Background The debate regarding the lower age limit for mammography service screening is old and lively; a product in part of the lower breast cancer risk in younger ages as well as the limited data available for studies of the younger age group. Recently the idea of inviting only high risk groups has gained momentum, however high risk might not be equivalent to greater benefit from screening. Therefore, there is a need for information on effectiveness of screening as it relates to young women and to specific risk groups. To this end, this thesis evaluates mammography screening for the age group – 40 to 49 year old women – in terms of breast cancer mortality reduction in total and in subgroups based on breast cancer risk factors. Overdiagnosis of mammography screening is also evaluated for women 40 to 49 years old. In addition, this thesis presents a statistical method to estimate this effectiveness and to test for differences in effectiveness between subgroups adjusted for non-compliance and contamination. Methods The studies of this thesis are based on data from the Screening of Young Women (SCRY) database. The SCRY database consists of detailed information on diagnosis, death, screening exposure and risk factors for breast cancer cases and population size by year (between 1986 and 2005) and municipality for women in Sweden between 40 and 49 years old. The material was divided into a study group consisting of the counties that invited women in the age group 40-49 years to mammography screening, and a contemporaneous control group consisting of the counties that did not. Effectiveness was estimated in terms of rate ratios for two different exposures (invitation to and participation in screening), and overdiagnosis for subsequent screening was estimated adjusting for lead time bias. Defining a reference period enabled adjustment for possible underlying differences in breast cancer mortality and incidence. A statistical model for adjusting for non-compliance and contamination in randomised controlled trials was further developed to allow for adjustment in cohort studies using a Poisson model with log-linear structure for exposure and background risk. Results During the study period (1986-2005), there were 619 and 1205 breast cancer deaths and 6047 and 7790 breast cancer cases in the study group and the control groups, respectively. For women between 40 and 49 years old, the breast cancer mortality reduction was estimated at 26% [95% CI, 17 to 34%] for invited to screening and 29% [95% CI, 20 to 38%] for attending screening. The RR estimates for the high-risk groups based on the risk factors parity, age at birth of first child, and socio-economic status were equal to or higher than that of the low risk groups. The new statistical method showed that the decrease in effectiveness with parity was not a statistically significant trend. The overdiagnosis from subsequent screening for 40 to 49 year old women was estimated at 1% [95 % CI, -6 to 8 %] (i.e., not statistically significant). Conclusion Subgroup specific effectiveness was also estimated. The relative effectiveness of screening for breast cancer with mammography for women age 40 to 49 years appears to be comparable to that for older women. These findings and the fact that there was no statistically significant overdiagnosis from subsequent screening speak for inviting women 40 to 49 years old to screening. High-risk screening for nulliparous women aged 40 to 49 years, for example, might be an alternative in countries where population-based screening for all women between 40 and 49 years old is not possible. However, the matter of risk factors and the effect of their combinations is complex and risk group screening presents ethical and practical difficulties. The new statistical model is a useful tool for analysing cohorts with exposed and non-exposed populations where non-compliance and contamination is a potential source of bias.

