The analyses in this dissertation were designed to 1) extend the knowledge of characteristics associated with and predictive of energy intake plausibility (under or overreported energy intake), and 2) extend previous research in a sub-sample of this study population of baseline short-term weight loss predictors to evaluate within the full sample whether baseline psychosocial, behavioral and dietary predictors of weight loss varied by energy intake plausibility. Subjects were 155 overweight or obese perimenopausal women participating in a 4mo lifestyle weight loss program. Based on self-reported intake from 3-d dietary records, women were categorized as energy underreporters (n=71), accurate energy reporters (n=27), or energy overreporters (n=57), using the cut-off values for energy plausibility defined by Goldberg. All subjects completed a comprehensive behavioral and psychosocial battery assessing diet and weight history, life status, weight loss readiness, psychology, eating behavior, physical activity, and self-image. Results from logistic regression models showed that y of education, weight loss aspirations, exercise perceived competence, social support to exercise, and measures of body image were the best predictors of energy underreporting. Dietary carbohydrate and fat intake, health related quality of life, and profile of mood states (anger) were the best predictors of energy overreporting. Baseline predictors of successful weight loss did vary by energy plausibility group, with unique predictors for energy underreporters including fewer previous dieting attempts and exercise perceived obstacles, and energy overreporters including higher TEE, more negative mood status and higher perceived hunger. Overall, more successful weight loss was also associated with higher baseline fruit and vegetable intake. Validation of these findings will help lead to establish factors to account or adjust for bias from energy misreporting, reduce health or disease risk underestimation and improve understanding of nutrition, health and disease relationships. Further, identification of successful weight loss predictors unique to energy under- and overreporters will enhance weight loss profiling and tailoring of interventions to optimize success.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Cancer‐related fatigue (CRF) is a well‐documented symptom among gynecologic oncology patients. However, there is little known about the etiology, and treatment options are currently suboptimal. While the lack of knowledge surrounding the intricacies of CRF impedes effective care, there is arguably a more serious barrier to delivering adequate treatment. Fatigue symptoms are highly underreported to physicians making it impossible to offer treatment to a large subsection of patients. This study will focus specifically on gynecologic oncology patients, a population with a staggering prevalence of CRF. The purpose of this study is to identify clinical, psychosocial, and lifestyle characteristics that may be associated with the underreporting of fatigue specifically in gynecologic oncology patients. The design of this study is a cross‐sectional survey. 89 subjects were recruited from three outpatient sites. Inclusion criteria included: (a) women age ≥18 years old with a known ovarian, uterine, cervical, vaginal, vulvar, or primary peritoneal cancer; (b) Currently attending physician’s office hours and/or undergoing chemotherapy at one of the above listed centers. This study will focus specifically on the reporting of CRF in gynecologic oncology patients. Results showed that barriers to reporting fatigue were significantly correlated with the chemotherapy cycle a patient was undergoing. Additionally, the date of last treatment, a patient’s weight, and the cancer stage was associated with higher levels of underreporting in this population. The prevalence of cancer related fatigue is staggering; however, there is limited research as to why patients are underreporting such a significant symptom to their health care team. With the knowledge from this study, screening for fatigue can become more efficient by targeting women in specific chemotherapy cycles. Practitioners can also use this data to identify patients with high‐risk characteristics that might contribute to their unwillingness to discuss fatigue symptoms.

Partindo de hipóteses básicas onde o processo saúde-doença no período perinatal apresenta-se, por um lado, como expressão de condições particulares ás quais famílias estão submetidas, de maneira diferencial, em função de sua adscrição de classe e, por outro, como expressão da articulação de um conjunto de condições biológicas e sociais em permanente relação, o presente trabalho procura, em uma amostra de parturientes e recém-nascidos de hospitais de São Luis do Maranhão, refletir sobre o assunto. Conclui pela pertinência do emprego do conceito sociológico de classe social ao estudo de eventos perinatais que, articulado a esquemas teóricos mais elaborados do campo da Perinatologia, permite ampliar o nível de explicação do fenômeno. / This work searches for empirical sustenance concerning reflection on basic hypotheses whereby the health dickness process in the perinatal periode expresses particular conditions which families are undergoing especially as to their insertion in social classes, on one hand, and especially on the other, articulation of biological and social conditions in permanent relation. It is based on a sample of women-in-labour and newborn children in hospitals in São Luis do Maranhão, Brazil. It is concluded that Sociological concept of social class is pertinent whilst studying perinatal events along with more elaborate theoretical schemes in the field of Perinatology.

