ABSTRACT Background: Asthma is a chronic lung disease that inflames and narrows the airways. This results in recurrent episodes of coughing, wheezing, shortness of breath, and chest tightness. Although the causes of asthma are poorly understood, genetic and environmental factors have been implicated in the development and exacerbation of the disease. Among environmental risk factors, cigarette smoke is a well-known risk factor to trigger asthma symptoms. Exposure to secondhand smoke irritates the airways and may trigger an attack in adults with asthma. Smoke-free laws and regulations in the United States differ by state. The enforcement of smoke-free legislation has been related to asthma rates as it has been shown that they lead to a sustained drop in emergency hospital admission for asthma among adults. These laws and regulations are also necessary in reducing smoking rate and secondhand smoke exposure. Objective: The purpose of this thesis is to examine the association between tobacco smoke rates and asthma status among adults at the national and state levels and to evaluate the effects of state smoke-free laws and regulations on tobacco smoking rate among adults with asthma. Methods: The Centers for Disease Control and Prevention’s 2009–2010 Behavioral Risk Factor Surveillance System data was used for the analyses. SAS-callable SUDAAN (version 10.0.0, RTI International, NC) was utilized to account for the complex sampling design of the BRFSS, and sample weights were used to produce estimates that were generalizable to the state and U.S. adult population. In addition to calculating descriptive statistics, chi-square tests and multivariate logistic regression were used to test for group differences and association between variables of interest. State level smoking rates were ranked to identify states that are in the lower and upper 20th percentiles and compare them with states’ smoke-free laws and regulation status. Results were considered significantly different if 95% confidence intervals (CIs) did not overlap or if statistical testing at p<0.05 was applicable. Results: Asthma prevalence rates are higher among adults that smoke cigarettes (10.5%, [aPR] =1.2) compared to non-smokers (7.8%, [aPR] =1.0). Of the 869,519 adult respondents in the survey, 8.5% reported having asthma. Nearly one-fifth (17.2%) of adults without asthma smoked cigarettes, while (21.7 %) of adults with asthma smoked. Females (10.5%) had higher asthma prevalence rates than males (6.4%). Black persons (10.0%), persons of American Indian (13.0%) descent had higher, and those of Hispanic (6.7%) descent had lower asthma rates than white persons (8.6%). Adults with a high school education or less (9.1%) had higher asthma rates than those with an education level that was equivalent to a 4 year college or more (7.3%) , and those with low income (<$15,000) had higher rates (13.3%) than those with high income (6.8%). Percentage of male (23.4%) and females (20.7%) with asthma who smoke are higher than those that do not smoke (19.3% and 15.1%, respectively). Asthma prevalence rates and smoking rates vary by geographic location. Smoking rates among adults with asthma was highest in the South (LA, AL, SC, TN, OK, MS, AR, WV, KY) and a couple of Midwest states (OH, IN,). Evaluating the association between the 2008 State of Tobacco Control Report and smoking rate among adults with asthma by state showed a statistically significant relationship between smoking rate among adults with asthma and smoke-free policy and regulation at the state and national level. On average, states with the lowest smoking rate among persons with asthma (smoking rates less than 20th percentile) had significantly higher smoke-free policy grades (mean grade [sd]=7.2 [1.99]) than states with a high smoking rate (smoking rate of 80th percentile or more) (mean grade [sd]=2.0 [2.00]) (p-value < 0.00001). Conclusion: Although most U.S. state smoke-free policies and regulations are relatively new, it is evident that these laws are effective in promoting cessation among adults and reducing nonsmokers’ exposure to secondhand smoke. The study found that smoke-free laws may improve health by lowering asthma prevalence and smoking rates among adult smokers. Also, these policies in turn protect non-smokers from the harmful health effects of secondhand smoke.

