Maternal health services (MHS) provide primary, secondary, and tertiary levels of prevention to achieve better pregnancy outcomes. However, use of prenatal and natal services among Nigerian women has been ranked among the lowest in the world and, consequently, the country is among the 10 countries with the highest maternal mortality ratio. Moreover, nationwide community-based studies on the use of maternal health services in Nigeria are limited. To address this gap, this quantitative, cross-sectional study analyzed the 2008 Nigerian Demographic and Health Survey (NDHS) data to identify whether Nigerian women's biological, cultural, and socioeconomic characteristics are associated with their use of MHS and pregnancy outcome as measured by number of antenatal visits, place of delivery, and fetal outcome. The Anderson's health behavior model was used as the theoretical framework for this study. Respondents were women aged 15 - 49 years (N= 31,985), who had given birth between January 2003 and December 2008. Bivariate and multiple logistic regressions were conducted. The results indicated that religion, education, income, and availability of skilled health workers showed consistent significant statistical association with both the number of ante natal care (ANC) visits and place of delivery even after controlling for covariates. Overall, these findings have potential for social change on the choice of public health interventions with collaboration with social services such as education, community, and labor sectors. Further, a systematic involvement of local communities is needed to drive specific culturally-sensitive interventions.

[Abstract]: Only a minority of Australian women continue to breastfeed for what is known to be the optimal duration for the health of the mother and her baby. This mixed method study of the determinants of breastfeeding duration is situated within the post-positivist paradigm, and uses both qualitative and quantitative data in a triangulated study design. The study aimed to identify the psychological factors which influence the duration of breastfeeding, in the hope that modifiable factors would arise which may assist women to meet their longer term breastfeeding goals. This two-phase study was conducted in Toowoomba, Queensland and began with a qualitative enquiry involving three groups of mothers separated according to their various experiences of breastfeeding, and one group of experienced breastfeeding clinicians (n = 21). Using the nominal group technique, these women were asked to generate a list of the psychological factors they believed influenced the duration of breastfeeding. Group results were considered individually and collectively, and comparisons between groups were made. The groups generated a list of 53 psychological factors they believed may have an influence on the duration of breastfeeding. In Phase 2, these data and the extant literature were used to inform the content of a questionnaire constructed to measure the relevant individual psychological characteristics of a sample of postnatal women, and the relationship between these factors and breastfeeding duration to 6 months postpartum. Participants for Phase 2 were recruited from one public and one private hospital in the regional city of Toowoomba, Queensland (n = 372), and completed a self-report questionnaire during the 14 days following the birth. Telephone interviews at 6 months postpartum gathered data regarding the woman’s current feeding method and time of weaning. The duration of breastfeeding was associated with psychological factors including dispositional optimism, breastfeeding self-efficacy, faith in breastmilk, breastfeeding expectations, anxiety, planned duration of breastfeeding and the time of the infant feeding decision. After removing the effect of socio-demographic variables, the woman’s faith in breastmilk and her planned breastfeeding duration were unique predictors of the duration of Fully breastfeeding. Analysis of the data for the duration of Any breastfeeding revealed three unique predictors including faith in breastmilk, planned breastfeeding duration and breastfeeding self-efficacy. The data also showed that 44% of the sample experienced some form of postnatal distress in the 14 days following the birth in the form of anxiety, stress and/or depression. Of these three distinct states, only anxiety was associated with breastfeeding duration. This enhanced knowledge of the psychological variables which influence breastfeeding duration may be used to construct a tool capable of identifying women at risk of early weaning for additional support or interventions. Additionally, this knowledge may form the basis of an intervention designed to modify psychological variables known to place breastfeeding at risk, thereby assisting women to breastfeed for longer.

Thesis (Ph.D. (Economics))--North-West University, Potchefstroom Campus, 2007.

Exceptionally high FDI inflows into Ireland have been one of the main resources of Irish rapid economic growth, and earned the country a title of “Celtic Tiger”.  The goal of this thesis is to find out the driving sources behind this high inward investment and to examine whether Ireland has truly enjoyed higher amounts of FDI inflows than predicted by the model. This thesis analyzes the determinants of foreign direct investment in Ireland. The determinants being examined are GDP, GDP per capita, infrastructure, labor productivity, education and trade openness. The analyzed period is from 1997 to 2007 and data is collected for 30 OECD member states. With the help of the pooled regression we were able to obtain the following results: GDP, GDP per capita, infrastructure and education have a significant effect on FDI and FDI per capita inflows. However, labor productivity and trade openness turned out to be less significant in attracting FDI to Ireland. Moreover, based on the results, infrastructure had an unexpected negative sign, while the rest of the variables indicated expected positive relation to FDI.

