The overall aim of this thesis was to describe subjects with chronic obstructive pulmonary disease (COPD) from different perspectives. Focus was on patients at the time of diagnosis, impact of the disease in comparison to other chronic diseases, factors associated with good health and quality of life (QoL), and diagnostic spirometry in clinical practice. Methods: Qualitative method, grounded theory, was used to analyse patients´ perspectives at the time of diagnosis in a primary care setting (n=10). Public health surveys in the general population were used to compare chronic diseases (n=10,755) and analyse factors associated with health outcomes in COPD (n=1,475). Medical records and spirometry reports, from primary and secondary care, were analysed to assess diagnosis of COPD in clinical practice (n=533). Results: In clinical practice, 70% of patients at the time of diagnosis of COPD lacked spirometry results confirming the diagnosis. Factors related to consequences of smoking, shame and restrictions in physical activity (PA) in particular, were described by patients at the time of diagnosis of COPD. In general subjects with COPD (84%), rheumatoid arthritis (74%) and diabetes mellitus (72%) had an activity level considered too low to maintain good health. In COPD, the most important factor associated with good health and quality of life was a high level of PA. Odds ratios (OR (95%CI)) varied from 1.90 (1.47-2.44) to 7.57 (4.57-12.55) depending on the degree of PA, where subjects with the highest PA level had the best health and QoL. Conclusions: Subjects with COPD need to be diagnosed at an early stage, and health professionals should be aware that feelings of shame could delay patients from seeking care and thus obtaining a diagnosis. The use of spirometry and the diagnostic quality should be emphasised. In patients with COPD greater attention should be directed on increasing the physical activity level, as patients with a low level of physical activity display worse health and quality of life.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Diabetes disproportionately affects minority populations. Social support, and more specifically marriage, has been found to buffer the negative effects of diabetes and depression. Data collected from African Americans with type 2 diabetes in Atlanta and NHANES data were compared to examine whether marriage affects health status and mental health. Approximately, 1742 African Americans aged 18-80 were included in this study. Chi square analysis revealed that married men had lower rates of depression (15.9% vs. 24.7%) compared to unmarried men (p < 0.05), but the same effect was not found in women. The findings show that marriage was not associated with HbA1c, but was associated with rates of depression. The lack of association of HbA1c with marriage may be because marriage may not be the best proxy of social support in the African American community. Future research should focus on alternative forms of social support such as cohabitation, extend family, and friend.

Disertantė: Rasa Savičiūtė Mokslinis vadovas: Prof. Habil. Dr. Algirdas Juozulynas (Vilniaus universitetas, biomedicinos mokslai, visuomenės sveikata – 09 B) Lietuvoje tik labai neseniai buvo pradėta analizuoti sveikatos santykis su sociologija, socialiniais santykiais ir pan. Pastaruoju metu visuomenės sveikatos tyrimai orientuojasi į tokias inovatyvias sritis kaip sveikatos kokybė, sveikatos paslaugų efektyvumas, veiklos solidarumas, integralumas, sveikatos politikos elementų diegimas visose socialinės ir ekonominės veiklos srityse. Visuomenės senėjimas, socialiniai, ekonominiai pokyčiai, rinkos elementų skverbimasis į sveikatos paslaugų sferą keičia visuomenės sveikatos būklės ir integralios aplinkos sąveikos pobūdį. Šios aplinkybės keičia ir sveikatos politikos veiksmingumo prielaidas. Jos turi remtis mokslinių tyrimų informacija. Deja, Lietuvoje nėra daug atlikta panašios krypties mokslinių tyrimų. Šiuo tyrimu mes siekiame sistematiškai ištirti ir įvertinti svarbiausių sveikatos ir socialinių veiksnių bei jų tarpusavio sąveikų poveikio visuomenės sveikatos būklei skirtumus ir tuo pagrindu besiformuojančias sveikatos socialines struktūras. Tyrimo metu analizuota subjektyviai vertinama sveikatos būklė, sergamumas, vyraujančios sveikatos problemos ir psichikos sveikatos būklės. Visa tai buvo nagrinėta skirtingose socialinių veiksnių, bei jų integralios tarpusavio sąveikos įtakos srityse. / Author: Rasa Savičiūtė Scientific supervisors: Prof. habil. dr. Algirdas Juozulynas (Vilnius University, biomedical sciences, public health – 09B) In fact, the relationship of health and sociology, social relations, etc., has been started to be analyzed recently in Lithuania. Recently, public health research is focused on innovative fields as health quality, efficiency of health services, solidarity and integrity of activity, introduction of health policy elements in all fields of social and economic activity. Aging society, social, economic changes, penetration of market elements in the sphere of health services change the nature of interaction between public health condition and integral environment that influences it. These circumstances also alter the assumptions of health policy effectiveness. The latter must be based on information of scientific research. Unfortunately, there has been carried out small number of research of similar direction in Lithuania. Hereby, we seek to explore systematically and assess the differences of the main health and social factors, and the impact of their interactions on public health condition and the emerging social structures of health. The research analyzed the subjectively assessed health condition, morbidity, prevailing health problems and mental health conditions. These aspects were examined in different fields of influence of social factors as well as in their integral interaction.

