Inflammatory bowel disease (IBD), characterized by chronic gastrointestinal inflammation, represents a significant childhood chronic disease. In this thesis, a case ascertainment definition of paediatric-onset IBD was validated using administrative data and developed the Ontario Crohn’s and Colitis Cohort (OCCC). The epidemiology of paediatric IBD in Ontario was described, demonstrating that Ontario has one of the highest worldwide incidence rates. Statistically significant increases in incidence were noted in 0-4 year olds (5.0%/year, p=0.03) and 5-9 year olds (7.6%/year, p<0.0001), but not in other age groups. Lower income children were more likely to be hospitalized at least once (hazard ratio (HR) 1.17, 95% confidence intervals (CI) 1.05-1.30) or visit the ED (HR 1.21, 95% CI 1.09-1.35) and had more IBD-related physician visits (odds ratio (OR) 3.73, 95% CI 1.05-13.27). Lower income children with Crohn's disease (CD) (not ulcerative colitis [UC]) were more likely to undergo intra-abdominal surgery within 3 years of diagnosis (OR 1.22, 95% CI 1.01-1.49), especially if diagnosed after 2000 (OR 1.79, 95% CI 1.27-2.53). Finally, changes in health services utilization and surgical rates were described, as were changes in specialist care provision and immunomodulator use in children with IBD between 1994-2007. The changes to care included increased outpatient care provided by paediatric gastroenterologists, and increased immunomodulator use. Children diagnosed with CD, but not UC, in recent years had lower surgical rates. In CD patients, intra-abdominal surgical rates within three years of diagnosis decreased from 18.8% in children diagnosed in 1994-1997 to 13.6% in those diagnosed in 2001-2004 (P = 0.035). When stratified by age at diagnosis, this decrease was significant in children diagnosed ≥10 years old (OR 0.67, 95% CI 0.48-0.93). The OCCC will continue to be used to investigate the epidemiology and burden of paediatric IBD and to improve the care received by children with IBD in Ontario.

Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. To counteract this, attention tends to focus around access (equality) of services. Yet access may not equate with the meaningfulness (equity) of services for women from different socioeconomic backgrounds. Without understanding equity we are not in a position to plan appropriate and equitable care. This study aimed to determine pregnant women's perceptions of the current antenatal provision and to determine if women from the extremes of socioeconomic background perceived their antenatal care differently. Longitudinal interviews were undertaken with multiple, comparative antenatal case studies between January 2007 and April 2009. Cases were primigravida women from ‘least deprived’ (n=9) and ‘most deprived’ (n=12) geographical areas as identified by the Scottish Index of Multiple Deprivation (SIMD 2006). The data were analysed using case study replication analysis. Analysis of categorical data from the sample groups indicated they were less diverse than might have been expected in terms of age and education. However in the key variables of housing tenure, potential income and socioeconomic status based on area of residence, the groups were indicative of the SIMD target populations. The preliminary analysis showed that the sample groups considered the initial General Practitioner contact to be less than adequate and the subsequent utility of antenatal education to be based on self perceived relevance. The substantive analysis showed little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups but perception of care differed. A key difference concerned the level of ‘engagement’ (defined as personalisation and active involvement in care, power and relationships and health literacy). Using these concepts, engagement was present in most of the ‘least deprived’ group and almost none of the ‘most deprived’ group. In comparison with women from affluent areas, more deprived women described less evidence of: personal connection to their own care; shared decision making; and perceived value in relation to the written educational aspects of antenatal care. In terms of the preliminary analysis, the results suggest that utility of educational material may need to be reviewed to ensure it is relevant to specific needs. Without this relevance, key information may be missed. The substantive analysis suggests that for women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing quality of antenatal services. The lack of engagement perceived by those who are most deprived suggests that equity of service has yet to be attained for those who are most in need. Future research needs to be directed to the potential reasons that may undermine equity and engagement in women from lower socioeconomic areas.

This diploma thesis deals with revitalization of landscape and recultivation in Sokolov region. In its first part the paper deals with socioeconomic analysis of region Sokolov. The main task of this analysis is, evaluate present progress of this region. It also describes history of brown coal mining in brown coal field of Sokolov region and negative effect for landscape. Next chapters of this thesis show: recultivation in general, project documentation, financing arrangements, company Sokolovská uhelná a.s. and its privatisation. One of the most important parts of this diploma thesis deals with recultivation in Sokolov region and description of particular locations in this region. The last part gives an evaluation of socioeconomic developmet in dependence on recultivation in Sokolov region.

Subjective socioeconomic status (SES) has previously been shown to be correlated with a large number of health measures. In this study, the subjective SES measure is modified and translated to measure childhood SES. The subjective SES scale is examined in a participant's hometown, community, and nation. Both an immigrant Hispanic and a Caucasian sample were studied (31 Hispanic males; 42 Hispanic females; 38 Caucasian males, 40 Caucasians females). Childhood SES was the most significant predictor of self-reported health in both sample groups.

