In exploring current responses to crime, particularly youth involvement in gangs, this thesis examines two approaches: Crime Prevention through Social Development (CPSD) and risk-based prevention. The former is associated with the provision of socially-designed measures to address and eliminate the risk factor associated with persistent offending. The latter, however, refers to the implementation of risk management and statistical assessment to manage the risk factor associated with persistent offending. In light of these two approaches, this thesis examines a debate which purported that crime prevention practices has wholly shifted away from an emphasis on CPSD towards risk-based prevention. This thesis also examines the opposing debate which explains that CPSD and risk-based prevention have emerged into a balanced approach. Taking into account 19 youth gang prevention projects in Canada, the above debates are investigated. Drawing from the analysed project, this thesis concludes that, the crime prevention practices of the analyzed projects significantly rely on risk-based prevention. As a result, the approaches of CPSD still exist in rhetoric and in practice however, its influence on crime prevention initiatives is very limited. Hence, current approaches neither reflect a total shift away from CPSD nor a balanced approach.

This empirical research study focuses on the qualities of resilient adolescents in a technical school. The study indicates why some adolescents in a technical school are resilient, while other adolescents in this technical school are not resilient. Thirty resilient and thirty non-resilient adolescents in a technical school were chosen to participate in the empirical study. The empirical study consisted of quantitative research (a questionaire that was completed by the sixty adolescents), and qualitative research (three chosen resilient adolescents took part in an interview). This study is therefore a mixed methods study. The conclusions of the study were supported by the literature. The qualities of the resilient adolescent in a technical school are similar to the qualities of resilient adolescents in other contexts. Resilient adolescents in this technical school were characterized by protective factors and processes that had their roots in the individual, the community, culture and relationships. This study is an explorative study. More rigorous research is needed before this study's findings can be generalised. / Thesis (M.Ed.)--North-West University, Vaal Triangle Campus, 2008.

Noncommunicable diseases (NCDs) are the most prominent cause of adult mortality, killing 38 million people each year and on the rise[1]. Cancer, heart disease, diabetes and chronic respiratory diseases are responsible for 82% of NCD-related illness and death. These four diseases, along with mental illness, are estimated to cost the developing world $21 trillion over the next two decades.[2] Given the substantial health and economic detriments of NCDs, policy makers, government officials, and enterprises around the globe have begun to focus efforts on better understanding and preventing the proliferation of these diseases. Lifestyle factors, including increased inactivity, poor diet, and alcohol and tobacco consumption are currently the most commonly attributed risk factors of NCDs. With the influx of epidemiological literature linking meat consumption to western disease prevalence, and the World Health Organization (WHO) releasing a statement this year classifying processed meat as a Group 1 carcinogen alongside cigarette smoking, this thesis seeks to understand more thoroughly the role of diet, specifically meat consumption, in the incidence of cancer, heart disease and diabetes around the world. This paper analyzes previous epidemiological studies on dietary consumption and disease incidence as well as conducts an empirical analysis of data from the WHO and the Food and Agriculture Organization of the United Nations (FAO) to understand the relationship between meat consumption and disease prominence. This paper is the first of its kind to compare country-level data on dietary and lifestyle factors with respective disease incidence and mortality rates in order to observe the impact of country consumption trends on health outcomes. The results of this analysis may provide insight into global economic, health policy and individual-level consumption recommendations in order to mitigate the occurrence of ill-health.

Resilience characteristics typically have been studied among children and adolescents. A new line of research on resilience is focused on exploring the resilience characteristics of adults exposed to short and long-term adversity. In the present study, 585 master's-level counseling students responded to the Resilience Scale (Wagnild & Young, 1993). The purpose of this study was to examine the relationship between counseling students' level of resilience and specific background variables (age, gender, marital status, ethnicity, education, income, employment, living situation, sexual orientation, and country of origin), counselor-education program variables (primary field of study, number of credits taken, academic status, professional affiliations, supervision status, counseling courses, role identification, and accreditation), and risk (poverty, natural disasters, and terrorism) and protective variables (perceived support, school expectations, and community involvement). The results of this study indicated that resilience characteristics and the overall resilience score were associated with background variables, risk and protective variables, and counselingtraining- program variables. The counseling-training-program variables examined were minimally correlated with participants' resilience characteristics or their resilience score. The results of this study offer support for the adoption of wellness-based assessments of counseling trainees, as opposed to measures of impairment. Suggestions are offered for counselor educators and supervisors regarding possibilities for fostering the resilience of counseling trainees as well as counseling practitioners.