Partindo de hipóteses básicas onde o processo saúde-doença no período perinatal apresenta-se, por um lado, como expressão de condições particulares ás quais famílias estão submetidas, de maneira diferencial, em função de sua adscrição de classe e, por outro, como expressão da articulação de um conjunto de condições biológicas e sociais em permanente relação, o presente trabalho procura, em uma amostra de parturientes e recém-nascidos de hospitais de São Luis do Maranhão, refletir sobre o assunto. Conclui pela pertinência do emprego do conceito sociológico de classe social ao estudo de eventos perinatais que, articulado a esquemas teóricos mais elaborados do campo da Perinatologia, permite ampliar o nível de explicação do fenômeno. / This work searches for empirical sustenance concerning reflection on basic hypotheses whereby the health dickness process in the perinatal periode expresses particular conditions which families are undergoing especially as to their insertion in social classes, on one hand, and especially on the other, articulation of biological and social conditions in permanent relation. It is based on a sample of women-in-labour and newborn children in hospitals in São Luis do Maranhão, Brazil. It is concluded that Sociological concept of social class is pertinent whilst studying perinatal events along with more elaborate theoretical schemes in the field of Perinatology.

The identification of potential underreporting in employment evaluations is important to consider when examining a measure’s validity. This importance increases in personnel selection involving high-virtue positions (e.g., police officers and firefighters). The current study aimed to utilize an archival firefighter applicant sample to examine the construct validity of the Minnesota Multiphasic Personality Inventory-2-Restructured Form’s (MMPI-2-RF) underreporting scales (L-r and K-r). Results were analyzed using a correlation matrix comprised of a modified version of the Multi-Trait Multi-Method Matrix (MTMM), as well as multiple regression and partial correlation. The present study provides additional support for the construct validity of the MMPI-2-RF’s underreporting validity scales. Further research using outcome measures and alternate assessment methods would be able to provide further information on the efficacy of these scales.

How fast and how far China’s fertility declined in the 1990s has long been a matter of considerable debate, despite very low fertility consistently being reported in a number of statistical investigations over time. Most demographers interpreted this as a result of serious underreporting of births in population statistics, due to the family planning program, especially the program strengthening after 1991. Consequently, they suggested that fertility fell only moderately below-replacement level, around 1.8 children per woman from the early 1990s. But some demographers argued that surveys and census may have reflected a real decline of fertility even allowing for some underreporting of births, given the consistency between data sources and over time. They believed that fertility declined substantially in the 1990s, very likely in the range between 1.5 and 1.6 by the year 2000.¶ The controversy over fertility is primarily related to the problem of underreporting of births, in particular the different estimations of the extent of underreporting. However, a correct interpretation of fertility data goes far beyond the pure numbers, which calls for a thorough understanding of different data sources, the programmatic and societal changes that occurred in the 1990s, and their effects on both fertility changes and data collection efforts. This thesis aims to address the question whether the reported far-below-replacement level fertility was a reality of substantial fertility decline or just an illusion arising from underreporting of births. Given the nature of the controversy, it devotes most efforts in assessing data quality, through examining the patterns, causes and extent of underreporting of births in each data source; reconstructing the decline of fertility in the 1990s; and searching corroborating evidence for the decline.