This dissertation focuses on the relationship between the education-based fertility gap and economic growth and on policy as a determinant of fertility. In the first essay I evaluate the impact of differential fertility (the difference between fertility rates of women with high educational attainment and women with low educational attainment) on economic growth by accounting for critical marginal effects and the general level of educational attainment in a given country. I also examine the possibility that this effect varies based on level of inequality and income levels. I find that for a less developed country with high income inequality, higher fertility rates of women with lower education has a favorable impact on economic development. In the second essay I examine the transmission and magnitude of the effect of differential fertility on economic growth at the subnational level. I explore the relationship between differential fertility and economic growth in a cross-U.S. state context. I find that a larger gap in fertility rates between highly-educated and less-educated women is strongly associated with a decrease in the rate of long-run economic growth across U.S. states, even after accounting for the levels of inequality and overall fertility. In the third essay I explore policy as a determinant of the education-based fertility gap. I use the 2007 Massachusetts healthcare reform which provides a good setting for evaluating the effect of an exogenous policy on the fertility. I find that fertility increases among young married women and decreases among young unmarried women but that there is no asymmetrical fertility response based on the education level of the mother.

Thesis (Ph.D.)--University of Wollongong, 2004. / EMBARGOED - this thesis is subject to a 2 year embargo (21/06/05 to 21/06/07) and may only be viewed and copied with the permission of the author. For further information please Contact the Archivist. Typescript. Includes bibliographical references: p. 237-247.

Thesis (M.S.)--Mississippi State University. Department of Sociology, Anthropology and Social Work. / Title from title screen. Includes bibliographical references.

Thesis (Ph.D. in Clinical Sciences) -- University of Colorado at Denver and Health Sciences Center, 2005. / Typescript. Includes bibliographical references (leaves 103-110). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Bipolar disorder (BD) is one of the leading causes of disability worldwide and has a detrimental impact on health-related quality of life (HRQoL), and personal and social functioning. Despite this, there is insufficient knowledge of the costs, HRQoL implications relevant to BD, and the cost-effectiveness of current treatments for BD in the UK. This thesis aims to inform decisions about local and national service provision by applying a variety of health economic tools to build an economic case for BD. First, economic evaluations of BD management strategies are systematically reviewed. A cost-of-illness study is then conducted to estimate the societal burden of BD in the UK and explore the factors that drive variations in these costs. The appropriateness of applying the EQ-5D-3L outcome measure in BD is assessed, and the feasibility of mapping disease-specific measures to the EQ-5D-3L is explored. Finally, a cost-utility analysis (CUA) is conducted to bring together evidence on the costs and outcomes associated with alternative psychological interventions in BD management. This thesis makes critical contributions to multiple research domains, informing the allocation of scarce healthcare resources in this context. There is a sheer dearth of evidence on cost-effectiveness strategies for the long-term management of BD in the UK, especially the evidence for psychological therapies is limited. The annual societal costs associated with BD in the UK are estimated to be £5.14 billion, demonstrating the significant economic burden associated with this disease. The EQ-5D-3L instrument is found to be useful in measuring HRQoL in BD patients who predominantly experience depressive symptoms but is not sensitive enough to detect changes in individuals with mania. More psychometric evidence is therefore required before this instrument can be widely applied in economic evaluations of BD-related interventions. Finally, the CUA indicates that a novel structured psychoeducation intervention in individuals on remote mood monitoring in the UK is not cost-effective.

