Magister Scientiae (Physiotherapy) - MSc(Physio) / Dance movements requires explosive power, sustained effort and both local and general endurance. Musculoskeletal injuries (MSI) are the most frequent medical problems among dancers in ballet, which is partly owing to inadequate training and dancers not being properly prepared for the demands of the dance performance. The purpose of the present study was to determine the cumulative incidence of musculoskeletal injuries amongst student dancers at TUT. The study used a prospective, cohort design. A total of 49 student dancers at Tshwane University of Technology (TUT) were followed up over 16 weeks in the 2007 academic year. The student dancers completed a questionnaire about previous injuries, and factors influencing injuries. Of the 49 student dancers, 41 (83%) consent to participate. There were 10 cumulative injuries incurred by 41 student dancers over 16 weeks period i.e. 7.1 %, 0.06 injuries incurred per student month at risk.The main limitations to this study were small sample size and possible reporting biases. Further research should aim to standardize injury definitions and classifications.

Bullying victimization is a common experience for many students (Hoover, Oliver, & Hazler, 1992; Lund & Ross, 2017; Modecki, Minchin, Harbaugh, Guerra, & Runions, 2014). The vast majority of studies on the subject have focused on children and adolescents, but research shows that bullying victimization may continue into adulthood for some (Chapell, Casey, & De la Cruz, 2004; Finn, 2004). This suggests that certain students are at risk throughout their lifetime likely due to stable or innate risk factors. Researchers have proposed that personality traits, specifically neuroticism, and emotion regulation deficits are risk factors for bullying victimization (Hemphill, Tollit, Kotevski, & Heerde, 2015; Mynard & Joseph, 1997; Nielsen & Knardahl, 2014). The current study assessed bullying victimization for students attending a public Midwestern university. The rates for college students, influence of prior bullying victimization, and common associated difficulties were assessed. In addition, the current study measured difficulties in emotion regulation and changes in affect in response to bullying victimization vignettes. The results from the current study indicated that bullying continues into college for some students and is best predicted by bullying victimization in primary and secondary school. Results from this study supported the use of a vignette as a mood induction procedure for both victimized and non-victimized students. When taken together, these findings have implications for future research and intervention efforts, which are discussed.

Pediatric food allergies (FA) are increasing in prevalence and have been associated with decreased quality of life (QOL) and impairment in physical, social, academic, and family functioning; however, little is known about the risk factors for psychological distress in this cohort. This was the first large-scale study to examine child, parent, and FA-related factors that may affect functioning in youth with FA. The sample consisted of 533 mothers of children with FA and 241 mothers of children with no chronic medical conditions, recruited through online forums. Mothers completed online questionnaires assessing their child's psychosocial health, physical health, and FA characteristics, as well as their own parenting behaviors and symptoms of psychological distress. It was hypothesized that (1) FA children would exhibit poorer functioning than healthy children; (2) mothers of FA children would exhibit higher levels of psychological distress than mothers of Healthy Control (HC) children; (3) higher FA severity would predict poorer child functioning; and (4) maternal psychological symptoms, overprotection, and gender would moderate the associations between presence of FA and child functioning, and between FA severity and child functioning. Results showed that (1) FA youth exhibited significantly better functioning than healthy children; (2) mothers of FA youth reported significantly less psychological distress than mothers of healthy children; (3) higher FA severity predicted poorer child functioning; and (4) these associations were moderated by maternal depression, anxiety, stress, and overprotection, but not by gender. Specifically, associations between presence of FA and child health-related QOL, child psychosocial health, and physical health were significantly stronger among children whose mothers were more depressed, anxious, and stressed. The associations between presence of FA and child psychosocial health were significantly weaker among highly overprotective mothers, indicating that in line with the anxiety disorder literature, overprotection in mothers of children with FA may serve a maladaptive function. These findings suggest that FA youth and their mothers are a particularly vulnerable population who may benefit from psychosocial interventions to address the psychological distress and interference associated with having FA.

Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can positively impact crisis intervention. Because these clinicians often develop long-term relationships with patients and work with them on a consistent basis, they are well-positioned to recognize early signs of crisis and make timely referrals to the appropriate health and social service providers but currently lack resources to guide in this decision-making. A better understanding of characteristics of this population related to crisis is needed in order to develop accessible and useful screening tools and to improve clinical reasoning. The purpose of this dissertation was to identify pertinent risk factors related to crisis for individuals with IDD using a novel, objective crisis definition. Using a mixed methods approach, a revised definition of crisis was developed through surveying of expert clinicians and healthcare administrators at a specialty care clinic for individuals with IDD. The addition of four crisis-related events were included in the definition: (1) unplanned hospital utilization; (2) involvement with the criminal justice system; (3) abuse/victimization; (4) unplanned change in living environment. Using retrospective chart review, these four crisis-related events were further analyzed and validated by comparing their occurrence in patients who did (N=41) and did not (N=144) receive formal crisis intervention services at the clinic between January 1, 2014 and March 1, 2019. The risk for unplanned hospital utilization was 3.4 times higher for crisis patients. The risk for involvement with the police or criminal justice system was 13.86 times higher for crisis patients. The risk for abuse and/or victimization was 6.21 times higher for crisis patients. The risk for unplanned change(s) in living environment was 12.7 times higher for crisis patients. Overall, 90% of crisis patients experienced at least one of the four crisis-related events during the study period, compared to 54.2% of non-crisis patients. Five additional risk factors were identified that increased crisis risk: hypothyroidism, bipolar disorder, intermittent explosive disorder, personality disorder, and have multiple psychiatric disorders. No statistically significant differences were found between crisis and non-crisis patients for intellectual disability severity level, mobility status, communication status, neurodevelopmental diagnosis, age, race/ethnicity, or living environment. To the best of our knowledge, the identification of hypothyroidism as a potential crisis risk factor was a novel discovery not previously reported in the literature. The findings of this dissertation have multiple implications for clinical practice and add to the body of knowledge regarding crisis experiences for individuals with IDD. First and foremost, over a fifth of our study sample (22%) utilized formal crisis management services during the study period. This suggests that crisis episodes are common in the IDD population. As the majority of individuals with IDD are community-dwelling and life expectancy continues to increase, the likelihood of physical therapists encountering adults with IDD in clinical practice will subsequently increase. However, physical therapists and physical therapy students routinely report feeling unconfident and uncomfortable treating individuals with disabilities, including individuals with IDD. There is a need, then, to improve clinician confidence and skills to ensure that individuals with IDD receive optimal care, especially into adulthood. The findings of these studies provide foundational knowledge and point toward trends in crisis experiences that can help guide physical therapists and other rehabilitation clinicians.

With the recent emergence of candidemia as a significant cause of mortality in our health care system, clinicians must identify methods to minimize the sequelae of infection of this type in patients already burdened with serious underlying conditions. While well established as a major cause of blood stream infection (BSI), candidemia has been shown to have some of the highest rates of inappropriate therapy when compared to infections from all other sources. Rates of inappropriate therapy may be even higher for some of the less common and antifungal resistant non-albicans candidemia. Identifying those patients at risk for the development of these types of infections will help improve clinical outcomes. Antifungal activity is dependent both on species and agent, describing the unique susceptibility patterns between Candida species can help identify the appropriate therapy. We performed a case-case-control study to identify clinical risk factors for the development of Candida glabrata candidemia compared to Candida albicans candidemia and an uninfected control using multivariate and logistic regression analysis. We observed that patients in the C. glabrata cohort were more likely to have gastrointestinal disorders and peripheral vascular disease than patients suffering from C. albicans BSIs. We also determined that when compared to the uninfected control group, patients with C. glabrata BSIs were more likely to have been prior colonized with C. glabrata, undergone dialysis, and have been catheterized with both arterial and urinary catheters. We concluded that patient exposure to unique clinical risk factors may be predictive of the development of future candidemia and may help distinguish between albicans versus non-albicans candidemia. We performed a drug susceptibility study using time-kill methods with the echinocandin antifungal agents on Candida parapsilosis and two newly identified species of Candida, C. orthopsilosis and C. metapsilosis. The echinocandins as a group displayed primarily fungistatic activity against the clinical isolates tested. However, we observed substantial variability in antifungal activity that varied by both the echinocandin used and Candida species analyzed. We concluded that this variability in activity that is both species and drug dependent should be considered when selecting the treatment of candidemia resulting from these non-albicans species.