¶ After reviewing programmatic changes in the 1990s, this thesis suggests that the program efforts were greatly strengthened, which would help to bring fertility down, but the birth control policy and program target were not tightened as generally believed. The program does affect individual reporting of births, but the completeness of births in each data source is greatly dependent on who collects fertility data and how the data are collected. The thesis then carefully examines the data collection operations and underreporting of births in five sets of fertility data: the hukou statistics, the family planning statistics, population census, annual survey and retrospective survey. The analysis does not find convincing evidence that fertility data deteriorated more seriously in the 1990s than the preceding decade. Rather, it finds that surveys and censuses have a far more complete reporting of births than the registration-based statistics, because they directly obtain information from respondents, largely avoiding intermediate interference from local program workers. In addition, the detailed examination suggests that less than 10 percent births may have been unreported in surveys and censuses. The annual surveys, which included many higher-order our-of-plan births being misreported as first-order births, have more complete reporting of births than censuses, which were affected by the increasing population mobility and field enumeration difficulties, and retrospective surveys, which suffered from underreporting of higher-order births.¶ Using the unadjusted data of annual surveys from 1991 to 1999, 1995 sample census and 2000 census, this research shows that fertility first dropped from 2.3 to 1.7 in the first half of the 1990s, and further declined to a lower level around 1.5-1.6 in the second half of the decade. The comparison with other independent sources corroborates the reliability of this estimation. Putting China’s fertility decline in international perspective, comparison with the experiences of Thailand and Korea also supports such a rapid decline. Subsequently, the thesis reveals an increasingly narrow gap between state demands and popular fertility preferences, and great contributions from delayed marriage and nearly universal contraception. It is concluded that the fertility declined substantially over the course of the 1990s and dropped to a very low level by the end of last century. It is very likely that the combination of a government-enforced birth control program and rapid societal changes quickly moved China into the group of very low-fertility countries earlier than that might have been anticipated, as almost all the others are developed countries.

Numerous studies have documented the application of crash severity models to explore the relationship between crash severity and its contributing factors. These studies have shown that a large amount of work was conducted on this topic and usually focused on different types of models. However, only a limited amount of research has compared the performance of different crash severity models. Additionally, three major issues related to the modeling process for crash severity analysis have not been sufficiently explored: sample size, model misspecification and underreporting in crash data. Therefore, in this research, three commonly used traffic crash severity models: multinomial logit model (MNL), ordered probit model (OP) and mixed logit model (ML) were studied in terms of the effects of sample size, model misspecification and underreporting in crash data, via a Monte-Carlo approach using simulated and observed crash data. The results of sample size effects on the three models are consistent with prior expectations in that small sample sizes significantly affect the development of crash severity models, no matter which model type is used. Furthermore, among the three models, the ML model was found to require the largest sample size, while the OP model required the lowest sample size. The sample size requirement for the MNL model is intermediate to the other two models. In addition, when the sample size is sufficient, the results of model misspecification analysis lead to the following suggestions: in order to decrease the bias and variability of estimated parameters, logit models should be selected over probit models. Meanwhile, it was suggested to select more general and flexible model such as those allowing randomness in the parameters, i.e., the ML model. Another important finding was that the analysis of the underreported data for the three models showed that none of the three models was immune to this underreporting issue. In order to minimize the bias and reduce the variability of the model, fatal crashes should be set as the baseline severity for the MNL and ML models while, for the OP models, the rank for the crash severity should be set from fatal to property-damage-only (PDO) in a descending order. Furthermore, when the full or partial information about the unreported rates for each severity level is known, treating crash data as outcome-based samples in model estimation, via the Weighted Exogenous Sample Maximum Likelihood Estimator (WESMLE), dramatically improve the estimation for all three models compared to the result produced from the Maximum Likelihood estimator (MLE).