Research Question: This research adapted, tested, and evaluated a methodology to set priorities for systematic reviews topics within the Cochrane Collaboration that is sustainable and incorporates the social determinants of health and health equity into the analysis. Background: In 2008 a study was conducted to review, evaluate and compare the methods for prioritization used across the Cochrane Collaboration. Two key findings from that study were: 1) the methods were not sustainable and 2) health equity represented a gap in the process. To address these key findings, the objective of this research was to produce and test a method that is sustainable and incorporates the social determinants of health and health equity into the decision making process. As part of this research, the methods were evaluated to determine the level of success. Methodology: With assistance from experts in the field, a comparative analysis of existing priority setting methods was conducted. The Global Evidence Mapping (GEM) method was selected to be adapted to meet our research objectives. The adapted method was tested with assistance of the Cochrane Musculoskeletal Group in identifying priorities for Osteoarthritis. The results of the process and the outcomes were evaluated by applying the “Framework for Successful Priority Setting”. Results: This research found that the priority setting method developed is sustainable. Also, the methods succeeded in incorporating the social determinants of health and health equity into the analysis. A key strength of the study was the ability to incorporate the patients’ perspective in setting priorities for review topics. The lack of involvement of disadvantaged groups of the population was identified as a key limitation. Recommendations were put forward to incorporate the strengths of the study into future priority setting exercises within Cochrane and to address the limitations.

Although Fair Trade provides better trading mechanisms and a set of well-documented tangible benefits for small-scale coffee producers in the Global South, large inequities persist within Fair Trade certified cooperatives. In particular, gender equity and womens empowerment are considered to be integral considerations of this system but visible gender inequities within certified cooperatives persist. Responding to this apparent contradiction, local partners in Nicaragua articulated a need to better understand how gender equity is understood and acted upon and thus this research projectan exploration of implemented gender equity-promoting processes at three different organizational levels (a national association of small-scale coffee producers, a second-tier cooperative, and a base cooperative)emerged. Drawing on feminist and social determinants of health approaches to research, the study was informed by semi-structured key informant interviews and document revision. Both the interviews and the documents revealed that although gender work is being considered at all three levels, each organizations approach and interpretation is unique, which exposes different challenges, tensions, and experiences.<p> Notably, results indicate that there is no clear definition of gender equity amongst the different organizational levels. As a result, these groups appear to be interpreting gender equity, and therefore initiating equity-promoting processes based on different criteria. Interviews also revealed that although there is no evidence of active discrimination or exclusion of women within cooperatives, gender equity work is nonetheless constrained by a constellation of socio-cultural and organizational challenges that women face. Examples of socio-cultural challenges revealed through the interviews include illiteracy, ascribed child-rearing responsibilities, household chores, machista culture, land tenure arrangements and gendered power relations in terms of decision-making, while organizational challenges include the attitudes and influence of leaders, a lack of gender mainstreaming in the cooperatives work and the fact that becoming a member requires an input of resources that most women do not have access to.<p> In eliciting experiences and perspectives from various levels of organizations in the Fair Trade coffee sector, the research revealed numerous tensions between rhetoric and practice. These tensions reflect blind spots in Fair Trade marketing and research wherein existing rhetoric does not reflect the experiences of the women, cooperatives, and organizations shared in this research. The three most predominant tensions that are explored in this study are: empowerment and organizational autonomy versus standardization; the subordination of gender work to commercial interests and; the concentration of power within democratically-organized cooperatives. The study acknowledges that it is not the primary role of Fair Trade to solve gender inequities, but does suggest that through some basic changes, including most notably a stronger consideration of local contexts, Fair Trade and local cooperatives can effectively support local gender work and contribute to womens empowerment and health.

The disparity in tuberculosis rates between Indigenous and non-Indigenous people persists in Canada and New Zealand. The most common form of tuberculosis in humans is pulmonary tuberculosis so eliminating tuberculosis transmission is an important obstacle to decreasing the overall rates of the disease. In both Canada and New Zealand, social determinants of health such as housing conditions, access to health care and historical influences (including similar experiences with colonization) have been implicated in the high rates of tuberculosis. This thesis examines and compares the social determinants of tuberculosis transmission among Aboriginal people in the Canadian province of Alberta and Maori and Pacific people in New Zealand. In Alberta, ten Aboriginal individuals with smear-positive pulmonary tuberculosis participating in a larger prairie wide study were divided into two groups (transmitter and non-transmitter) based on transmission events identified through contact tracing and DNA fingerprinting. Interviews with the ten participants were analyzed and compared using an interpretive phenomenological perspective and informed by an Aboriginal framework of health. Survey data from the same individuals provided complementary descriptive statistics. In New Zealand, interviews with Maori and Pacific pulmonary TB participants that had been conducted as part of other studies were accessed and analyzed using an interpretive phenomenological perspective. Like in Canada, Indigenous frameworks of health specific to Maori and Pacific people informed the analysis. The Canadian analysis identified three factors of greater relevance within the transmission group: substance use, patient-delay-in-seeking-treatment, and number of contacts. These factors were also relevant for the Maori and Pacific experience of tuberculosis. The results of this cross-cultural comparative study highlight the complexity of the experience of tuberculosis for Indigenous people in both Canada and New Zealand. Future research and education and intervention programs must not only consider the proximal social determinants of health, such as poverty, unemployment, etc, but also the more distal social determinants of health and the causes of causes such as colonization and its multi-generational effects.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

This paper examines the underlying drivers of MLB franchise value. Using panel data for MLB teams from 2000-2010, I find that a team’s ballpark and metro-area market are significant determinants, yet revenues truly drive value. Further, I find that incremental increases in winning percentage by a particular team has an insignificant effect on total revenues and has no marginal impact on the value of the team, particularly if the team recognizes consistent revenue streams every year. Finally, I show that the modern sabermetric approach to player management negatively impacts firm value, suggesting that although small market teams have been successful using this strategy to increase their on-field performance, its use in isolation is not financially beneficial to the organization in the long run.