Age-related bone fractures are usually painful and have highly negative effects on a geriatric patient's functional status, quality of life, and survival. Currently, there are few analgesic therapies that fully control bone fracture pain in the elderly without significant unwanted side effects. However, another way of controlling age-related fracture pain would be to preemptively administer an osteo-anabolic agent to geriatric patients with high risk of fracture, so as to build new cortical bone and prevent the fracture from occurring. A major question, however, is whether an osteo-anabolic agent can stimulate the proliferation of osteogenic cells and build significant amounts of new cortical bone in light of the decreased number and responsiveness of osteogenic cells in aging bone. To explore this question, geriatric and young mice, 20 and 4 months old, respectively, received either vehicle or a monoclonal antibody that sequesters sclerostin (anti-sclerostin) for 28 days. From days 21 to 28, animals also received sustained administration of the thymidine analog, bromodeoxyuridine (BrdU), which labels the DNA of dividing cells. Animals were then euthanized at day 28 and the femurs were examined for cortical bone formation, bone mineral density, and newly borne BrdU+ cells in the periosteum which is a tissue that is pivotally involved in the formation of new cortical bone. In both the geriatric and young mice, anti-sclerostin induced a significant increase in the thickness of the cortical bone, bone mineral density, and the proliferation of newly borne BrdU+ cells in the periosteum. These results suggest that even in geriatric animals, anti-sclerostin therapy can build new cortical bone and increase the proliferation of osteogenic cells and thus reduce the likelihood of painful age-related bone fractures.

For an equity-linked insurance, the death benefit is linked to the performance of the company’s investment portfolio. Hence, both mortality risk and equity return shall be considered for pricing such insurance. Several studies have found some dependence between mortality improvement and economy growth. In this thesis, we showed that American mortality rate and Dow Jones Industrial Average (DJIA) index price are negatively dependent by using several copulas to define the joint distribution. Then, we used these copulas to forecast mortality rates and index prices, and calculated the payoffs of a 10-year term equity-linked insurance. We showed that the predicted insurance payoffs will be smaller if dependence between mortality and index price is taken into account. / October 2016

Worldwide, more than 1 million infants die as a result of premature birth. In the United States, where 1 in 10 births occurs preterm, premature birth is the leading cause of infant mortality. Premature infants have high rates of mortality and morbidity, with the highest rates seen in those infants born extremely preterm -- prior to 30 weeks gestation. Severe morbidity in these infants often contributes to life-long health problems. Maternal hypertension (HTN) is one contributor to preterm birth and also contributes to fetal growth restriction, resulting in birth weights which are small for gestational age (SGA, and generally within the lowest 10th percentile). Within this high risk population, SGA infants have increased risk of mortality compared to appropriate for gestational age infants. Therefore the impact of maternal HTN on neonatal outcome might be presumed to be negative. Previous studies however, have been contradictory, with both higher and lower rates of infant mortality reported in infants born to mothers with HTN, as well as differing reports analyzing the relationship between serious morbidity and maternal HTN. Utilizing the Vermont Oxford Network Very Low Birth Weight database, a collaborative database of Level III Neonatal Intensive Care Units across the world, 88,275 North American infants born between 22+0 and 29+6 weeks gestational age between 2008 and 2011 were identified. This dissertation explores the relationship between maternal HTN and gestational age at time of birth within this population, and the reported rates of morbidity and mortality in infants born prior to 30 weeks gestation. The independent contributions of maternal HTN with neonatal morbidity and mortality in our population were estimated using logistic regression and adjusting for factors previously known to be associated with risk, including birth weight, antenatal steroid exposure, infant sex, maternal race/ethnicity, prenatal care, inborn/outborn status, and birth year. We hypothesized that mortality rates would be lower for infants born to mothers with HTN compared to those born due to other factors, when corrected for the noted confounding variables and surviving infants would have better prognoses, as evidenced by lower rates of severe morbidity, including bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and infection. Within the higher-risk SGA population, we hypothesized that mortality rates would be higher than observed in appropriately grown infants, but decreased in those born to mothers with HTN, despite the association between maternal HTN and SGA. This dissertation begins with an explanation of current knowledge about preterm birth, maternal HTN, and their associations. Chapter 2 focuses on the relationship between maternal HTN and infant mortality in extremely preterm infants. Chapter 3 examines the risk associated with severe morbidities in surviving infants. In addition, we also use a combined morbidity risk assessment score which has previously been used to determine future risk of long term disability. In Chapter 4, SGA infants are separately evaluated for their risk of mortality and the association with maternal HTN. These analyses support the high mortality and morbidity rates seen in extremely preterm infants. Maternal HTN, after adjustment, results in reduced risk of both mortality and severe morbidities in infants compared to infants born to mothers with other underlying contributors to preterm birth. This suggests that clinical practices and parental counseling should reflect differing risk profiles in sub-populations of extremely preterm infants.

