Recent research suggests that sedentary behaviours have detrimental effects on the health and well-being of children, including effects on obesity. Specifically, television viewing is consistently associated with childhood obesity. Two explanations have been proposed: 1) reduced energy expenditure, and 2) increased food intake. However, it has been suggested that the association between television viewing and childhood obesity may be better explained by an increase in energy intake than by a reduction in energy expenditure. To date, children of different weight status have not been compared in their dietary patterns in front of the television, and it is not known if total sedentary time is linked with food intake in children. The objectives of this thesis are: 1) to determine if obese children consume food more frequently while watching television than normal weight children, and 2) to examine which of television viewing or total sedentary time better predicts dietary patterns in children. Overall, our results re-affirm the notion that television viewing is associated with obesity, although physical activity plays a role in this association. Also, children who are obese consume fast food and fruits/vegetables more frequently during television watching than normal weight children. Furthermore, television viewing appears to be a better predictor of dietary patterns in children than overall sedentary time. Globally, these results provide evidence for the deleterious effects of television viewing on children’s dietary patterns and justification for future intervention studies designed to reduce television viewing in children with obesity.

Recent research suggests that sedentary behaviours have detrimental effects on the health and well-being of children, including effects on obesity. Specifically, television viewing is consistently associated with childhood obesity. Two explanations have been proposed: 1) reduced energy expenditure, and 2) increased food intake. However, it has been suggested that the association between television viewing and childhood obesity may be better explained by an increase in energy intake than by a reduction in energy expenditure. To date, children of different weight status have not been compared in their dietary patterns in front of the television, and it is not known if total sedentary time is linked with food intake in children. The objectives of this thesis are: 1) to determine if obese children consume food more frequently while watching television than normal weight children, and 2) to examine which of television viewing or total sedentary time better predicts dietary patterns in children. Overall, our results re-affirm the notion that television viewing is associated with obesity, although physical activity plays a role in this association. Also, children who are obese consume fast food and fruits/vegetables more frequently during television watching than normal weight children. Furthermore, television viewing appears to be a better predictor of dietary patterns in children than overall sedentary time. Globally, these results provide evidence for the deleterious effects of television viewing on children’s dietary patterns and justification for future intervention studies designed to reduce television viewing in children with obesity.

Les études observationnelles en pharmacoépidémiologie sont souvent mises en place pour évaluer un médicament mis sur le marché récemment ou concurrencé par de nombreuses alternatives thérapeutiques. Cette situation conduit à devoir évaluer l'effet d'un médicament dans une cohorte comprenant peu de sujets traités, c'est à dire une population où l'exposition d'intérêt est rare. Afin de prendre en compte les facteurs de confusion dans cette situation, certains auteurs déconseillent l'utilisation du score de propension au profit du score pronostique, mais cette recommandation ne s'appuie sur aucune étude évaluant spécifiquement les faibles prévalences de l'exposition, et ignore le type d'estimation, conditionnelle ou marginale, fournie par chaque méthode d'utilisation du score pronostique.La première partie de ce travail évalue les méthodes basées sur le score de propension pour l'estimation d'un effet marginal en situation d'exposition rare. La deuxième partie évalue les performances des méthodes basées sur le score pronostique rapportées dans la littérature, introduit de nouvelles méthodes basées sur le score pronostique adaptées à l'estimation d'effets conditionnels ou marginaux, et les compare aux performances des méthodes basées sur le score de propension. La dernière partie traite des estimateurs de la variance des effets du traitement. Nous présentons les conséquences liées à la non prise en compte de l'étape d'estimation du score de propension et du score pronostique dans le calcul de la variance. Nous proposons et évaluons de nouveaux estimateurs tenant compte de cette étape. / Pharmacoepidemiologic observational studies are often conducted to evaluate newly marketed drugs or drugs in competition with many alternatives. In such cohort studies, the exposure of interest is rare. To take into account confounding factors in such settings, some authors advise against the use of the propensity score in favor of the prognostic score, but this recommendation is not supported by any study especially focused on infrequent exposures and ignores the type of estimation provided by each prognostic score-based method.The first part of this work evaluates the use of propensity score-based methods to estimate the marginal effect of a rare exposure. The second part evaluates the performance of the prognostic score based methods already reported in the literature, compares them with the propensity score based methods, and introduces some new prognostic score-based methods intended to estimate conditional or marginal effects. The last part deals with variance estimators of the treatment effect. We present the opposite consequences of ignoring the estimation step of the propensity score and the prognostic score. We show some new variance estimators accounting for this step.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22044号 / 社医博第97号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 福原 俊一, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Syftet med studien är att undersöka hur musiklärare i grundskolan skapar förutsättningar för musikaliskt lärande samt vilka resurser de använder sig av. Data har samlats in genom videoobservation av musikundervisning i två grundskoleklassrum. I bakgrundsdelen presenteras tidigare forskning inom området samt relevanta begrepp för designteoretiska och multimodala perspektiv. Observationerna har bearbetats utifrån dessa perspektiv för att lyfta fram signifikanta detaljer och synliggöra både designer som undervisningen bygger på och de multimodala resurserna som används i förverkligandet av dessa. I resultatet framkommer fyra huvudteman bland designer: musicerande, teoretiska förlagor, individuell instrumentundervisning samt instrumentundervisning i grupp. De multimodala resurserna som används följer fem huvudteman: resurser för puls och rytm, pedagogiska resurser, gestaltande resurser, resurser vid samspel samt formativa resurser. Likheter och olikheter i de två lärarnas designer och kommunikation diskuteras. I sista kapitlet jämförs resultaten med både observationer och teoretiska modeller som beskrivits i tidigare forskning. / The aim of this study is to investigate how music teachers in the Swedish comprehensive school system create the preconditions for musical learning as well as which resources they make use of. Data has been gathered through video observation of music teaching in two comprehensive school classrooms. In the literature review, previous research in the area is presented, along with concepts relevant to design-theoretical and multimodal perspectives. The observations have been analyzed from these perspectives in order to identify significant details and reveal both the designs underpinning the teaching and the multimodal resources that are used in realizing these designs. In the results section, four main themes emerge among the designs: music-making, theoretical models, individual instrumental instruction and instrumental instruction in groups. The multimodal resources that are used follow five main themes: resources for pulse and rhythm, pedagogical resources, embodied resources, resources for coordinated music-making and formative resources. Similarities and differences between the two teachers’ designs and communication are discussed. In the final chapter, the results are compared with observations and theoretical models described in the literature.

