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In today’s market, digitization and automation are crucial for the survival of most companies due to the high level of software already present. The need to adapt to the demands of the day, forces a big mechanical company to perform a paradigm shift towards becoming a software producing company as well. However, the current systems are limited, they are not developed for such a change. Machines in the construction industry are complicated vehicles that require careful configuration by the operators. Each operator may have their own personal preference of how the settings of a construction machine should be configured in order to get full utilization. The problem for the operators revolves around the current situation of frequently having to configure these settings each time operating a machine, requiring time. Consequently, creating the risk of operators neglecting the configuration. Therefore, the problem of the thesis is that there is no existing system of how to facilitate this reoccurring activity. The purpose of this thesis is to prove the usefulness of introducing a mobile application as the missing system for when operators switch machines, through a proof of concept. The proof of concept suggests a quality approach towards the first steps in automating the work environment of operators for construction machines. The objective is to improve the efficiency of the workflow by saving the operators machine settings in a profile, in order to transfer the settings between the machines. The goal is to investigate and deliver a proof of concept for how to store and transfer the personal settings in a useful manner. Due to the limited time of the thesis, the starting focus is placed on wheel loaders with the research limited to one specific type of machine. The thesis consists of a qualitative study, analysing inductively from details to produce abstractions and hypotheses. The agile design science research method applied to the research, was evaluated continuously in the different phases and iterations of the thesis plan to adjust to improvements reviewed as necessary. The observational research includes an explorative and evaluative aspect, first to form an idea and consequently to prove the idea. A design of an user interface of a mobile application served as a method to support the evaluation. The result for the thesis is the proof of concept of a useful mobile application system to automate the personal settings of the construction machines. The evidence is supported by information gathered during the pre-study and the demonstration of a small prototype tested by engineers as well as the intended users, the operators. The questionnaires prove the prototype to be a useful improvement in the operators daily work environment. The documentation and suggested system construction are approved by the target audience to be viable and of value. / På dagens marknad är digitalisering och automatisering avgörande för de flesta företags överlevnad på grund av den höga nivån av mjukvara som redan finns. Behovet av att anpassa sig till dagens krav tvingar ett stort mekaniskt företag att utföra ett paradigmskifte mot att också bli ett mjukvaruproducerande företag. De nuvarande systemen är dock begränsade, de är inte utvecklade för en sådan förändring. Maskiner inom byggbranschen är komplicerade fordon som kräver noggrann konfiguration av operatörerna. Varje operatör kan ha sina egna personliga preferenser för hur inställningarna för en entreprenadmaskin ska konfigureras för att få fullt utnyttjande. Problemet för operatörerna kretsar kring den nuvarande situationen att ofta behöva konfigurera dessa inställningar varje gång man använder en maskin, vilket kräver tid. Följaktligen skapar risken för att operatorer försummar konfigurationen. Därför är problemet med avhandlingen att det inte finns något befintligt system för hur man kan underlätta denna återkommande aktivitet. Syftet med detta examensarbete är att bevisa användbarheten av att introducera en mobilapplikation som det saknade systemet för när operatörer byter maskin, genom ett proof of concept. proof of concept antyder ett kvalitetstänkande mot de första stegen i att automatisera arbetsmiljön för operatörer för entreprenadmaskiner. Målet är att förbättra effektiviteten i arbetsflödet genom att spara operatörens maskininställningar i en profil, för att överföra inställningarna mellan maskinerna. Målet är att undersöka och leverera ett proof of concept för hur man lagrar och överför de personliga inställningarna på ett användbart sätt. På grund av projektets begränsade tid läggs startfokus på hjullastare med forskningen begränsad till en specifik maskintyp. Projektet består av en kvalitativ studie, som induktivt analyserar från detaljer för att producera abstraktioner och hypoteser. Den agila designvetenskapliga forskningsmetoden som tillämpades på projektet utvärderades kontinuerligt i de olika faserna och iterationerna av projektplanen för att anpassa sig till förbättringar som granskades vid behov. Observationsforskningen innefattar en utforskande och utvärderande aspekt, först för att bilda en idé och följaktligen för att bevisa idén. En design av ett användargränssnitt för en mobilapplikation fungerade som en metod för att stödja utvärderingen. Resultatet för avhandlingen är ett bevis på konceptet för användbarheten av det mobila applikationssystemet för att automatisera entreprenadmaskinernas personliga inställningar. Bevisen stöds av information som samlats in under förstudien och demonstrationen av en liten prototyp som testats av ingenjörer såväl som de tilltänkta användarna, operatörerna. Enkäterna visar att prototypen är en användbar förbättring i operatörens dagliga arbetsmiljö. Dokumentationen och den föreslagna systemkonstruktionen godkänns av målgruppen för att vara lönsam och av värde.