Introduction: The risk factors involved in treating transgender individuals with hormone therapy have been documented, but a full understanding of them remains elusive. Much of the research performed in transgender medicine is old or being completed overseas. It is thus the responsibility of current providers and investigators to expand our current knowledge, so this often marginalized population can receive the best quality care. Methods: A group of 28 transgender men and women who received care from the Endocrinology Clinic at Boston Medical Center were randomly selected as part of a quality control project to evaluate the risk factors involved in hormone therapy. Analysis was two-fold. First, change in lab values associated with known risk factors over a two-year period were assessed in individual patients. Second, group analysis sought to correlate changing hormone levels with lab values associated with known risk factors. Results: The result of the analysis was the majority of the patients who were observed did not suffer from any of the risk factors commonly associated with hormone therapy, and if anything benefited from the consistent clinical care. Several correlations were calculated between hormone levels and the lab values associated with the risk factors, however further analysis must be completed to confirm any connection. Discussion: The goal of this project was to not only evaluate care at Boston Medical Center, but also to draw attention to transgender health. In doing so, we have given an example of safe and effective hormone therapy and shown additional avenues for future research.

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.

MSc (Med), Epidemiology and Biostatistics, University of the Witwatersrand / Introduction This secondary data analysis of a prospective cohort study set out to describe the association between the use of hormonal contraception and sexually transmitted infection (STI) acquisition in a cohort of 752 HIV negative women who were followed up for a year. Methods Outcome variables were measured by standard laboratory tests (PCR for Chlamydia trachomatis (CT) and Neiserria gonorrhoea (NG), culture for Trichomonas vaginalis (TV) and gram stain with Nugent score for Bacterial Vaginosis (BV). Exposure variable information was collected by structured interview. Basic descriptive statistics were applied to describe the characteristics of the cohort, including a comparison of women who used contraception and those who did not. A time series analysis including incidence rates for the outcomes (CT, NG, TV and BV), Kaplan Meier curves for time to event measurement and Cox regression models (univariate and multivariate), for the estimation of risk were applied. Results The analysis found no significant difference between women who use hormonal contraception and those who did not with respect to baseline demographic characteristics. Incidence rates per 100 women years to follow up with 95% confidence intervals were: CT 13 (7 to 17), NG 2 (1 to 4), TV 6 (4 to10), BV 72 (63 to 83). Kaplan Meier curves showed no significant difference in time to event between women who used contraception and those who did not. Adjusted hazard ratios for women who used contraception was 1.12 (0.69 to1.82) for CT, 0.47 (0.17 to 1.30) for NG, 1.06 (0.48 to 2.34) for TV and 0.27 (0.05 to 1.52) for BV. Conclusion This analysis did not reveal any significant associations between the use of hormonal contraception and the acquisition of STIs, however the trends in risks follow those reported in the literature.

Rapid migration of people to the urban areas of developing countries resulted in a shortage of housing and the location of people in poor housing and unhealthy environments. Studies have shown that people who live in poor housing are at increased risk of exposure to the determinants of respiratory diseases. Objective: This study investigated the influence of housing conditions on respiratory disease in selected low cost housing settlements in Johannesburg, South Africa. Methodology: Secondary data analysis based on the Health, Environment and Development (HEAD) cross-sectional study were used to explore housing conditions in relation to respiratory health. Results: Black African households comprised (77%) the major population group in the study. The overall mean number of people per household was five with household size ranging from 1 to 22 people permanently living in the household. Most of the households (48%) had an average monthly income of R1001 to R2000. The self reported household prevalence of asthma was highest among households in Riverlea (21%). Households in Riverlea had reported higher levels of asthma 33% relative to households in Bertrams. Hairdressing activities within dwellings increased the risk of asthma (OR: 2.89, 95% CI 1.46-5.73). Tuberculosis was associated with household size (OR 0.9, 95% CI 0.79 – 0.99) and smoking (OR 0.4 CI 0.12 - 0.96) in the univariate analysis. However in the multivariate analysis there was no significant association between tuberculosis with household size (OR 0.92, 95% CI 0.80 - 1.05) or smoking (OR 0.03, 95% CI 0.12 – 1.00). Conclusion: In this study housing quality was an important determinant of respiratory health. More intervention strategies need to be employed to improve the living environment. These include increasing awareness and education to the public and other sectors, source reduction and more guidelines for healthy housing. Finally, more research on housing and health is needed to determine the effect of housing on health.