Sjuksköterskans omvårdnadsarbete har förändrats genom tiderna. I början av 1900-talet var sjuksköterskeyrket ett kall, vilket huvudsakligen innefattades av att se till att smittosamma sjukdomar inte spreds vidare, samt hålla patienten ren. Idag innefattar sjuksköterskeyrket ett mer komplext arbete där administration, specialistvård, teknik, patientnära omvårdnad samt kontakt med andra yrkeskategorier och instanser ska vävas samman. Syftet med den här pilotstudien var att belysa hur fördelningen av sjuksköterskans arbetsuppgifter ser ut över dygnets 24 timmar. Strukturerad observationsmetod användes för datainsamling. Observationer utfördes på en infektionsavdelning i södra Sverige och tre sjuksköterskor observerades. Det kvantitativa materialet analyserades genom deskriptiv statistik. Resultatet kunde delas in i två kategorier; direkt- och indirekt vård och visade att fördelningen av sjuksköterskans arbete över dygnet till störst del bestod av indirekt vård vilket utgjordes till 64 % och direkt vård, det vill säga patientnära omvårdnad, utfördes till 33 %, övriga 3 % utgjordes av personalens raster. / The nursing care has changed over time. From being a calling in the beginning of the 20th century with responsibility and obligations like prevent contagious diseases to spread and to keep the patient clean. Nowadays a more complex work and responsibilities has occurred containing; administration, specialist care, technique, close patient care and contact with other profession’s and authority’s. The aim of this pilot study was to illustrate the distribution of the nurses’ work over a 24-hour period. A structured observational method was used in order to the gather data. The observations took place at an infection department in southern Sweden, and three nurses were observed. The material was analyzed quantitatively with descriptive statistics. The results could be divided in two categories; direct- and indirect care and it appeared that indirect care amounted to 64 % over a 24-hour period, and direct care amounted to 33 %, the last 3 % represent the nurses’ food and coffee breaks.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13560号 / 論医博第2289号 / 新制||医||1067(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 森信 暁雄, 教授 村井 俊哉, 教授 林 康紀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24472号 / 医博第4914号 / 新制||医||1062(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 山本 洋介, 教授 小濱 和貴 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24191号 / 医博第4885号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 松村 由美, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Symptomatic spinal disorders affect a large proportion of the population and are associated with substantial morbidity, social burden, and economic impact. Spine surgery interventions can provide excellent results in carefully selected patients whose symptoms fail to improve with non-operative management, but an evidence-based approach is paramount to optimize outcomes and rigorous standards of health research methodology are critical to avoid misleading conclusions. This thesis aimed to investigate and apply modern innovations in health research methodology to the field of spine surgery. It consists of seven chapters divided between three sections: randomized controlled trials, observational studies, and systematic reviews and meta-analyses. By applying the findings of each chapter, clinicians, researchers, and other evidence users can advance the credibility of future research and enhance the care of patients with spinal disorders. / Thesis / Doctor of Philosophy (PhD)