Doctor of Philosophy / Department of Family Studies and Human Services / Kristy Archuleta / This dissertation explores the association of culture with financial satisfaction. Social identity theory, a successor of symbolic interaction framework (Mead, 1930) serves as the theoretical framework for this study, conceptualizing the impact of culture on identity formation through the values, norms, and beliefs of cultures adopted by individuals. Social identity theory also provides an understanding of the power and influence of reference groups supplied by culture through the context provided for the internal determination of satisfaction. The cultures examined (e.g., geography, socioeconomic status, religiosity), each had associations with life domains which influence satisfaction according to well-being research. The associations of cultures with financial satisfaction is a largely unexplored area of research, perhaps due to the difficulty in defining and measuring culture, as well as the challenges associated with influencing financial satisfaction. Data for this study was obtained from the 2012 General Social Survey, conducted by the National Opinion Research Center. This study found the geographic characteristics of home ownership and living in a single family home were associated with financial satisfaction and individuals living in the same state as they did when age 16 had more points of association with financial satisfaction than those not living in the same state. Further, of the SES measures in the study, income was found to be consistently associated with financial satisfaction. Religiosity, including religiosity by religious text (e.g., Bible, Torah, Quran) and prayer were not found to be associated with financial satisfaction. However, frequency of attendance at religious services had a statistically significant association with financial satisfaction and was found to be a moderator of the financial satisfaction of those living in the Eastern and Western U.S. Regions. Understanding the association of culture with financial satisfaction may provide planners with insights into factors which contribute to a client’s values, beliefs and attitudes about their finances. An awareness of the power of cultural values, beliefs and values to influence satisfaction may make a positive contribution to the quality of conversation between planners and clients as they work toward establishing authentic goals and objectives for the client and develop plans to achieve those goals.

The purpose of this study was to identify factors that contribute to women delaying seeking treatment for obstetric fistula. A stratified random sampling technique was used to select 384 study participants. A cross sectional analytical research design was used; data was collected by structured, closed ended questionnaires. Bivariate and multivariate logistic regression models were applied. Results show a significant correlation between traditional treatment and delay in seeking treatment (P-Value = 0.012). The presence of parents has a significant correlation in reaching treatment centres (p-value = 0.013), those women who are speaking about their fistula have less chance of delay in seeking treatment (p-value = 0.008), having no income significantly associated with delay in seeking treatment (AOR = 0.28) and women living closer to the treatment centres have less chance of delay (p-value = 0.008). Therefore, there are a number of factors that significantly influence women from early seeking of treatment for their fistulae. / Health Studies / M.A. (Public Health)

The development of children’s language skills during the preschool years plays a crucial role in subsequent reading and school success. Some children may enter kindergarten with oral language skills that lag behind their peers’. Two such groups are children from low-socioeconomic status (SES) families and those who are deaf or hard of hearing (DHH). Study 1 considered parents’ linguistic input during interactions with their Head Start pre-kindergarten children in two conversational contexts. The first, shared storybook reading, has featured prominently in early language interventions but proven less efficacious among low-SES samples. The second, shared reminiscing, offers a theoretically promising setting in which to promote child vocabulary skills but lacks empirical support. This study examined features of parental language known to relate to children’s vocabulary, including parents’ quantity of speech, lexical diversity, syntactic complexity, and intent to elicit child language. Parents’ and children’s expressive vocabulary knowledge was also considered. Forty parent-child dyads’ conversations during storybook reading and shared reminiscing were audiorecorded, transcribed, analyzed, and coded. Paired t-tests revealed that, while parents talked more during book reading, they used greater levels of syntactic complexity and language-eliciting talk during shared reminiscing. Parents’ own vocabulary knowledge was related to their children’s but not to linguistic input in either context. Study 2 considered the oral narrative skills of DHH preschoolers relative to language-matched hearing children. School-age DHH children often experience delays in the development of narrative skills compared to their hearing peers. Little is known about the narrative abilities of DHH children during the preschool years. This study examined 46 DHH and 58 vocabulary-matched hearing preschoolers’ overall language production, lexical diversity, syntactic complexity, and narrative comprehension skills. DHH children produced a similar number of words and demonstrated similar levels of narrative understanding compared to their hearing peers. However, DHH children’s narratives contained significantly less complex syntax. Gains in lexical diversity differed by group, with DHH children demonstrating less growth over the course of the school year despite making more gains on a standardized measure of vocabulary. Implications for instruction, assessment, and future research are discussed for both low-SES and DHH children.

For generations, researchers have been examining attributes that make low socioeconomic status students resilient. Attributes that help one become resilient are known as protective factors. The purpose of this study was to describe the protective factor(s) that contributed to the first-generation, low socioeconomic status students’ enrollment at The University of Kentucky. The population for this study consists of the University of Kentucky First Scholars participants during the 2015 – 2016 academic year. The researcher examines the existing literature on low socioeconomic status effects on post-secondary education. Recommendations were made for the University of Kentucky’s First Scholars Program on how to further enhance their program and continue promoting low socioeconomic status students with opportunities in higher education.

