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京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第23820号 / 社医博第120号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 小杉 眞司, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Trustworthy clinical practice guidelines assist health care professionals in selecting the management options that optimize patient health outcomes. The development of trustworthy guidelines requires the consideration of many aspects and the involvement of multiple contributors, often working in groups. The guideline panel plays the key role in the development process as it is responsible for prioritizing topics that should be covered as part of the guideline effort, formulating questions, reviewing the evidence, developing and agreeing on the recommendations, and endorsing the final guideline document. Ensuring transparency throughout the process by appropriately organizing and documenting panel activities is an essential standard that is used to assess the credibility of a developed guideline and its resulting recommendations. The adoption of conceptual frameworks that systematically guides panel members in their decision-making process (e.g. the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks) can aid in the formulation of methodologically sound recommendations. In this dissertation, I used the example of a guideline on diagnosis and treatment of autism spectrum disorders to describe how rigorous research methods can support guideline panels in the development process from early stages to the formulation of recommendations. In another prominent guideline development effort with the American Society of Hematology, I have identified two steps in the process where panel members may benefit from further support and addressed these gaps by conceptualizing and developing novel approaches. The first approach comprises modelling baseline risk estimates for patient-important outcomes when only surrogate data is available. The second approach proposes a method to estimate decision thresholds for judgments on health benefits and harms using the GRADE EtD framework. While these approaches are tailored to address specific guideline panel needs, guideline methodologists could use the underlying concepts to find solutions to aid guideline panels in other steps of the development process. / Thesis / Doctor of Philosophy (PhD) / Clinical practice guidelines assist health care professionals in selecting management options that can best improve the health outcomes of their patients. The development of trustworthy guidelines is a complex process that requires the contribution of several entities. The guideline panel, which typically comprises different experts (clinicians, patient representatives, experts in research methodologies) plays the key role in this process as it is responsible for selecting the most important questions to address in the guideline, reviewing the evidence supporting an option, agreeing on the recommendations, and endorsing the final guideline document. To ensure that the process of developing guidelines is transparent and that the recommendations are credible, it is important that panel activities are well documented and follow rigorous methods. Structured frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) approach, have been developed to systematically guide the panel members and to minimize the error that could be introduced while making decisions. In this thesis, I describe the development of an approach and its application for comprehensive guideline development by the Italian National Health Institute, to describe rigorous guideline development and propose two novel approaches to further assist panel members in enhancing their guideline development. The first of these two enhancements to guideline development describes how to derive a modelled estimate of the risk of having certain health conditions when this data is not directly available in the medical literature. The second of the two enhancements is a method to support guideline panels in judging how substantial the desirable and undesirable effects of health interventions are. Both approaches were tailored to fit specific needs but can be adapted to inform the improvement of other steps in the guideline development process.

Cooperative Extension (CE) is a nationwide system that addresses leading concerns for United States residents from agricultural production to healthy youth development. As 80% of Americans are not meeting the Physical Activity Guidelines (PAG), promoting physical activity is a recent addition to CE priority areas. To build capacity of CE to offer physical activity, training on physical activity within the system is needed. Since yoga is a public health intervention growing in popularity due to its link to flourishing and mental well-being, this is a holistic practice that may target physical and mental health in the United States. Due to the variety of yoga practices one could engage with it is important to clarify the link between physical activity and yoga. This dissertation included four studies to promote physical activity and yoga within CE. Study one established the efficacy of a virtual micro-credentialing program for CE professionals (N = 64) that increased their knowledge about physical activity programming and increased their own physical activity levels. The second study was an iterative and pragmatic investigation of wellness initiatives for CE professionals to increase flourishing and physical activity within themselves. The third study explored the degree to which temperature and tempo of yoga classes impacted measured heart rate and rate of perceived exertion. Preliminary evidence suggests that ~30% of the yoga class contributed to moderate-vigorous physical activity, regardless of the temperature and speed. The fourth study was a systematic appraisal of urban and rural yoga studio offerings. The results included that most studios offer 60-minute classes, focused on asana (movement) rather than the other limbs (components) of yoga. This work also resulted in a studio audit form for CE professionals to assess yoga studios for appropriateness to recommend to their participants. Future work includes scaling out the micro-credentialing program and determining the degree to which knowledge of physical activity leads to physical activity program adoption (study 1); ensuring CE professionals have access to wellness initiatives to avoid burn out (study 2); ongoing investigation of the physiological benefits of yoga (study 3); and testing the utility of the studio audit form (study 4). / Doctor of Philosophy / Physical activity is an important part of living a healthy life and can look different for everyone. The Physical Activity Guidelines for Americans recommend for people to get 2 days of full body strength training along with 150 minutes of moderate intensity aerobic activity each week. Aerobic activity is activity that gets your heart rate up. In the first manuscript of this dissertation, Cooperative Extension professionals were trained in how to promote physical activity and physical activity programming. Cooperative Extension is a nationwide program that helps get research knowledge from the universities to the public. The second manuscript looks at how Cooperative Extension professionals were able to incorporate more mindfulness, yoga, and self-care for themselves through employee wellness programs, and which programs worked best in a practical way. The third manuscript looks at if the physical practice of yoga can increase heart rate to moderate to vigorous intensity zones in order to determine if a typical community-based yoga flow could contribute to meeting the aerobic components of the Physical Activity Guidelines. Based on this study, yoga can help participants get into the moderate intensity aerobic activity zone. The fourth manuscript explores the research and development of a yoga studio audit tool. This tool helps assess yoga studios so that public health professionals can recommend the studio that is the right fit for their clients.