IntroductionLes raisons de l’excès de risque d’asthme chez la femme ne sont pas établies. La réversion du sexe ratio autour de la puberté a fait évoquer le rôle des hormones sexuelles féminines dans l’asthme. Cependant l’histoire naturelle de l’asthme après 50 ans a été très peu étudiée. L’objectif général de cette thèse était d’apporter des nouveaux éléments de connaissance sur l’histoire naturelle de l’asthme de la femme. Les objectifs spécifiques étaient l’étude de l’incidence de l’asthme allergique et non-allergique de la femme et de son évolution avec le vieillissement (différences par rapport aux hommes après 50 ans, et association avec la ménopause) et l’étude de certains facteurs de risque associés à l’asthme de la femme.Matériels et méthodesL’incidence et l’évolution de l’asthme ont été étudiées chez 2 125 hommes et 2 298 femmes, initialement âgés de 20 à 44 ans et suivis pendant 20 ans dans la cohorte européenne sur la santé respiratoire « ECRHS ». Les associations entre la ménopause et l’asthme de la femme ont été étudiées dans un échantillon de 67 872 femmes, initialement âgées de 41 à 68 ans et suivies pendant 12 ans au sein de la cohorte E3N. Les données sur les expositions environnementales de l’Etude des facteurs Génétiques et Environnementaux de l’Asthme (EGEA) ont été utilisées pour étudier l’association entre l’usage domestique d’eau de Javel et l’asthme auprès de 607 femmes âgées de 44 ans en moyenne. L’asthme allergique est défini par la présence de tests cutanés positifs.RésultatsDans la cohorte ECRHS, les femmes étaient plus à risque que les hommes de développer de l’asthme non-allergique (Odds-Ratio (OR) ; Intervalle de confiance à IC95% : 4,0 [2,5-6,5]). Cette différence était moins marquée pour l’asthme allergique (OR 1,7 [1,0-2,7]), et on n’observait pas de différence dans la progression de l’asthme.L’analyse de la cohorte E3N ne montre pas de différence dans l’incidence de l’asthme entre les femmes pré-ménopausées et post-ménopausées de même âge, chez les femmes de corpulence normale (Hazard Ratio(HR) :1,1 [0,8-1,3]). Cependant, chez les femmes obèses, l’incidence de l’asthme augmentait lors de la transition vers la ménopause (aHR :1.9[1.0-3.7]) et en post-ménopause (HR :2,9 [1,1-4,1]). La ménopause chirurgicale était également associée à un plus grand risque d’asthme.Dans la cohorte EGEA, seuls 2% d’hommes contre 37% des femmes utilisaient hebdomadairement l’eau de Javel pour faire le ménage. Chez les femmes, l’usage fréquent d’eau de Javel était associé à un plus grand risque d’asthme non-allergique (OR :1,7 [IC :1,0-3,0]), mais il n’y a pas d’association avec l’asthme allergique. Chez les femmes asthmatiques, l’usage d’eau de javel était associé à une neutrophilie plus élevée.ConclusionA l’issue de ce travail, nous avons montré que le risque accru d’asthme chez la femme persistait au-delà de la période reproductive, et que la chute des hormones sexuelles féminines à la ménopause n’était pas indépendamment associée à l’incidence de l’asthme. D’autres facteurs, dont l’interaction entre les facteurs métaboliques et hormonaux, et les expositions genre-dépendantes pourraient expliquer l’excès de risque d’asthme non-allergique chez la femme. / IntroductionThe reason for the higher asthma incidence in women during the reproductive years is still unknown. The gender switch in asthma incidence around puberty has been put forward to suggest a role of female sex hormones in asthma. However, there are limited findings in the natural history of asthma after age of 50 and whether the transition through menopause is associated with change in asthma incidence is unknown.The objective of this thesis was to investigate the natural history of allergic and non-allergic asthma in women in term of incidence, evolution with aging (menopause) and risk factors of asthma in women with a focus on the gender differences.Materials and methodsThe gender differences in allergic and non-allergic asthma was assess in 2.125 men and 2.298 women free of asthma at baseline (aged 20-44) followed for 20 years as a part of the European Community Respiratory Health Survey (ECRHS). The association between asthma incidence and menopausal status was assessed in 67,872 women free of asthma at baseline (aged 41-68 years) and regularly followed-up as a part of the French E3N cohort. Association between the domestic use of cleaning bleach and allergic and non-allergic asthma have been assess in 607 women (mean age 44 years) participating in the first follow-up of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA). Allergy was define by a positive skin prick test.ResultsWith data from ECRHS we showed that the incidence of non-allergic asthma was higher in women as compared to men (Odds Ratio (OR): 4.0 [95% Confident Interval (CI95%): 2.5-6.5]. The female predominance was less marked for allergic asthma (OR :1.7 [IC :1.0-2.7]). However, in asthmatics there was no gender differences in the progression of asthma. With data from E3N we showed that among normal-weight women, there was no difference in asthma incidence between premenopausal and naturally postmenopausal women of the same age (Hazard Ratio(HR) :1,1 [0,8-1,3]). However, in obese women, the transition through menopause (HR: 1.9[1.0-3.7]) and the later period after menopause (HR:2.1 [1.1-4.1]) were associated with a higher asthma incidence. Surgically post-menopausal women were also at increased risk of developing asthma (HR:1.33[95%CI 1.01-1.75]).In EGEA, only 2% of men and 37% of women reported using bleach weekly for home cleaning. Women using bleach were at increased risk for non-allergic asthma (OR 3.3; 95%CI 1.5-7.1), and more particularly for non-allergic adult-onset asthma (OR 4.9; 95%CI 2.0-11.6). No association was observed for allergic asthma. Among women with asthma, frequent use of bleach was significantly associated with higher blood neutrophil cell counts.ConclusionGender differences in asthma incidence still persist in older adults however, changes in female sex hormones level occurring around natural menopause was not independently associated with change in asthma incidence in women. Our findings do not support the hypothesis that female sex hormones are independently associated with asthma incidence. The interaction between metabolic and hormonal factors and the gender difference in environment factor such as bleach use might explain the gender switch in asthma incidence around puberty and the female predominance in asthma more particularly for non-allergic asthma in adulthood.

