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<p>Human atherosclerosis is a disease of the blood vessel wall caused by an interplay between inflammatory, thrombotic, and lipid factors. A contributing or causal role for infection in that inflammatory response was first proposed in the 19th century, and with the advent of more sophisticated diagnostic techniques, a new search for a microbiologic etiology of human atherosclerosis has been rekindled. In this thesis, I examine methods for investigating whether infections contribute to human atherosclerotic cardiovascular disease. I explore three different technologies: serology (measuring antibody), inflammatory markers (as risk markers and as surrogates for infections), and the direct measurement of bacterial or viral DNA in the bloodstream. I examine three different study designs: cross-sectional, case-control, and cohort. Chlamydia pneumoniae , an obligate intracellular bacterium, is the primary focus of these studies. In addition, cytomegalovirus and other infections are included as controls, with the a priori expectation that these other infections would not be related to cardiovascular disease. We found a relationship between cardiovascular disease and C. pneumoniae antibody status in a small case-control study, but found no independent association in a large, prospective study. Inflammatory markers were measured in the prospective study, and were associated with cardiovascular events, yet no clear association between inflammation and infection was found. However, in developing methods for directly detecting bacterial and viral DNA in the bloodstream, we found that serology itself was not associated with current detection of bacterial DNA. Furthermore, we found a strong relationship between C. pneumoniae and smoking, and conclude that future studies need to examine the interaction between infection, inflammation, and smoking status.</p> / Doctor of Philosophy (PhD)

abstract: This dissertation describes a qualitative research study that was conducted in order to deconstruct the notion of trauma using a resiliency framework in one Pueblo Indian community in New Mexico. Trauma is widely discussed in relation to mental health issues impacting Indigenous peoples worldwide, as demonstrated in my review of the literature and throughout this work. Yet, the result of most research tends towards pointing out deficiencies in Indigenous communities. Rarely, if ever, is trauma explored through a strengths-based and resiliency approach. This study represents the first attempt to do so in and with a Pueblo Indian community. As a Pueblo researcher working with my own community of Kewa, my goal was to go back to the very people consistently being studied, that is, the Indigenous community, and to re-examine what is trauma, including its definitions and with a focus on local culturally-based interventions. This work is broken down into three components that are woven together through the common theme of understanding, deconstructing, and addressing trauma: a journal article, book chapter and policy brief. The journal article is titled: “Walking the Path: A Pueblo Journey through Trauma and Healing.” The journal article begins by reviewing concepts on trauma and resilience documented in a literature. I both review the literature and offer critiques from the perspective of a Pueblo Indian researcher working in the field of health. This segues into my dissertation study. A series of eight qualitative, semi-structured interviews were conducted using an interview guide with open-ended questions. I found that participants reported ample evidence of both trauma and resilience, documenting the need for further research in this area and, most importantly, a values-based intervention. Critical in my research findings is that participants revealed the types of trauma relevent to Pueblo people, which points to our understanding of local issues that may also resonate with the experiences of other Indigenous peoples but that are intended to speak to Pueblo communities. Through my research, I consistently assert that understanding trauma also includes the need to document how Pueblo people have coped and overcome their trauma. These forms of resilience were also documented in the findings. The book chapter is titled, “Using Pueblo Values to Heal from Trauma.” This section of the dissertation details Pueblo values and the implications on trauma. Pueblo values are described in detail based on my research and explicated in relation to theory that I propose. In this book chapter, I argue that these Pueblo values play an integral role in how we cope and heal from trauma. To summarize what participants explained, the idea is proposed that following these values will lead you to “the right path.” Suggestions for an ideal intervention based on participant interviews include the development of a values-based curriculum whose success is contingent on following Pueblo values that teaches values as defined by the Pueblo community. My dissertation concludes with a policy section that focuses on “Finding the Path when you have Fallen Off.” This section talks about “cultural freezing” and the need to integrate positive cultural identity in youth, who are especially vulnerable in Indigenous communities, through the development of a values-based curriculum. The policy section will focus on the implications of trauma concepts defined for Native People that have demonstrated the need to process trauma. In order to process trauma, culturally-relevant frameworks and curricula such as “Transcending the Trauma” or “Gathering of Native Americans” (GONA) have been developed to help guide communities to begin the conversation around trauma. These discussions help to raise awareness around trauma and help people begin their healing journey. However, these developed concepts, frameworks and curricula have only started the journey and now there is a significant need for interventions to sustain recovery from trauma. These interventions also must include levels of individual and community readiness to address trauma and align with the values of the community and individual. It is a step we need to take to decolonize education and unfreeze culture / Dissertation/Thesis / Doctoral Dissertation Justice Studies 2018

