While osteoporosis is a major public health concern in the developed world, little research regarding factors influencing bone mineral accrual in children has been conducted in developing countries. South Africa is of particular interest since the incidence of hip fractures in South African Blacks has been reported to be amongst the lowest in the world (32; 253). In this thesis, the association of lifestyle factors; in particular physical activity (PA), socio economic status (SES) and dietary calcium intakes on the growing skeleton of Black and White South African children is investigated. After using accelerometry to validate a physical activity questionnaire (PAQ), in a convenience sample of South African Black, White, male and female children (n=30), fitness levels were assessed in a larger group (n=69) of similarly aged children, stratified by race and gender. Fittest subjects had significantly greater physical activity scores (p=0.022) as reported on the PAQ, lower body mass index’s (BMI) (p=0.001) and least percentage body fat (p=0.001) (as assessed using Dual Energy X-ray Absorptiometry (DXA), than least fit subjects. White males who reported to be significantly more active than all other groups on the PAQ were significantly fitter (p<0.001) than White females and Black males and females. The next study sought to determine whether differences observed in physical activity levels between groups showed an association with bone mineral content (BMC), density (BMD) and area (BA) (as assessed using DXA). PA was analyzed in terms of a metabolic (METPA; weighted metabolic score of intensity, frequency, and duration) and a mechanical (MECHPA;sum of all ground reaction forces multiplied by duration) component for 386 children aged 9.5 (0.04) years recruited from a longitudinal birth cohort study. White children expended a significantly greater energy score (METPA of 21.7 (2.9)) than Black children (METPA of 9.5 (0.5), p< 0.001). When children were divided into quartiles according to the amount and intensity of sport played, the most active White children had significantly higher (p<0.05) whole body BMD and higher hip and spine BMC and BMD after adjustment for body size than less active children. White children in the highest MECHPA quartile also showed significantly higher (p<0.05) whole body, hip, and spine BMC and BMD after adjustment for body size than those children in the lowest quartile. No association between PA and bone mass of Black children was found. No significant differences between METPA and MECHPA quartiles and BA were observed for any group. Given the disparate backgrounds from which many South African children come, the next study sought to determine whether differences in socio-economic status between Black and White South African children influence PA patterns. This study explored the relationship between socio-economic status, PA anthropometric and body composition (via DXA) variables in 381 children aged (9.5 (0.04) years) recruited from a longitudinal birth cohort study . Children falling into the highest socio-economic status quartile had mothers with the highest educational levels, generally came from dual parent homes, were most physically active, watched less television, weighed more and had greater lean tissue than children in lower socio-economic quartiles (p<0.001). Significantly greater levels of lean mass (p<0.001) with increased activity level were observed after controlling for television watching time and fat mass. There were high levels of low physical activity and high television watching time among lower socio-economic status groups. White children were found to be more active than Black children, more likely to be offered physical education and to participate in physical education classes at school and watched less television than Black children. The final study sought to investigate the association between habitual PA patterns and dietary calcium intakes with bone mass acquisition over a one year period in 321 pre-pubertal South African children recruited from a longitudinal birth cohort study. Data were analyzed by regressing change in BMC and BA from age nine to ten years, against BA (for BMC), height and body weight. The residuals were saved and called residualized BMCGAIN and BAGAIN. Residualized values provide a good indication of weight, height and BA-matched accumulation rates. White children had significantly higher PA levels and calcium intakes than Black children. Most active White males had significantly higher residualized BMCGAIN and BAGAIN at the whole body, hip and spine but not at the radius, than those who were less active. Most active White females had significantly higher residualized BAGAIN at all sites except the radius than less-active girls. No such effects were seen in Black children. There was no interactive effect on residualized BMCGAIN or BAGAIN for calcium intake and PA in boys or Black girls, but an interactive and possible synergistic effect of calcium and physical activity was observed at the spine, radius and hip in White girls. In this population, PA has an osteogenic association with White children, but not Black children, which may be explained by the lower levels of PA in the Black children. Despite this, Black children had significantly greater bone mass at the hip and spine (girls only) (p< 0.001) even after adjustment for body size.In conclusion, differences between White and Black children’s PA levels were observed, with White children reporting higher PA levels and exhibiting higher fitness levels than Black children. Physical fitness correlated well with self reported physical activity levels on the PAQ and objectively measured body composition. Socio-economic status differences between White and Black children are highly related to differences in physical activity patterns and body composition profiles. Bone mass and area gain is accentuated in pre- and early-pubertal children with highest levels of habitual physical activity. Limited evidence of an effect of dietary calcium intakes on bone mass in boys and Black girls was found. The role of exercise in increasing bone mass may become increasingly critical as a protective mechanism against osteoporosis in both South African race groups, especially because the genetic benefit exhibited by Black children to higher bone mass may be weakened with time, as environmental influences become stronger.

