No / Almost all studies in health research control or investigate socioeconomic position (SEP) as exposure or confounder. Different measures of SEP capture different aspects of the underlying construct, so efficient methodologies to combine them are needed. SEP and ethnicity are strongly associated, however not all measures of SEP may be appropriate for all ethnic groups. Methods We used latent class analysis (LCA) to define subgroups of women with similar SEP profiles using 19 measures of SEP. Data from 11,326 women were used, from eight different ethnic groups but with the majority from White British (40%) or Pakistani (45%) s, who were recruited during pregnancy to the Born in Bradford birth cohort study. Results Five distinct SEP subclasses were identified in the LCA: (i) "Least socioeconomically deprived and most educated" (20%); (ii) "Employed and not materially deprived" (19%); (iii) "Employed and no access to money" (16%); (iv) "Benefits and not materially deprived" (29%) and (v) "Most economically deprived" (16%). Based on the magnitude of the point estimates, the strongest associations were that compared to White British women, Pakistani and Bangladeshi women were more likely to belong to groups: (iv) "benefits and not materially deprived" (relative risk ratio (95% CI): 5.24 (4.44, 6.19) and 3.44 (2.37, 5.00), respectively) or (v) most deprived group (2.36 (1.96, 2.84) and 3.35 (2.21, 5.06) respectively) compared to the least deprived class. White Other women were more than twice as likely to be in the (iv) "benefits and not materially deprived group" compared to White British women and all ethnic groups, other than the Mixed group, were less likely to be in the (iii) "employed and not materially deprived" group than White British women. Conclusions LCA allows different aspects of an individual’s SEP to be considered in one multidimensional indicator, which can then be integrated in epidemiological analyses. Ethnicity is strongly associated with these identified subgroups. Findings from this study suggest a careful use of SEP measures in health research, especially when looking at different ethnic groups. Further replication of these findings is needed in other populations.

No description available.

The main aim of this thesis is to analyse different mortality models regarding the longevity risk. We focus on the well-known stochastic models (Lee-Carter model, Age-period-cohort model by Renshaw and Haberman, Cairns-Blake-Dowd two-factor model) and compare them with relatively new Taiwanese model by Yang, Yue and Huang which is based on principal component analysis. Both the theoretical and also the empirical parts are included. Empirical part evaluates all the models mentioned above on the Czech mortality data from 1970-2000 for individuals aged between 50-100 years. Final mortality predictions are made for next 30 years.