M.A. (Psychology) / Please refer to full text to view abstract

M.A. / Over the years it has become clear that divorce is an increasingly common occurrence. As a legal process, divorce sanctions the dissolution of a marriage but it does not necessarily dissolve the connections that developed between the individuals during a marriage. This is particularly the case when children are involved. Parents might choose to relinquish their connection to each other as husband and wife but they cannot relinquish the connection to their children as mother and father. This study was designed to explore the way in which the effects of parental divorce surface during the developmental period of young adulthood. The aim of the study was to offer some insight into the long-term effects of parental divorce and to add to the knowledge and understanding of this complex phenomenon. The design of the study was qualitative and data was collected through in-depth unstructured interviews with three young adults who have experienced parental divorce. The interviews with each of the participants were conducted as part of a therapeutic process. An intra-individual analysis of the information offered by each participant rendered an understanding of their phenomenological experience of parental divorce while an inter-individual analysis of their accounts permitted a discussion of common and contrasting themes and patterns. The literature reviews on the effects of parental divorce and the findings of this study, have formed the basis for a proposed a theoretical framework which will enhance the understanding of the phenomenological experience of parental divorce. It is hoped that the information gained will serve as guidelines for those working with individuals who have experienced parental divorce. Key Words: Parental divorce, young adult, identity, relationship, holism, system, cybernetics, constructivism, phenomenological, qualitative investigation, process.

Nurses as professionals and front-liners in patient care should possess good knowledge about health research, as this is critical in improving patient outcomes. The purpose of this study was to determine the level of knowledge and attitudes that public health clinic nurses possess regarding health research in Botswana in order to make recommendations to enhance a research culture among nurses. A quantitative study with a cross-sectional study design was used. Twenty-six clinics in Gaborone were sampled and 168 nurses participated in the survey. Data was analysed using Stata version 15.1. Only 51% of the nurses demonstrated satisfactory knowledge of health research. Despite this limited knowledge, nurses had a good attitude towards health research (66%). Degree nurses were more likely to have satisfactory knowledge, as were those who reported research training and experience. Additionally, research training and experience were associated with a good attitude. Recommendations include provision of research training and practicums as part of the nursing education curriculum, as well as in-service training, in order to improve the levels of knowledge of health research among nurses. / Health Studies / M. P. H.

This thesis explores the transformations of evidence in health research synthesis studies – studies that bring together evidence from a number of research reports on the same/ similar topic. It argues that health research synthesis is a broad and intriguing field in a state of pre-formation, in spite of the fact that it may appear well established if equated with its exemplar method – the systematic review inclusive of meta-analysis. Transformations of evidence are processes by which pieces of evidence are modified from what they are in the primary study report into what is needed in the synthesis study while, supposedly, having their integrity fully preserved. Such processes have received no focused attention in the literature. Yet they are key to the validity and reliability of synthesis studies. This work begins to describe them and explore their frequency, scope and drivers. A ‘meta-scientific’ perspective is taken, where ‘meta-scientific’ is understood to include primarily ideas from the philosophy of science and methodological texts in health research, and, to a lesser extent, social studies of science and psychology of science thinking. A range of meta-scientific ideas on evidence and factors that shape it guide the analysis of processes of “data extraction” and “coding” during which much evidence is transformed. The core of the analysis involves the application of an extensive Analysis Framework to 17 highly heterogeneous research papers on cancer. Five non-standard ‘injunctions’ complement the Analysis Framework – for comprehensiveness, extensive multiple coding, extreme transparency, combination of critical appraisal and critique, and for first coding as close as possible to the original and then extending towards larger transformations. Findings suggest even lower credibility of the current overall model of health research synthesis than initially expected. Implications are discussed and a radical vision for the future proposed.