Objective: To determine the dental treatment needs of Canadians and how they are distributed. Methods: A secondary analysis of data from the Canadian Health Measures Survey was undertaken. Weights were applied to make the data nationally representative. Bivariate and multivariate regressions were used to identify predictors of need. Sensitivity, specificity, positive and negative predictive values were calculated to compare self-reported and clinically determined needs. Results: Of the 34.2% who required dental treatment, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. A discrepancy was found between clinical and self-reported needs. Conclusions: Roughly 12 million Canadians have unmet dental needs. A number of factors are predictive of having unmet dental conditions. Program and policymakers now have information by which to assess if their programs match the dental needs of Canadians.

La mayoría de los bosques del planeta, exceptuando, quizá, el cinturón más húmedo del trópico, han sufrido perturbaciones recurrentes por incendios, desde hace miles de años. Sin embargo, en el último siglo, la combinación de factores socio-económicos y ambientales han alterado la frecuencia y distribución de incendios en casi todos los ecosistemas forestales. Esta mala distribución del fuego ha conllevado la acumulación de este elemento perturbador en ecosistemas poco adaptados a su presencia (e.g. bosques tropicales húmedos), mientras que otros ecosistemas han sufrido los efectos de las políticas de supresión de incendios (e.g. bosques templados norteamericanos). Entre las consecuencias de estas alteraciones, algunas se refieren a variaciones en el régimen de incendios, con implicaciones en términos de conservación forestal, impacto ecológico, económico y social. La presente tesis analiza la influencia de factores ambientales y socio-económicos en algunas características del régimen de incendios en ecosistemas tropicales y mediterráneos. En el ámbito tropical, la zona de estudio es el Estado mexicano de Chiapas, y los objetivos son básicamente dos: 1) caracterizar el régimen de incendios en el Estado, en términos de frecuencia de incendios, distribución, áreas y ecosistemas afectados, tipología de incendios, causalidad, y su interacción con algunos factores como el fenómeno de El Niño, la distribución de la tenencia de la tierra o la variación de las precipitaciones. 2) Analizar la influencia relativa de factores ambientales frente a factores socio-económicos, en años de condiciones climáticas normales y años de El Niño. El objetivo último era determinar variaciones en la afectación de los principales ecosistemas y listar los factores más importantes a considerar, a nivel de gestión forestal contra incendios. A nivel de ecosistemas mediterráneos, se seleccionó el incendio del Solsonés 1998, como caso estudio, siendo los principales objetivos: 3) Seleccionar la metodología de clasificación post-incendio más eficiente entre varias técnicas analizadas (teledetección y muestreo de campo). 4) Analizar la influencia de diversos factores ambientales en la formación de islas de vegetación en un gran incendio, empleando las laderas como unidad espacial. 5) Verificar la importancia de la estructura forestal y la continuidad del combustible en la heterogeneidad final de las severidades de afectación de un incendio. En relación a estos objetivos, las principales aportaciones de este estudio han sido, en lo referente a ecosistemas tropicales: La descripción de los incendios en Chiapas como mayoritariamente superficiales, afectando principalmente a estratos no arbóreos, de grandes dimensiones, de origen antrópico y con cierta propensión a afectar zonas protegidas. La aportación clave sin embargo, hace referencia a la demostración de la importancia de El Niño en la afectación de los ecosistemas tropicales húmedos, principalmente influenciado por la presencia de pastos alrededor de bosques fragmentados. El cambio de importancia relativa de los factores ambientales en años de no-ENSO frente a la mayor importancia de los factores socio-económicos en años de ENSO. También se puede remarcar el cambio de ecosistema afectado condicionado por el tipo de año (condiciones climáticas normales o extremas, ENSO o no ENSO: pino-encino versus bosques tropicales húmedos). En relación a los bosques mediterráneos, las técnicas más sencillas de teledetección resultaron las adecuadas para la identificación de islas. La formación de estas islas se ve condicionada por el tamaño y orientación y pendiente de