Theoretischer Hintergrund: Aktuelle Studien zeigen spezifische Zusammenhänge von peripartalen psychischen Störungen und kindlichen Entwicklungsauffälligkeiten. Fragestellung: Haben Kinder von Müttern mit einer peripartalen Angst- oder depressiven Störung ein erhöhtes Risiko für (visuo–)‌motorische, sprachliche und kognitive Entwicklungsauffälligkeiten? Methode: In der prospektiven MARI-Studie (N = 306) wurden peripartale psychische Störungen mit dem CIDI-V in jedem Schwangerschaftstrimester sowie 2, 4 und 16 Monate nach der Geburt erhoben. Die kindliche Entwicklung wurde mit dem Neuropsychologischen Entwicklungs-Screening im Alter von 4 (N = 263) und 16 Monaten (N = 241) erfasst. Ergebnisse: Maternale depressive Störungen vor der Schwangerschaft waren negativ mit der visuellen Entwicklung (4 Monate; OR = 3.3) und der Haltungs- und Bewegungssteuerung (16 Monate; OR = 4.4) des Kindes assoziiert. Diskussion: Entwicklungsauffälligkeiten könnten u. a. durch ein verändertes Interaktionsverhalten (z. B. weniger Blickkontakt/Ermutigung) betroffener Mütter begründet sein. / Theoretical background: Anxiety and depressive disorders are among the most prevalent perinatal disorders, and specific associations with child development have to be distinguished to derive early targeted interventions. Objective: Are children of mothers with peripartum anxiety or depressive disorder at increased risk for (visuo–)‌motor, language, and cognitive developmental abnormalities? Method: In this prospective-longitudinal MARI study, N = 306 women were examined three time during pregnancy and at 2, 4, and 16 months after delivery using the Composite International Diagnostic Interview for Women (CIDI-V) to assess their anxiety and depressive disorders. Child development was assessed at 4 (N = 263) and 16 months postpartum (N = 241) using a standardized development test (Neuropsychologisches Entwicklungs-Screening, NES). Results: Maternal depressive disorders prior to pregnancy were associated with infant visual development at 4 months (OR = 3.3) and motor development at 16 months (OR = 4.4) postpartum. The results remained stable after adjustment for preterm delivery and perceived maternal social support. Discussion and conclusion: Developmental adversities in infants of mothers with prior depressive disorders might be explained by altered mother-child interaction (e. g., less eye contact, less engagement). Early identification of expectant mothers with a history of depressive disorders is crucial for early targeted intervention. Further studies are needed to examine the mechanisms of transmission to derive innovative approaches for prevention.

Tesis por compendio / [ES] El trabajo de investigación realizado en esta tesis se ha centrado en la aplicación de técnicas recientes e innovadoras en el estudio de la percepción de productos sin gluten. Primero, se estudió cómo tratar la información que hay en Twitter para conocer las opiniones de los consumidores sobre "sin gluten". Los temas más relevantes fueron 5 productos (pan, tarta, galleta, pizza, cerveza), situaciones de consumo, recomendaciones, lugares y aspectos relacionados con la celiaquía. Para explorar automáticamente la información de Twitter, se estudió utilizar redes de co-ocurrencia, que fueron útiles para interpretar los tweets, representar los aspectos más relevantes (ocurrencia) y ponerlos en contexto y en relación con otros (co-ocurrencia). Se observó que es posible automatizar sin un pre-tratamiento manual, permitiendo analizar de forma efectiva gran cantidad de información disponible online. Después, se estudiaron diferentes panes comerciales sin gluten en cuanto al comportamiento en boca para entender mejor los factores involucrados en la percepción de textura. Los panes (5 sin gluten; 2 normales) se caracterizaron en cuanto a propiedades mecánicas, estructura, fragmentación, saliva incorporada y consistencia y adhesividad del bolo. Las sensaciones de textura variaron a lo largo de la masticación, dependiendo de su estructura inicial, propiedades mecánicas, fragmentación, formación de bolo o actividad oral. Posteriormente, se estudió cómo los cambios en la estructura de panes sin gluten obtenidos por modificaciones en panificación (tiempo de fermentación e hidratación) afectan al procesamiento y actividad oral y las sensaciones de textura, que variaron principalmente según el tiempo de fermentación. Especialmente al principio, las diferencias en las sensaciones de textura se explicaron por las diferencias en la estructura y fragmentación en boca. Por último, se estudió la atención visual (con eye-tracking) y la respuesta de consumidores celíacos a paquetes de pan sin gluten, observando que el tipo de marca y la presencia del logo de certificación sin gluten influían en lo que miran. Todos los panes les dieron confianza, sin afectar la presencia del logo, pero condicionando lo que miran. El tipo de marca afectó la confianza y la expectativa de aceptabilidad, que fueron más altas para marcas específicas de sin gluten. La aceptabilidad también se explicó por otras características de cada pan. Se