Background: Wind turbines are a form of renewable energy, which generate electricity from wind energy, a practice dating back over 100 years. More recently, large-scale wind energy developments have started to employ one or several industrial wind turbines, which produce the majority of wind energy in Ontario. The production of electricity from the movement of industrial wind turbine motor blades creates both mechanical and aerodynamic noise. This type of environmental noise is a growing public health concern, especially for residents living close to industrial wind turbines. A body of evidence now exists to suggest that industrial wind turbine noise can impair health and contribute to annoyance and sleep disturbance. However, in Ontario, little is known about how industrial wind turbines impact people living in their vicinity. Objectives: This investigation was a cross-sectional study involving eight Ontario communities that contain greater than ten industrial wind turbines. The objectives of this study were to explore the association between proximity to industrial wind turbines and self-reported health effects, specifically quality of life (both physical and mental health) and sleep disturbance, in residents living close to wind turbines. Dose-response relationships were also explored in an attempt to investigate acceptable exposure levels and appropriate setback distances for industrial wind turbines. Methods: Eight wind farms in Ontario were selected for analysis. For this cross-sectional study, the ???Quality of Life and Renewable Energy Technologies Study??? survey was used to measure the impact of industrial wind turbines on health. Using Canada Post???s Unaddressed Admail Service, surveys were sent to 4,876 residences near industrial wind turbines in these eight communities. Survey responses were sent back to the University of Waterloo and data from the surveys were used for analysis. Descriptive analyses were performed and multiple regression models were run to investigate the effect of the main independent variable of interest (distance to nearest industrial wind turbine) on the various outcome variables. Descriptive statistics, including means and standard deviations were performed on a number of dependent and independent variables including age, sex, time in home, number of industrial wind turbines within 2,000 meters and sleep and health outcomes. Results: In total, 412 surveys were returned (8.45% response rate); 16 of these survey respondents did not provide their home address. Therefore, 396 surveys were included in the analysis. The mean self-reported distances of survey respondents to wind farms was 2,782 meters +-3,950 meters (range: 0.40-55,000 meters). The mean calculated distance from residence to the closest industrial wind turbine was 4,523 meters +-4,420 meters (range: 316-22,661 meters). The difference between the calculated and perceived distance measurements was statistically significant (P<0.001) with survey respondents reporting that they live, on average, 1,741 meters closer to wind farms than they actually do. The relationship between Pittsburgh Sleep Quality Index and ln(distance) was found to be statistically significant (P=0.01) when controlling for age, gender and county, meaning that as distance increased (move further away from an industrial wind turbine), Pittsburgh Sleep Quality Index decreased (i.e. sleep improved) in a logarithmic relationship. Among the eight Wind Turbine Syndrome index variables, the relationship between vertigo and ln(distance) was statistically significant (P<0.001) when controlling for age, gender, and county. Additionally, the relationship between tinnitus and ln(distance) approached statistical significance (P=0.08) when controlling for age, gender and county. Both vertigo and tinnitus were worse among participants living closer to industrial wind turbines. Conclusion: Study findings suggest that industrial wind turbines could have an impact on health. Using a sample of rural Ontario residents (although not necessarily representative of the target population), this study explored the quality of life (both physical and mental health) and sleep disturbance of residents living in the vicinity of industrial wind turbines. However, because of study limitations, there are many questions still to be answered before firm conclusions can be drawn. Based on the findings of this study it is recommended that further studies be carried out to examine the effects of low-level stressors, such as industrial wind turbine noise, on health. Specifically, study findings suggest that future research should focus on the effects of industrial wind turbine noise on sleep disturbance and symptoms of inner ear problems. Although the study findings could suggest that there is a possible association between various health outcomes and how far someone lives from an industrial wind turbine, it is important to remember that there are limitations to these conclusions.

