Infant health is an important comprehensive measure of the health in a society. Experiences during infancy can create durable and heritable patterns of social deprivation and illness ultimately producing health disparities in a population. This thesis sought to determine the relationship between maternal circumstances and infant mortality, morbidity and congenital anomaly rates in Winnipeg, Manitoba, Canada. Using logistic regression models the study explored provincial program screening data and administrative data held. The study found higher rates of congenital anomalies within two parent families and male infants. There was a relationship between hospital readmission rates and social and economic factors. Newborn hospital readmissions were associated with social support factors, while post-neonatal hospital readmissions were associated with contextual factors. Understanding the odds of infant mortality, morbidity and congenital anomaly in relation to different maternal socioeconomic factors may contribute to future health planning and the development of interventions that can improve health equity. / October 2015

Research Question: This research adapted, tested, and evaluated a methodology to set priorities for systematic reviews topics within the Cochrane Collaboration that is sustainable and incorporates the social determinants of health and health equity into the analysis. Background: In 2008 a study was conducted to review, evaluate and compare the methods for prioritization used across the Cochrane Collaboration. Two key findings from that study were: 1) the methods were not sustainable and 2) health equity represented a gap in the process. To address these key findings, the objective of this research was to produce and test a method that is sustainable and incorporates the social determinants of health and health equity into the decision making process. As part of this research, the methods were evaluated to determine the level of success. Methodology: With assistance from experts in the field, a comparative analysis of existing priority setting methods was conducted. The Global Evidence Mapping (GEM) method was selected to be adapted to meet our research objectives. The adapted method was tested with assistance of the Cochrane Musculoskeletal Group in identifying priorities for Osteoarthritis. The results of the process and the outcomes were evaluated by applying the “Framework for Successful Priority Setting”. Results: This research found that the priority setting method developed is sustainable. Also, the methods succeeded in incorporating the social determinants of health and health equity into the analysis. A key strength of the study was the ability to incorporate the patients’ perspective in setting priorities for review topics. The lack of involvement of disadvantaged groups of the population was identified as a key limitation. Recommendations were put forward to incorporate the strengths of the study into future priority setting exercises within Cochrane and to address the limitations.

In Canada, accessible and culturally relevant population health data for urban First Nations, Métis and Inuit people are almost non-existent. There is a need for Aboriginal community centric research and data systems, specifically in the area of mental health and substance misuse. The goal of this research was to address these knowledge gaps. The three linked studies being presented were nested in the Our Health Counts (OHC) project, a multi-partnership study aimed at developing a baseline population health database for urban Aboriginal people living in Ontario. In the first study, concept mapping was used to engage urban Aboriginal stakeholders from three culturally diverse communities in identifying health priorities. After completing brainstorming, sorting and rating, and map interpretation sessions, three unique community specific maps emerged. Map clusters and their ratings reflected First Nations, Inuit, and Métis understandings of health. Concept mapping encouraged community participation and informed the development of three health assessment surveys. The second study generated a representative sample of First Nations adults and children living in Hamilton, Ontario by utilizing Respondent Driven Sampling (RDS), a modified chain-referral sampling approach. Population estimates were generated for household and personal income, mobility, over-crowding and food availability. Results revealed striking disparities in social determinants of health between First Nations and the general population. The third study used the RDS generated sample to examine mental health and substance misuse among First Nations adults living in Hamilton. Prevalence estimates were generated for diagnosis and treatment of a mental illness, depression, anxiety, post-traumatic stress disorder (PTSD), suicide, alcohol and substance misuse, and access to emotional supports. Findings indicated that First Nations adults living in Hamilton experience a disproportionate burden of mental health and substance misuse challenges. The three linked studies make innovative contributions to Aboriginal health research. Results clearly exemplify the effective application of community-based research methods that are grounded in local knowledge and built on existing community strengths and capacities. Representative population health data for urban First Nations will contribute to current deficiencies in health information; will shape policy and programming priorities as well as future research directions, particularly with respect to health and social disparities among this population.