Introdução: A varicela é uma doença exantemática benigna da infância, causada por uma infecção primária pelo vírus Varicela-zoster. No Estado de São Paulo, no ano de 2003, foram notificados 58.972 casos de varicela mediante ocorrências de surtos, configurando um ano hiperendêmico para a doença. De um total de 60 óbitos em todo o Estado, 47 ocorreram em menores de 4 anos. Mais da metade dos óbitos incidiu em moradores da Região Metropolitana da Grande São Paulo. Objetivos: Descrever e caracterizar os indivíduos residentes na Região Metropolitana da Grande São Paulo que evoluíram para gravidade ou óbito por varicela em 2003 e estudar os fatores preditores desses eventos. Métodos: Realizou-se um estudo descritivo das variáveis sociodemográficas, clínicas, antecedentes pessoais e epidemiológicos dos casos de varicela, além de uma análise exploratória dos fatores preditores de gravidade e óbito pela doença. A existência de associação entre as exposições de interesse e gravidade ou óbito por varicela foi investigada pelas estimativas não ajustadas e ajustadas do odds ratio, com os respectivos intervalos de confiança de 95%, utilizando-se a regressão logística não condicional. Resultados: As seguintes variáveis demonstraram associação independente com gravidade e óbito por varicela: complicações raras, pulmonares, hemorrágicas e neurológicas. Cirurgia realizada durante a internação por varicela também foi um fator preditor de gravidade. A taxa de mortalidade foi 36 vezes maior na faixa etária de menores de 15 anos em relação à faixa etária de adultos, e 5 vezes maior na faixa de menores de um ano em comparação à faixa de 1 a 14 anos. Conclusão: O amplo conhecimento da epidemiologia da varicela, suas complicações e fatores de risco para gravidade e óbito, é de extrema importância para fundamentar a implementação de estratégias de prevenção e controle deste agravo nos grupos de maior risco. / Introduction: Chickenpox is a benign exanthematous disease of childhood, whose primary infection is caused by the Varicella-zoster virus. In the State of São Paulo, in 2003, 58,972 chickenpox cases were notified following outbreaks, configuring a hyperendemic year for the disease. From a total of 60 deaths in the whole State, 47 happened in children up to 4 years old. More than half of the deaths occurred in residents of the Greater São Paulo Metropolitan Area. Objectives: To describe and characterize those individuals residents in the Greater São Paulo Metropolitan Area who developed chickenpox severity or death during the year 2003, and to study the predictive factors of these events. Method: A descriptive study was performed, analyzing clinical and social-demographic variables, personal and epidemiological records of the chickenpox cases. Besides, an exploratory analysis of the redictive factors of severity and death by the disease was made. Association between exposures of interest and chickenpox severity or death was investigated by unadjusted and adjusted odds ratio estimation, with 95% confidence intervals, using unconditional logistic regression. Results: The following variables keep an independent association with severity and death for chickenpox: development of rare, pulmonary, hemorrhagic and neurological complications. The need of surgery during the chickenpox hospitalization was an independent predictive factor for severity only. The mortality rate was 36 times greater in the age group from 0 to 14 years old than in the adult age group, and 5 times greater in children up to 1 year old than in the age group ranging from 0 to 14 years old. Conclusion: The comprehensive knowledge of the chickenpox epidemiology, its complications and risk factors for severity and death is extremely important to base the implementation of prevention and control strategies for groups at greater risk of infection.

