Many men who have sex with men (MSM) engage in alcohol and drug use. Drug use, particularly methamphetamines, amyl nitrates (poppers), and drugs used to treat erectile dysfunction among MSM may also contribute to risks such as unprotected sex, which leads to the possibility of contracting syphilis, Human immunodeficiency virus (HIV), and other Sexually Transmitted Infections (STIs). In the Metro Atlanta Area (Fulton and Dekalb Counties), primary and secondary syphilis rates among MSM are still rising and rank highest among the other counties in the area. Guided by the risk and protective factor theory, the purpose of this study was to determine if club drug use was a contributing factor in high-risk sexual behavior among MSM with syphilis. Data were collected from the State Electronic Notifiable Disease Surveillance System with permission from the State of Georgia's Division of Public Health's STD division and was tested by using hierarchical regression analyses. The findings were inconsistent with the reported literature; there was no association between drug use and risky sexual behavior in this sample of MSM infected with syphilis. However, there was an association between prior incarceration being predictive of engaging in sex with anonymous partners and having sex while high. Implications for positive social change include evidence for the need for public health interventions that target incarcerated MSM because they exhibit the highest-risk sexual behavior due to their time served in the correctional system. Further exploration of this topic could be used to develop health information and policies to meet the needs of those affected by high-risk sexual behavior while incarcerated and upon release, ultimately reducing the spread of HIV.

Multidrug-resistant Mycobacterium tuberculosis (MDR-TB) is a leading cause of morbidity and mortality in the Philippines. The purpose of this study was to gain knowledge about the relationship between potential risk factors and MDR-TB. Risk factors (the independent variables) for MDR-TB (the dependent variable) include previous TB treatment, infection with HIV, exposure to patients with drug-susceptible TB/MDR-TB, delays in diagnosis and treatment, employment status, smoking, imprisonment, alcohol abuse, and poor compliance with TB treatment regimens. The study was based on the epidemiological approach to causal inference work. A case-control study design was used wherein a quantitative method was applied in data analysis to assess the strength of the pre-identified possible risk factor(s) association to MDR-TB infection. Data were collected using survey questionnaires that were administered to patients (N = 172) from health centers in Leyte, San Mateo Rizal, and San Lazaro. Hypotheses were tested using chi-square analysis, Fisher's exact test, and an odd ratio. Drug-susceptible TB respondents who smoked on a daily basis were three times more likely (95% CI 1.021-13.341, OR 3.69) to develop an MDR-TB infection than were other respondents. Respondents who did not comply with the anti-TB treatment regimen were nine times more likely (95% CI 2.104-43.059, OR 9.519) to develop an MDR-TB infection than other respondents. Health care providers may be able to use study findings to develop programs to help drug-susceptible TB patients stop smoking and better comply with treatment regimens designed to prevent MDR-TB infection, resulting, potentially, in improved public health outcomes for patients.

The current study examined whether elevations on four variables (drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness) were related to increased risk of developing an eating disorder over a 4-year prospective interval. Subjects (N = 191) were female undergraduates who were assessed with the Anorexia-Bulimia Inventory (ABI), Eating Disorder Inventory (EDI), and a structured clinical interview. Results indicated that individuals with elevated scores on each of the four variables at the initial assessment did not show higher absolute eating disorder incidence rates over the 4-year interval. However, initial scores on the four variables together lll explained approximately 13% of both anorexia and bulimia symptom severity variance at the final assessment. Changes over time in the four variables were more highly related to later symptom severity, explaining 34% of the variance in anorexic severity and 16% in bulimic severity. Thus, the findings suggest that initial scores, and especially changes in scores, on the four variables were related to severity of symptoms 4 years later. However, a large proportion of the variance in eating disorder severity remained unexplained. Examination of the role of each risk variable individually revealed that initial elevations on maladaptive cognitions and drive for thinness subscales were related to higher anorexic symptom severity at the later assessment. Of interest was the absence of significant relationships between early scores on maladaptive cognitions and drive for thinness and subsequent bulimic symptoms, suggesting that anorexia and bulimia may have somewhat different risk pathways. The pretest scores on the depressed mood and ineffectiveness subscales were not significantly correlated with symptom severity at the later assessment, and were not identified by the regression analyses as parsimonious or efficient predictors of eating disorder symptoms. This finding suggests that perhaps early difficulties with depression and low self-esteem are less related to onset of later eating disorders than previously believed. Finally, the overall 4-year incidence rate of .6% found in the current study suggests that as women move through their college years, they are departing the developmental period of high risk for onset of eating disorders, and thus, new cases become increasingly rare.