Yes / Research ethics review by ethics committees has grown in importance since the end of the Nuremberg trials in 1949. However, ethics committees have come under increasing criticisms either for been ‘toothless or too fierce’ (Fistein & Quilligan, 2012:224). This paper presents a personal account of my experience in obtaining ethical approval for my PhD study from a UK university and the ethical dilemmas encountered in the fieldwork in Ghana. In this paper I question whether strict adherence to ethical guidelines developed from western perspectives is useful in conducting research in non-western societies. As more academics are increasingly been mandated to undertake international research, the paper argues for more flexibility in the ethical approval process to accommodate cultural differences.

New developments often lack regional identity and distinctiveness of place. Before the industrial revolution, landscapes were the result of social, cultural and environmental constraints. Currently, a strong sense of place is lacking in many American cities. Santa Fe, New Mexico, as an example, faces the challenge of integrating new development with existing historic areas. While the downtown central core of Santa Fe has a distinctive and unique character, the outlying fringes of Santa Fe County are being developed in ways that undermine the sense of place that is valued by its residents and visitors. Current county development patterns do not meld with the intimate, small-scale character of the older neighborhoods in the downtown central core areas of the city. To address this issue, this thesis uses theory related to sense of place to identify distinctive characteristics that can be adapted for projects outside Santa Fe's central core. The study uses a mixed method approach, including a literature review and field study methods to assess Santa Fe's distinctive physical characteristics. The results are a set of contemporary community design guidelines for the Santa Fe, New Mexico region that address sense of place in the following categories: (a) Spatial Planning and Architecture: street design characteristics and their physical relationship to architecture; (b) Environmentally Responsive Architecture: architecture design characteristics that respond to the regional environment and Santa Fe Style; (c) Decorative Architectural Details: architectural detail design characteristics that respond to the regional vernacular and the Santa Fe Style; (d) Integration of Architecture and Landscape: open space design the physical relationship between the local landscape and architecture; and, (e) Landscape and Cultural Character: regional landscape and art design characteristics that respond to Santa Fe's environment and culture. The resulting design principles are expressed as guidelines to support sense of place and their application to new development in Santa Fe County. / Master of Landscape Architecture

As large displays become more affordable, researchers investigate their productivity impacts and try to develop techniques for making the large display user experience more effective. Studies show that large displays enable users to create and manage more windows and engage in more complex multitasking behavior. Although recent work demonstrates significant productivity benefits of large shared displays, it shows numerous usability issues because current software design is not scaling well. Therefore, we took steps towards developing two user interface design guidelines for large shared displays. Specifically, empirical studies have been conducted to compare the effects of large shared display and personal display use. When each of them is used as a secondary display, large shared displays impose increased interruption and comprehension. Empirical and qualitative studies are designed to develop two user interface design guidelines for large shared displays. We designed a system called SuperTrack that uses a large shared display and the proposed guidelines to further enhance team efficiency and productivity in collaborative software development environments. Finally, an in-situ evaluation assesses the benefits of SuperTrack. Results show that exposing software development team members to a large shared display through SuperTrack leads to more communication among the members and improved group awareness — leading to increased productivity and efficiency. / Master of Science

Food and beverage marketing influences the preferences and diet quality of adolescents. In 2009, about one third (23.8 million US dollars) of the 77 million US dollars spent on celebrity marketing targeted to American adolescents promoted sugar-sweetened beverages (SSB) associated with obesity and type 2 diabetes. Research is limited on how celebrity endorsement influences adolescents' SSB choices and intake. This M.S. thesis describes a study with three research objectives conducted among 28 adolescents in Virginia to explore their beverage intake and views about celebrity endorsement of beverage products. Participants completed four activities including: BEVQ-15 to determine the type and amount of beverages consumed; a familiarity survey with 48 celebrities and their endorsements for six beverage product categories; Q methodology study that used 48 celebrity images depicting beverage brand and product endorsements where participants sorted the images on a normal distribution (+4 to -4) based on perceived celebrity credibility (i.e., expertise, attractiveness and trust); and a post Q sort questionnaire. The BEVQ-15 revealed that 96.3% of participants did not adhere to healthy beverage guidelines. A majority of participants recognized between 51% and 75% of the celebrities, but only 4.9% accurately identified celebrities and their associated beverage endorsement category. The Q methodology study used factor analysis to identify three unique viewpoints: (1) entertainment image emulators; (2) inspirational celebrities for perceived healthier beverages; and (3) multi-cultural celebrity appreciators. Study results may inform future policies and actions to ensure that celebrity endorsement encourages adolescents to buy and consume healthy beverages that align with guidelines. / Master of Science

Yes / The way we perceive and portray dementia has implications for how we act towards people with dementia and how we address the issue of dementia within society. As a multi-disciplinary working group, established within the framework of the European Dementia Ethics Network of Alzheimer Europe, we aimed to describe the different ways that people with dementia are perceived and portrayed within society and to consider the moral implications of this. In the current paper, we address perceptions of dementia as reflected in explanatory models of its cause and nature, descriptions of characteristics of people with dementia, the use of language, media portrayals and the views of people living with dementia. Academics and professionals could use this exploration to reflect on their behaviour and their use of language regarding people with dementia / The taskforce’s work arises from the 2013 Work Plan of Alzheimer Europe, which received funding from the European Union in the framework of the Health Programme.