No Brasil, desde a constituição do SUS, a Promoção da Saúde encontra-se dentre suas tarefas, compondo a linha de cuidado integral dos sujeitos. No entanto, ainda há o despreparo dos profissionais para captar e trabalhar com as dimensões subjetivas. Dessa forma, surge a necessidade de instrumentos que permitam indicar as ações de promoção da saúde para a prática de uma clínica com olhar mais ampliado. Neste trabalho optou-se como base teórica a perspectiva de Promoção da Saúde de Labonte, pois articula a abordagem biomédica e comportamental das ações em saúde e agrega à perspectiva sócio-ambiental e emocional intrínseca ao processo saúde doença. Teve como objetivo verificar e descrever os limites e possibilidades do WHOQOL-bref para identificar as dimensões de saúde e bem estar proposta por Labonte. Como metodologia, utilizou-se a técnica Delphi, que consiste em consultar um grupo de especialistas em determinado assunto, por meio de um questionário repassado entre todos os respondentes. Para selecionar os especialistas foram consultados os bancos on-line de teses e dissertações da USP e Unicamp, sendo procurados trabalhos com o descritor WHOQOL e promoção da saúde, dos últimos três anos. A partir da leitura do resumo destes trabalhos foram escolhidos os especialistas cujas temáticas tivessem uma proximidade com o foco deste estudo. Portanto, para o tema promoção da saúde foram escolhidos 14 pesquisadores e para o tema qualidade de vida foram 18. Aceitaram participar da pesquisa 7 pesquisadores da área de qualidade de vida e 9 da área de promoção da saúde. Para cada questão do WHOQOL-bref, excluindo-se a primeira e a segunda, foi perguntado se as mesmas relacionavam-se com um ou mais dimensões de saúde e bem estar de Labonte: Energia Vital, Projeto de Vida e Vida Comunitária. Cada participante recebeu um e-mail que continha uma carta explicitando sobre a pesquisa bem como as dimensões de Labonte para uma possível associação com as questões que se encontravam no site http://qlqt.ipdsc.com.br, como pesquisa Delphi. Após a coleta dos dados, para cada questão do WHOQOL-bref foi aplicado o índice de equivalência em cada dimensão de Labonte. Considerou-se consenso, a dimensão que obteve equivalência maior ou igual a 80% na questão, em ambos os grupos pesquisados. Foram trabalhadas em nova rodada as questões cujas equivalências estivessem entre 25% e 80%, nos dois grupos pesquisados. Portanto, foram necessárias duas rodadas de perguntas para que se chegasse ao resultado. O instrumento WHOQOL-bref demonstrou-se como uma opção de ferramenta auxiliar para captação das dimensões de Promoção da Saúde, pois 83,3% das questões deste teve relação com as dimensões de Saúde e Bem Estar de Labonte. Demostrou-se maior relação com os domínios Energia Vital e Vida Comunitária (42,10% ambos) e menor relação com o domínio Projeto de Vida (15,8%). Evidenciou-se a necessidade de mais estudos que aprimorem o uso do mesmo na prática clínica, contemplando a ampliação da visão do profissional de saúde para questões referentes à Promoção da Saúde. / In Brazil, since the inception of the Brazilian National Health Care System (SUS), Health Promotion has been a priority among its tasks, composing a line of integrated care for individuals. However, there is still the lack of training for professionals to capture and work with the subjective dimensions. Thus, the need arises for instruments to indicate the actions of health promotion in clinical practice with a broader vision. This work was chosen as the theoretical basis of the perspective of Health Promotion of Labonte, articulates the approach for biomedical and behavioral health interventions and adds that environmental and socio-emotional, is intrinsic to the disease process. This study aimed to verify and describe the limits and possibilities of the WHOQOL-bref \"to identify the dimensions of\" health and wellness \"proposed by Labonte. For methodology, the Delphi technique was used, and consisted of consulting a group of subject matter experts through a questionnaire passed among all respondents. On-line banks of theses and dissertations from USP and Unicamp, were consulted to select the experts and to seek works with the descriptor \"WHOQOL\"and \"health promotion\", during