Takanen Niklasson, C. Självrapporterad hälsa hos män som genomgått screening av bukaorta. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Högskola: Hälsa och Samhälle. Utbildningsområde omvårdnad 2012.Abdominellt aortaaneurysm (AAA) är den 13:e vanligaste orsaken till dödsfall i västvärlden på män över 65 år och är fyra gånger vanligare hos män än hos kvinnor. Sedan 2010 erbjuder Region Skåne ultraljuds screening av bukaorta till alla män är 65 år för att upptäcka ev. AAA. AAA uppkommer genom förhöjt kolesterol, rökning kombinerat med högt blodtryck. Även en genetisk faktor spelar roll. Syfte: Studiens syfte var att kartlägga självrapporterat hälsotillstånd och rökvanor hos patienter som via screening diagnostiserats med aortaaneurysm i jämförelse med män med normal aorta. Metod: Studien är en deskriptiv tvärsnittsstudie som bygger på självskattade hälsoformulär som har tagits fram för screeningverksamheten. Dessa fylldes i av männen i hemmet som de sedan lämnade på screeningmottagningen. Data analyserades manuellt i antal och procent i jämförelse mellan män med AAA och de med normal aorta. Resultat: Studiens resultat visade att män med AAA hade högt BMI (Body Mass Index) och led av andra sjukdomar. Vidare hade männen med AAA låg utbildning. Nästan hälften av männen med AAA rökte. Däremot beskrev männen oavsett grupp sin hälsa på liknande sätt i den öppna frågan rörande deras nuvarande hälsotillstånd. Slutsats: Resultatet kan indikera tidigare forskning som visat alla riskfaktorer som leder till ateroskleros även kan leda till utveckling av AAA. Men eftersom ingen statistik har använts i resultatet för att belägga skillnader kan datan endast ses som en trend. Denna kunskap kan utgöra en bas för sjuksköterskans preventiva arbete i mötet med patienter som diagnostiserats med AAA. / Takanen Niklasson, C. Self-reported health of men who underwent abdominal aortascreening. Degree Project, 15 Credit Points. Malmö University: Health and Society, Department of Nursing, 2012.Abdominal aortic aneurysm (AAA) is the 13:th most common cause of death in the western world in men over 65 years old and is four times more common in men than in women. The County Council of Skåne started in 2010 a screening program in men 65 years of age to possibly discover AAA. AAA generates through elevated cholesterol and smoking combined with high blood pressure. There is also a genetic factor involved. Aim: The aim of this study was to chart self-reported state of health and smoking habits of men diagnosed with AAA through screening compared with men with normal aorta. Method: the study is a descriptive cross-sectional survey built on self-rated health questionnaires which was developed for use in the screening program. These were filled out by the men at home and gathered at the screening examination. The data was analyzed manually in numbers and percent and compared between men with AAA and those with normal aorta. Results: The results showed that men with AAA had high BMI (Body Mass Index) and suffered from other diseases. Further had men with AAA a low educational level. Almost 50% of the men with AAA were also smoking. However, all men, irrespective of having AAA or not, described their health in a similar way in the open question regarding their current health status. Conclusion: The result can indicate previous research showing that all risk factors associated with development of atherosclerosis also is associated with the development of AAA. However, no statistics were being used in the result to claim differences so the data can only be a trend. This knowledge can constitute a base for nursing prevention measures in the care of men diagnosed with AAA.

Self-reported health is typically captured as a response to the question, “In general, would you rate your health as excellent, very good, good, fair or poor?” Among community-dwelling older adults (≥65 years), self-reported health decreases as the number of chronic conditions increases. Despite this well-documented relationship, little is known about how other sociodemographic or health-related factors may shape this relationship, what may predict high self-reported health among this population, or how older adults perceive these factors as influencing their perceptions of health. Informed by the Lifecourse Model of Multimorbidity Resilience, the objective of this multimethod research study was to advance understanding of self-reported health among community-dwelling older adults. To this end, four research studies were completed: 1) scoping review of the factors associated with self-reported health, 2) cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging to understand the relationship between multimorbidity and self-reported health and the factors that predict high self-reported health; 3) qualitative case study to explore the influence of individual, social, and environmental factors on self-reported health, including multimorbidity resilience, in community-dwelling older adults, and; 4) a multimethod study that brought together all findings in a matrix analysis. From this work, two meta-inferences were generated: 1) the factors that shape self-reported health are multidimensional and complex; and 2) adaptation to health adversity, resulting from experiences acquired over the lifecourse, shape how older adults perceive their health. Findings from this work advance three implications. First, there is a need to use and apply information gained by asking about self-reported health in clinical practice to inform care planning. Second, there is a need for whole person care to guide health and social care policy for older adults. Third, future health research must further explore longitudinal understanding of self-reported health as well as additional qualitative understanding of the differences of those older adults with the well-being paradox. / Dissertation / Doctor of Philosophy (PhD)