Esta dissertação analisa os impactos de fatores socioeconômicos e psicossociais sobre a prevalência da depressão no Brasil através de modelos probit e da decomposição de Oaxaca-Blinder aplicados às bases de dados dos suplementos de saúde da Pesquisa Nacional por Amostra de Domicílios (PNAD Saúde) e da Pesquisa Nacional de Saúde 2013 (PNS 2013). Neste trabalho, foram usados dois critérios básicos de identificação de indivíduos deprimidos: os que referiram ter recebido o diagnóstico de depressão de algum profissional de saúde e os que obtiveram um escore superior a 4 no teste PHQ-9 (cujas perguntas constam na PNS 2013). Foram obtidos resultados estatisticamente significativos, evidenciando a maior probabilidade da depressão entre mulheres e a relação inversa do transtorno com as variáveis renda domiciliar, desemprego, escolaridade e idade. Fatores como doenças físicas, doenças mentais e deficiências demonstraram uma relação direta com a depressão, embora as quantificações de suas magnitudes tenham sido sensíveis à especificação dos modelos. Também mostraram uma relação direta com o transtorno depressivo variáveis associadas a traumas e estresse emocional (como ter perdido um filho, ter sofrido algum tipo de violência, ter um filho com problemas de saúde, etc.). Outras variáveis como raça e região geográfica apresentaram resultados ambivalentes, também sensíveis às diferentes especificações de modelo. Ainda, variáveis referentes ao mercado de trabalho como o tipo de vínculo empregatício e setor de atividade apresentaram resultados inconclusivos. Por fim, outra conclusão importante foi que o critério de identificação dos indivíduos com depressão é determinante nos resultados. / This dissertation analyses the impacts of socioeconomic and psychosocial factors over the prevalence of depression in Brazil through probit models and the Oaxaca-Blinder decomposition applied to the data in Brazilian National Household Survey Health Supplement (PNAD Saúde) and the National Health Survey (PNS 2013). In this dissertation, two basic criteria were used to identify individuals with depression: those who declared to have received a depression diagnosis from a health professional and those who scored more than 4 in the PHQ-9 depression test (whose questions are included in PNS 2013). Statistically significant results were found, showing a higher probability of depression among women and an inverse relationship between the disorder and household income, unemployment, education and age. Factors such as chronic physical diseases, mental illnesses and deficiencies have showed a direct relationship with depression, although the quantification of such effects had a rather high sensitivity to model specification. Also, variables associated with emotional stress (such as having lost a child, being victim of some sort of violence, having a child with health problems) showed a direct relationship with depressive disorder. Other variables such as race and geographic region showed ambivalent results also very sensitive to different model specifications. Furthermore, labor market variables like type of work contract and activity sector show inconclusive results. Finally, another important finding is that the criteria for identifying individuals with depression were determinant for the results and conclusions.

This dissertation consists of three chapters that study social influence and the diffusion of information in decision making contexts with limited observable outcomes. Chapter 1 studies social interactions and female genital mutilation (FGM), a traditional procedure of removing the whole or part of the female genitalia for non-medical reasons. Using survey data from Egypt, this paper attempts to identify effects of peer adoption and medicalization on a household's decision to opt for FGM. We find that households are less likely to adopt if their peers adopt less and (in certain areas) if medicalization is more widely used by their peers. Chapter 2, using a lab experiment, studies how influence of any given agent in a social network is driven by assessments of their reliability by network members based on observations of their past behavior. Agents repeatedly make choices, the optimality of which depends on an unobserved state of the world; they are able to communicate those choices with their social peers; and earn a reward after the last period. We enrich the non-Bayesian DeGroot model by postulating that the extent to which network members are influenced by a peer member depends on the extent of nonconformity, variability and extremeness of their past choices. We find that inferred reliability has an effect as significant as network centrality on social influence; when weighting the views of their peers, individuals are sensitive to their observed behavior, especially for those peers with low centrality. Chapter 3 analyzes the effects of a large-scale randomized intervention which provided incentivized block grants with the aim of improving twelve health and education outcomes. Communities were incentivized by having grants sizes dependent on performance. Our goal is to refine an earlier intention-to-treat evaluation, by examining the intervention's heterogeneous effect on the different subpopulations of households defined by their participation in health information outreach. We find that incentivized grants have a strong effect on immunization rates of children from households participating in outreach activities: as high as a 14.3% increase for children aged six months or less, compared to a maximum average treatment effect of 3.7%.