Abstract Temporomandibular disorders (TMD) are described as a variety of dysfunctions and pains related to the masticatory system. Clicking in the temporomandibular joints (TMJs) and pain in the masticatory muscles are the most common symptoms and signs of TMD. Other frequently reported symptoms are headache, facial pain, and symptoms in the ears. The prevalence of TMD signs in the adult population has been shown to vary between 33% and 86%, being more common in women than in men. TMD has been found to be most prevalent at 20–50 years of age. The aim of this cross-sectional study was to investigate the prevalence of TMD and associated risk factors in the Finnish adult population based on the Northern Finland Birth Cohort (NFBC) 1966. Altogether 1 962 cohort subjects at the age of 46 years (1 050 women, 912 men) responded to questionnaires and participated in a clinical medical and dental examination in 2012–2013. The stomatognathic examination was performed according to a modified protocol of diagnostic criteria for TMD (DC/TMD). The prevalence of TMD signs among the examined cohort subjects was 34.2%; women had clinical signs of TMD more often than men. Clinical signs were registered more often than self-reported TMD symptoms. The most common clinical signs were clicking in the TMJs (26.2%) and palpation pain in the masticatory muscles (11.2%). The most common diagnosis was disc displacement with reduction (7.0%). TMD signs were associated with unstable occlusion. Occlusal disturbances were associated with palpation pain in the masticatory muscles, as well as myalgia and arthralgia diagnoses. Pain-related TMD symptoms and clinical signs correlated strongly with a poor self-reported health condition as well as with painful general health problems. / Tiivistelmä Purentaelimistön toimintahäiriöt (engl. temporomandibular disorders, TMD) on yhteisnimitys leukanivelten, puremalihasten, hampaiston ja niihin liittyvien kudosten sairaus- ja kiputiloille. Leukanivelen naksuminen ja kipu purentaelimistön alueella ovat tavallisimmat oireet, mutta myös päänsärky, kasvokipu ja korvaoireet ovat yleisiä TMD-potilailla. Väestötutkimuksissa on havaittu suurta vaihtelua TMD:n esiintyvyydessä (33–86 %). TMD:n oireita sekä löydöksiä todetaan tavallisimmin 20–50-vuotiailla ja naisilla enemmän kuin miehillä. Tutkimuksen tarkoituksena oli selvittää TMD:n esiintyvyyttä ja riskitekijöitä suomalaisessa aikuisväestössä Pohjois-Suomen syntymäkohortti 1966:n (Northern Finland Birth Cohort, NFBC) aineistossa. Vuosina 2012–2013 tutkittiin 1 962 kohortin henkilöä 46 vuoden ikäisinä (1 050 naista, 912 miestä). Tutkimus koostui kyselyistä sekä lääketieteellisestä ja suun terveydentilan kliinisestä tutkimuksesta. Purentaelimistön tutkimuksessa käytettiin kansainvälistä TMD:n diagnostista kriteeristöä (engl. diagnostic criteria for TMD, DC/TMD). TMD-löydösten esiintyvyys tutkitussa kohorttiaineistossa oli 34,2 %. Kliiniset löydökset tutkituilla henkilöillä olivat yleisempiä kuin heidän raportoimansa oireet. Yleisimmät löydökset olivat leukanivelen naksuminen (26,2 %) ja palpaatiokipu puremalihaksissa (11,2 %). Yleisin diagnoosi oli leukanivelen välilevyn palautuva virheasento (7,0 %). TMD-löydösten ja epästabiilin purennan välillä havaittiin yhteys. Purennassa olevien häiriöiden ja puremalihasten palpaatiokivun sekä leukanivelkivun välillä todettiin selvä yhteys. TMD-löydöksillä ja niihin liittyvillä kivuilla havaittiin tilastollisesti merkitsevä yhteys koettuun heikentyneeseen terveydentilaan sekä kivuliaisiin yleissairauksiin.

Background: Diabetes mellitus and vascular diseases have a significant impact on the eye. / Aim: To determine the prevalence, risk factors, and racial/ethnic differences of major eye conditions, particularly retinal conditions, associated with diabetes and vascular diseases. / Scope: To date, the majority of studies have examined the association of retinal vascular calibre and diabetes in predominantly white Caucasian populations. Further elucidation of ethnic differences in effects of hyperglycaemia on early microvascular disease is relevant, particularly amongst Asians where diabetes is likely to see the largest increase in prevalence over the next decade. We therefore examined these findings from three Asian population-based studies, the Singapore Malay Eye Study (n=3280), Singapore Prospective Cohort Study and Singapore Cardiovascular Cohort Study 2 (n=3748). / Results: The prevalence of diabetic retinopathy in the Singapore Malay Eye Study was 35%, and associated with longer duration of diabetes, poorer glycemic and blood pressure control. More importantly, 9.0% had vision-threatening retinopathy, and retinopathy was found in 6.0% of people without diabetes. Retinal vascular calibre changes were incriminated in diseases such as diabetes and hypertension, independent of traditional cardiovascular risk factors. Wider venular calibre was independently associated with early age-related macular degeneration. We also found a novel association between peripheral artery disease and glaucoma, stronger in persons with diabetes, independent of vascular risk factors, supporting the vascular theory of glaucoma. / Implications: Subtle changes in retina, including retinal vascular calibre may be early markers of widespread microvascular changes in diabetes, resulting from chronic hyperglycaemia and other pathogenic processes. These results will have broad implications for understanding the impact of both microvascular and macrovascular complications of diabetes in the Asia Pacific region and targeting relevant therapeutic interventions.

