Magister Public Health - MPH / Introduction: In recent years, cardiovascular disease (CVD) has emerged as a leading cause of death in developing countries. It is important to identify and target people who are at risk,given that a third of all deaths are expected to be due to CVD by 2020. Studies have shown socio-economic patterning in the prevalence of risk factors for CVD, including obesity,smoking and lipid profile. In developed countries, the association between socio-economic status (SES) and CVD risk factors is negative, with a higher prevalence of CVD risk factors among people of lower SES. However, findings from studies in developing countries on this including South Africa has been inconsistent. In addition, there is scant information on differences in socio-economic patterning of CVD risk factors between urban and rural areas in South Africa.Aim: To examine the association between SES indicators and CVD risk factors among an adult population cohort of Black South Africans living in a rural and urban community.Study design: Quantitative cross-sectional analytical study of baseline data of a populationbased cohort of 2000 Black South African men and women aged 30-70 years who are part of the Cape Town arm of the Prospective Urban and Rural Epidemiology (PURE) Study. The study cohort has been established in Mount Frere, Eastern Cape (rural) and Langa, Cape Town(urban) since 2009 and the current work is secondary analysis of the baseline study data.Data collection/synthesis: SES indicators including income, employment status, marital status and completed education were gleaned from the baseline data of the PURE Cape Town study for all study participants. Then CVD risk factors including obesity, hypertension, selfreported diabetes, consumption of tobacco and alcohol consumption were also determined for the same participants. Data analysis: Data was analysed using SPSS version 20 for Windows. Descriptive statistics including frequency counts, percentages, mean and standard deviations (where normal distribution) and median and interquartile range (where non-normal) were used to summarise data on SES and CVD risk factors. This was performed separately for rural and urban study participants. Analytical statistics was used to examine associations between SES indicators and CVD risk factors with risk factors as both dichotomous and multi-level categorical variables. Kendall’s τ rank correlation coefficient was obtained to assess the relationship between the three indicators of SES. Prevalence rates reported with 95% confidence intervals was determined for risk factors across categories of SES indicators. P-values for trends in CVD risk factors were obtained by treating the SES indicators as categorical variables in logistic regression analyses. Multiple logistic regression analysis to estimate independent effects of the different SES indicators on risk factors was performed. In all analyses, P-values < 0.05 were regarded as significant.Results: There was a significant difference in the socioeconomic and CVD risk factors profile of urban and rural participants. Except for hypertension and tobacco use with insignificant higher prevalence in the urban location, all CVD risk factors were significantly higher in urban than rural participants. Some CVD risk factors (hypertension and diabetes) were positively associated with high SES (income) and some others (tobacco use) were negatively associated with employment status. Highest income earners had the highest risk of hypertension (AOR= 2.4, 95% CI 1.5-3.9) and diabetes (AOR= 2.2, 95% CI 1.2-4.1) after adjusting for age, sex and other SES variables. Marital status however showed the most consistent association across all CVD risk factors; widowed participants had a high risk of hypertension (OR=2.1, 95% CI 1.2-3.7) and diabetes (OR=2.0, 95% CI 1.1-3.7), but had the lowest risk of tobacco (OR=0.3, 95% CI 0.14-0.66) and alcohol use (OR=0.3, 95% CI 0.15-0.72). The distribution of CVD risk factors by SES gradient showed inconsistent patterning and difference between the urban and rural participants.Conclusion: In this cohort of adult Black South Africans, high income earning and widowed marital status were associated with higher hypertension and diabetes prevalence, while unemployment was associated with higher tobacco use.Recommendations: CVD risk reduction interventions that recognise the differential susceptibility of individuals in different SES group need to be designed and implemented.Widows and widowers should be given focussed attention in health screening as they may have increased vulnerability to diseases especially CVDs. There is however need for more research to establish the pathway through which SES factors predispose or protect individuals from CVDs.