In fact, the relationship of health and sociology, social relations, etc., has been started to be analyzed recently in Lithuania. Recently, public health research is focused on innovative fields as health quality, efficiency of health services, solidarity and integrity of activity, introduction of health policy elements in all fields of social and economic activity. Aging society, social, economic changes, penetration of market elements in the sphere of health services change the nature of interaction between public health condition and integral environment that influences it. These circumstances also alter the assumptions of health policy effectiveness. The latter must be based on information of scientific research. Unfortunately, there has been carried out small number of research of similar direction in Lithuania. Hereby, we seek to explore systematically and assess the differences of the main health and social factors, and the impact of their interactions on public health condition and the emerging social structures of health. The research analyzed the subjectively assessed health condition, morbidity, prevailing health problems and mental health conditions. These aspects were examined in different fields of influence of social factors as well as in their integral interaction. / Lietuvoje tik labai neseniai buvo pradėta analizuoti sveikatos santykis su sociologija, socialiniais santykiais ir pan. Pastaruoju metu visuomenės sveikatos tyrimai orientuojasi į tokias inovatyvias sritis kaip sveikatos kokybė, sveikatos paslaugų efektyvumas, veiklos solidarumas, integralumas, sveikatos politikos elementų diegimas visose socialinės ir ekonominės veiklos srityse. Visuomenės senėjimas, socialiniai, ekonominiai pokyčiai, rinkos elementų skverbimasis į sveikatos paslaugų sferą keičia visuomenės sveikatos būklės ir integralios aplinkos sąveikos pobūdį. Šios aplinkybės keičia ir sveikatos politikos veiksmingumo prielaidas. Jos turi remtis mokslinių tyrimų informacija. Deja, Lietuvoje nėra daug atlikta panašios krypties mokslinių tyrimų. Šiuo tyrimu mes siekiame sistematiškai ištirti ir įvertinti svarbiausių sveikatos ir socialinių veiksnių bei jų tarpusavio sąveikų poveikio visuomenės sveikatos būklei skirtumus ir tuo pagrindu besiformuojančias sveikatos socialines struktūras. Tyrimo metu analizuota subjektyviai vertinama sveikatos būklė, sergamumas, vyraujančios sveikatos problemos ir psichikos sveikatos būklės. Visa tai buvo nagrinėta skirtingose socialinių veiksnių, bei jų integralios tarpusavio sąveikos įtakos srityse.

Societies that foster high quality social environments and integration produce healthier populations. The mechanisms underlying the protective effect of social integration appear to be through various forms of social support. In the Canadian Aboriginal context, few authors have explored the relationship between health and social support. This gap in understanding is significant because Aboriginal frameworks of health point to the salience of larger social structures (i.e., family), yet patterns of population health point to distinctly social causes of morbidity and mortality (e.g., violence, alcoholism). An interesting paradox emerges: patterns of Aboriginal health suggest that social support is not working to promote health. This dissertation explores this paradox through a mixed-methods approach to describe the value of social support for Aboriginal health, and to critically examine the social-structural processes and mechanisms through which social support influences Aboriginal health at the community level. / Principal components analyses of the 2001 Aboriginal Peoples Survey (APS) identified social support as a consistent dimension of Metis and Inuit health, and multivariable logistic regression modelling of the 2001 APS identified social support to be a significant determinant of thriving health among Indigenous men and women (e.g., those reporting their health as excellent/very good versus good/fair/poor). The results also indicate a distinct social gradient in thriving health status and social support among Aboriginal Canadians. / Narrative analyses of 26 interviews with Aboriginal Community Health Representatives point to two key explanations for the health-support paradox: (i) social support is not a widely accessible resource; and (ii) the negative health effects of social support can outweigh the positive ones. The formation of health behaviours and cultural norms - which underpin social supports - are inextricably tied to the poor material circumstances that characterize Canada's Aboriginal communities. The thesis concludes with a critical examination of the processes through which environmental dispossession has influenced the determinants of Aboriginal health, broadly speaking. Effects are most acute within the material and social environments of Aboriginal communities. More research attention should focus on identifying the pathways through which the physical, material and social environments interact to influence the health of Aboriginal Canadians.