the last three years. After reading the summary of these works, experts were chosen whose themes had a closeness with the focus of this study. Fourteen researchers were chosen for the theme \"health promotion\" and eighteen researchers were chosen for the theme \"quality of life\". Seven researchers agreed to participate in the survey in the area of \"quality of life\" and nine in the area of \"health promotion\". For each question of the WHOQOL-bref, excluding the first and second questions, the researchers were asked whether they were related to one or more areas of \"health and welfare\" of Labonte: \"Vital Energy\", \"Project Life and Community Life\". Each participant received an e-mail that contained a letter explaining the survey and the areas of Labonte, for any possible association with the issues that were on site http://qlqt.ipdsc.com.br as the Delphi survey. After collecting the data for each question of the WHOQOL-bref an equivalency index was applied to each area of Labonte. A consensus was considered when an area obtained an equivalency higher than 80% in a question in both research groups. A new round of questions was worked in areas that were higher than 25% and less than 80% in both research groups. Therefore, it took two rounds of questions to achieve the result. The instrument WHOQOL-bref was perceived as an auxiliary tool of choice for capturing the dimensions of health promotion, for 83.3% of the questions that had to do with the dimensions of Health and Welfare of Labonte. It also had a higher relation in the areas of Vital Energy and Community Life (42.10% both) and lower relation in the area Life Project (15.8%). This study demonstrated the need for more studies to prove and improve the relationship of the instrument within the areas of health and well being of Labonte as well as its use in clinical practice contemplating broadening the vision of the health professional for issues related to the Promotion of Health.

Introdução: Dentre as várias áreas, abordagens e temas que compõem a Saúde Pública, a Promoção da Saúde constitui-se como um dos mais estabelecidos o que indica a pertinência de reflexão sobre sua produção. E dentre as linhas de pesquisa na área de Promoção da Saúde, nos últimos anos, tem se destacado o tema de Determinantes Sociais de Saúde, essa preocupação expressa por essa linha de pesquisa e atuação sobre os Determinantes Sociais de Saúde (DSS) assim como as propostas de promoção da saúde remetem necessariamente à reflexão sobre a dinâmica social visto que estão voltadas para a transformação das condições de vida. Objetivo: Esse estudo teve por objetivo identificar a produção da pesquisa em DSS na Faculdade de Saúde Pública da Universidade de São Paulo, no período de 2004 a 2008, e apontar as áreas de interesse e tendências desse campo de estudo. Metodologia: A metodologia consistiu em uma revisão bibliográfica de estudos sobre DSS, realizada a partir de um levantamento de dados baseado na consulta às seguintes bases de dados: BVS (Biblioteca Virtual em Saúde), SciELO (Scientific Electronic Library Online) e banco de tese da Capes. Os indexadores para a pesquisa foram selecionados segundo os Descritores em Ciência da Saúde (DeCS). Resultados: Dentre os diversos determinantes sociais de saúde encontrados durante a coleta de dados, os mais citados foram: inclusão social, segurança, justiça social, transporte, qualidade de vida, modelos de atenção à saúde, educação, lazer, ambiente de trabalho, equidade, distribuição de renda, recursos sustentáveis, ecossistema saudável, stress e saneamento. Deu-se preferência pelos resultados que se referiram diretamente ao tema da pesquisa sobre Determinantes Sociais de Saúde, resultados esses que foram classificados por ano, tipo de publicação: teses, dissertações, artigos de periódicos e por classificação de determinantes sociais de saúde. Conclusão: Verificou-se que a produção cientifica com Determinantes Sociais de Saúde na Faculdade de Saúde Pública USP tem crescido continuamente nesses últimos anos e que a maioria dos trabalhos está voltada para o estudo sobre as iniquidades em saúde seguido, de estudos sobre o empoderamento e a qualidade de vida / Introduction: Among the various areas, approaches and themes that