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Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-12T18:14:24Z No. of bitstreams: 1 leandrohermisdorffbernardo.pdf: 2471442 bytes, checksum: d3adf8f386800446bd62310452998a26 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-27T19:54:28Z (GMT) No. of bitstreams: 1 leandrohermisdorffbernardo.pdf: 2471442 bytes, checksum: d3adf8f386800446bd62310452998a26 (MD5) / Made available in DSpace on 2016-06-27T19:54:28Z (GMT). No. of bitstreams: 1 leandrohermisdorffbernardo.pdf: 2471442 bytes, checksum: d3adf8f386800446bd62310452998a26 (MD5) Previous issue date: 2013-03-25 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O foco específico na relação homem e saúde vêm ocorrendo, nos últimos anos, tanto nos meios acadêmicos quanto no âmbito dos serviços de saúde. Incluir a participação do homem nas ações de saúde é, no mínimo, um desafio, por diferentes razões. Apesar de avanços no campo da saúde do homem, muitas questões ainda precisam ser consideradas no cuidado destes com a própria saúde. Uma questão importante seria como esta população avalia seu próprio estado de saúde, bem como os fatores que estão associados a esta avaliação pois permite identificar o perfil desta população ainda pouco estudada, o que pode, assim, auxiliar no planejamento de medidas de prevenção e promoção de saúde, bem como subsidiar estratégias necessárias para o maior alcance destes homens em termos de saúde. O objetivo do presente estudo foi avaliar condições de saúde auto-referidas, e os possíveis fatores relacionados, da população masculina na cidade de Belo Horizonte (MG), nos anos de 2006 e 2011. Trata-se de um estudo epidemiológico longitudinal, que se propõe fazer a análise desta população em 2006 e 2011, através de inquérito telefônico (VIGITEL 2006 e 2011). As amostras foram compostas por 782 indivíduos em 2006 e 836 em 2011, com idades superiores a 18 anos. Os dados foram processados em um banco de dados criado por meio do software Statistical Package forthe Social Sciences (SPSS), versão 20.0, que permitiu verificar a associação entre cada uma das variáveis independentes com a variável dependente, através da utilização do teste Qui-quadrado (χ²). Houve uma significativa mudança na idade dos indivíduos entrevistados, onde a média passou de 41,9 em 2006 para 44,2 anos em 2011; diminuição significativa, de 59,2% para 51,7% (2006 e 2011, respectivamente), do consumo alcoólico;melhora nas condições de saúde auto-referidas, aumentando de 21,1% (0,18 – 0,23) para 28,1% (0,24 – 0,31) a proporção de indivíduos que referiram a saúde como excelente. Esses dados chamam a atenção para a necessidade de políticas públicas e ações de saúde voltadas para essa população, com ênfase em ações educativas, preventivas, e de promoção à saúde. Apesar de o VIGITEL constituir um importante instrumento de coleta de dados que favoreçam o entendimento acerca das doenças crônicas não transmissíveis, a inclusão de questões referentes às condições econômicas dos participantes seria importante para se traçar com maior clareza os fatores associados às morbidades nas populações estudadas. / The specific focus in the relationship between man and health has been occurring, in the last years, both in academic terms and in scope of health services. For many reasons, it's a challenge to include man's participation in care health. Although there are advances in the field of human health, many questions have to be considered in the care of man with own health. An important point would be how this population evaluates its own state of health, as well as the factors that are associated to this evaluation because it allows us to identify this population profile, which is still not very studied, which may, thus, help in the planning of prevention methods and health promoting, as well as support strategies, which are necessary to a higher reach of these men in terms of health. The objective of this study was to evaluate conditions of self-reported health and the possible factors related of the male population in Belo Horizonte (MG) in 2006 and 2011. This is a longitudinal epidemiological study which proposes to do an analysis of this population in 2006 and 2011 through telephonic survey (VIGITEL 2006 and 2011). The samples were composed of 782 people in 2006 and 836 in 2011 with more than 18 years. The data were processed on a database created through the software Statistical Package for Social Sciences (SPSS), version 20.0, which allowed to verify the association between each one of the independent variables with the dependent variable, through the use of qui-square test. There was a meaningful change in the interviewed individuals age, in which the average changed from 41.9 in 2006 to 44.2 years old in 2011; meaningful decrease, from 59.2% to 51.7% (2006 and 2011, respectively), in the alcoholical consume; self reported health condition improvement, increasing from 21.1% (0.18-0.23) to 28.1% (0.24-0.31) the individuals proportion that referred to the health as excellent. These data call our attention to the need for policies and health public actions focused on this population, with emphasis on educational actions, preventive and promotion to the health. Although VIGITEL be an important tool for data collection to encourage the understanding of chronic diseases, including questions relating to economic conditions of the participants would be important to more clearly delineate the factors associated with morbidity in the populations studied.

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Integrating intersectionality theory with a quantitative design, this analysis investigates the intersectional dynamics of self-reported health inequalities among lone parents in England and Wales. This study examines the association between lone parenthood, gender, and migrant status simultaneously on health outcomes. It applies logistic regression using data from the 2011 Census Microdata Individual Safeguarded dataset. The findings demonstrate the presence of multiple identity factors that contribute to health inequality, which consequently highlights the impact of cumulative socioeconomic privilege and disadvantage, impacting the health of lone parents. Regardless of gender or migration status, being a lone parent has a negative effect on health. The healthy migrant effect is evident across intersected categories of migrants and socioeconomic groups, particularly among men, partnered parents, and immigrants from Western societies. These results emphasize the significance of considering additional dimensions of social positioning and adopting an intersectional perspective in monitoring health inequalities in the country.