Com a finalidade de conhecer a história da epidemia de AIDS no Município de São Paulo, analisou-se a mortalidade pela síndrome, de 1983 a 1986. Utilizando a metodologia de revisão dos atestados de óbito, foi possível conhecer algumas características desses indivíduos e detectar casos de AIDS não notificados ao sistema de vigilância epidemiológica. Foram revistos os atestados de óbito de indivíduos do sexo masculino, de 20 a 49 anos, que faleceram no Município de São Paulo, de 1983 a 1986. Os atestados foram selecionados pela causa básica, onde esta era AIDS, imunodeficiência, doenças indicativas de AIDS ou infecções oportunistas e outras patologias que poderiam estar mascarando casos de AIDS. Entre 4023 atestados selecionados, 359 se referiam a AIDS e, destes, 305 (85 por cento ) eram óbitos de casos notificados e 54 (15 por cento ) óbitos de casos não notificados. No grupo não notificado, a AIDS, ou apenas imunodeficiência, era causa básica em 26 declarações de óbito e em outras 10 ela era mencionada, ainda que não como causa básica. Os 54 casos identificados pelo estudo representam um aumento de 7 por cento no número de casos de AIDS do Município de São Paulo e de 7,3 por cento no número de óbitos pela doença, neste mesmo local, sendo que a letal idade da AIDS passa de 77,8 por cento para 79,3 por cento no período considerado. Os casos detectados de AIDS eram em sua maioria indivíduos solteiros (81,9 por cento ), jovens (58 por cento tinham de 20 a 34 anos) e que faleceram em hospitais (95,3 por cento dos óbitos). As profissões mais referidas foram de bancário e economiário (6,7 por cento dos atestados), auxiliar de escritório (6,4 por cento ), seguidas de cabeleireiro (5,3 por cento ) e de comerciante (3,9 por cento ). Entre os casos não notificados havia maior freqüência de indivíduos com nível superior de educação em relação aos que não tinham sido notificados. / To assess the history of AIDS epidemics in the City of São Paulo, we analysed the mortality of this syndrome, from 1983 to 1986. Underreported AIDS cases were detected thru reviewing death certificates. Those from 20 to 49 years old males were reviewed. Deaths from AIDS, immunodeficiency or other diseases that seemed to be AIDS cases, were selected and analysed in reference to age, occupation, case reporting to the surveillance system and the diseases mentioned in the death certificates. Three hundred and fifty nine death out of 4023 death certificates were caused by AIDS. Of these, 305 (85 per cent ) were cases reported to the surveillance system. AIDS or immunodeficiency were mentioned in 54 deaths not reported as AIDS cases and this disease was the underlying cause of death in 26 of them and in 10, AIDS was mentioned but not as the underlying cause of death. Those 54 cases identified by this study increases 7 per cent the number of AIDS cases in the City of São Paulo and 7,3 per cent the deaths caused by this syndrome. The letality increases from 77,8 per cent to 79,3 per cent in the period considered. The AIDS cases identified in this study were of young men (58 per cent were between 20 and 34 year old) and single males (81,9 per cent ) and the death occurred in the Hospital (95,3 per cent ). The most frequent occupation were bank clerks (6,7 per cent ), office clerks (6.4 per cent ), hairdressers (5.3 per cent ) and commercial workers (3.9 per cent ). Among underreported cases there were more people with university degrees.

O consumo de alimentos é frequentemente avaliado em estudos sobre a etiologia de doenças crônicas não-transmissíveis. A maioria desses estudos nutricionais utiliza métodos que dependem de auto-relato e são susceptíveis a potenciais erros. Um desses principais vieses é o sub-relato da ingestão energética, o qual consiste no relato de energia implausivelmente inferior às quantidades mínimas necessárias à manutenção do peso corporal do indivíduo. Objetivos: Identificar a prevalência e os fatores associados ao sub-relato e analisar os padrões dietéticos de indivíduos sub-relatores e não sub-relatores da ingestão energética. Métodos: Foram utilizados dados do estudo transversal de base populacional ISA - Capital 2008, de indivíduos com 20 anos ou mais, de ambos os sexos. A ingestão energética foi avaliada pela média de dois recordatórios de 24 horas coletados em dias não consecutivos. O gasto energético total foi calculado por equação preditiva, considerando sub-relatores indivíduos com ingestão energética inferior a 1 ou 2 desvios-padrão (DP) da razão ingestão energética/gasto energético total predito. A análise de regressão múltipla foi utilizada para identificar os fatores associados à subnotificação e a análise fatorial por componentes principais foi utilizada para identificar os padrões alimentares. Resultados: A prevalência de sub-relatores da ingestão energética utilizando o ponto de corte de 2 DP foi de 15,1 por cento e com 1 DP, 60, 9 8 por