Trends and patterns of cancer mortality in Kazakhstan in comparison with some selected European countries from 1986 to 2008 Abstract Cancer is the third leading cause of premature death in Kazakhstan. Every year more than thirty thousand Kazakhstani people are diagnosed with cancer. This master thesis tries to provide base for the cancer control programmes in Kazakhstan. It also analyses the changes of the mortality level and distribution by the most important groups of tumours for men and women. The most common types of cancer are lung, skin, breast and stomach. These four cancers combined account for over 44% of new cases of cancer. Lung cancer is the most common cancer in men accounting for nearly a quarter of cancer cases in men. Breast cancer is by far the most common cancer in women accounting for 20%. Cancer remains mainly a disease of older Kazakhstanis. The largest proportion of cancer deaths for both men and women were from lung cancer mainly caused by smoking. Deaths from cancers of the lung, stomach, breast and esophagus together accounted for almost a half (46%) of all cancer deaths. With an estimated ASMR 225.5 for males and 122.0 for females in 2008, cancer remains an important public health problem in Kazakhstan. The international comparison illustrates the differences in cancer mortality in...

The thesis focuses on the mortality projections by causes of death. The thesis includes also the application of such knowledge on the data of the Czech population. The mortality projections are used nowadays more and more often due to the population ageing. The results of this thesis may be interesting both for financial institutions such as insurance companies and for the purposes of certain areas of government policy with regards to the pension planning. So far not many articles have been published in the Czech language, nor are there any published results of similar projections using the data derived from the Czech environment. Powered by TCPDF (www.tcpdf.org)

Reproductive health patterns in post-Soviet Central Asian countries Abstract This study aims to evaluate reproductive health patterns among post-Soviet Central Asian republics since their independence. The reproductive health indicators of individual countries were researched and compared. Furthermore, cluster country groups among selected post-Soviet, post-Socialist and capitalist countries were identified based on certain reproductive health indicators for the beginning and the end of the research period. The subsequent research was focused on 1999 Kazakhstan Demographic and Health Survey data. This thesis explores statistically significant factors influencing pregnancy outcomes in the country. According to the results, never married, urban women, women of Ukrainian, Russian, and other ethnicities, women living in the East and North regions were more likely to terminate a first pregnancy by an induced abortion rather than giving a live birth. Additionally, the same categories were proven to be statistically significant using the Poisson regression analysis, except the regions were shown to be the West and the North. Keywords: post-Soviet Central Asia, reproductive health, maternal mortality, pregnancy outcomes

In the northeast Pacific, salmon are an integral part of ecology, economics and culture. Nearshore areas, where juvenile salmon reside upon leaving their natal streams, are important habitat during a critical time where growth can determine overall survivorship. With the rise in human development in coastal areas, these valuable habitats are becoming increasingly modified, however, the ecological ramifications are not fully understood. This study focuses on two types of anthropogenic influence including shellfish aquaculture, which modifies intertidal areas by adding structures such as intertidal fencing and anti-predator nets, and plastic marine pollution in the form of microplastics. We beach seined at sites within an area extensively modified for shellfish aquaculture (Baynes Sound) to examine juvenile salmon abundance, condition, feeding intensity and prey at aquaculture and non-aquaculture areas. In addition, we also beach seined, and along the east coast of Vancouver Island to determine the incidence of microplastics in juvenile Chinook salmon and their nearshore environments. No significant differences were found between areas in the abundance, diets, condition or feeding intensity of juvenile Coho and Chinook. Chum had different prey and a higher condition and feeding intensity at aquaculture sites, suggesting that species such as Chum feeding on more benthic prey items have a higher probability of being impacted by shellfish aquaculture modifications and in this case we observed positive effects. Microplastic analysis showed juvenile Chinook salmon contained 1.15 1.41 (SD) microplastics per individual while water and sediment samples had 659.88 520.87 microplastics m-3 and 60.2 63.4 microplastics kg-1 dry weight, respectively. We found no differences in microplastic concentrations in juvenile Chinook and water samples among sites but observed significantly higher concentrations in sediment at our Deep Bay site compared to Nanaimo and Cowichan Bay. These differences may be due to site bathymetry and oceanographic differences facilitating settlement at the Deep Bay site and/or may be a result of differential plastic sources in the area including shellfish farming and a marina. Shellfish aquaculture had negligible or positive effects on juvenile salmon abundance, diet, condition and feeding intensity and Chinook microplastic concentrations were relatively low compared to literature values. Although fitness consequences and ecosystem-wide implications must be addressed in the future, it appears shellfish aquaculture and microplastics are not immediate threats to juvenile Pacific salmon along the east coast of Vancouver Island at this time. However, continued monitoring programs and larger-scale studies should be implemented as shoreline modification and plastic use continues to increase. / Graduate / 2017-08-14