las laderas, así como la cantidad y madurez de los rodales afectados, siendo las laderas más extensas, de orientación noroeste, de mayor pendiente, con mayores extensiones forestales y bosques más maduros (en términos de mayores tamaños), las más propicias a formar islas. Las características estructurales de los rodales fue de gran importancia para predecir la supervivencia forestal en zonas de condiciones climáticas moderadas. / The great majority of the forests of the world, excepting perhaps, the wettest belt of the tropics, have been burned over, at more or less frequent intervals, for many thousands of years. In the last century however, a combination of human and environmental factors have altered the frequency and distribution of fire, almost everywhere. This maldistribution of fire has resulted in an accumulation of this element in ecosystems not adapted to high frequencies of fire (i.e. tropical and sub-tropical areas), while other ecosystems have suffered the effects of fire suppression policies (i.e. north American temperate forests). Among the consequences of these alterations, some of them refer to variations in fire regimes, with implications in terms of forest conservation, ecological, economic and social impact. The present thesis analyses the influence of environmental and socio-economic factors for certain elements of the fire regime in tropical and Mediterranean ecosystems. In tropical areas, the study case relates to the tropical Mexican State of Chiapas, and the objectives are basically two: 1) to characterize the fire regime in the State, in terms of frequency of fires, fire distribution, areas and ecosystems affected, type of fires, causality, and their interaction with some factors like the phenomenon of El Niño, the land distribution, or the variation of rainfall values. 2) To analyse the relative influence of environmental factors versus socio-economic factors, in years of normal climatic conditions and years of El Niño. The final objective is to detect variations in the affectation of the major ecosystems and to list the most important factors to consider for forest fire management. For the Mediterranean ecosystems, the fire of Solsonés 1998 was selected as case study. Main objectives are: 3) To select the most efficient methodology for post-fire classification among several techniques: image classification and field survey. 4) To determine the influence of diverse environmental factors in the formation of vegetation islands inside a large forest fire, using "slope", as the spatial unit. 5) To verify the importance of forest structure and fuel continuity in the final heterogeneity of fire severities in a large fire. In relation to these objectives, the main contributions of this study are, with respect to tropical ecosystems: The characterization of fires in Chiapas, as in other tropical areas, mainly as superficial fires, frequently affecting non-arboreal layers. Major problems focus on large forest fires, which are responsible for the major burned areas. Fires are mainly human related and display certain propensity to affect protected zones. The key contribution nevertheless, refers to the major importance of El Niño in the affectation of humid tropical ecosystems. This is specially enhanced by the presence of cattle pasture surrounding the fragmented forests. The shift on the importance of environmental factors in years of no-ENSO versus the greater importance of socio-economic factors in years of ENSO, is also a major achievement. Moreover, shifts in ecosystem affectation have also been observed depending on the climatic conditions: pine-oak in no-ENSO years versus humid tropical forests in ENSO years. Regarding the Mediterranean forests, the simplest techniques of teledetection were the best performing ones for island identification. The formation of these islands is conditioned by the size and aspect of the slopes, as well as by the amount and maturity of the affected patches. Most extensive slopes, north-western orientations, more abrupt, larger forest extensions per slope, and more mature forests (in terms of greater sizes), are the most suitable combination of factors to form islands. This formation of islands does not have, therefore, a random distribution. Besides, the structural characteristics of the forest patches was confirmed to be of great importance to predict the forest survival in areas were fire burned under moderate climatic conditions. Larger patches and larger trees are the ones that will survive fire the best.