Magister Public Health - MPH / Introduction: In recent years, cardiovascular disease (CVD) has emerged as a leading cause of death in developing countries. It is important to identify and target people who are at risk,given that a third of all deaths are expected to be due to CVD by 2020. Studies have shown socio-economic patterning in the prevalence of risk factors for CVD, including obesity,smoking and lipid profile. In developed countries, the association between socio-economic status (SES) and CVD risk factors is negative, with a higher prevalence of CVD risk factors among people of lower SES. However, findings from studies in developing countries on this including South Africa has been inconsistent. In addition, there is scant information on differences in socio-economic patterning of CVD risk factors between urban and rural areas in South Africa.Aim: To examine the association between SES indicators and CVD risk factors among an adult population cohort of Black South Africans living in a rural and urban community.Study design: Quantitative cross-sectional analytical study of baseline data of a populationbased cohort of 2000 Black South African men and women aged 30-70 years who are part of the Cape Town arm of the Prospective Urban and Rural Epidemiology (PURE) Study. The study cohort has been established in Mount Frere, Eastern Cape (rural) and Langa, Cape Town(urban) since 2009 and the current work is secondary analysis of the baseline study data.Data collection/synthesis: SES indicators including income, employment status, marital status and completed education were gleaned from the baseline data of the PURE Cape Town study for all study participants. Then CVD risk factors including obesity, hypertension, selfreported diabetes, consumption of tobacco and alcohol consumption were also determined for the same participants. Data analysis: Data was analysed using SPSS version 20 for Windows. Descriptive statistics including frequency counts, percentages, mean and standard deviations (where normal distribution) and median and interquartile range (where non-normal) were used to summarise data on SES and CVD risk factors. This was performed separately for rural and urban study participants. Analytical statistics was used to examine associations between SES indicators and CVD risk factors with risk factors as both dichotomous and multi-level categorical variables.Kendall’s τ rank correlation coefficient was obtained to assess the relationship between the three indicators of SES. Prevalence rates reported with 95% confidence intervals was determined for risk factors across categories of SES indicators. P-values for trends in CVD risk factors were obtained by treating the SES indicators as categorical variables in logistic regression analyses. Multiple logistic regression analysis to estimate independent effects of the different SES indicators on risk factors was performed. In all analyses, P-values< 0.05 were regarded as significant.Results: There was a significant difference in the socioeconomic and CVD risk factors profile of urban and rural participants. Except for hypertension and tobacco use with insignificant higher prevalence in the urban location, all CVD risk factors were significantly higher in urban than rural participants. Some CVD risk factors (hypertension and diabetes) were positively associated with high SES (income) and some others (tobacco use) were negatively associated with employment status. Highest income earners had the highest risk of hypertension (AOR= 2.4, 95% CI 1.5-3.9) and diabetes (AOR= 2.2, 95% CI 1.2-4.1) after adjusting for age, sex and other SES variables. Marital status however showed the most consistent association across all CVD risk factors; widowed participants had a high risk of hypertension (OR=2.1, 95% CI 1.2-3.7) and diabetes (OR=2.0, 95% CI 1.1-3.7), but had the lowest risk of tobacco (OR=0.3, 95% CI 0.14-0.66) and alcohol use (OR=0.3, 95% CI 0.15-0.72). The distribution of CVD risk factors by SES gradient showed inconsistent patterning and difference between the urban and rural participants.Conclusion: In this cohort of adult Black South Africans, high income earning and widowed marital status were associated with higher hypertension and diabetes prevalence, while unemployment was associated with higher tobacco use.Recommendations: CVD risk reduction interventions that recognise the differential susceptibility of individuals in different SES group need to be designed and implemented.Widows and widowers should be given focussed attention in health screening as they may have increased vulnerability to diseases especially CVDs. There is however need for more research to establish the pathway through which SES factors predispose or protect individuals from CVDs.