Background and objectives: Childhood sexual abuse (CSA) is a substantial public health and human rights problem, as well as a growing concern in sub-Saharan Africa (SSA). It has both short and long term effects on girls: physical and psychological, including negative sexual outcomes. Up to one-third of adolescent girls report their first sexual experience as being forced. Despite growing evidence supporting a link between contextual factors and violence, no studies have investigated the connection between CSA and contextual factors. It is therefore important to identify the extent of CSA and understand factors associated with it in SSA in order to develop interventions aimed to address the scale of the problem. Aim: The overall aim of this thesis is to assess the individual and contextual factors associated with CSA. In addition, the thesis aims to quantify the magnitude of CSA and describe the factors associated with CSA among women from SSA (Study I). This thesis also examines the independent contribution of individual and community socio-economic status on CSA (Study II). Moreover, it scrutinises the effect of social disorganisation on CSA (Study III) and explores the relationship between CSA and sexual risk behaviours as well as potential mediators (Study IV). Methods: This thesis used the Demographic and Health Survey (DHS) datasets conducted between 2006 and 2008 from six SSA countries. The thesis used multiple logistic regression models to describe and explore factors associated with CSA among 69,977 women (Study I).  It used multivariable multilevel logistic regression analysis to explore the effect of contextual level variables (neighbourhood socio-economic status) on CSA among 6,351 girls (Study II). Neighbourhood socio-economic status was operationalized with a principal component analysis using the proportion of respondents who were unemployed, illiterates, living below poverty level and rural residents. Study III applied multivariable multilevel logistic regression analysis on 6,351 girls and considered five measures of social disorganisation at the community level: neighbourhood poverty, female-headed households, residential mobility, place of residence, population density, and ethnic diversity. In study IV, 12,800 women from the Nigerian DHS were used. Structural equation modelling was applied using a two-step approach. The first step used a confirmatory factor analysis to develop an acceptable measurement model while the second step involved modifying the measurement model to represent the postulated causal model framework. Results: In study I, the reported prevalence of CSA ranged from 0.3% in Liberia to 4.3% in Zambia when the prevalence was based on all respondents aged between 15 and 49 years and who were present during the survey. None of the socio-economic factors were associated with CSA. In study II, where the data was restricted to permanent residents aged between 15 and 18 years, the prevalence ranged between 1.04% in Liberia to 5.8% in Zambia. At the individual level, there was no significant association between CSA and wealth status while at the community level, there was no significant association between CSA and socio-economic position. However, 22% of the variation in CSA was attributed to the community level factors. In study III, there was significant variation in the odds of reporting CSA across the communities, with community level factors accounting for 18% of the variation. In addition, respondents from communities with a high family disruption rate were 57% more likely to have reported sexual abuse in childhood. Study IV showed that there was a significant association between CSA and sexual risk behaviours and the association was mediated by alcohol and cigarette use. Conclusions: The study provides evidence that adolescents in the same community were subjected to common contextual influences. It also highlighted the significance of mediators in the relationship between CSA and sexual risk behaviours. It is therefore important that effective preventive strategies are developed and implemented that will cut across all socio-economic spheres in a context that both permits and encourages disclosure as well as identifying predisposing circumstances for recurrence.

Darbo tikslas: nustatyti pirmų klasių mokinių fizinio aktyvumo ir mitybos sąsajas su šeimų socialine ir ekonomine padėtimi Kauno miesto mokyklose. Darbo uždaviniai: 1. Įvertinti Kauno miesto pirmų klasių mokinių fizinį aktyvumą; 2. Įvertinti Kauno miesto pirmų klasių mokinių mitybos ypatumus; 3. Išanalizuoti Kauno miesto pirmų klasių mokinių šeimų sociolinius-ekonominius veiksnius; 4. Nustatyti sąsajas tarp Kauno miesto pirmų klasių mokinių fizinio aktyvumo, mitybos bei šeimos socialinės-ekonominės padėties. Tyrimo metodika: COSI tyrimo pagrindu, apklausos anketoje tėvams/globėjams buvo pateikti 48 klausimai. Anketą Kauno mieste užpildė 407 tėvai. Duomenų statistinė analizė atlikta naudojant SPSS 19.0 for Windows programą. Rezultatai: Pusė Kauno miesto pirmų klasių mokinių yra fiziškai aktyvūs – 53,4% berniukų ir 55,3% mergaičių. Švieži vaisiai pirmų klasių moksleivių racione vartojami dažniau nei šviežios daržovės (p<0,05), Bulvių traškučiai, pica yra valgomi retai – kelis kartus per mėnesį, o sausainiai ir saldainiai pirmų klasių mokinių valgomi 1-3 kartus per savaitę. Didžioji dalis 82,2% berniukų ir 77,9% mergaičių gyvena pilnoje šeimoje (p>0,05), namuose su visais patogumais. Daugumos tėvų išsialvinimas yra vidutinis, mamų – dažniausiai yra aukštasis. Išvados: Dauguma Kauno miesto pirmokų yra fiziškai aktyvūs. Nustatyta, kad dauguma pirmokų pusryčiauja kiekvieną rytą. Švieži vaisiai pradinių klasių moksleivių racione vartojami dažniau nei šviežios daržovės. Pirmų klasių... [toliau žr. visą tekstą] / The aim of the study: set the first grade students of physical activity and dietary links to families' social and economic situation in Kaunas city schools. The objectives of the study: 1. Rate Kaunas city first-grade students of physical activity; 2. Rate Kaunas city first-grade students nutrition features; 3. Analyze Kaunas city first-grade students of families of social and economic situation; 4. Identify links between Kaunas city first grade students of physical activity, nutrition and social and economic situation. Research Methods: COSI research-based questionnaire survey to parents / guardians were present 48 questions. The form is filled out in Kaunas 407 parents. The statistical analysis was performed using SPSS 19.0 for Windows program. Results: Half of the city of Kaunas first grade students are physically active – 53,4% of boys and 55,3% girls. Fresh fruits in the diet of first-grade students used more often than fresh vegetables (p<0.05), potato chips, pizza is eaten rarely – a few times a month, and cookies and candy in the first grade eaten 1-3 times a week. The majority of the 82.2% of boys and 77.9% girls living in nuclear family (p>0.05), at home with all the amenities. The majority of parents are išsialvinimas average, mothers – are usually higher. Conclusions: Most of the the city of Kaunas and first graders are physically active. It was found that the majority of first graders have breakfast every morning. Fresh fruits in the diet of the children were... [to full text]