The purpose of this essay is to analyze the economic factors behind the supply of children engaged in child prostitution in Thailand. Children are recruited to the sex industry either by parents, adults in their immediacy or choose it themselves. There are several factors that contribute to pushing children towards prostitution. Many of these factors such as credit constraints and mortality are related to poverty, the most quoted of economic factors behind the supply of child prostitution. Associated to poverty is the high discount rate which means that people prioritize present over future consumption. In combination with a lack of alternatives, this makes people engage in risky activities such as prostitution. This also seems to be the case in Thailand.   To analyze the different alternatives faced by children in Thailand, a calculation of present value of life time wages of the alternative activities a child faces was computed. The computation of present value of life time wages of alternative activities of children in the face of different discount rates is in line with economic theory and shows that education confers the highest reward unless the discount rate is extremely high. If education is unavailable, as it is for unregistered children in Thailand, or discount rates are very high, as it can be for very poor families, prostitution will be the occupation with the highest returns. 

Objective: To determine the dental treatment needs of Canadians and how they are distributed. Methods: A secondary analysis of data from the Canadian Health Measures Survey was undertaken. Weights were applied to make the data nationally representative. Bivariate and multivariate regressions were used to identify predictors of need. Sensitivity, specificity, positive and negative predictive values were calculated to compare self-reported and clinically determined needs. Results: Of the 34.2% who required dental treatment, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. A discrepancy was found between clinical and self-reported needs. Conclusions: Roughly 12 million Canadians have unmet dental needs. A number of factors are predictive of having unmet dental conditions. Program and policymakers now have information by which to assess if their programs match the dental needs of Canadians.

This study addressed important issues on infant and child mortality in Zimbabwe. The broad objective of the study is to establish levels and trends of under-5 mortality and to determine the impact of maternal, socioeconomic and environmental contamination variables on infant and child mortality. Data from four DHS surveys conducted in Zimbabwe were used. It was found that mortality at all ages below 5 years old remained more or less constant from the period 1990-1994 to the period 1995-1999 and declined from the period 1995-1999 to 2001-2005. Mortality below 5 years old declined from 102 deaths per 1,000 live births during 1995-1999 to 82 deaths in 2001-2005. This decline was unexpected and it is argued that this decline is probably not genuine. Various types of evidence are provided to support the view that this decline in mortality probably did not take place. Analysis of ZDHS 2005- 06 showed that births of order 6+ and short preceding interval (intervals of less than or equal to 18 months) had the highest infant mortality risk. Infants with these characteristics were significantly more likely (2.75 times) to die in infancy relative to births of order 2-5 and long preceding birth interval (p<0.001). The infant mortality risk associated with multiple births was 2.08 times more relative to singleton births (p<0.001). The results indicated that socioeconomic variables did not have a distinct impact on infant mortality. Determinants of child mortality were different in relative importance from those of infant mortality. The effect of maternal education, though not significant, implied a decline in child mortality with increasing maternal schooling. The provision of piped drinking water and flush toilets to the households had a stronger impact on child mortality than infant mortality. Including HIV prevalence in the models elevated the odds of dying in infancy and childhood stages by 10 percent and 63 percent, respectively. This suggests that HIV/AIDS directly and/or indirectly influences the current levels of under-5 mortality in Zimbabwe. This study supports health policy initiatives stimulating use of family planning methods to increase birth intervals. Family planning programmes should be aimed at educating women and men with low educational levels and those in rural areas about the potential benefits of long-term birth spacing. These and other results are expected to assist policy makers and programme managers in the child health sector to formulate appropriate strategies to improve the situation of under-5 children in Zimbabwe. / Thesis (PhD)--University of Pretoria, 2010. / School of Health Systems and Public Health (SHSPH) / PhD / Unrestricted