The aims of this thesis were to estimate the lifetime prevalence of physical, sexual, and psychological abuse in a random population-based sample of women aged 18-60 years; to estimate current suffering thereof; and to investigate associations between abuse and health problems, more specifically to study abuse related variables associated with somatization and PTSD, respectively. The studies had a cross-sectional design. Studies I and II comprised 4150 women 18-60 years. Study III included 547 women, and study IV consisted of 213 women, randomly selected from the population-based sample of the first two studies. The first study found lifetime prevalence rates of 19.4% for physical abuse, 9.2% for sexual abuse, and 18.2% for psychological abuse. Abused women reported more ill-health and a less advantageous social situation than non-abused women. There was an association between magnitude of abuse and health problems. Even a low magnitude of abuse was substantially associated with ill-health. In the second study we found that of the 27.5% of women who had reported any kind of abuse in the first study, 69.5 % reported current suffering thereof. Abused suffering women reported more health problems than abused non-suffering women and non-abused women, and abused non-suffering women reported more health problems than non-abused women. In study three, psychological abuse and sexual abuse without penetration were found to be associated with somatization. Physical abuse and sexual abuse with penetration were not associated with somatization, when adjustments for other kinds of abuse were made. In study four, PTSD and somatization were found to be separately reported phenomena in abused women, although PTSD was positively associated with having somatic symptoms. Women with PTSD reported higher total magnitude of abuse and a higher number of perpetrators than women with somatization. Sexually abused women with PTSD more often described their experience as an act of abuse compared with sexually abused women with somatization. The present thesis demonstrates that even a low magnitude of abuse is associated with health problems. It also shows that a majority of the abused women, when investigating lifetime history of abuse, reported current suffering thereof, which warrants considering abuse an important societal problem. The relationship between somatization and posttraumatic stress in abused women is discussed in relation to abuse variables. Other factors than severity of abuse, such as whether the abused woman herself perceives her experience as abuse, seem to be more decisive for development of somatization in abused women. The findings suggest that PTSD is not a necessary mediator between abuse and somatization.

Purpose: Little is known about the use of complementary and alternative medicine (CAM), including traditional Chinese medicine (TCM) in ethnic populations with cancer living in Canada. The purpose of this study was to assess the prevalence and predictors of TCM/CAM use in newly diagnosed Chinese cancer patients who were starting cancer treatments. <p>Patients and Methods: A consecutive sample of newly diagnosed Chinese cancer patients treated at the British Columbia Cancer Agency over a four month period was surveyed. During admission, the study questionnaire was distributed along with other registration forms and anonymously returned in well-labeled boxes. A bilingual Chinese interpreter was available to answer any questions potential participants might have had. The 15-item questionnaire focused on TCM/CAM use, socio-demographics, and medical and cultural factors. <p>Results: Ninety-one patients completed the questionnaire. The majority of respondents (90%) were born outside of Canada and 64% completed the questionnaire in Chinese. TCM/CAM was used by 44% of respondents. Herbal remedies, vitamins/minerals, and prayer were the most commonly used therapies. In the bivariate analysis, factors predicting TCM/CAM use were prior TCM/CAM use (p < 0.001), having received chemo/radiotherapy (p = 0.021), female sex (p = 0.015), immigrant status (p = 0.040), and reporting a non-official language most frequently used at home (p = 0.018). Following multivariate analysis, it was found that prior CAM use (p < 0.001), lower income (p = 0.043), and immigrant status (p = 0.030) were associated with TCM/CAM use. <p>Conclusion: TCM/CAM use in newly diagnosed Chinese cancer patients is very common and results are comparable to previous studies in other populations. Healthcare practitioners must become aware of the widespread use of CAM and engage discussions about CAM use with their patients, especially those of a specific ethno-cultural group who may be less acculturated to Western society.

<i>Escherichia coli</i> O157 is a food borne pathogen of increasing public health concern worldwide. Cattle have been implicated as the primary reservoir of <i>E. coli</i> O157. The fact that the livestock industry has rapidly expanded in Saskatchewan makes it imperative to have a clear scientific understanding of the prevalence of <i>E. coli</i> O157 in this province as well as its survival in soil under ambient conditions.<p>Longitudinal and point studies were employed to determine the prevalence of <i>E. coli</i> O157 among Saskatchewans cattle. During a 2-year period, 23 feedlot and cattle operations were examined and an overall prevalence of 15.6% was reported. The most important finding was that the prevalence rates were highly dependent on cattle density. All <i>E. coli</i> O157 isolates obtained from this study were characterized by using multiplex PCR, RAPD fingerprinting, a Vero cell cytotoxicity assay and antibiotic susceptibility tests. This characterization revealed a surprisingly highly virulent and heterogenous population of <i>E. coli</i> O157 isolates. <p>Subsequently, the survival characteristics of <i>E. coli</i> O157:H7 ATCC 43894 in sterile soil and manure-amended soil microcosms, as well as in situ under ambient environmental conditions were examined. Findings from this work indicated that desiccation had the most lethal effect on cell viability, whereas nutritionally-rich soils significantly increased survival times of the pathogen population. <p>A final study was designed to examine the survival strategy of hyper- and hypothermally adapted <i>E. coli</i> O157 cells exposed to high and low temperatures, with specific focus on the role of RpoS. Using wild type and its rpoS null allele <i>E. coli</i> O157 strains, in combination with 2D PAGE, It was found that both heat and cold post-acclimation stimulons consisted of two large sub-groups: (i) stress proteins, and (ii) housekeeping proteins. Comparative proteomic analyses revealed that the GroEL/S chaperonin complex and Pnp ribonuclease played a crucial role in growth resumption during high and low temperatures, respectively. Notably, RpoS had no control over key stress proteins in either stress stimulon. RpoS, however, showed a significantly more pronounced role during cold temperatures, where it was seen to regulate key proteins involved in homoeoviscous adaptation as well as various housekeeping proteins of both stress stimulons.