This study was designed to identify ninth grade students&amp / #8217 / misconceptions about static electricity concept and to determine relationship among students&amp / #8217 / gender, socio-economic status, interest, experience with students&amp / #8217 / misconceptions about static electricity. For this study, Static Electricity Concept Test (SECT) and Socio-Economic Status, Interest and Experience Questionnaire about Static Electricity (SESIEQ) were developed to assess students&amp / #8217 / misconceptions related to static electricity and their socio-economic status, interest and experience about static electricity, respectively. This study was carried out during 2002-2003 spring semester with 1260 ninth grade students from 9 Anatolian and regular high schools in &Ccedil / ankaya and Mamak districts of Ankara. Findings of the concept test indicated that many students had misconceptions about static electricity. Negative and significant relationships among students&amp / #8217 / gender, socio-economic status, interest, experience and misconception scores were found. The difference between misconception scores of male and female students was significant in favor of males. However, when the data were analyzed using ANCOVA while controlling students&amp / #8217 / socio-economic status, interest in static electricity and experience about static electricity, no difference was observed between the misconception scores of male and female students.

Low-skilled, low socio-economic status, young, co-resident, working fathers: Their experience of fatherhood Using open-ended interview techniques, 23 low-skilled, low socio-economic status fathers aged 20-29 were interviewed about their experience of fatherhood. All participants were in unskilled jobs and all lived with and supported their partners and child/children. This population of fathers is generally overlooked by researchers. Because they take responsibility for some of society’s most vulnerable families and children, understanding how they conceive of their role as fathers can promote the welfare of those families and children. Participants were recruited by casual connections, snowballing and advertisement. The interviews explored the participants' experience of fatherhood and their reasons for being active and committed family members. Focus was given to how they made sense of fatherhood in terms of their life course. Participants had two interviews, the first generic and the second idiographic. Interviews were tape-recorded and later transcribed. A social constructionist approach was used: transcripts were analysed by identifying and examining the primary domains in which participants experienced fatherhood. Participants spoke of fatherhood as an affective activity, the primary object of good fatherhood being to maintain an emotional bond with one’s children. Being a good father was thought to involve eschewing deleterious family practices such as those which had marred their own childhoods. In this regard, participants saw themselves as repairing their family-of-origin's dysfunctional style. Providing was described as a core feature of fatherhood – subsidiary to, but corollary on, being an emotionally-engaged father. Good fathers were described as committed providers, albeit participants did not consider their own limited earning capacity to compromise their fatherhood. Obtaining a job and providing for one’s family was one of the ‘pro-socializing’ effects of fatherhood. Participants considered fatherhood to not only improve but to also redeem their lives, giving a purpose and focus they had lacked prior to their becoming parents. Being a good father also involved being a good partner. For many of the participants, this involved adopting non-gendered roles in the home. The sharing of housework and childcare improved home life by reducing the partner's workload. Those who failed to adopt the gender-neutral stance acknowledged this as a personal shortcoming that they planned to remedy. Fatherhood for these 23 interviewees was one of the few means by which they could obtain social value and status as adults. They lacked access to financial resources, education or supportive family connections, but fatherhood was a domain in which they could present themselves as significant members of society. It also provided a network of emotional relationships which promoted their sense of self-worth and their social and emotional wellbeing.