This study examined the effects of a learning environment (embodying many of De Corte et al.’s, (2004) CLIA-model components) on secondary students’ mathematical beliefs. Such mathematical beliefs have been of interest to the research community due to their expected impact on students’ willingness to engage in mathematical problem-solving. This research adopted an action research methodology using a quasi-experimental sequential explanatory mixed methods design. Data was collected using the Mathematics Related Beliefs Questionnaire (MRBQ) and a number of focus groups and individual interviews were undertaken. The sample selected (age 13-14) was from a population of convenience. There was one treatment class (N=22) and three control classes (N=45). The classroom intervention was of six months duration and was carried out by the researcher teacher in a secondary community school. Findings revealed no significant positive effects on students’ beliefs from the new learning environment about the teacher’s role in the classroom, their personal competence and the relevance to their lives and mathematics as an inaccessible subject. A more negative outcome for the fourth factor of the MRBQ scale, ‘mathematics as an inaccessible subject’, resulted for all participants (experimental and control combined) with a moderate effect of eta2=0.09. Findings from the qualitative data indicated the experimental participants found mathematics to be a difficult but useful subject. Findings, overall, revealed no significant differences between the experimental and control classes, indicating the new learning environment had not had a positive impact on the beliefs examined. Possible factors identified were the length of the intervention, the ages of participants and the socio-economic status of the majority taking part in this study. Qualitative data also indicated participants in the treatment class had found some of the activities used in the intervention to be interesting and enjoyable. Responses to the use of group work indicated participants were both willing and able to enter into communities of learners. Other results showed that participants with the highest achievement scores appeared to be the most confident learners of mathematics. Participants appeared to accept the need to have patience and perseverance when solving difficult problems but this was not translated into action in the classroom. The importance of understanding mathematics appeared to be accepted by participants. Implications for methodology, research and practice are discussed in light of these findings.

Human population-based studies of longitudinal design observe that higher intelligence in youth confers protection from premature mortality in adulthood. This field of study (“cognitive epidemiology”; Deary & Batty, 2007) has firmly established associations between intelligence and health outcomes, and has begun to address the likely mechanisms involved. The present thesis assessed some social, educational, and lifestyle factors that potentially confound and/or mediate the intelligence-mortality link. First, I carried out a systematic review of longitudinal cohort studies reporting intelligence differences in youth in relation to adult mortality risk, and in meta-analysis I aggregated the effect sizes from 16. A one SD advantage in intelligence scores was associated with 24% (95% CI 23% to 25%) lower risk of death, during 17- to 69-year follow-up; this magnitude showed no sex differential. Socioeconomic status in early life did not explain the effect. Rather, the person’s own occupational status in adulthood and educational attainment explained a third and a half of the association, respectively. One issue in controlling for education, in such models, is its strong correlation with intelligence test performance, which could lead to statistical overadjustment. A second aspect of this thesis, therefore, addressed the nature of the intelligence-education covariance in two behaviour-genetic studies of large general population-based samples of schoolchildren from England and The Netherlands. Previous studies that reported intelligence—education genetic covariances were potentially biased in their use of twin self-selection or pre-selection sampling. Moreover, the analysis in this thesis used a novel statistical approach, and included non-twin data to represent fully the variance in performance scores of a population. Analysis of the English cohort confirmed the top end of estimates from previous studies: 76% to 88% of the phenotypic correlation was due to heritability. The Dutch cohort showed greater variance for equivalent estimates (33% to 100%). The results indicate a limit to the extent to which education and intelligence might be causative of one another suggesting caution in interpreting some of the substantive attenuation effects by education reported in the literature. Third, I investigated pathways from intelligence to cardiovascular disease risk factors, given the consistent and robust finding that an advantage in intelligence relates to lower cardiovascular disease-outcomes. I used data from the 1958 National Child Development Study to investigate age-11 intelligence in association with inflammatory and haemostatic biomarker status at age 46 years. The results replicated inverse associations previously reported in an older age sample, and a one SD advantage in intelligence related to a 1.1mg/L decrease in C-reactive protein. The effect was largely mediated by lifestyle factors, including smoking, occupational status and abdominal obesity. In two further studies I used the west of Scotland Twenty-07 cohort, to investigate processing speeds among 16, 36 and 56 year-olds in relation to: (1) Inflammation, and (2) metabolic-risk, after 20 years. The advantage of experimental rather than psychometric measures of cognitive ability is their reduced cultural and social bias. Faster reaction time predicted lower systemic inflammation in the youngest male cohort, which appeared to be partially confounded by baseline smoking and socioeconomic status. Furthermore, advantage in reaction time performance in the young and middle-aged cohorts significantly predicted reduced metabolic risk. This was partially explained by occupational status, but retained statistical significance in some fully-adjusted models. A one SD advantage in age 16 simple reaction time variability, related to the 21% (95% CI 12% to 30%) reduced odds of metabolic syndrome by age 36 in the basic model, and this effect remained unchanged after controlling for all covariates. The growing evidence for specific social and behavioural factors that mediate intelligence-to-mortality pathways are discussed, in respect of indirect evidence that underlying system integrity or early life confounding may contribute incrementally to the effect.