Introdução: O diabetes é considerado um problema crescente de saúde pública, devido o aumento da sua incidência e prevalência, principalmente na infância e na adolescência, além da sua inclusão entre as dez principais causas de mortalidade no Brasil e no mundo. Objetivos: Conhecer aspectos da saúde relacionados aos fatores de risco para o DM2 em adolescentes do ensino público do Município de Rio Branco Acre e a percepção dos pais dos adolescentes sobre a doença diabetes, assim como sinais e sintomas, medidas preventivas e suas aspirações sobre o tema. Procedimentos Metodológicos: O estudo quanti-qualitativo foi do tipo transversal com amostragem probabilística e representativa de 720 adolescentes, de ambos os sexos e com idades entre 10 e 18 anos, matriculados nas escolas públicas do ensino fundamental, da área urbana do Município de Rio Branco Acre. A análise estatística foi do tipo descritiva: distribuição de frequência, medidas de tendência central e medidas de dispersão. Os testes de Qui-quadrado de Pearson e Fischer foram utilizados para verificar possíveis associações entre as variáveis categóricas e, para verificar a diferença de médias, o teste t de Student. Para o estudo qualitativo utilizou-se a técnica de grupo focal e a análise de conteúdo na amostra constituída por seis pais de adolescentes com glicemias de jejum alteradas/limítrofes. Para a coleta de dados foram utilizados os seguintes instrumentos: questionário socioeconômico e demográfico, o Rec24h, para avaliação do consumo alimentar e o IPAQ para avaliação do nível da atividade física, além do roteiro semi-estruturado para a condução do grupo focal. Resultados: Dos 720 adolescentes, 51,8por cento eram do sexo feminino, com média de idade de 12,73 anos, (dp ± 1,57), variando entre 10 e 18 anos; a etnia autorreferida predominante foi a branca 576 (80por cento ). Foi possível observar que 153 (21,3por cento ) estavam com sobrepeso, 273 (37,9por cento ) sedentários, além de 244 relatos de história familiar de diabetes. O sexo masculino apresentou maior média de consumo de energia, macronutrientes e fibras. A média glicêmica foi de 55,18mg/dl, com 10 (1,4por cento ) adolescentes apresentando glicemia plasmática de jejum alterada/limítrofe. As frequências entre a associação de fatores de risco para o diabetes foi maior entre 2 (87,8por cento ) que 3 (12,2por cento ) fatores. O grupo de pais demonstrou ter conhecimento de alguém diabético com relacionamento familiar ou social, dificuldade em entender o processo de manifestação da doença e interesse em conhecer os fatores de risco da mesma. Conclusão: Os fatores de risco para o diabetes estão presentes entre os adolescentes do Município de Rio Branco Acre / Introduction: Diabetes is considered a growing public health problem because of its increased incidence and prevalence, especially during childhood and adolescence in addition to its inclusion among the ten leading causes of death in Brazil and all over the world. Objectives: To find out what are the health aspects related to risk factors for type 2 diabetes in adolescents from the public school system in the city of Rio Branco - Acre and to find out what is the perception of the parents of teenagers about diabetes, as well as what are the signs and symptoms, the preventive measures and their expectancies regarding this issue. Methodological Procedures: This quantitative and qualitative study was cross-sectional study with probability sampling representing 720 adolescents of both sexes and aged between 10 and 18 years, who were enrolled in public primary schools in the urban area of the municipality of Rio Branco - Acre. The statistical analysis was descriptive: frequency distribution, central tendency measures and dispersion measures. The Chi-square tests of Pearson and Fischer were used to investigate possible association among the categorical variables and to detect averages differences we used the \"t\" Student test. For the qualitative study we used the focus group technique and the content analysis on a sample of six parents of adolescents with impaired / borderline fasting glucose. To collect data we used the following instruments: socioeconomic and demographic questionnaire and anthropometric data, Rec24h to assess dietary intake and the IPAQ to evaluate the level of physical activity, besides the semi-structured guidelines to conduct the focus group. Results: Of 720 adolescents, 51.8per cent were female, mean age of 12.73 years (SD ± 1.57), ranging between 10 and 18 years, the predominant self-reported ethnicity was Caucasian 576 (80 per cent ). It was observed that 153 (21.3per cent ) were overweight, 273 (37.9per cent ) sedentary, besides the 244 reports of a family history of diabetes. Males had higher mean intake of energy, macronutrients and fiber. Mean blood glucose was 55.18 mg / dl, with 10 (1.4per cent ) adolescents with fasting plasma glucose impaired / borderline. The frequency among factor associat ion of risk factors for diabetes was higher between 2 (87,8per cent ) than 3 (12,2per cent ) factors.The group of parents demonstrated, through their statements that they knew someone with diabetes in their family or social relationships; they had difficulties to understanding the disease manifestation process and they were interested in getting to know which were the risk factors. Conclusion: The risk factors for diabetes are present among the adolescents in the city of Rio Branco Acre.