estudió la atención visual (eye-tracking) y las motivaciones de niños celíacos y sus padres al comprar galletas en comparación con los no celíacos. El patrón de fijación cambió en niños y padres: los niños celíacos se fijaron más en ingredientes, palabras y símbolos sin gluten, y menos en la imagen de las galletas; los padres de niños celíacos se fijaron más en ingredientes y símbolo sin gluten, y menos en la imagen de la galleta, nombre, dibujo e información nutricional. Para todos los niños y padres, lo más importante fue elegir una galleta que les gustara, pero solo los niños celíacos mostraron interés en la marca y por probar un producto nuevo. Otro motivo importante para los padres fue la salud, pero por diferentes atributos (padres de celíacos: certificación sin gluten o lista corta de ingredientes; padres de no celíacos: bajo en azúcar o grasa). El precio o la confianza fueron relevantes solo para los padres de niños celíacos. Esta Tesis ha aportado conocimiento sobre el uso y la practicidad de técnicas recientes en ciencia sensorial y del consumidor. La investigación confirma que se puede conseguir una comprensión plena de la compleja respuesta del consumidor recabando información desde perspectivas muy distintas. Sin embargo, para responder a cuestiones específicas en investigación, cada una de estas técnicas (análisis de las redes sociales, estudio del procesado oral de los alimentos o la técnica eye-tracking) puede contribuir de forma individual a entender mejor la aceptabilidad o la elección de alimentos del consumidor. / [CA] El treball de recerca realitzat en esta tesi s'ha centrat en l'aplicació de tècniques recents i innovadores en l'estudi de la percepció de productes sense glútens. Primer, es va estudiar com tractar la informació que hi ha en Twitter per a conéixer les opinions dels consumidors sobre "sense glútens". Els temes més rellevants van ser 5 productes (pa, pastís, galeta, pizza, cervesa), situacions de consum, recomanacions, llocs i aspectes relacionats amb la celiaquia. Per a explorar automàticament la informació de Twitter, es va estudiar utilitzar xarxes de co-ocurrència, que van ser útils per a interpretar els tuits, representar els aspectes més rellevants (ocurrència) i posar-los en context i en relació amb uns altres (co-ocurrència). Es va observar que és possible automatitzar sense un pre-tractament manual, permetent analitzar de manera efectiva gran quantitat d'informació disponible en línia. Després, es van estudiar diferents pans comercials sense glútens quant al comportament en boca per a entendre millor els factors involucrats en la percepció de textura. Els pans (5 sense glútens; 2 normals) es van caracteritzar quant a propietats mecàniques, estructura, fragmentació, saliva incorporada i consistència i adhesivitat de la bitla. Les sensacions de textura van variar al llarg de la masticació, depenent de la estructura inicial, propietats mecàniques, fragmentació, formació de bitla o activitat oral. Posteriorment, es va estudiar com els canvis en l'estructura de pans sense glútens obtinguts per modificacions en panificació (temps de fermentació i hidratació) afecten el processament i activitat oral i les sensacions de textura, que van variar principalment segons el temps de fermentació. Especialment al principi, les diferències en les sensacions de textura es van explicar per les diferències en l'estructura i fragmentació en boca. Finalment, es va estudiar l'atenció visual (amb eye-tracking) i la resposta de consumidors celíacs a paquets de pa sense gluten, observant que el tipus de marca i la presència del logotip de certificació sense gluten influïen en el que miren. Tots els pans els van donar confiança, sense afectar la presència del logotip, però condicionant el que miren. El tipus de marca va afectar la confiança i l'expectativa d'acceptabilitat, que van ser més altes per a marques específiques de sense glútens. L'acceptabilitat també es va explicar per altres característiques de cada pa. Es va estudiar l'atenció visual (eye-tracking) i les motivacions de xiquets celíacs i els seus pares en comprar galetes en comparació amb no celíacs. El patró de fixació va canviar en xiquets i pares: els xiquets celíacs es van fixar més en ingredients, paraules i símbols sense glútens, i menys en la imatge de les galetes; els pares de xiquets celíacs es van fixar més en ingredients i símbol sense gluten, i menys en la imatge de la galeta, nom, dibuix i informació nutricional. Per a tots els xiquets i pares, el més important va ser triar una galeta que els agradara, però només els xiquets celíacs van mostrar interés en la marca i per provar un producte nou. Un altre motiu important per als pares va ser la salut, però per diferents atributs (pares de celíacs: certificació sense gluten o llista curta d'ingredients; pares de no celíacs: baix en sucre o grassa). El preu o la confiança van ser rellevants solo per als pares de xiquets celíacs. Esta Tesi ha aportat coneixement sobre l'ús i la practicitat de tècniques recents en ciència sensorial i del consumidor. La investigació confirma que es pot aconseguir