Environmental Impact Assessments ("EIA") have been regulated for the last 12 years in South Africa, initially through the Environment Conservation Act 1989, and since 2006 through the National Environmental Management Act 1998 ("NEMA"). The former applied the standard of "substantial detrimental effect" to the environment in determining whether an authorisation should be granted. NEMA requires the authority to take into account environmental management principles. These principles inter alia require that development must be socially, environmentally and economically sustainable. This is also known as sustainable development ("SD"). Administrative officials tasked with considering EIAs have been given legislative direction with respect to the environmental issues which need to be assessed. They have been given no direction on how to assess socioeconomic issues. Notwithstanding this there have been an increasing number of decisions based on socio-economic factors, notwithstanding that the environmental impacts have been determined to be acceptable. In Fuel Retailers Association of South Africa v Director-General: Environmental Management, Department of Agriculture, Conservation and Environment, Mpumalanga Province and Others the Constitutional court held that SD must be applied by environmental authorities when they consider applications for EIA authorisation. However a careful analysis of NEMA and the Constitution of the Republic of South Africa, 1996, highlight that our administrators and courts have adopted a one dimensional and ultimately inaccurate interpretation of the application of SD. This is prejudicing the fulfilment of the objective of EIA, namely the determination of the acceptability of a project's environmental impacts. Whilst SD does have a role to play in the EIA process it is more defined, and does not take the central role the Constitutional Court has indicated. The aim of is to determine whether there are adverse impacts associated with a project. If there are, then ordinarily authorisation should be refused. However the authorities are enjoined to go a step further. They must determine whether the identified adverse impacts can be satisfactorily mitigated, and whether any positive socio-economic factors would accrue Page (iii) should the project be authorised. If both are answered in the affirmative, then a positive decision is appropriate. This is the balance which NEMA calls for, and this is the correct application of SD in an EIA. The broader application of SD espoused by the Constitutional Court is achieved not through the environmental authorities in the EIA process alone, but through the constitutional principle of cooperative governance. All authorities with an interest in a particular project must apply the principle of SD within the scope of their administrative functions. The environmental authorities consider the environmental impacts, the planning authorities consider the socio-economic impacts, the agricultural authorities determine the project's impacts on agricultural land, etc. The outcome of their individual decisions can then collectively be assessed to determine whether a project is sustainable or not. There are various measures which can be employed to address the interpretational deficiency which has now manifested. These include improving cooperative governance principles and practices in decisionmaking; undertaking strategic environmental assessments; and a dedicated Sustainable Development Act. / Dissertation (LLM)--University of Pretoria, 2011. / Centre for Human Rights / unrestricted

Magister Scientiae Dentium - MSc(Dent) / General dentists in practice (both public and private) are often reluctant to perform interceptive orthodontic procedures on patients that present to their practices. As interceptive orthodontic treatment (IOT) can be of great benefit to some patients, it validates the need to assess the factors that influence the implementation of such treatment.

No / . The placement of welfare advice services in family practice to assist patients with health-related social and economic issues (e.g. disability benefits) has gathered momentum over the last decade in the UK. This expansion of primary care raises a number of issues for practices hosting these services. Objectives. To gain the views of advice workers and primary care staff about the issues raised in hosting a welfare advice service across 30 practices in inner city Bradford. Methods. Views were obtained through focus groups with six advice workers, and primary care staff in 14 practices. A questionnaire was also posted to all practice managers asking their opinions about the service. Results. The focus groups highlighted a number of advantages for patients, including improvements in health and quality of life through increased income and reduced stress from social and economic issues. For practice staff, the service provided a resource to refer patients for welfare advice, reducing the time spent dealing with welfare issues, thereby reducing workload. This was confirmed in the questionnaire to practice managers where 72% said the service had saved time for GPs and reception/office staff. The advice workers raised concerns about the perceived level of commitment to the service from some staff at some practices. Practice staff were particularly concerned about the need for feedback about referrals. Conclusion. Providing welfare advice in family practice can act as a valuable resource for primary care staff helping to address their patients health-related social and economic needs.