Hypertension, diabetes, depressive symptoms, and smoking are predictors of cognitive decline in late life. However, it is not known if these risk factors are associated with cognition during midlife orif the associations between these risk factors and cognition vary by race. This longitudinal study hypothesized that (1) the risk factors would predict cognitive decline in midlife, (2)African Americans would have greater cognitive decline than European Americans and East Asians, and (3) there would be stronger associations between risk factors and cognition for African American women compared to European American and East Asian women. Participants (aged 42-52) were European American (n= 1,000), African American (n= 516), and East Asian (n= 437) women from the Study of Women’s Health Across the Nation who were studied for 8 years. Risk factors (i.e., diabetes, hypertension, smoking, and depressive symptoms) and cognitive outcomes (i.e., episodic memory, processing speed, and working memory) were measured at multiple timepoints. Two-level hierarchical linear models tested change in cognition over time controlling for income, education, and age. African Americans had lower scores than European Americans and East Asians on all cognitive outcomes. East Asian smokers had greater episodic memory decline compared to European American smokers. Depressive symptoms did not adversely impact processing speed for East Asian relative to European Americans. Contrary to our hypothesis, hypertension was associated with improved processing speed over time for African Americans compared to European Americans. Racial disparities in cognition were evident for African American women.

付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 新制・課程博士 / 博士(医学) / 甲第23093号 / 医博第4720号 / 新制||医||1050(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 古川 壽亮, 教授 今中 雄一, 教授 近藤 尚己 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

One of the most common types of cancer among women is breast cancer. It represents one of the diseases leading to a high number of mortalities among women. On the other hand, prostate cancer is the second most frequent malignancy in men worldwide. The early detection of prostate cancer is fundamental to reduce mortality and increase the survival rate. A comparison between six types of machine learning models as Logistic Regression, Decision Tree, Random Forest, Gradient Boosting, k Nearest Neighbors, and Naïve Bayes has been performed. This research aims to identify the most efficient machine learning algorithms for identifying the most significant risk factors of prostate and breast cancers. For this reason, National Health Interview Survey (NHIS) and Prostate, Lung, Colorectal, and Ovarian (PLCO) datasets are used. A comprehensive comparison of risk factors leading to these two crucial cancers can significantly impact early detection and progressive improvement in survival. / Includes bibliography. / Thesis (P.S.M.)--Florida Atlantic University, 2021. / FAU Electronic Theses and Dissertations Collection

Background: Predictive psychological variables to sport injury have been extensivelyexplored during the last three decades. More recently, sociocultural variables have beenemphasized having a significantly impact in the injury process. Objectives: The objective was (1) systemic review studies investigating psychological, social,and cultural risk factors to acute sports injury, (2) contribute with future methodologicaldevelopment within the field of sport injury prediction. Design: Systematic literature review. Methods: The electronic databases PsychINFO, PubMed, Science Direct, Web of Science andSPORTDiscus as well as two earlier injury predictive reviews were searched. The inclusioncriteria were (a) prospective designs that continuously monitored injury during the studyperiod, (b) defined injury as acute/traumatic, (c) investigated the relationship or predictiveeffect between psychological and/or sociocultural risk factors and acute injury in sport.Results: In total, the literature review resulted in 65 studies. Most of the studies had aparticular focus on psychological variables, where only a minority investigated socioculturalrisk factors. The studies used mostly one single measurements wave´s for the risk factors,with regression analyses to analyze the result. The result showed that psychological as well associocultural variables can influence the risk of becoming injured. Conclusion: Progress has been made in the field of predictive research on injury. In order tocontinue with an innovative development, four specific needs for future research is proposed:(1) the application of sophisticated analyses investigating how patterns of risk factors, andtheir interrelationship, is related with injury, (2) more regularly use of repeated-measuredesigns (preferable three occasions) combined with person-oriented analyses, (3) expand theknowledge regarding intrapersonal, interpersonal, and structural factors as a “third variable”,(4) focus on the sociocultural and behavioral influences in acute injury.The necessity of an integrated and holistic standpoint is warranted for future research, whereresearch based on the inclusion of various theoretical models which seek to explain the injuryprocess will expand the understanding of the complex, interactive, and dynamic conditions.