una comprensió plena de la complexa resposta del consumidor recaptant informació des de perspectives molt diferents. No obstant això, per a respondre a qüestions específiques en investigació, cada una d'estes tècniques (anàlisis de les xarxes socials, estudi del processament oral dels aliments o la tècnica eye-tracking) pot contribuir de manera individual a entendre millor l'acceptabilitat o l'elecció d'aliments del consumidor. / [EN] The research of this thesis is focused on the application of recent and innovative techniques to study the perception of gluten-free products. First, it was studied how to manage the information available on Twitter to get consumers' opinions about "gluten-free". The most relevant topics when talking about gluten-free on Twitter were five products (bread, cake, cookie, pizza, beer), situations of consumption, recommendations, places, and aspects related to coeliac condition. To automatically explore the information from Twitter, the possibility to use co-occurrence networks was studied. Co-occurrence networks were useful for interpreting tweets' content, representing the most relevant aspects mentioned (occurrence) and putting them into context and in relation to others (co-occurrence). It was found that automated without manual pre-treatment of text is possible, as an efficient analysis of big amounts of online data. Secondly, different commercial gluten-free breads were studied in terms of in-mouth behaviour to better understand the factors involved in texture perception. The breads (5 gluten-free; 2 regular) were characterised regarding mechanical properties, structure, fragmentation, saliva incorporated, and bolus consistency and adhesiveness. Texture sensations varied along mastication, depending on their initial structure, mechanical properties, fragmentation pattern, bolus formation or oral activity. Subsequently, it was studied how changes in structure of gluten-free breads achieved by modifications in breadmaking (fermentation time and hydration) affect oral processing, oral activity and texture sensations. Oral behaviour and texture perception varied mostly according to the fermentation time. Especially at the beginning, differences in texture sensations were explained by the differences in structure and how it fragmented in mouth. Lastly, visual attention (with eye-tracking technique) and response of coeliac consumers to gluten-free bread packages were studied, finding that the type of brand and presence of gluten-free certification logo influenced the visual behaviour. All gluten-free breads were perceived as trustworthy, not being affected by the presence of gluten-free certification logo, but conditioning the visual behaviour. The type of brand affected trust and expected acceptability, being both higher for brands specific of gluten-free. Liking was also explained by other individual characteristics of breads. Visual behaviour and motivations of coeliac children and their parents when purchasing biscuits were studied in comparison to non-coeliac ones. Eye-tracking showed that fixation pattern changed for coeliac children and their parents. Coeliac children fixated more on ingredients, gluten-free words and symbols, and less on biscuit image. Parents of coeliac children fixated more on ingredients and the gluten-free symbol, and less on biscuit image, product name, cartoon, and nutritional information. For all children and parents, liking was the most important reason for choosing a biscuit, but only coeliac children showed interest in brand and unknown products. Other important motivation for parents was health, but the attributes were different (parents of coeliac group: having gluten-free certification or a short ingredients list; parents of non-coeliac group: low sugar or fat contents). Price or trust were relevant motivations only for parents of celiac children. On overall, this Thesis provided knowledge about the usage and practicality of recent techniques or approaches in sensory and consumer science. This investigation confirms that a full understanding of complex consumer's response can be achieved by gathering consumer's information from different perspectives. However, for answering specific research questions, these different tools (social media exploration, food oral processing approach or eye-tracking technique) can individually contribute to better understand consumer acceptability or food choice. / Puerta Gil, P. (2022). Novel Techniques in Sensory and Consumer Research Applied to Understand Gluten-Free Products Perception [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/182293 / Compendio