cento. Indivíduos com excesso de peso e insatisfeitos com o peso corporal apresentaram maior chance de serem sub-relatores quando comparados aos indivíduos sem excesso de peso e aos satisfeitos com peso corporal, respectivamente. A média de IMC entre indivíduos sub-relatores mostrou-se significativamente superior à de não sub-relatores, contraditoriamente, a média da ingestão energética foi estatisticamente inferior. Em cada grupo, foram identificados três padrões principais não semelhantes. Não houve diferença entre os grupos no consumo de carboidratos, mas a proporção de gorduras e proteínas foi maior no grupo de sub- relatores. Conclusão: É necessário o estudo de métodos que sejam viáveis de serem aplicados em estudos de base populacional e isso se torna mais relevante quando a população tem elevada prevalência excesso de peso, pois o mesmo associa-se tanto à maior ocorrência de doenças crônicas não-transmissíveis quanto à maior chance de sub-relato / The consumption of food is often evaluated in studies on the etiology of chronic diseases. Most of these nutritional studies use methods that rely on self- report and are subject to potential errors. One such bias is the major underreporting of energy intake, which consists of the report implausibly energy less than the minimum necessary to maintain the individual\'s body weight. Objectives: To identify the prevalence and factors associated with underreporting and analyze dietary patterns of underreporters and non- underreporters of energy intake. Methods: We used data from a cross-sectional population-based ISA - Capital 2008, individuals aged 20 or more, of both sexes. Energy intake was assessed by averaging two 24-hour recalls collected on nonconsecutive days. Total energy expenditure was calculated by the predictive equation, considering underreporters if energy intake less than 1 or 2 standard deviations (SD) of the ratio energy intake / predict energy expenditure. A multiple regression analysis was used to identify factors associated with underreporting and principal components factor analysis was used to identify dietary patterns. Results: The prevalence of underreporters of energy intake using the cutoff of 2 SD was 15.1 per cent and using 2 SD was 60.8 per cent. Individuals who are overweight and dissatisfied with body weight were more likely to be underreport when compared to individuals without overweight and satisfied with body weight, respectively. The mean BMI among individuals underreporters was significantly 11 higher than that of non-sub-rapporteurs, contradictorily, the average energy intake was significantly lower. In each group, identified three main patterns are not similar. There was no difference between groups in carbohydrate intake, but the proportion of fat and protein was higher in the group of underreporters. Conclusion: It is necessary to study methods that are feasible to be applied in population-based studies and this becomes more relevant when the population has a high prevalence of overweight, because it is associated with both a higher incidence of chronic non- transmitted as a higher likelihood of underreporting

Abstract Tuberculosis (TB) is the leading cause of death from a single infectious disease. Unfortunately, 4.1 million cases were missed in 2017 globally, and Nigeria contributes 9% of the missing TB cases. At least 73% of the estimated TB cases in Nigeria were not reported in 2017 to the National TB Program (NTP); therefore, the true burden of TB was not certain, and this affected planning for prevention and control of TB. This quantitative secondary data analysis (NTP Lagos TB Inventory study database) guided by the integrated behavioral model assessed TB underreporting based on the TB reporting process in Nigeria. Chi-square and binomial logistic regression were used to assess the association between TB underreporting and the characteristics of health facilities (HFs), health workers' (HWs) awareness, barriers to TB reporting, and patient-related factors. The results indicate at least 60% of all HFs underreported TB, with an average of 7.4% underreporting between HFs records and TB program reports. There was a statistically significant association between NTP nonengaged health facilities (χ2 (1) = 20.547, p <.05), HWs' awareness of TB reporting (χ2 (1) = 6.576, p <.05), and barriers for TB reporting (χ2 (1) = 4.106, p < .05) with TB underreporting. The following patient factors were statistically significant predictors of TB underreporting with over 50% increased odds, p<0.05: previously treated, extrapulmonary, unknown TB site, HIV negative, and HIV unknown. This study supports social change through NTPs ensuring the establishment of a coordinating mechanism for TB reporting within and between HFs and supply of TB reporting tools to all HFs to know the true burden of TB for better planning and monitoring of quality care for TB patients.