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Submitted by CAROLINA RODRIGUES BORTOLATTO (ca.bortolatto@gmail.com) on 2018-09-12T13:11:43Z No. of bitstreams: 1 Dissertação.pdf: 4592627 bytes, checksum: 514785a828a15943e215023b83ab2f05 (MD5) / Approved for entry into archive by Claudia Adriana Spindola null (claudia@fct.unesp.br) on 2018-09-12T14:02:55Z (GMT) No. of bitstreams: 1 bortolatto_cr_me_prud.pdf: 4585620 bytes, checksum: 43b9db35d78b2abb801b7360dbf4f437 (MD5) / Made available in DSpace on 2018-09-12T14:02:55Z (GMT). No. of bitstreams: 1 bortolatto_cr_me_prud.pdf: 4585620 bytes, checksum: 43b9db35d78b2abb801b7360dbf4f437 (MD5) Previous issue date: 2018-07-06 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Hipertensão arterial (HA) é importante problema de saúde pública devido à sua cronicidade e aos altos custos com assistência a saúde. O aumento da prevalência de HA é atribuído principalmente à inatividade física e à obesidade. Dessa forma, o objetivo do presente artigo foi analisar o efeito isolado e combinado da inatividade física (IF) e obesidade abdominal (AO) sobre os custos com saúde em hipertensos na atenção primária ao longo de 24 meses de seguimento. Os custos com saúde foram avaliados através de prontuários médicos. HA, IF e OA foram verificados por meio de avaliações. Estatística descritiva foi expressa por valores de média, desvio padrão e intervalo de confiança de 95%, foi utilizada análise da covariância, com teste post hoc de Bonferroni, o tamanho do efeito foi expresso pelo eta-square (ES-r). O nível de significância foi definido em p-valor <0,05. No baseline, a amostra foi composta por 354 pacientes, com idade acima de 50 anos. Após 24 meses, a amostra acompanhada consistiu em 167 pacientes, composta por 51 homens e 116 mulheres, com média de idade de 61,6 anos, 63,5% (n=106) dos pacientes eram hipertensos e apresentaram custo total mediano de R$ 70,30. Quando comparada com o grupo perda amostral houve diferença significativa apenas no valor de pressão arterial sistólica com p = 0.023 e condição econômica p = 0.003. Identificou-se incidência e prevalência de HA, respectivamente, de 1,8% e 65,3% ao longo de 24 meses. Modificações no nível de inatividade física e obesidade abdominal não apresentaram variância significativa nos resultados. Quanto ao efeito combinado do nível de IF e OA sobre os custos em hipertensos, o grupo obeso e inativo apresentou custos estatisticamente maiores (pvalor=0,018) quando comparado ao grupo ativo com peso normal e ao grupo obeso e inativo. Resultados levam a acreditar que apenas o efeito combinado da IF e AO aumentam os custos com saúde em pacientes hipertensos e independente do efeito isolado ou combinado da OA e IF sobre a hipertensão, ocorre à influência de outros fatores (condição econômica, sexo, idade e comorbidades), verificada na ausência de diferença significativa após os ajustes. / Arterial hypertension (AH) is an important public health problem because of its chronicity and the high costs to health. The increase in the prevalence of AH is attributed mainly to physical inactivity (PI) and obesity. Thus, the objective of this study was to analyze the isolated and combined effect of PI and abdominal obesity (AO) on health costs among patients with AH in primary care during 24 months of follow-up. Health costs were assessed through medical records. AH, PI and AO were assessed through questionnaires and measurements. Descriptive statistics were expressed as mean, standard deviation, and 95% confidence intervals. Analysis of covariance with Bonferroni post hoc test were used and the size of the effect was expressed by eta-square (ES-r). The level of significance was set at p-value <0.05. At baseline the sample was composed of 354 patients (age > 50 years) and, after 24 months of follow-up, the sample consisted of 167 patients (51 men and 116 women, mean age of 61.6 years). 63.5% (n = 106) of the patients had AH and presented total median cost of R$ 70.30. When compared to the dropout sample, there were significant differences for systolic blood pressure (p = 0.023) and economic condition (p = 0.003). Incidence and prevalence of AH were respectively 1.8% and 65.3% at the end of follow-up period. Changes in PI and AO presented no significant variance in the results. Regarding the combined effect of PI and AO on costs, the group with PI and AO presented higher costs when compared to the AO or PI group and Active and no AO group (p = 0.018). These results suggest that only the combined effect of PI and AO increases health costs among patients with AH. / CNPq: 134243/2016-1

Introduction: Treatment of dental diseases makes up 4.6% of global health expenditure and dental caries is the most prevalent condition worldwide. In higher-income countries, population-wide prevention has brought prevalence down and it is now concentrated in 20% of the population. Currently the only single predictor of future caries is caries, meaning risk cannot be assessed before the disease is already present. Additionally, studies show different types of caries patients respond differently to prevention. As resources to provide dental services are limited, there is a need to understand what these different groups are and how we currently allocate resources to optimize prevention. It has been shown that the bacteria S. mutans is cariogenic and that there is a genetic component to caries risk. Methods: A prospective cohort study in Västerbotten County, Sweden identified genetic polymorphisms (i.e. mutations) which predispose to dental caries. This thesis calculated expenditure on caries prevention based on the dental records of this study and examined allocation between different risk groups according to observed risk, professionally estimated risk, genetic and bacterial risk (S. mutans). Results: Prevention costs are distributed rather equally regardless of professionally estimated, genetic or bacterial risk. Spending was overall low (median = 26 SEK). Discussion: Compared to other diseases, this annual expenditure is negligible. There is scope to increase this and focus it on highest-risk patients. For this, more research is needed to refine risk groups as well as the development of diagnostic tools to allow early detection and effective prevention.