La méthodologie de l’évaluation en psychothérapie s’est longtemps limitée aux résultats issus d’essais cliniques comparatifs de groupes. L’objectif, engagé dans les années 2000, de comprendre ce qui cause son efficacité a engagé un renouvellement méthodologique. Son application concrète est peu documentée. La première partie présente, à partir d’une revue de la littérature centrée sur l’introduction de la recherche sur le processus associée aux résultats, comment le paradigme interactionnel multifactoriel de la psychothérapie a stimulé le développement de méthodes adaptées à la complexité et à l’observation en conditions naturelles. La seconde partie introduit autour de cinq axes principaux les questions méthodologiques générales et spécifiques de cette nouvelle orientation : 1. une épistémologie interactionnelle et transactionnelle ; 2. Un recentrage sur les études mixtes intensives de cas ; 3. Une investigation clinique et théorique multifocale des processus et mécanismes de changement ; 4. une forte relation clinicien-chercheur ; 5. une approche statistique innovante. La troisième partie expose l’expérience et les questions soulevées par la mise en œuvre de ce programme dans le cadre d’un réseau de recherche clinique centré sur les pratiques, du recueil des données jusqu’à l’analyse des processus et mécanismes de changement, et les résultats qui en sont issus. La quatrième partie présente une revue détaillée de la littérature. Ce travail devrait favoriser les collaborations avec les disciplines connexes et l’efficience des traitements par une meilleure connaissance des conditions et des mécanismes de changement associée au développement d’une base de données issue d’études de cas. / The methodology of assessment in psychotherapy has long been limited to results from comparative group clinical trials. The objective, expressed in the 2000s, to understand what is causing its effectiveness has involved a methodological renewal. Its concrete application is poorly documented. The first part presents, from a review of the literature focusing on the introduction of research on the process associated with outcomes, how the multifactorial interactional paradigm of psychotherapy has stimulated the development of methods adapted to the complexity and observation in natural conditions. The second part introduces the general and specific methodological questions of this new orientation around five main axes: 1. an interactional and transactional epistemology; 2. A refocusing on intensive mixed case studies; 3. A multifocal clinical and theoretical investigation of the processes and mechanisms of change; 4. a strong clinical-researcher relationship; 5. an innovative statistical approach. The third part presents the experience and issues raised by the implementation of this program as part of a practice-oriented clinical research network, from data collection to analysis of processes and mechanisms of change, and results. The fourth part presents a detailed review of the literature. This work should foster collaborations with related disciplines and treatment efficiency through a better understanding of the conditions and mechanisms of change associated with the development of a case study database.

Although the female menopause has been extensively characterized as a well-defined symptomatic state of oestrogen deficiency, which responds relatively well to oestrogen replacement therapy, the symptomatic state of androgen deficiency in men is poorly defined and uncertainty exists whether it responds to testosterone replacement. It has been proposed that hypothalamic-pituitary-testicular (HPT)-axis function (responsible for the production of androgens) and regulation could be viewed as a ‘barometer’ of health status in older men and that potential alterations in HPT-axis function and regulation reflect subclinical and clinical deficits in function and health, which may result in an aged phenotype of human health and disease in older men. The HPT-axis constitutes a well-defined, tractable, clinically-relevant, biological system, which may permit insight into the mechanisms underlying the expression of ageing-related phenotypes of human health and disease. By using a different lens – such as the genetic background; the compensatory responses within the HPT-axis; the syndromes of androgen deficiency; the ethnic background of an individual or the life course trajectory of function and health from conception into older age – to magnify potential dysregulation in the HPT-axis will it be possible to visualize and understand the phenotypic expression of human male ageing as a gradient of functional and health outcomes. This will allow for a better understanding of the physiological mechanics underlying symptomatic expression of dysregulation in the HPT-axis.

(Synopsis to introductory statement): An introductory statement to five documentary films made by Ian Lang in Australia between 1981 and 1997 exemplifying  a 'democratising' model of sustainable and ethical documentary film production. This document critically reflects on the production process of these films to accompany their submission for the degree of Doctor of Philosophy by Publication at Griffith University. It finds that a contemporary tendency towards 'post-industrial' conditions allows an observational film-maker to negotiate a critical inter-dependence rather than a romantically conceived 'independence' traditional to the genre. [Full thesis consists of introductory statement plus six DVD videodiscs.]

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.