Se hizo una revisión de la literatura publicada sobre el origen de la sociología médica y su campo de acción. Para ello, se analizaron diversas publicaciones y se resumieron los aspectos más relevantes. A pesar de que la enfermedad siempre ha estado ligada a aspectos socioculturales, recién a mediados del siglo XX, la medicina reconoce la importancia de la sociología en la explicación de temas relacionados a la salud, especialmente para explicar los determinantes sociales de la salud. En la actualidad, los sociólogos trabajan de manera multidisciplinaria con médicos para investigar y analizar cuestiones concernientes a la salud de las personas, para mejorar el bienestar y la calidad de vida de la población. En este sentido, el aporte de la sociología no solo ha enriquecido la comprensión de algunas enfermedades, sino también diferentes aspectos en el quehacer de la medicina. / Revisión por pares / Revisón por pares

Background Malnutrition is a major risk factor of infant mortality in India. Policies targeting poverty and food insecurity may reduce infant malnutrition. The Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), a wage-for employment policy of the Indian Government, targets deprivation and food insecurity in rural households. MGNREGA could prevent infant malnutrition by improving household food security or increase the risk of malnutrition by reducing the time devoted to infant care if mothers are employed. This study analyzed the effect and the pathways of effect of households' and mothers' participation in MGNREGA on infant malnutrition. Methods A community based mixed methods study using cross-sectional survey and focus group discussions (FGDs) was conducted in Dungarpur district of Rajasthan, India. Cross-sectional study included 528 households with 1,056 participants who were infants 1 to <12 months and their mothers/caregivers. Selected households were divided into MGNREGA-households and non-MGNREGA-households based on participation in MGNREGA between August-2010 and September-20ll. Anthropometric indicators of infant malnutrition-underweight, stunting, and wasting (WHO criteria) were the outcomes. Eleven FGDs with 62 mothers were conducted. Results Of 528 households, 281 participated in MGNREGA (53%). Mothers were employed in 51 (18%) households. Prevalence of wasting was 39%, stunting 24%, and underweight 50%. Households participating in MGNREGA were less likely to have wasted infants (OR 0' 57, 95% Cl 0•37-0'89; p=O'014) and underweight infants (OR 0'48,95% Cl 0•30-0'76; p=0'002) than non-participating households. Stunting did not differ significantly between groups. Although MGNREGA reduced starvation, it did not confer food security to the participating households because of lower than standard wages and delayed payments. Results from path analysis did not support an effect through household food security and infant feeding, but suggested a pathway of effect through birth-weight. Mothers' employment had no significant effect on the outcomes in the cross-sectional study, but the qualitative study indicated that it could compromise infant feeding and care. Conclusion Participation in MGNREGA was associated with reduced infant malnutrition possibly mediated indirectly via improved birth-weight rather than improved infant feeding. Providing child care facilities at worksites could mitigate the negative effects of mother's participation in MGNREGA. Further, improving mothers' knowledge of appropriate feeding practices in conjunction with providing employment (to address deprivation and food insecurity) is key in the efforts to reduce infant malnutrition.

Research Question: This research adapted, tested, and evaluated a methodology to set priorities for systematic reviews topics within the Cochrane Collaboration that is sustainable and incorporates the social determinants of health and health equity into the analysis. Background: In 2008 a study was conducted to review, evaluate and compare the methods for prioritization used across the Cochrane Collaboration. Two key findings from that study were: 1) the methods were not sustainable and 2) health equity represented a gap in the process. To address these key findings, the objective of this research was to produce and test a method that is sustainable and incorporates the social determinants of health and health equity into the decision making process. As part of this research, the methods were evaluated to determine the level of success. Methodology: With assistance from experts in the field, a comparative analysis of existing priority setting methods was conducted. The Global Evidence Mapping (GEM) method was selected to be adapted to meet our research objectives. The adapted method was tested with assistance of the Cochrane Musculoskeletal Group in identifying priorities for Osteoarthritis. The results of the process and the outcomes were evaluated by applying the “Framework for Successful Priority Setting”. Results: This research found that the priority setting method developed is sustainable. Also, the methods succeeded in incorporating the social determinants of health and health equity into the analysis. A key strength of the study was the ability to incorporate the patients’ perspective in setting priorities for review topics. The lack of involvement of disadvantaged groups of the population was identified as a key limitation. Recommendations were put forward to incorporate the strengths of the study into future priority setting exercises within Cochrane and to address the limitations.

