratamento. E todos os pacientes que foram a óbito durante o acompanhamento (5) eram pacientes com mais de um ano de uso de varfarina. Para a resolução de eventos adversos na maioria dos casos o paciente realizou cuidado domiciliar (53,4%), seguido por busca pela Unidades Básicas de Saúde, 7 pacientes buscaram o serviço de emergência e 5 realizaram internação hospitalar. Observou-se que aproximadamente metade dos pacientes não mostrou seus exames de INR (Razão Normalizada Internacional) ao médico. E na falta de varfarina na rede pública de saúde do município, que ocorreu entre os meses 13 e 16, entre 24,9 a 43,5%, deixaram de usar o medicamento. Os resultados do polimorfismo demonstram que 47 (71,2%) não apresentam polimorfismo ao genótipo CYP2C9, e 24 (36,4%) ao genótipo VKORC1. Avaliando os dois genótipos associados, verifica-se que 17 (25,8%) não apresentam polimorfismo a nenhum destes. Não foi observada associação estatística do polimorfismo com sexo e raça. Observou-se diferença significativa entre a dose utilizada para os diferentes polimorfismos (p=0,013). Da mesma forma, para o VKORC1, houve diferença significativa entre a dose e o genótipo (p=0,018). Conclusão: Estes resultados demonstram a necessidade de uma maior assistência a estes pacientes, buscando melhores resultados clínicos, com menos eventos adversos. / Introduction: Warfarin is an oral anticoagulant (OAC) most used in primary health care. With narrow therapeutic window, shows great variability in drug response, and greater susceptibility to adverse events such as bleeding and venous thromboembolism. Among the factors that influence the amount of variability highlights the interactions with both drugs, as with diet and genetic polymorphism. Objectives: To estimate the incidence of adverse events related to warfarin use and describe the user journey through the public health system to the problems. Methods: This is a prospective cohort study conducted over a period of 18 months with users of the public health service in the use of warfarin, the city of Ijuí/RS. The data were collected monthly interviews in homes and complemented with medical information obtained in primary and tertiary care. Drug interactions were checked in databases and eating habits as validated methodology. The statistics used to associate bleeding and Time in Therapeutic Range (TTR) and the risk factors was Poison test. The project was approved by the Research Ethics Committee of UFRGS, with opinion number 336259/2013. Results: We interviewed and followed 69 patients, 64 completed the follow-up and 5 died during the study, 55.1% were female, mean age 64.3 ± 13.7 years. The mean duration of warfarin use was 5.5 years, the average weekly dose was 30.69 ± 15,19mg and the main reason for warfarin use was valvular prosthesis (39.7%). The average per user used medications was 9.6 ± 4.5. As for events, the bleeding had incidence of 37.7 / 100 patients / year, thromboembolism of 4.8 / 100 patients / year and deaths of 4.8 / 100 patients / year. Bleeds were associated with having more than three drug interactions with warfarin (p = 0.048) and use of self-medication by drugs (p = 0.030). As for the TTR was no association with age less than 65 years (p = 0.032). And 67 users were susceptible to medicamentosasas interactions with warfarin, with a predominance of moderate, with an average of interactions with this drug of 2.91 ± 1.52. Most interactions acting on the anticoagulant effect of warfarin, increasing the probability of bleeding. Among the interactions that users had, at the time of bleeding, the most common were with: omeprazole, simvastatin and acetaminophen. Most respondents showed low consumption of vitamin K. It was found that bleeding and venous thromboembolism were more frequent in patients starting treatment. And all patients who died during follow-up (5) were patients with more than one year of warfarin use. For adverse event resolution in most cases the patient underwent home care (53.4%), followed by search for the Basic Health Units, 7 patients sought emergency services and 5 held hospitalization. It was observed that approximately half of the patients showed their INR test (International Normalized Ratio) to the doctor. And in the absence of warfarin in public municipal health, which occurred between the months 13:16, from 24.9 to 43.5% stopped using the drug. The polymorphism results demonstrate that 47 (71.2%) did not have the polymorphism CYP2C9 genotype, and 24 (36.4%) the VKORC1 genotype. Evaluating the two genotypes associated, it is found that 17 (25.8%) did not show any polymorphism thereof. There was no statistical association of the polymorphism with gender and race. A significant difference between the dose for different polymorphisms (p = 0.013). Likewise, for the VKORC1, a significant difference between the dose and genotype (p = 0.018). Conclusion: These results demonstrate the need for further assistance to these patients, looking for better clinical outcomes, with fewer adverse events.

IQ has been shown to predict life outcomes such as income and education, but to benefit men more than women. Parenthood is in turn known to be partly predicted by variables correlated with IQ, with more educated and well-paid subjects being more probable to become parents. Previous research has found evidence for a “fatherhood premium” for men and a “motherhood penalty” for women, with fathers tending to earn more than comparable non-fathers and mothers in turn earning less than childless women. This study used data from a longitudinal Swedish study to investigate the relationship between IQ, parenthood and income. Results showed that both men and women in the low IQ group had a lower probability of parenthood, men significantly so. A fatherhood premium was found, but it disappeared when controlling for working hours. A more consistent and significant motherhood penalty disfavoring women with children was found in the high IQ group, but this difference could not explain much of the much larger income difference between the genders. Whereas the average hourly wages of all groups of men were higher than those of all groups of women, all groups of women had a higher mean probability of parenthood than all groups of men.  Previous research has indicated that some groups seem to “have it all” in the sense of being uniformly well-adjusted, but in this sample it appears to be more of a trade-off with no group being consistently at an advantage on all indices of adjustment.