adolescent sexual activity and subsequent pregnancy are ii an increasing dilemma facing American society . There appears to be an increase in the incidence of casual sexual activity among adolescents that leads to over 50% of students between grades 9 and 12 having been involved in sexual intercourse. This study examines changes in adolescent sexual attitudes, behaviors, and values in a select population over a 2-year time span. A survey of 548 families with adolescents was used to determine the impact of the Facts and Feelings home-based sexual abstinence program on mean scores for academic aspirations, academic achievement , sexual knowledge, the intention to have intercourse, sexual behavior, religiosity, mother approachability, father approachability, frequency of parental communication, sexual abstinence skills, friends' approval of premarital sex, value against sex prior to marriage, risk of contracting a sexually transmitted disease, sex being acceptable in relationships, adolescent's values match parent's values, parents approve of premarital sex, and adolescent's rating of physical maturity. The sample was randomly split into equal size experimental and control groups . The treatment materials were given to the experimental group following a baseline measurement, and the control group received the materials after the study was completed 2 years later. Data were collected at four time intervals: pretest, 3-rnonth posttest, 1-year posttest, and 2-year posttest . Dependent variables were identified from previous research as possible antecedents to early sexual activity The youth studied were in the sixth and seventh grades, and were generally sexually abstinent throughout the study. Hypotheses were related to gender, group membership, and the i nteraction of these variables over time. A majority of the significant findings carne in the hypotheses regarding gender. There were limited findings in the hypothesis that dealt with group membership, group membership by gender, and the interaction effects of gender by group over time . Most of the treatment effects were time limited and not maintained for l ong periods of time following the treatment. There was evidence that the Facts and Feeling materials used in the study were beneficial in changing behavior, values, and attitudes regarding teenage abstinence for a short time immediately following the treatment period.

Orientador: Rômulo Araújo Fernandes / Resumo: Objetivo: Analisar a associação entre a manutenção da prática esportiva e os parâmetros inflamatório, metabólicos e cardiovasculares entre adolescentes. Métodos: Estudo de 12 meses de seguimento, dados provenientes do estudo intitulado “Analysis of Behaviors of Children During Growth” (ABCD Growth Study) conduzido em Presidente Prudente, SP. Por meio de amostragem por conveniência foram selecionadas instituições de ensino e clubes esportivos da cidade de Presidente Prudente e região. Destas instituições, após a aprovação dos diretores e técnicos, foram convidados para participar do ABCD Growth Study todos os adolescentes com idade entre 11 e 18 anos. Na primeira fase do estudo, 285 adolescentes aceitaram participar, destes 259 (esportistas n=168; não esportistas n= 91) completaram as avaliações iniciais. Após 12 meses, 189 adolescentes permaneceram no estudo (124 esportistas e 65 não esportistas). Prática esportiva foi autorrelatada. Proteína C reativa (PCR) foi dosada por meio do método de imunoensaio de ponto fixo química seca. Espessura médio-intimal das artérias carótida e femoral e variáveis dopplerfluxométricas foram avaliadas por meio de um aparelho de ultrassonografia. Adiposidade corporal foi estimada pela densitometria óssea. Colesterol total (CT), lipoproteínas de alta (HDL-c), baixa (LDL-c) densidade, triacilglicerol (TG) e glicose foram mensuradas pelo método de inibição seletiva, química seca. A insulina foi analisada pelo método de quimioluminescencia e a resis... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To analyze the association between the maintenance of sport participation and inflammatory, metabolic and cardiovascular parameters in adolescents. Methods: Study of 12 months of follow up, in which dataset is part of an ongoing study intitled “Analysis of Behaviors of Children During Growth” (ABCD Growth Study) developed in Presidente Prudente, SP. Through convenience sampling was selected educational institutions and sport clubs of Presidente Prudente and region (gymnastics, track and field, karate, judo, kung fu, baseball, basketball, swimming and tennis). From these facilities, after principals and coaches approved the study, our staff invited all adolescents aged 11 to 18 years. In the first phase of the study, 285 adolescents accepted to participe, however 259 (sports n=168; non-sport= 91) completed all measurements. After 12 months of follow-up 189 adolescents was examined (124 engaged in sports and 65 non-sport group). Engagement in sport was self reported. C reactive protein (CRP) was determined by the immunoassay method using a specific kit. Carotid and femoral intima-media thickness and blood flow markers were assessed using an ultrasound equipment. Body fatness was estimated through densitometer scanner. Total cholesterol (TC), high (HDL-c), low (LDL-c) density lipoprotein, triacylglycerol (TG) and glucose were measured by the colorimetric method of dry chemistry. Insulin levels was analyzed by chemiluminescence method using a microparticle immunoassay ... (Complete abstract click electronic access below) / Doutor

Numerous Thai older people fall each year. Although it has been shown that only 3.1% of fallers sustained fractures (Nevitt, Cumming, Kidd, & Black, 1989), injuries in older people are often more serious. For example, hospital charges for older adult fall injuries are about US $2,000 per person higher than for young fallers (Ellis & Trent, 2001). Moreover, falling can lead to social isolation, physical restraint, disability and institutionalisation (Donald & Bulpitt, 1999; Tideiksaar, 1994). Therefore falling in old age results in a considerable burden on, not only the individual concerned, but also the whole society. Internationally, a successful falls prevention program usually employs a multidimensional approaches (Alexander & Edelberg, 2002; Mosley, Galindo- Ciocon, Peak, & West, 1998). However, limited information about fall prevention has been reported in Thailand. A survey indicated that Thai elderly fall outside their homes which is different from the findings in Western countries (Jitapunkul et al., 1998). This suggests that adoption of fall prevention strategies from Western countries might not be successful in Thailand. Prior to this study, details of fall circumstances in terms of location, time, associated activity, hazards and type of falls in Thai older people were not available. Moreover, there was no information about fear of falling and activity restriction. These are important fall consequences that impact on quality of life and themselves are risk factors for falls. The purpose of this study was to determine the prevalence of fear of falling, and to describe activity restriction in fallers and non-fallers, and the circumstances associated with falls in Thailand. No fear of falling measurement tools for Thai older people were available prior to the study. / Therefore the Survey of Activities and Fear of Falling in the elderly (SAFE) has been modified for use with Thai elderly people. The SAFE was translated to Thai by a certified translator, checked for cultural relevance and back-translated by a second translator; reliability testing then took place in Thailand. Face validity and cultural appropriateness were tested with a sample of convenience of 10 bilingual Thai elderly people living in Perth, Australia. After translation into Thai, 4 items showed less than 80% agreement and required adjustment to capture the equivalent meaning of the original version. The ‘take a show/wash yourself with a basin of water’ was added because the participants reported that taking a tub bath is not common or traditional in Thailand. However, the item ‘take a tub bath’ was retained until the examination in the main study confirmed that less than 1% of Thai older persons had taken a tub bath and inclusion of the item confounded actual fear of falling results. Interrater reliability was tested; nine 4th year occupational therapy students and 15 older persons living in the Chiang Mai community were recruited. The intraclass correlation coefficient of