compose the Public Health, Health Promotion was established as one of the most established which indicates the relevance of reflection on their production. And among the lines of research in the area of Health Promotion, in recent years has highlighted the topic of Social Determinants of Health, this concern expressed by this line of research and action on the Social Determinants of Health (SDH) as well as proposals for health promotion necessarily refer to a reflection on the social dynamics as they are geared towards the transformation of living conditions. Objective: This study aimed to identify the production of research in SDH at the School of Public Health, University of São Paulo in the period 2004 to 2008, and point out areas of interest and trends of this field of study. Methodology: The methodology involved a literature review of studies in SDH. Data collection was based on consultation with the following databases: BVS (Virtual Library in Health), SciELO (Scientific Electronic Library Online) and CAPES thesis database. The indices for the study were selected according to the Health Sciences Descriptors (DeCS). Results: Among the many social determinants of health found during the data collection, the most cited were: social inclusion, security, social justice, transportation, quality of life, models of health care, education, leisure, work environment, fairness and distribution in income, resources sustainable, healthy ecosystem, stress and sanitation. It was given preference for results that are reported directly to the research theme on Social Determinants of Health, these results were sorted by year, type of publication: theses, dissertations, journal articles and for classification of social determinants of health. Conclusion: It was found that the scientific production with the Social Determinants of Health in the School of Public Health - USP has grown steadily in recent years and that most work is directed toward the study of inequities in health, followed by studies on the empowerment and quality of life

The epidemic of maternal obesity is increasing worldwide. Simple, effective and acceptable interventions are needed to combat obesity and improve pregnancy outcomes in women with metabolic risk factors such as dyslipidaemia and obesity. Dietary and lifestyle interventions reduce gestational weight gain, however, their effect on maternal and fetal outcomes is not clearly known. I conducted a large pragmatic randomised trial to evaluate the effectiveness of a Mediterranean-based dietary intervention to reduce the risk of adverse maternal and fetal outcomes in pregnant women with metabolic risk factors (The ESTEEM trial). The intervention significantly reduced gestational diabetes and gestational weight gain by an average of 1.2 Kg with some protective effect on fetal outcomes. I analysed the methodological challenges encountered in the trial and discussed applied solutions. I conducted a systematic review on the commonly used dietary assessment tools in trials involving pregnant women to assess their characteristics, validity, and applicability. Self-reporting dietary tools were the most commonly used to assess dietary intake in pregnancy such as food frequency questionnaires. Only 8% of studies validated the chosen tools and applied a defined adherence criterion. I applied the findings of this review to develop and validate a custom designed food frequency questionnaire, and a short 12 items questionnaire, to assess the participants' adherence in the ESTEEM study. I assessed the dietary intake in a randomised cohort from the ESTEEM study and compared the questionnaires' accuracy to 24 hour dietary recalls as the reference method. Both the FFQ and the short questionnaire performed well for assessing the adherence to and the intake of key foods in the Mediterranean diet. I systematically reviewed available online information sources on the risks and management of obesity in pregnancy in the English language. I assessed 53 websites for their information credibility, accuracy, readability, content and technological quality. Overall I found that non-governmental funded websites that are obesity-specific and targeting healthcare users presented better overall information quality.