The pace at which change is occurring in the life of human beings, due to technological advancement, could be described as logarithmic. This fast-paced change is not just of consequence to the individual, but to countries, governments, companies, big and small systems like villages and sports clubs and the like, as well. This study case was inspired by the fact that what was a little-known threat yesterday, could suddenly become a crippling matter. It is, therefore, critical for individuals and businesses to consider risk not just in the usual context but with an open mind. This is especially true for systems in the Third World or developing nations where evolutionary stages of advancement and development are known to have been skipped due to forced or influenced adoption by the advanced or First World dictates. An example is the adoption of Carbon Emission Minimisa tion Pacts that have also been mooted for developing nations, even though their participation in causing the past Industrial Revolution pollution was minimal. A small operation in the Eastern Cape may, today, see no need to attract an overseas customer, not realising that the local customer may enter a merger or be bought out by an international organisation which would demand international protocols on the local supplier. Such is the risk with Globalisation. Local businesses should embrace global competitive practices for sustainability in the global business arena that is surely upon the business place today and the short term. South African businesses are no longer protected by the country borders, or the government and political systems such as the apartheid-born sanctions and tariff regimes. The objective of this study of Legionella bacteria risk management by business firms in the Eastern Cape (East London and Border Areas) is to obtain an insight into how they fare on one of the risks that, in Europe, is legislated and, in many parts of the First World, is regarded as fundamental. Beside the globalisation issues mentioned above, the South African workforce has been noted as highly affected by HIV and TB, which are symptomatic of people susceptible to Legionnaire‟s Disease. The high cost and skills shortage in the South African industry demand great care in order to prevent further loss, due to sick absenteeism or the death of workers. The study included a comprehensive literature review of issues around Legionella bacteria in industrial operations and how ill effects could be prevented and managed. A questionnaire was then drawn up and used to check for awareness, capability and ascertain what motivational factors could influence Legionella risk management by businesses in the geographical study area. All businesses with facilities utilising water cooling towers, safety showers, waste water treatment plants, humidifier air conditioning and water fountains, were presented with the questionnaire. A 56 percent return was achieved and responses were processed and analysed using Microsoft Excel on a Windows XP computer package. The findings showed that there was a poor awareness of Legionella bacteria and the risk they posed, a factor that may be used to explain the poor questionnaire returns. The capability assessment also showed a weak status. Legislation, proof of outbreak and fines were determined as effective would-be motivators for full Legionella risk management. The study concluded with recommendations for awareness programmes by interested bodies like the Legionella Action Group, Department of Labour and companies providing Legionella consulting services. While legislation and, therefore, fines, were not yet applied in South Africa, the drive for employee and community welfare should be adequate motivating factors for businesses to manage Legionella risk. Foreign capital inflow into the South African economy was also a factor that should be considered by businesses that looked to expand and need to access these funds through mergers or acquisitions. These funds would require financial as well as technical audits that show adequate risk protection.

This thesis is devoted to the lifestyle of the Czech population. The empirical research aims identify key characteristics of lifestyle of the Czech population, show the range of approaches to health, find out in what ways the Czech population cares about health, study to what extent Czechs respect the principles of a healthy lifestyle and investigate how well informed Czechs are about health. The theoretical part of this study consists of analyzing specialized literature in order to provide a comprehensive definition. Then using a number of previous studies it maps the risk behavior of the Czech population in relation to non-communicable diseases that can be caused by unhealthy lifestyle. The empirical part of the thesis provides tentative answers to the questions mentioned above. That is done by analyzing survey data complemented by an analysis of data provided by Marketing & Media & Lifestyle. The analyses concern both the entire Czech population and subsequently three selected sub-groups of respondents: (1) those who consider their lifestyle as healthy, (2) those who do not, and (3) a category of young people.

The thesis deals with the healthy lifestyle of Czech university students. The main objectives are to map the healthy lifestyle of Czech university students, especially to find out whether they follow the principles of healthy lifestyle, to find out their knowledge concerning this issue, to find out if there are any obstacles to follow the healthy lifestyle and to find out whether they know any projects supporting health and healthy lifestyle. In the theoretical part of the thesis the basic terms are defined. There is also introduced the system of public health in the Czech Republic, occurrence of non-communicable diseases caused by unhealthy lifestyle and risk factors causing these diseases. Practical part maps the healthy lifestyle of Czech university students and fulfills stated objectives by using questionnaire survey and data mining.