fear of falling of activities done, activities not done and activity restriction scores were .9845, .9236 and .9718 respectively (p < 0.001). Four raters and 50 older community dwellers participated in the intrarater and test-retest reliability tests. The results showed that intrarater reliability of all raters exceed 0.8 in every scores (p < .001). / The test-retest also demonstrated good reliability: .9960, .9376 and .9849 (p < 0.0001) for fear of falling of activities done, activities not done and activity restriction scores respectively. Five hundreds and forty six Thai older adults were then recruited by multistage random sampling. Fall history, fall circumstances, fear of falling and activity restriction data were obtained by structured interview and using the Thai version of the SAFE. The results demonstrated that prevalence of falls, fear of falling and activity restriction in Thai older people were 21%, 48% and 18%, respectively. Comparison between fallers and non-faller showed that fallers were more likely to be older (p < .001), female [χ2(1, N = 546) = 6.133; p = .013], not married [χ2 (4,N=546)=61.102;~= .001], living alone[χ2 (l,N=546)=4.313;p= ,041, rated their health as poorer [χ2 (4, N = 546) = 13.232; p < .001], had fear of falling [χ2 (1, N = 546) = 6.265; p = .015] and activity restriction [χ2 (1, N = 546) = 5.488; p = ,0271]. Older persons with a fear of falling tended to be older (p = .005), lower educated (p < .001), female [χ2 (1, N = 546) = 29.602; p = .001], rated their health as poorer [χ2 (4, N = 546) = 69.70; p < .001], had fallen [? (1, N = 546) = 6.265; p = ,0151 and had activity restriction [χ2 (l, N = 546) = 23.267; p < .001]. Older adults who curtailed their activities tended to be married [χ2 (1, N = 546) = 6.188; p = ,0131, rated their health as poorer [χ24, N = 546) = 14.302; p = ,0061, have a fall history [χ2 (1, N = 546) = 5.488; p = ,0271 and have a fear of falling [χ2(1, N = 546) = 23.267; p < .001]. / Using Chi-square test, the results showed that there were significant associations between falls and fear of falling χ2(l,N=546)=6.265;p=.015], falls and activity restriction [χ2 (l,N= 546) = 5.488; p = ,0271] and fear of falling and activity restriction [χ2 (1, N = 546) = 23.267; p < .001]. Fall circumstances of 114 falls demonstrated that most falls took place outdoors (65%), were associated with work (40%), involved environmental hazards (76%), occurred during the daytime (90%). Moreover most falls were falls on the same level from slipping, tripping or stumbling (61%). Logistic regression analysis indicated that risk factors for fear of falling in Thai older people were age (odds ratio = 1.025), unmarried-female (odds ratio = 5.979), married female (odds ratio = 1.903), poor self perceived health (odds ratio = 3.383) and more than 2 falls experience (odds ratio = 7.202). The protective factors were unmarried marital status for men (odds ratio = 0.344) and level of education (odds ratio = 0.933 2 or less falls and = 0.5625 if more than 2 falls in 12 months). The logistic model also provided a logistic equation for individual prediction of probability of fear of falling. To calculate the probability of having fear of falling, 6 parameters are required: age, gender, marital status, level of education, self-perceived health and number of falls in the past 12 months. The equation predicts with 70% accuracy and can be used for screening fear of falling in Thai elderly people. In conclusion, this study has modified a measurement tool (the SAFE Thai version) and developed a screening tool (logistic equation) for fear of falling. Both of them appear to be appropriate to further examine FOF in Thai elderly. The survey results showed a considerably number of Thai elderly people have fall experiences, fear of falling and activity restriction. / The predisposing factors for each problem have been identified. The association between 3 problems implicated that fear of falling and activity restriction interventions are necessary for fall prevention. The fall circumstances data show that conditions of falls in Thai elderly people were similar and dissimilar to those in Western countries. The preventive efforts to reduce falls should consider these distinctive fall circumstances.