Darbo tikslas. Įvertinti natūralaus maitinimo ir socialinių – ekonominių veiksnių sąsajas su vaikų sveikata. Uždaviniai. 1) Palyginti natūralaus maitinimo ir maitinimo adaptuotais pieno mišiniais sąsajas su vaikų sveikata; 2) Nustatyti socialinių – ekonominių veiksnių (tėvų išsilavinimo, šeimos pajamų, gyvenimo sąlygų, gyvenimo būdo) sąsajas su vaikų sveikata. Tyrimo metodika. Atliktas vienmomentinis anoniminis anketavimas. Tiriamąją grupę sudarė 200 2 – 5 metų amžiaus vaikų mamų. Duomenų analizė buvo atlikta remiantis statistiniu paketu SPSS (16.0 versija). Ryšiai tarp požymių buvo vertinami chi kvadrato (χ2) kriterijumi bei laisvės laipsnių skaičiumi (lls). Tyrimo rezultatai. 183 (91,5 proc.) respondenčių žindė savo kūdikius ir 17 (8,5 proc.) visiškai nežindė. I š visų žindytų vaikų dažniausiai pasitaikė žindytų ilgiau kaip pusę metų (43,7 proc.). Žindytų vaikų sveikatą gerai įvertino 67,6 proc. motinų, nežindytų 38,9 proc. Žindytų tiriamųjų iki pusės metų amžiaus sveikatos būklę gerai įvertino 59,2 proc. motinų, žindytų ilgiau kaip pusę metų 77,5 proc. Ilgiau nei 6 mėn. žindė respondentės, kurių šeimos pajamos siekia iki 3000 lt. per mėnesį (47,8 proc.). Labai dažnai virškinimo sutrikimais skundėsi 18,8 proc. valgančių maistą iš šaldytų produktų ir tik 2,7 proc. nevalgančių. Dažnai valgantiems maistą paruoštą iš šaldytų produktų odos alergijos pasitaikė 31,3 proc. tiriamųjų, nevalgantiems 7,6 proc. Lankantys vaikų lopšelį – darželį ir ten besimaitinantys tiriamieji... [toliau žr. visą tekstą] / The aim of this work. To evaluate breastfeeding and social – economic factors associated to children’s health. Objectives. 1) Compare breastfeeding and formula feeding influence to children’s health. 2) Estimate social and economic factors (parents education level, family’s incomes, living conditions, lifestyle) influence to children’s health. Methodology. Anonymous questionnaire given to a research group – 200 mothers raising children from 2 to 5 years old. Have been accomplished data analysis referring to statistical packet SPSS (version 16.0 ). Relations between features was considered regarding to chi quadrate (χ2) parameters and a number of degree of freedom (lls). Results. 183 (91,5 %) of respondent women breastfed their babies comparing to 17 (8,5 %.) that didn’t breastfed . From all breast-fed babies, most of them have been breastfed longer than 6 months (43,7 %). Breastfed babies state of health have been estimated as good by 67,6 % breastfeeding mothers, comparing to 38,9 % of not breastfed babies. Breastfed babies up to 6 months health condition have been estimated as good by 59,2 % mothers, breastfed more that 6 months - 77,5 %. More than 6 months breastfeeding mothers family incomes were up to 3000 Lt in a month (47,8 %.) 18,8 % of respondent children consuming frozen products frequently had digestive problems and only 2,7 % that didn‘t consumed. Respondents consuming frozen products had regular skin allergy 31,3 % and 7,6 % it appeared for the ones who... [to full text]