With a growing concern of an infectious diseases spreading in a population, epidemiology is becoming more important for the future of public health. In the past epidemiologist used existing data of an outbreak to help them determine how an infectious disease might spread in the future. Now with computational models, they able to analysis data produced by these models to help with prevention and intervention plans. This paper looks at the design, implementation, and analysis of a computational model based on the interactions of the population between individuals. The design of the working contact model looks closely at the SEIR model used as the foundation and the two timelines of a disease. The implementation of the contact model is reviewed while looking closely at data structures. The analysis of the experiments provide evidence this contact model can be used to help epidemiologist study the spread of an infectious disease based on the contact rate of individuals.

The fight against epidemics/pandemics is one of man versus nature. Technological advances have not only improved existing methods for monitoring and controlling disease outbreaks, but have also provided new means for investigation, such as through modeling and simulation. This dissertation explores the relationship between social structure and disease dynamics. Social structures are modeled as graphs, and outbreaks are simulated based on a well-recognized standard, the susceptible-infectious-removed (SIR) paradigm. Two independent, but related, studies are presented. The first involves measuring the severity of outbreaks as social network parameters are altered. The second study investigates the efficacy of various vaccination policies based on social structure. Three disease-related centrality measures are introduced, contact, transmission, and spread centrality, which are related to previously established centrality measures degree, betweenness, and closeness, respectively. The results of experiments presented in this dissertation indicate that reducing the neighborhood size along with outside-of-neighborhood contacts diminishes the severity of disease outbreaks. Vaccination strategies can effectively reduce these parameters. Additionally, vaccination policies that target individuals with high centrality are generally shown to be slightly more effective than a random vaccination policy. These results combined with past and future studies will assist public health officials in their effort to minimize the effects of inevitable disease epidemics/pandemics.

Increasing prevalence of non-communicable diseases, aging, and population growth pose significant sustainability challenges to health systems. Especially the health systems of low- and middle-income countries are more vulnerable to the risks related to non-communicable diseases and demographic changes. As the Covid-19 pandemic demonstrates, the quality of health systems is vital to save lives, and even the most developed countries are not immune to the consequences of global health crises. The World Health Organization estimates that non-communicable diseases such as cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes cause around 40 million deaths in a year, and 15 million people aged between 30 and 69 suffer from premature deaths mostly in low- and middle-income countries. The United Nations aim to address this problem through the Sustainable Development Goal 3.4 that stresses to reduce by one third premature mortality from non-communicable diseases through prevention and promote mental health and well-being until 2030. Poor quality health systems and inadequate access to healthcare services by the most vulnerable groups are some of the main reasons for premature deaths. Improving the quality of health systems through innovation and digitalisation is strategic to deliver essential healthcare services to the most vulnerable people. Digital health technologies such as mobile health applications for chronic disease self-management play a key role in improving the health status of individuals and the accessibility of healthcare services. Type 2 Diabetes Mellitus (‘T2DM’) is one of the most prevalent non-communicable diseases suffered by almost half a billion people, and current developments in digital health technologies offer innovative methods for its treatment. Hence, this study investigates the effectiveness of a T2DM self-management smartphone application called DiaWatch and its potential benefits for the Sustainable Development Goals in terms of addressing the challenges of health systems. Methodology: Using the Technology Acceptance Model as an overall conceptual framework, a comprehensive literature review was performed to clearly define the objectives and methods for the study. Based on these findings, two sets of semi-structured qualitative interview questions have been prepared for collecting empirical data. Ten healthcare professionals working at a university hospital in Istanbul, Turkey, and ten T2DM patients using a T2DM self-management app called DiaWatch have been interviewed from mid-February to early-March. A thematic analysis has been carried out to analyse the empirical data collected through the semi-structured interviews. Results: Firstly, the results of the interviews with T2DM patients using the DiaWatch app suggest that the health status and chronic condition self-management experience of the majority of the interviewees improved since using the app and they adopted behavioural changes, such as being more adherent to the treatment, increased physical activity, having a healthier diet and measuring blood glucose level more regularly. The interviewees reported less dependency on healthcare facilities and increased accessibility of healthcare services, as they are tele-monitored by their physicians. Secondly, the results of the interviews with healthcare professionals highlight the benefits of digital health technologies for the health systems in terms of facilitating the job of healthcare staff, reducing the costs, and saving time. The interviewees state that tele-monitoring helps to decrease the number of redundant hospital admissions and screenings; however, data privacy and irreplaceability of face-to-face medical examinations are the main concerns before the acceptance of these technologies.