Thesis (M. Ed.)--University of Hong Kong, 1995. / Includes bibliographical references (leaves 115-125).

Thesis (M.Ed.)--University of Hong Kong, 1995. / Includes bibliographical references (leave 115-125). Also available in print.

Background: Compliance with CPAP treatment for OSA is not reliably predicted by the severity of symptoms or physiological variables. I conducted a series of studies to examine a range of factors that may affect compliance with CPAP. Methods: I performed a retrospective study examining association of demographic factors and OSA severity with long-term CPAP compliance. In a prospective study, I looked at the correlation of short and long-term CPAP compliance with socio-economic status, education, type D personality, demographics, disease severity, mood and clinician's prediction. I undertook a prospective, cross-over trial comparing the impact of Bi-level PAP therapy in individuals with low tolerance of CPAP. Results: In a retrospective analysis, an improvement in subjective daytime somnolence was correlated with optimal compliance. In the prospective study, median compliance with CPAP at 6 months was 5.6 (3.4- 7.1) hours/night with 73% of subjects using CPAP ≥ 4 hours/night. Compliance with CPAP was not found to be associated with socio-economic class for people in work, type D personality, education, sex, age, baseline sleepiness (ESS score) or disease severity (ODI). The clinician's initial impression had no predictive value for individual patients. Subjects who were long-term unemployed or reporting mood disorders (High Beck's Depression Index scores) were likely to have poor compliance and sub-optimal CPAP usage (OR 4.6, p = 0.011 and OR 1.4. p=0.04 respectively). Subjects experiencing side effects after the first night on treatment showed lower acceptance and subsequent compliance. In the cross-over trial, changing to Bi-level PAP in individuals with suboptimal compliance due to pressure related intolerance, did not lead to an improvement in CPAP compliance. In post-hoc analysis, compliance and comfort were better in the subgroup that complained of difficulty with exhalation on CPAP. Conclusion: My research as presented in this thesis, did not find an association between disease severity (ODI), socio-economic status (for people in employment), education or personality type and CPAP compliance. My research demonstrated that subjects with long-term unemployment, mood disorders and those experiencing side effects on the first night of treatment were likely to have sub-optimal compliance. Changing to Bi-level PAP is only likely to be useful for a sub-group of subjects experiencing pressure related intolerance. More research is needed to explore whether intensive support to individuals with OSA and long term unemployment, as well as mood disorders, may improve compliance.