Dicyemid mesozoans are endoparasites inhabited in benthic cephalopod molluscs. Previous studies of dicyemids were mostly concentrated on their taxonomy. The life cycle remains a mystery since Cavolini observed this animal in 1787. The purpose of this study is to investigate further on the dicyemid life cycle building on the limited knowledge from previous studies, and investigate the infection of dicyemid in octopuses in tropical waters, using the area in the southwestern Taiwan as a model. A total of 324 octopus hosts was collected¡Aincluding 3 genera and 13 species from DungGang Fish Market from 2001 to 2002. There were 9 host species detected with dicyemid mesozoans including 14 species within 2 genera. Moreover, there is no dicyemid species overlap among the octopus species indicating high host-specificity. There is large range of the dicyemid infection prevalence among octopod hosts. Cistopis indicus has the highest prevalence (91%) and Octopus luteus the lowest (20%) in this study. In C. indicus, the infected mechanism correlated with season. The infusoriform larvae of dicyemid mesozoan dispersal from the host to sea water in the autumn and winter, then entering host in the spring and summer. The change of dicyemid life cycle stage in the C. indicus kidney correlates with the sharp decrease of infection intensity. However, the dicyemid infection in Octopus marginatus correlates with body size, not with season. Besides, there is significant difference of dicyemid development between two kidneys of the same individual, both in the analysis of C. indicus and O. marginatus. It indicates the separated way of dicyemid infection into two sides of kidneys.

Introduction: The incidence of anal cancer, whose primary cause is human papillomavirus (HPV) infection, has increased in United States (US) men almost three-fold in three decades; however, little is known about the epidemiology of anal HPV, especially in heterosexual men. Furthermore, advancements in knowledge about the epidemiology of anal HPV may be hampered by measurement error in the collection of sexual behavior data. Methods: From two US cities, behavioral data and anal biological specimens were collected from 253 men who acknowledged sexual intercourse with a woman in the previous year. PCR and genotyping were used to assess the presence of HPV DNA. In addition, two HPV questionnaires were assessed for test-retest reliability: the first was a self-administered questionnaire associated with the collection of the biological specimens while the second was a computer-assisted self-interview (CASI) with 1069 men in Brazil, Mexico, and the US. Results: Based on DNA analysis, overall anal HPV prevalence was 24.8% in 222 men who acknowledged no prior sexual intercourse with men. Risk factors independently associated with anal HPV were lifetime number of female sexual partners and frequency of sex with females in the past month. Based on kappa and intraclass correlation coefficients (ICC), both HPV questionnaires were found to be highly reliable with low refusal rates; however, three discrete measures in the multi-national interview asking for the number of sexual partners had lower reliability. The ICC of these questions increased to greater than or equal to 0.79 when a small number of extreme outliers (less than or equal to 3) were removed. Predictors of unreliable reporting were age and lifetime number of female sexual partners while years of education was inversely associated with unreliable reporting. Discussion: These results suggest anal HPV is common in heterosexual men. Risk factors associated with anal HPV did not explain how HPV was transmitted to the anal region. Both instruments used to collect sexual behavior data were highly reliable including the CASI instrument used in three culturally and linguistically distinct countries; however, caution is warranted with discrete measures that ask participants to report the number of sexual partners.