The physical, psychological and social development of school children has been neglected - partly because they were seen as healthy "survivors" of the ravages of childhood illnesses, and partly because of the way in which health services are organized (such as the traditional under-five maternal and child health (MCH) services and the curative PHC clinic services). From the age of five years children undergo rapid and profound bio-psycho-social development, to emerge in adolescence as the next generation of leaders and workers. Securing their future growth and development is vital for any society to be economically and socially productive. A substantial body of national and intemational literature has recognised the detrimental impact of helminthic infections and micronutrient deficiencies on the physical and psychological health and development of school children; which requires appropriate nutritional interventions. Concern has been expressed that these adverse biological, physical and social deprivations have a cumulative impact on several dimensions of children's growth. Most important, apart from stunting physical growth, is the inhibition of educational development of school children. Recent evidence strongly suggests a powerful interaction between physical and psychosocial growth and development of children. Inhibition of either component of a child's well-being has adverse implications. Conversely, investments in the physical and psychological development of children are likely to generate substantial health and educational benefits and are a worthy investment to secure a healthy future generation. In summary, there are a number of reasons for, and benefits of, investing in school-based health and nutrition interventions. They are likely to improve learning at school and enhance educational outcomes; create new opportunities to meet unfulfilled needs; redress inequity; build on investments in early child development and promote and protect youth and adolescent development. Health and nutrition interventions such as school feeding programmes, micronutrient supplementation and deworming aim to improve primary outcomes of macro and micro-nutrient deficiencies, parasitic and cognitive status; as well as secondary outcomes of developing integrated comprehensive school health policies and programmes. This rationale served as the conceptual framework for this study. This theoretical framework views improvements of the health, nutritional, cognitive and scholastic development status of school children as the primary focus of policies, strategies and programmes in the health and education sector. This focus constitutes the central core of this thesis. Optimum social development requires investments in both the health and educational development of school children, so as to maximise the synergies inherent in each sector and to operationalise national and international strategies and programmes. As part of the larger RCT study a comprehensive nutritional, health and psychological profile of rural school children was established through a community-based cross-sectional study. Eleven schools were randomly selected from the Vulamehlo Magisterial District in southern KwaZulu-Natal (KZN). Within each school, all Standard 1 pupils, aged between 8 - 10 years, were selected giving a final study sample of 579 children. Some of the observed prevalence's were stunting (7.3%), wasting (0.7%), anaemia (16.5%) (as measured by haemoglobin below 12 g/dl), vitamin A deficiency (34.7%) (as measured by serum retinol below 20 ug/dl) and serum ferritin below 12ng/ml (28.1%). This study established that micronutrient deficiency, parasitic infestations and stunting remain significant public health problems among school-aged children in South Africa. Combining micronutrient supplementation and deworming are likely to produce significant health and educational gains. To determine the impact of single and combined interventions (anthelminthic treatment and micronutrient supplements) on nutritional status and scholastic and cognitive performance of school children, a double-blind randomised placebo controlled trial was undertaken among 579 children 8-10 years of age. There was a significant treatment effect of vitamin A on serum retinol (P<0.01), and the suggestion of an additive effect between vitamin A fortification and deworming. Vitamin A and iron fortification also produced a significant treatment effect on transferrin saturation (P<0.05). Among the dewormed group, anthelminthic treatment produced a significant decrease in the prevalence of helminthic infections (P<0.02), but with no significant between-group treatment effect (P>0.40). Scholastic and cognitive scores and anthropometric indicators were no different among the treated or the untreated children. Fortified biscuits improved micronutrient status among rural primary school children; vitamin A combined with deworming had a greater impact on micronutrient status than vitamin A fortification on its own; while anthelminthic treatment produced a significant reduction in the overall prevalence of parasite infection. The prevalence's of Ascaris lumbricoides, Trichuris trichiura and Schistosoma haematobium declined significantly sixteen weeks post-treatment. The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were 94.4% for Ascaris lumbricoides, 40% for Trichuris trichiura, and 72.2% for Schistosoma haematobium. The benefits of