The lifting associated with childcare has been linked to musculoskeletal disorders (MSDs) in mothers (Griffin & Price, 2000; Sanders & Morse, 2005). The purpose of the current study was to investigate, for the first time through observation, the lifting of young children by mothers in the home environment to identify risk factors which might give rise to MSDs. Twenty five mothers with one or two children weighing between 9 and 15kg (n = 30) completed a self-report survey modified for the New Zealand context (The Ergonomics of Caring for Children (Sanders & Morse, 2005)). They also took part in a structured observation of lifting in the home using a checklist based on the New Zealand Manual Handling Hazard Control Record NZMHHCR (OSH & ACC, 2001). Modifications were derived from careful consultation of current literature to enable contributory factors related to the load, the mother, the environment and the task to be assessed and a rating of low, medium, or high risk to be assigned to each factor. A protocol to guide risk assessment was developed to accompany the tool. The modified observational checklist was named the OMLITH (Observing Mothers Lifting In The Home). Survey data identified the mothers as aged between 28 and 40 years, predominantly NZ European, and of average height (χ = 1.69cm) and weight (Body Mass Index = 24). The children in the sample weighed between 9 and 14.5kg and had an average age of 17months. All the mothers were either married (n=20) or living with a significant other (n=5) and their partners frequently (n=13) or always (n=12) helped with childcare. The mean time mothers spent per week on the following activities were: sleep, 6.8hrs (n=25), housework, 14.9hrs (n=25), exercise, 2.9hrs (n=22), watching television or using the home computer, 4.3hrs (n=22), hobbies, 2.2hrs (n=19), gardening or home maintenance, 2.9hrs (n=18). Thirteen of the mothers worked (3 full-time, 10 part-time) and 20 mothers used childcare services. Ratings of the physical stress associated with 50 childcare tasks showed that mothers differentiated between tasks in terms of physical stress to a significant degree (p.000), typically rating ‘Bending while carrying a child’ as almost twice as stressful as the average rating. Other categories rated significantly above the average stress rating were: ‘Use of a backpack to carry infant/child’, ‘Use of baby jogger’, ‘Carrying child on your shoulders’, ‘Standing bent over to wash child in bath or sink’, ‘Lifting child into or out of cot’, ‘Prolonged squatting or stooping while playing with child’, and ‘Placing child in car seat or removing child from car seat’. Mothers reported experiencing MSDs most commonly in the low back (n=16), and the neck, shoulder and upper back (n=8 each). Data from the 87 observations using the OMLITH showed that children were a challenging load due to their moving centre of gravity, and were often unpredictable or awkward to handle. The grip required to lift a child more often than not fell outside the National Institute for Occupational Safety and Health (NIOSH) recommendation. In 72.9% of tasks the child’s weight created a high risk level. The lifting tasks involved horizontal and vertical lift distances that presented a moderate to high risk level in 82.8% of situations. Lifting while twisting and side-bending was assigned a moderate to high risk level in 72.4% of tasks. Risk associated with working at an externally controlled pace; and handling children while seated or kneeling/crouching was also observed. The home environment presented risk associated with obstacles, a variety of floor surfaces and stairs or slopes. Mothers were also observed lifting in confined spaces. Individual factors identified as important considerations were: a mismatch between mothers’ strength and fitness and the lifting requirements, pain or injury, pregnancy, and fatigue. The structured checklist proved to be an appropriate tool to identify the contributory risk factors present when mothers lift in the home and to make an assessment of the level of risk. Results suggest a notable number of risk factors which might give rise to MSDs are present when mothers lift their children at home. The author concludes that further research is warranted to quantify risks, to identify prevention strategies for MSDs in this population, and to guide health providers with regard to treatment and rehabilitation of mothers with MSDs.

It is consistently documented in the literature that Asian Indians are at high risk of coronary heart disease and this risk is exacerbated among migrant Asian Indians globally. Asian Indians have a premature, markedly severe and malignant course of coronary heart disease. This study was built on the premise that in order to provide culturally competent and sensitive care for migrant Asian Indians with coronary heart disease in a multicultural society such as Australia, it is important to explore migrant Asian Indians’ experiences, risk factor knowledge and health beliefs and behaviours in relation to coronary heart disease. Findings indicate the need for health promotion and cardiac illness prevention programs that use intervention models of health behaviour change and are sensitive to the needs of migrants from Asian Indian culture. The major limitation of the study was that the data obtained were from a group of tertiary-educated migrant Indians. Future studies should explore the coronary heart disease perspectives of migrant Indians with different education levels and from the perspective of second-generation Indians in Australia. / Doctor of Philosophy (PhD)