African American women (AAW) are at a high risk for type 2 diabetes, a debilitating and potentially fatal disease for which there is no cure. The purpose of this study was to extend the research of Mosca et al. (2012) by examining the relationship between caregiver status and self-reported health status for AAW 18 years or older diagnosed with type 2 diabetes. The chronic care model (CCM) provided the theoretical framework for this study. The CCM promoted routine care for patients with chronic illnesses to migrate from acute care to proactive, planned, and risk-based protocols. A binomial logistic regression investigated the relationship between caregiver status, categorized as paid or unpaid, and self-reported health status, which was dichotomized as either good to excellent health or poor to fair health. There was a statistically significant relationship between primary caregiver status and self-reported health status among AAW diagnosed with Type 2 diabetes after controlling for age, education, and marital status (p < .004). Based on the fitted binomial logistic regression model, there were 186 cases of AAW with type 2 diabetes; having a paid caregiver was associated with a lower odds of having good to excellent health (OR = 0.294). About 12.3% of the variance in self-report health status was attributable to caregiver status. Overall, 82.6% of predictions were accurate. Nearly all participants required frequent assistance from a caregiver in the preceding 12 months. These findings suggest a critical need for healthcare service providers to educate caregivers as a means to deliver post-acute care to AAW diagnosed with type 2 diabetes, consistent with the CCM.

Hintergrund: Schwindel ist ein häufig vorgetragenes Symptom beim Hausarzt. Seine erhöhte Vergesellschaftung mit Ängstlichkeit und Depressivität ist aber bisher zu wenig untersucht worden, ebenso wenig ist dieser Zusammenhang Gegenstand der hausärztlichen Behandlung von Schwindelpatienten. Zielstellung: Kommen unbekannte psychische Hintergründe in Kombination mit Schwindel im hausärztlichen Patientengut häufiger vor als ohne Schwindel? Ergeben sich daraus als Konsequenz unterschiedliche Versorgungsformen durch den Hausarzt? Wie verhält es sich mit deren subjektiven Gesundheitszustand, dem Erfolg der hausärztlichen Behandlung, dem ihnen entgegengebrachten Verständnis und der Häufigkeit der Arztbesuche der Betroffenen? Studiendesign: Prospektive Multicenterstudie in der Allgemeinpraxis Untersuchungsregion: Zehn Hausarztpraxen in Halle a.d. Saale und Nordsachsen/ Leipzig im städtischen und ländlichen Einzugsbereich, welche von Fachärzten für Allgemeinmedizin geführt wurden. Methodik: Die Studie untersuchte insgesamt 590 zufällig am Untersuchungstag eintreffende Patienten in jeweils einer von insgesamt zehn Hausarztpraxen. Die Ausprägung von Schwindelbeschwerden und eventuell vorhandene Merkmale von Ängstlichkeit und Depressivität beim jeweiligen Patienten wurden mit Elementen des Gießener Beschwerdebogens 24 und der Hospital Anxiety and Depression Scale (deutsche Version) untersucht. Ergebnisse: Die Patienten wurden in eine Gruppe mit relevanten (29,7%, n=175) und in eine Gruppe ohne relevante Schwindelbeschwerden (70,3%, n=408) eingeteilt (Cut off >=8 nach GBB 24). Die Gruppe mit relevantem Schwindel wies häufiger Merkmale für Ängstlichkeit (p<0,001) und Depressivität (p<0,001) in allen Altersgruppen auf, zeigte sich unzufriedener mit ihrem Behandlungserfolg (p=0,004), schätzte ihren aktuellen Gesundheitszustand schlechter ein (p<0,001) und konsultierte ihren Hausarzt in den letzten zwölf Monaten häufiger (p=0,020). Sie stellten sich nach ICPC-2 häufiger wegen neurologischer (p<0,001), psychologischer (p=0,026) und unspezifischer Beschwerden (p<0,001) vor. Sie erhielten mehr Diagnosen aus den ICD-10-Kapitel V (Psychische und Verhaltensstörungen) (p=0,030). Diese Patienten waren nach HADS-D auch häufiger psychisch auffällig (p<0,001). Relevanter Schwindel kam bei Frauen aller Altersgruppen häufiger vor als bei Männern (p<0,001). Dennoch ergaben sich keine Behandlungsunterschiede durch die Hausärzte zwischen beiden Gruppen (p=0,101 bis 0,930 je nach ärztlicher Maßnahme). Schlussfolgerung: Schwindelpatienten weisen häufger Ängstlichkeit und Depressivität auf, welche den Schwindel unterhalten. Dieser Zusammenhang sollte in der Sprechstunde bedacht werden. Die psychischen Hintergründe sollten vom Hausarzt aufgedeckt und behandelt werden. Dadurch könnte der Schwindel und damit der subjektive Gesundheitszustand der betroffenen Patienten verbessert und die Inanspruchnahme des Gesundheitswesens verringert werden.