Magister Chirurgiae Dentium - MChD / Oral ulcers and oral thrush could be indicative of serious illnesses such as oral cancer, HIV and other sexually transmitted infections (STIs), among others. There are many different health care workers that can be approached for advice and/or treatment for oral ulcers and oral thrush (sometimes referred to as mouth sores by patients), including pharmacists. In fact, the mild and intermittent nature of oral ulcers and oral thrush may most likely lead the patient to present to a pharmacist for immediate treatment. In addition, certain aspects of access are exempt at a pharmacy such as long queues and waiting times, the need to make an appointment and the cost for consultation. Thus pharmacies may serve as a reservoir of undetected cases of oral cancer, HIV and other STIs. Aim: To determine how community pharmacists in the Western Cape manage oral ulcers and oral thrush. Objectives: The data set included the prevalence of oral complaints confronted by pharmacists, how they manage oral ulcers, oral thrush and mouth sores, their knowledge about these conditions, and the influence of socio-economic status (SES) and metropolitan location (metro or non-metro) on recognition and management of the lesions. Method: A cross-sectional survey of community pharmacists in the Western Cape was conducted. A random sample of pharmacies was stratified by SES (high and low), and metropolitan location. A structured questionnaire was used to conduct a telephonic interview. The questionnaire was faxed to pharmacists 24 hours prior to the interview. Pharmacists were also telephoned 24 hours prior to the interview, but after the questionnaire was faxed, in order to gain informed consent for participation in the study, and to confirm a convenient time to conduct the interview. Results: Two thirds (63%) of pharmacists managed oral problems nearly everyday, and 30% managed these more than once a week. More pharmacists in high SES (73%) areas managed oral problems nearly everyday (Fisher Exact, p=0.0005). Just over half (56%) and 49.2% of pharmacists said that ulcers and thrush, respectively, was the most common oral problem that they encounter. The prevalence of oral thrush was significantly higher in non-metro areas (58%) (RR=0.7 (0.5-1.0) ChiSquared=4.0, p=0.04), and it was also significantly lower in low SES areas (RR=1.6 (1.1-2.4), Chi Squared=6.5, p=0.01). Half the pharmacists reported that they would manage the patient comprehensively. Most would take a history but the quality of the history is poor, thereby compromising their ability to manage these cases appropriately. Only a third would refer a simple oral ulcer, thrush or mouth sore to a doctor/dentist but all pharmacists would have referred a longstanding ulcer to a doctor/dentist. In terms of knowledge, only 33% of pharmacists were aware that oral ulcers and thrush could be indicative of HIV infection, and only 8% linked oral ulcers with oral cancer. There was no discernable pattern of management of oral ulcers and thrush, or of knowledge of the link between these lesions with underlying diseases, by SES and metropolitan locations (Chi Squared, Fisher Exact, p>0.05). Conclusion: The result of this study strengthens the current view of pharmacists as oral health advisors as they encounter oral problems regularly, most commonly oral ulcers and oral thrush. Therefore, the pharmacist can play an important role in the early detection of HIV and oral cancer. However many pharmacists fail to refer these cases to a dentist. Most pharmacists lacked specific knowledge about the relationship of oral ulcers and thrush with underlying conditions, which may explain why many pharmacists are not managing these cases correctly. There is a definite need to train pharmacists at both an under- and post-graduate level with specific emphasis on the proper management of oral ulcers, oral thrush and mouth sores, as well as comprehensive training that outlines why vigilant management of oral ulcers and oral thrush is necessary. / South Africa

Thesis (Ph.D.(Curriculum Studies)) -- University of Limpopo, 2020 / Community education has driven change in societies for time immemorial. The successes of educational services in influencing socio-economic issues in societies across the globe are captured through empirical studies. There are community education services conducted in the Gravelotte community, but they seem not to address socio-economic needs. The level of illiteracy and joblessness is not abated. The purpose of the study was to investigate the extent to which community education services in the Gravelotte community influences socio-economic issues. Qualitative study approach was employed in the study to investigate the subject. The research paradigm engaged was Interpretive within a case study. I used three methods to collect data which were in-depth individual interviews, document analysis and participant observation. Ten participants were interviewed individually using open-ended interview guides. Minutes, journals and related documents were analysed for data triangulation. I participated and observed public meetings and stakeholders’ gatherings within the area under study. The study was conducted in the small semi-urban area of Gravelotte community in Ba-Phalaborwa municipality with a population of about 500 residents of mixed races. The sampling was done purposively as the participants were requested to respond to a matter relative within the community. The generated data was thematically analysed. I interpreted the data generated from informants to make conclusions on answering the main research question. The study brought forth the following findings. There is no secondary school in the Gravelotte community which is detrimental for socio economic development in the area. Community education programmes offered in Gravelotte have significant successes. Several graduates from the TVET college can find employment and some of them start their businesses. The ABET centre in Gravelotte Primary assists mine workers to earn better salaries. There is evidence of success in the education programmes provided in the Gravelotte community. However, the study discovered that the programmes were offered amidst challenges. Planning, participation and partnership were identified as obstacles to proper implementation of education programmes. The use of common planning to deal with educational goals is most required to enhance the success of educational programmes. There is an increased appreciation by the local community to participate in educational matters. Partnerships are being forged between the local community, the municipality and the mines to address the successful implementation of educational programmes. The study recommends that one primary school in the area be empowered to proceed to include a secondary school or provide education up to grade 9. Additionally, that more research is directed into the gap between provision and demand in the future such that the challenges can be extensively investigated. Likewise, that further researches be encouraged to investigate the ability of TVET colleges to collaborate with local communities with intent to find solutions on educational challenges. In conclusion, the study clearly outlines the effects that education has on the socio-economic issues within the Gravelotte community. There are diverse opinions that support each other in areas that are very important for socio-economic development