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: A spinal cord injury (SCI) results in a change, either temporary or permanent, in the cord’s normal motor, sensory or autonomic function. In addition, secondary medical complications are common, following an SCI. As such, mortality risk in the spinal cord community remains higher, when compared to the general population. Understanding the complexity of factors related to mortality, remains paramount. Aim: The overarching aim was to assess mortality and secondary medical complications, four years after traumatic spinal cord injury (TSCI) in the City of Cape Town, South Africa. Secondarily, factors associated with mortality and the development of secondary medical complications were assessed. Methods: A prospective, population-based design was used. The study population consisted of all respondents with TSCI, who were enrolled in an earlier incidence study that was conducted in 2013/2014. For this follow-up study, an inclusive sampling strategy was used. All eligible respondents (N=145), or a family member of the deceased, were initially telephonically contacted and requested to complete a valid and reliable interview-administered questionnaire, to be completed face-to-face, or telephonically. Of those patients who were deceased, a close family member, or former caretaker was asked to participate in this current study. In order to aid the generalisability of the findings to the immediate source population, every non-responder with information available from baseline data collected in 2013/2014, were accounted for. Descriptive statistics were used to describe the cohort and to present the mortality rate, as well as point-prevalence of secondary medical complications. Inferential statistics, namely, bivariate logistic regression analysis, were used to identify factors associated with mortality and the development of secondary medical complications.

Magister Curationis - MCur / Despite the awareness of the importance of initiating antenatal care in the first trimester of a pregnancy (before 12 weeks gestation), late initiation of antenatal care (on or after 24 weeks of gestation) remains a common trend amongst pregnant women. The late initiation of antenatal care poses such a risk, to both the pregnant women and their unborn babies that it can contribute to maternal and foetal mortality and morbidity. The late initiation of antenatal care, an entirely avoidable occurrence, has an impact on targets set by the United Nations Millennium Development Goals (MDGs), now focusing on the Sustainable Development Goals (SDG‟s) set out by the United Nations. This study aim to investigate the factors which contribute to and cause the late initiation of antenatal care in pregnant women in a region in the Western Cape. Aim: The aim of this study was to investigate the factors that influence pregnant woman and contribute to late initiation of antenatal care (after 24 weeks gestational age) in one health facility/district in Cape Town. The findings of the study identified possible factors that may cause pregnant women to initiate antenatal care late in pregnancy and these findings could facilitate planning and possible interventions targeting the importance of early initiation in the community.

Magister Public Health - MPH / Background: Antenatal care serves as a key entry point for a pregnant woman to receive a broad range of services and should be initiated at the onset of pregnancy (WHO, 2016). Cameroon has one of the highest maternal mortality ratios in the world (UNICEF, 2016). The majority of pregnant women in Cameroon initiate antenatal care after the first trimester (Njim, 2016). Most studies on initiation of antenatal care in Cameroon have not explored in greater depth the reasons why most of the pregnant women initiate antenatal care late. Methodology: The aim of the study is to understand the reasons why pregnant women initiate antenatal care late in Nkwen Baptist Health Center, North West Region, Cameroon. It is an exploratory study and applied purposive sampling to recruit eighteen pregnant women and three key informants for data collection through individual interviews. Pregnant women who initiated antenatal care after the first trimester were recruited during antenatal care clinics and interviewed in a room at the antenatal care unit. Key informants were midwives working at the antennal care unit. Participation in the study was voluntary. Participants were explained the purpose of the study and signed a consent form if they were willing to participate in the research. Participation in the research did not inhibit the respondent’s access to care. Data was collected using an audio tape and analyzed using Thematic Coding Analysis (TCA) to identify recurring themes that emerged from the data to adequately describe the perceptions of respondents on the reasons for late initiation of antenatal care.