A large number of people all over the world suffer from skin conditions. Dermatological problems comprise about 10 % of a general practitioner's caseload and probably more for pharmacists. The literature furthermore emphasises that skin diseases are becoming a significant problem in the developing world. There is a need to establish an effective method to achieve good health and quality of life for patients with dermatological problems. The general objective of this study was to investigate the usage patterns and cost of dermatological products in the private health care sector of South Africa by using a medicine claims database. The focus was specifically on dermatological products with a prevalence of more than 10 % in the database. A quantitative retrospective drug utilisation research design was used to evaluate the usage patterns and costs of dermatological products in three four-monthly intervals of 2001 and 2004. Data were analysed by using the Statistical Analysis System, 9.1 (SAS). The dermatological product groups for this study were antibacterial and antifungal drugs, corticosteroids and anti-acne products and were analysed according to the MIMS classification. Of all analysed prescriptions issued only 8.57 % (n = 126 447) during 2001 (N = 1 475 380) and 6.82 % (n = 177 122) during 2004 (N = 2 595 254) consisted of dermatological products. Of the total number of products prescribed, the dermatological products constituted 4.77 %I (n = 140 701) for 2001 (N = 2 95 1 326) and 3.77 % (n = 199 976) for 2004 (N = 5 305 882). The total cost of the dermatological products was 4.98 % (n = R18 913 889.92) of the total cost of all medicine products during 200 1 (N = R379 708 489). During 2004 (N = R66 1 223 146) the total cost of dermatological products was 4.09 % (n = R27 025 540.48) of the total cost of all medicine products in the database. The cost-prevalence index for 2001 and 2004 respectively showed that the dermatological products were relatively expensive with values of 1.03 and 1.09. The antibacterial and antifungal drugs, corticosteroids and anti-acne products represented 91.92 % (n = 129 336) and 87.97 % (n = 175 9 16) of all dermatological products during 2001 (N = 140 701) and 2004 (N = 199 976), respectively. These dermatological groups named above represented 91.57 % (n = R17 319 645.61) and 85.85 '% (n = R23 200 594.71), respectively, of the total cost of dermatological products during 200 1 (N = R18 9 13 889.92) and 2004 (N = R27 025 540.48). It was further found that the majority of dermatological products prescribed during the research periods was innovator products. The prevalence of innovator products for 2001 was 86.17 % (n = 12 1 249) with a total cost representing 94.16 % (n = R17 809 603.12). For 2004 the prevalence was 82.33 % (n = 164 640) with a total cost representing 91 .O1 '% (n = R24 594 923.72) of all the dermatological products prescribed. The number of innovator and generic products claimed during 2001 amounted to 86.17 % (n = 12 1 249) and 13.83 % (n = 19 452) respectively of the total number of products claimed (N = 140 701). During 2004 the number of innovator and generic products represented respectively 82.33 % (n = 164 640) and 17.67 O/o (n = 35 336) of the total number of products claimed (N = 199 976). The prevalence in the use of the dermatological products during 2004 increased with 55.25 % from January to April versus September to December. The cost-prevalence index indicated that the dermatological products were relatively expensive during January to August 2004. During September to December 2004 the cost-prevalence decreased and indicated that dermatological products became inexpensive. The average cost of dermatological products during the 2004 study period showed that the cost decreased. January to April (before implementation of the new single exit price structure) was compared to September to December (after implementation of the new single exit price structure). This comparison indicated that the average cost decreased by 22.88 %. It can be summarised that the average cost in the last study period decreased due to the changed price structure. The innovator products' prevalence was high and therefore more generics are needed in dermatology. If more generics are used the total cost of dermatological products might also decrease. The number of dermatological prescriptions increased towards 2004, but this may be because of more members or more medical aids claiming through this database. / Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2006.