El presente trabajo es una oportunidad de negocio que brinda asistencia y coaching nutricional a la población del distrito de San Juan de Lurigancho que es el más poblado de Lima con un sector industrial y comercial desarrollado, lo que hace de SJL un excelente lugar para el presente emprendimiento. Este servicio está dirigido a personas preocupadas por su apariencia física y/o que presentan sobrepeso y obesidad la cual puede desencadenar más adelante en enfermedades no transmisibles como diabetes, hipertensión arterial, enfermedades cardiovasculares, etc. Para el desarrollo de este proyecto se realizó un estudio de mercado que permiten realizar una eficiente segmentación de mercado. Obteniendo como resultado que los encuestados requerían y necesitaban este tipo de servicio. La empresa tendrá el nombre de NUTRIMIND S.A.C., brindará a nuestros clientes: consulta nutricional presencial y coaching nutricional vía online completando el servicio con talleres nutricionales y de mindfulness organizacionales. Todo ello para que nuestro cliente se sienta comprometido en lograr su objetivo de salud y tome conciencia de la importancia de esta. La implementación de este negocio requiere una inversión inicial de S/.25915.2 soles que será cubierta por el aporte de capital propio. Consecuentemente el estudio se presenta como un plan de negocios viable y rentable. Obteniéndose una TIR de 83% y un VAN de 69 738.36. Este negocio permitirá el emprendimiento y a la misma vez generar empleo a más profesionales de la salud debido a que sus resultados son favorables. / The present work is a business opportunity that provides nutritional assistance and coaching to the population of the district of San Juan de Lurigancho that is the most populated of Lima with an industrial and commercial sector developed which makes SJL an excellent place for the present venture. This service is aimed at people concerned about their physical appearance and/or who are overweight and obese which can later trigger in noncommunicable diseases such as diabetes, high blood pressure, cardiovascular disease, etc. For the development of this project a market study was carried out that allow efficient segmentation of the market. Getting as a result that respondents required and needed this type of service. The company will be named NUTRIMIND S.A.C., will provide our clients: face-to-face nutritional consultation and nutritional coaching via online completing the service with nutritional workshops and organizational mindfulness. All this so that our client feels committed to achieving their health goal and become aware of the importance of it. The implementation of this business requires an initial investment of S/.25915.2 soles that will be covered by the contribution of own capital. Consequently, the study is presented as a viable and profitable business plan. Obtaining an 83% TIR and a VAN of 69 738.36. This business will allow entrepreneurship and at the same time generate employment for more health professionals because their results are favorable. / Tesis

The purpose of this study was to evaluate the health outcomes of diabetic patients in Puerto Rico, before, during, and after Hurricane Maria, in 2017. The Department of Health in Puerto Rico provided the secondary data for the variables low-density lipoproteins (LDL) cholesterol, hemoglobin A1C (HbA1c), mortality, and consumer price index (CPI). The inclusion criteria were participants for whom electronic data were available before, during, and after Hurricane Maria; the sample size was 450. The theoretical framework for this investigation was the health outcomes and impact assessment. The data were analyzed by univariate and analysis of variance (ANOVA) to compare means and normality test analysis. Results of this study revealed that before Hurricane Maria, diabetics in Puerto Rico did not have control of their health. The American Diabetes Association (ADA) guideline for Hgb AIC is < 7.0; prior to Hurricane Maria Hgb AIC was 7.30 and after it was 7.21. The ADA LDL goal is