A retrospective mortality and cancer incidence study of former nuclear weapons assemblers from the Iowa Army Ammunitions Plant was conducted. This study examined whether or not workers at the plant exhibited higher rates of mortality or cancer as a result of their work-related activities. Potential exposures included radiation, beryllium, asbestos, and solvents. Cancer incidence was determined by calculating standardized incidence ratios (SIR) and using the Iowa population as reference. SIRs were calculated on 3,889 workers from1969-2005. Overall and cause-specific mortality was determined by calculating standardized mortality ratios (SMR) and using the U.S. and Iowa populations as reference. SMRs were calculated on 5,743 workers from 1947-2005. The SIR results showed that overall cancer incidence was lower than the Iowa population. Using the Iowa population as reference, the SMR analyses for men demonstrated excesses for all cancers (SMR 1.09, 95% CI 1.02-1.17), lung cancer (SMR 1.38, 95% CI 1.24-1.54), diseases of the respiratory system (SMR 1.15, 95% CI 1.03-1.46), mesothelioma (SMR 6.20, 95 % 1.28-18.1), asbestosis (SMR 9.28, 95% CI 1.12-33.5) and COPD (SMR 1.27, 95% CI 1.10-1.46). Significantly lower SMRs were observed stomach cancer and ischemic heart disease. For women excesses were observed for all cancers (SMR 1.41, 95% CI 1.17-1.69), lung cancer (SMR 2.47, 95% CI 1.72-3.44), ischemic heart disease (SMR 1.32, 95% CI 1.09-1.58), respiratory diseases (SMR 1.59, 95% CI 1.14-2.16), and COPD (SMR 2.47, 95% CI 1.60-3.65). Using the U.S. population, men experienced lower overall mortality while women had significantly higher overall mortality. In conclusion, the SIR portion of the study showed overall lower cancer incidence for both men and women. This may be due to the Healthy Worker Effect and the limited dates of study. There are no cancer registry data before 1969 thus missing cancers with short induction periods. Workers may have also moved out of the Iowa and had a cancer diagnosis in another state. Compared to Iowa population, there was an excess of respiratory disease deaths and deaths from lung cancer in both men and women. Considering the significant respiratory exposures workers may have experienced, further study with a nested case-control design is suggested.

Diabetes mellitus is one of the leading causes of death and disability in the United Sates. Certain Native American groups have been harder hit than the mainstream population, both in prevalence of the disease and in rates of related complications. The highest known prevalence in the world is found among a Southwestern U.S. Tribe, and other Native American Tribes have demonstrated similar prevalence rates. It has been shown that certain psychological factors such as depression and hostility impact both the occurrence and outcome of certain diseases, including diabetes. This study examined whether those individuals who have not met the criteria for diabetes mellitus were more prone to develop diabetes mellitus if they reported signs of depression, cynical hostility, or anger that is either expressed or not expressed. It also examined the impact of depression, cynical hostility, and anger on glucose control among individuals who were diagnosed with diabetes mellitus. Finally, an aim was to determine if "psychological distress, " rather than specific psychosocial variables, was related to poorer diabetic outcomes among a specific Native American population. Participants for this study were part of the Strong Heart Study and were examined at two different points in time (1992-1994 and 1997-1999). The current study found that psychosocial variables did not predict the incidence of diabetes mellitus. Depression was found to impact glucose control among individuals without diabetes or impaired glucose tolerance, but psychosocial variables did not appear to have any measurable influence on glucose control among those individuals with diabetes mellitus or impaired glucose tolerance. Overall, it appears that psychosocial variables do not play as large of role in both incidence and outcome among certain Native American tribes as has been shown among the mainstream population.

This thesis describes a study undertaken between 1992 and 2001 to explore the possible health impacts of human exposure to pesticides. The study followed the health outcomes of approximately 4000 outdoor workers over a period of up to sixty-one years. These workers comprised two subcohorts of approximately even size, one composed of agricultural workers with high insecticide exposures, and the other made up of outdoor staff from local councils in the same area with little or no occupational exposure to insecticides. Mortality and morbidity were compared between the two groups, and with the general Australian community. The study identifies significantly increased mortality among both exposed and control subjects when compared to the Australian population. The major cause of this increase was mortality from smoking related diseases. The study also identifies significant increases in mortality among exposed subjects for a number of conditions that do not appear to be the result of smoking patterns, both when compared to the control group and the Australian population. These include pancreatic cancer in some DDT exposed subjects and asthma, diabetes, and leukaemia in subjects working with more modern chemicals. There was also an increase in self reported chronic illness and asthma, and lower neuropsychological functioning scores among surviving exposed subjects when compared to controls. Diabetes was also reported more commonly by subjects reporting occupational use of herbicides.