Master of Public Health - MPH / Substance abuse has become a significant public health concern in South Africa, more specifically in the Western Cape province. This has become a source of great alarm as South African Police Service (SAPS) statistics show that 80% of the crimes committed in the Western Cape are related to substance abuse. The Western Cape was the province that reported the highest number of persons treated during the 2008-2010 period. During the period January to June 2016, there were 2,976 admissions across all treatment centres in the Western Cape, which was a slight increase compared to the 2,674 admissions during the previous six-month review period. It has also been reported that substance abuse has increased the burden on an already challenged primary health care system in South Africa. The proportion of new treatment admissions amounted to 71% of all admissions during the period 2015-2019.

Endometriosis is a gynaecological disorder that affects an estimated 176 million women worldwide. Endometriosis causes serious societal impacts, such as loss of work productivity and effectiveness of non-work-related activities. Regardless that a significant number of women are impacted, many clinical questions remain unanswered, treatment failures are common, diagnosis takes an average of seven and a half years, and there is little investment in investigating disease mechanisms. At the same time, in the last few decades, endometriosis has been repeatedly mislabelled, which still presents indications on the current endometriosis care. Furthermore, there is still a tendency to exclude women's experiential knowledge, which presents one of the biggest burdens of endometriosis. The Degree Project demonstrates communication barriers to early diagnosis from 262 women using survey data and aims to understand women and medicine's power relations. Through this analysis, women's perspective is presented and discussed. The analytical discussion is divided into four chapters: medical knowledge, pain communication, desired communication support and experiential support. The study identifies how the relationship of knowledge and power impact pain communication and consequently the diagnosis of endometriosis. This study contributes to endometriosis, gender and communication for development studies by suggesting the incorporation of women’s experiential knowledge to address the challenges of pain communication and the diagnostic delay.

Objective: Using the Social Determinants of Health as the study's theoretical underpinning, the authors examined the impact of the North Carolina Community Transformation Grant Project farmers' market initiatives on changes in awareness and use of farmers' markets, and fruit and vegetable consumption. Methods: During the farmers' market season, the researchers conducted a random digit-dial telephone survey among residents in 3 rural North Carolina counties to examine changes in farmers' market awareness, shopping, and fruit and vegetable consumption. They examined change over 1 year using t tests, chi-square tests, and propensity score matching. Results: In 1 county there were increases in farmers' market shopping and fruit and vegetable consumption, and in 1 county there were decreases in farmers' market shopping and fruit and vegetable consumption. Conclusions and Implications: The impact of farmers' market initiatives may be affected by county-specific socioeconomic contexts.

Introduction and Background Childhood obesity affects 17% of children in the United States (Whooten et al., 2018). It is well understood that many social determinants contribute to the manifestation and improvement of this disease. Purpose Statement I aim to compare the impact of increased health education through medical professional to families and obese/overweight children compared to implemented physical activity in social and personal settings on BMI improvement among the obese/overweight children. Literature Review Searches performed through the Sherrod Library data base at East Tennessee State University included the following key words: social determinants, long-term study, physical activity, clinical, community and family. Research was not limited to the United States population. Findings Review of these studies showed marked improvement in BMI for physical activity programs in association with schools. These activities resulted in BMI z-score improvements of -0.22, when 60 minutes of physical activity was implemented 3-day/week prior to school (Whooten et al., 2018). Studies surrounding medical counseling and education alone reported minimal improvements to BMI and limited sustainable of these results at follow-up. However, frequent routine meeting with medical profession and obese children and their family resulted in increased Pediatric Quality of Life scores. Conclusions While implantation of multiple discipline may be required to improved BMI in obese/overweight children, physical activity in the public social setting shows to be promising compared to increased education and counseling from medical professionals alone in reducing BMI.