(Truncated abstract) The aims of this thesis are: (i) To estimate the prevalence of psychiatric illness among persons with intellectual disability and, conversely, the prevalence of intellectual disability among persons with a psychiatric illness; (ii) To describe the disability and service utilisation profile of persons with conjoint disorder; (iii) To examine, in particular, intellectual disability co-occurring with schizophrenia; and (iv) To explore the role of hereditary and environmental (specifically obstetric) risk factors in the aetiology of (i) intellectual disability and (ii) intellectual disability co-occurring with psychiatric illness. This thesis has a special interest in the relationship between intellectual disability and schizophrenia. Where data and sample sizes permit, it explores that relationship at some depth and has included sections on the putative nature of the link between intellectual disability and schizophrenia in the introductory and discussion chapters. To realise its objectives, the thesis comprises a core study focusing on aims (i) – (iii) and a supplementary study whose focus is aim (iv). It also draws on work from an ancillary study completed prior to the period of candidacy...This thesis found that, overall, 31.7% of persons with an intellectual disability had a psychiatric illness; 1.8% of persons with a psychiatric illness had an intellectual disability. The rate of schizophrenia, but not bipolar disorder or unipolar major depression, was greatly increased among cases of conjoint disorder: depending on birth cohort, 3.7-5.2% of individuals with intellectual disability had co-occurring schizophrenia. Down syndrome was much less prevalent among conjoint disorder cases despite being the most predominant cause of intellectual disability while pervasive developmental disorder was over-represented. Persons with conjoint disorder had a more severe clinical profile including higher mortality rates than those with a single disability. The supplementary study confirmed the findings in the core body of work with respect to the extent of conjoint disorder, its severity, and its relationship with pervasive development disorder and Down syndrome. Moreover, the supplementary study and the ancillary influenza study indicated a role for neurodevelopmental insults including obstetric complications in the adverse neuropsychiatric outcomes, with timing of the insult a potentially critical element in defining the specific outcome. The supplementary study also added new information on familiality in intellectual disability. It found that, in addition to parental intellectual disability status and exposure to labour and delivery complications at birth, parental psychiatric status was an independent predictor of intellectual disability in offspring as well as a predictor of conjoint disorder. In conclusion, the facility to collect and integrate records held by separate State administrative health jurisdictions, and to analyse them within the one database has had a marked impact on the capacity for this thesis to estimate the prevalence of conjoint disorder among intellectually disabled and psychiatric populations, and to understand more about its clinical manifestations and aetiological underpinnings.

Coronary Heart Disease (CHD) is a major cause of death in Western countries. Mediterranean and Asian populations have a lower risk of death from CHD compared to Westernised population, as do vegetarian versus omnivorous populations. Dietary constituents of traditional diets consumed by these populations are thought to influence both the classical risk factors for CHD, and the more recently identified risk factors, such as oxidative modification of low density lipoprotein (LDL), LDL particle size, arterial compliance and haemostatic factors. The aim of this thesis was to examine the effects of several food components, particularly soybean and monounsaturated fat (MUFA), on CHD risk factors through 3 carefully controlled dietary interventions, and a cross-sectional study. A randomised crossover dietary intervention study was conducted in 42 healthy males to investigate the effect on CHD risk factors of replacing lean meat with tofu, a soybean product regularly consumed by Asian populations, while controlling all other dietary factors. The tofu diet resulted in significantly lower total cholesterol and triacylglycerol levels compared to the lean meat diet, and LDL particles that were more resistant to in vitro oxidative modification. However, insulin, fibrinogen, factor VII, and lipoprotein (a) were not significantly different on the 2 diets. A postprandial study was subsequently conducted to investigate any acute effects of a tofu test meal on the oxidative modification of LDL in 16 male subjects. There was no significant difference between the susceptibility of LDL to oxidative modification before and after the tofu meal. Twenty eight healthy subjects completed a separate randomised crossover dietary intervention comparing a high MUFA fat diet, using an Australian high oleic sunflower oil, with a low fat, high carbohydrate diet on CHD risk factors. The high MUFA oil diet significantly increased high density lipoprotein cholesterol compared to the low fat diet as well as producing LDL that were more resistant to oxidative modification. Neither the size of the LDL particle nor arterial compliance were significantly different on the 2 diets. Twelve matched pairs of vegetations and omnivores were also studies to compare the habitual diet of a low and higher risk population group, to compare their risk factors and identify dietary constituents that may explain the differences. The vegetarians consumed less saturated fat (SFA) and dietary cholesterol while consuming more polyunsaturated fat, dietary fibre and vitamin E compared to omnivores. The vegetarians had lower total cholesterol, LDL cholesterol and triacylglycerol levels compared to the omnivores and had LDL particles that were more resistant to in vitro oxidation. These findings contribute to our knowledge about the dietary constituents that can alter some CHD risk factors in healthy subjects, and which could reduce the risk of developing CHD. Investigations in high risk groups might reveal even more benefits.