Understanding chronic pain and disability in young people: A study with Catalan schoolchildren Anna Huguet Roselló Tesis doctoral dirigida pel Dr. Jordi Miró Martínez Departament de Psicologia, Universitat Rovira I Virigili, Tarragona Juny, 2007 El dolor crònic i recurrent és un problema molt estès; de fet és considerat un problema de salut pública (Crombie i col., 1999); que requereix d'una atenció especial pel sofriment i la discapacitat que pot generar tant al mateix individu com a les persones més pròximes a aquest (família). El dolor ha estat motiu d'atenció dels éssers humans des dels inicis de la història (veure per exemple, Sabatowski i col., 2004). No obstant, i paradoxalment, el dolor en nens ha estat totalment mancat d'interès fins a la dècada dels 70. Afortunadament, la situació en l'àmbit del dolor pediàtric ha canviat dràsticament. Durant els últims 25 anys, hi ha hagut un augment d'interès per a l'estudi del dolor en nens. Cada vegada més recursos estan sent invertits pel seu tractament, i la recerca paral·lelament també ha anat en augment. Aquest interès, no obstant, no és evident a tot arreu. Per exemple, i tal i com Reinoso-Barbero reconeix (2003), el dolor crònic és encara el germà pobre de la recerca del dolor en adults a Espanya. A pesar de l'elevat número de nens en necessitat de tractament, pocs clínics i investigadors estan donant a aquest problema l'atenció que es mereix. Per tant, la majoria d'aquests no estan rebent el tractament més apropiat perquè els clínics no estan familiaritzats amb aquestes condicions cròniques, mesures d'avaluació, i estratègies d'intervenció. En general, es pot dir que aquests nens han de combatre contra el seu dolor per ells mateixos, la majoria de les vegades sense rebre un tractament apropiat pel seu problema. Al mateix temps, les preocupacions i el sofriment dels pares augmenta perquè el dolor dels nens no remet, i ells no saben què fer. El propòsit d'aquest estudi és ajudar a entendre millor els problemes de dolor en nens i adolescents. Per això la tesi planteja tres objectius generals. (1) Treballar en l'àmbit de l'avaluació del dolor, i desenvolupar, adaptar i estudiar les propietats psicomètriques d'instruments de mesura que contribueixen a fer una avaluació multicontextual de nens catalano-parlants amb problemes de dolor. (2) Treballar en l'àmbit de l'epidemiologia, i aportar dades sobre els índex de prevalença i incidència dels problemes de dolor crònic en la nostra població de nens i adolescents d'entre 8 i 16 anys. I, aportar dades sobre les característiques d'aquests problemes i l'impacte que aquests problemes tenen sobre la vida del mateix nen. (3) Treballar per en l'àmbit de la prevenció secundària, i identificar predictors de tipus psicosocial del dolor crònic i/o la discapacitat. Understanding chronic pain and disability in young people: A study with Catalan schoolchildren Anna Huguet Roselló Tesis doctoral dirigida pel Dr. Jordi Miró Martínez Departament de Psicologia, Universitat Rovira I Virigili, Tarragona Juny, 2007 Recurrent and chronic pain is a widespread problem; in fact it has been considered to be a public health issue (Crombie, et al., 1999), one that requires careful attention due to the enormous amount of suffering and functional disability that it may cause. Pain has attracted attention of the humans since earliest recorded history (see for example, Sabatowski et al., 2004). However, and somewhat paradoxically, pain in children was completely devoid of interest until 1970s. Fortunately, the field of pediatric pain has changed dramatically. Over the last 25 years, there has been an increased interest in the study of pain as it occurs in youth. More and more resources have been invested into its treatment and prevention, research has paralleled growth too. This interest, however, is not so evident everywhere. For example, and as Reinoso-Barbero acknowledged (2003), pediatric pain still seems to be the poor brother of pain research in Spain. That is, despite the significant number of children in need of treatment, few clinicians and researchers are giving the attention to this problem that it deserves. Thus, most of these children do not receive the most appropriate treatment because clinicians are not familiar with these chronic conditions, assessment tools, and intervention strategies. In general, it can be said that children have to fight against their pain on their own, most of the times without receiving an appropriate treatment for their problem. At the same time, parents' concerns and suffering rise because their child's pain does not remit, and they do not know what to do. The propose of this study is to better understand chronic pain problems among the general population of children and adolescents. This thesis has tree aims. (1) To develop and examine the psychometric properties of assessment measure which allow us to understand pain problems from a biopsychosocial perspective. (2) To estimate the prevalence and incidence of chronic pain problems in Catalan schoolchildren aged 8 to 16 years and to examine the impact of pain problems on children's quality of life. (3) To work on the field of the secondary prevention and to identify psychosocial prognostic factors of the children's functioning and/or the course of pain complaints.

Aim of study to evaluate the epidemiological situation of overweight among Lithuanian adult population and its control possibilities in primary health care. Objectives- to evaluate the prevalence of overweight and obesity among Lithuanian population aged 20-64 years and its trends over 1994-2004, to determine the associations between overweight and social factors such as sex, age, the level of education and the place of residence and healt behaviuor,to determine the links between overweight and subjective health, to assess the level of giving advice on diet and physical activity by health care specialists and attempts of overweight persons to control their weight,to evaluate the possibilities of weight control in primary health care applying minimal intervention.

Previous studies based on data from the World Bank have shown a negative association between governance and HIV prevalence. Using the Index of African Governance, this study investigates the correlation between governance and HIV prevalence in all African countries (N = 53) in order to determine which dimension of governance is more predictive of this relationship. No statistically significant association was found between governance and HIV prevalence across the whole spectrum of countries. In the multivariate analysis, the most predictive dimension of governance, “Rule of Law, Transparency and Corruption” was found to be positively associated with HIV prevalence across all African countries (p <.001), Beta =.816 .When grouped by clusters, only two regions (North and West Africa) out of five showed negative significant associations between governance and HIV prevalence. The analysis of socio cultural and geographical factors revealed significant associations with HIV prevalence; religion and HIV prevalence ( p < .003), region, and HIV prevalence ( p < .001). French colonial heritage was found to be negatively associated with HIV prevalence. This study suggests that geographical location and religion predict HIV prevalence rather than governance. International organizations and public health program managers should consider these findings in the implementation of large multi-country and regional HIV programs in Africa.