targeted school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes were found to be consistent with the recommendations of WHO and UNICEF. The nutritional transition facing developing and middle-income countries also has important implications for preventive strategies to control chronic degenerative diseases (Popkin B, 1994; WHO 1998; Monyeki KO, 1999). This descriptive study, comparing BMI data of school children over three time periods, found a rising prevalence of overweight and obesity among South African school children. Obesity as a public health problem requires to be addressed from a population or community perspective for its prevention and management. Environmental risk factors such as exposure to atmospheric pollution remain significant hazards for children. Lead poisoning is a significant, preventable risk factor affecting cognitive and scholastic development among children. The prevalence of elevated blood lead (PbB) levels in rural and semi-urban areas of KwaZulu-Natal (KZN) as well as the risk factors for elevation of PbB among children in informal settlements were examined. This study investigated over 1200 rural and urban children in two age groups: 3-5 and 8-10 years old. Average PbB level in peri-urban Besters, an informal settlement in the Durban metropolitan region, was 10 ug/dl with 5% of the children showing PbB level of greater than 25 ug/dl. By comparison, average PbB value in Vulamehlo, a rural area located 90-120 km from Durban, was 3.8 ug/dl and 2% of the children's PbB levels were greater than 10 ug/dl. Since the cognitive and scholastic performance of school children was a primary outcome measure in this study, it was important to explore other factors that influenced this variable. The performance scores of all four tests in the battery, among the cohort of a thousand rural and urban children, were in the lower range. The educational deficit identified in this test battery clearly indicates the impact of the inferior "Bantu" educational system that African children have experienced in South Africa. Aspects of the School Health Services that were investigated in this descriptive study included the services provided and their distribution; assessment of health inspection; health education and referral processes undertaken by the School Health Teams; perceptions of managers, providers and recipients of the service; as well as the costs of the provision of the service in KwaZulu-Natal. In KwaZulu-Natal, there were School Health Teams In all the 8 health and education regions in the province. In total, there were 95 teams in the province, consisting of nearly 300 staff members. The School Health Teams were involved in a wide range of activities - 74% of all teams were involved in health inspection and 80% were involved in health education. The total annual cost of delivering School Health Services in the province in 1995 was estimated to be approximately R8 750 000. Given the rise of HIV and AIDS in the province, School Health Services need to play a central role not only in prevention, but also in assisting with the acceptance of HIV-positive children within schools. It is recommended that the current and future draft SHS policy guidelines be approved by the relevant authorities for immediate implementation. Districts should consider developing "Health Promoting Schools", with School Health Teams being a central resource. This thesis has explored several aspects of the epidemiological profile of school children in rural and urban settings in KwaZulu-Natal. It has established that school children are exposed to a range of risk factors ranging from nutritional deficits, parasitic infections, atmospheric lead poisoning and a rising prevalence of overweight. All of these risk factors may compromise their physical, psychological and social development. A number of health interventions have been identified, which have the potential to address these problems. Such investments are essential to secure the health of future generations. / Thesis (M.D.)-University of Natal, Durban, 2001.

Il benessere degli animali è uno dei temi più discussi temi delle scienze animali. Molti ricercatori hanno provato a darne una definizione e a sviluppare strumenti utili alla sua valutazione negli allevamenti di vacche da latte. Nel presente lavoro viene discussa la possibilità di valutare il benessere degli animali, attraverso sistemi di innovazione da diversi punti di vista: scientifico, economico e zootecnico. Quattro differenti ricerche sono state sviluppate per confrontare i risultati sulla valutazione del benessere degli animali negli allevamenti da latte ottenuti con: indici fisiologici, modello SDIB e un sistema di monitoraggio della ruminazione. / Animal welfare is one of the most discussed topic in the animal science. Many researchers have been proving to define animal welfare and to develop tools useful to assess its levels in dairy farms. In the present issue it is discussed with different point of view (scientific, economical and zootechnic) the opportunity to assess the animal welfare through innovations system. Our different research was develop to compare the results about animal welfare in dairy herds obtained by physiological indices as well as blood variables, a model for animal welfare assessment as well as IDSW model, a rumination monitoring system.

Bibliography: leaves 203-219. / 219 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000