Cette thèse a conduit à la mise au point de deux nouvelles approches statistiques pour l'identification automatique de populations cellulaires en cytometrie de flux multiparamétrique, et ceci pour le traitement d'un grand nombre d'échantillons, chaque échantillon étant prélevé sur un donneur particulier. Ces deux approches répondent à des besoins exprimés dans le cadre du projet Labex «Milieu Intérieur». Dix panels cytométriques de 8 marqueurs ont été sélectionnés pour la quantification des populations principales et secondaires présentes dans le sang périphérique. Sur la base de ces panels, les données ont été acquises et analysées sur une cohorte de 1000 donneurs sains.Tout d'abord, nous avons recherché une quantification robuste des principales composantes cellulaires du système immunitaire. Nous décrivons une procédure computationnelle, appelée FlowGM, qui minimise l'intervention de l'utilisateur. Le cœur statistique est fondé sur le modèle classique de mélange de lois gaussiennes. Ce modèle est tout d'abord utilisé pour obtenir une classification initiale, le nombre de classes étant déterminé par le critère d'information BIC. Après cela, une méta-classification, qui consiste en l'étiquetage des classes et la fusion de celles qui ont la même étiquette au regard de la référence, a permis l'identification automatique de 24 populations cellulaires sur quatre panels. Ces identifications ont ensuite été intégrées dans les fichiers de cytométrie de flux standard (FCS), permettant ainsi la comparaison avec l'analyse manuelle opérée par les experts. Nous montrons que la qualité est similaire entre FlowGM et l'analyse manuelle classique pour les lymphocytes, mais notamment que FlowGM montre une meilleure discrimination des sous-populations de monocytes et de cellules dendritiques (DC), qui sont difficiles à obtenir manuellement. FlowGM fournit ainsi une analyse rapide de phénotypes cellulaires et se prête à des études de cohortes.A des fins d'évaluation, de diagnostic et de recherche, une analyse tenant compte de l'influence de facteurs, comme par exemple les effets du protocole, l'effet de l'âge et du sexe, a été menée. Dans le contexte du projet MI, les 1000 donneurs sains ont été stratifiés selon le sexe et l'âge. Les résultats de l'analyse quantitative faite avec FlowGM ont été jugés concordants avec l'analyse manuelle qui est considérée comme l'état de l'art. On note surtout une augmentation de la précision pour les populations CD16+ et CDC1, où les sous-populations CD14loCD16hi et HLADRhi CDC1 ont été systématiquement identifiées. Nous démontrons que les effectifs de ces deux populations présentent une corrélation significative avec l'âge. En ce qui concerne les populations qui sont connues pour être associées à l'âge, un modèle de régression linéaire multiple a été considéré qui fournit un coefficient de régression renforcé. Ces résultats établissent une base efficace pour l'évaluation de notre procédure FlowGM.Lors de l'utilisation de FlowGM pour la caractérisation détaillée de certaines sous-populations présentant de fortes variations au travers des différents échantillons, par exemple les cellules T, nous avons constaté que FlowGM était en difficulté. En effet, dans ce cas, l'algorithme EM classique initialisé avec la classification de l'échantillon de référence est insuffisant pour garantir l'alignement et donc l'identification des différentes classes entre tous échantillons. Nous avons donc amélioré FlowGM en une nouvelle procédure FlowGMP. Pour ce faire, nous avens ajouté au modèle de mélange, une distribution a priori sur les paramètres de composantes, conduisant à un algorithme EM contraint. Enfin, l'évaluation de FlowGMP sur un panel difficile de cellules T a été réalisée, en effectuant une comparaison avec l'analyse manuelle. Cette comparaison montre que notre procédure Bayésienne fournit une identification fiable et efficace des onze sous-populations de cellules T à travers un grand nombre d'échantillons. / In the course of my Ph.D. work, I have developed and applied two new computational approaches for automatic identification of cell populations in multi-parameter flow cytometry across a large number of samples. Both approaches were motivated and taken by the LabEX "Milieu Intérieur" study (hereafter MI study). In this project, ten 8-color flow cytometry panels were standardized for assessment of the major and minor cell populations present in peripheral whole blood, and data were collected and analyzed from 1,000 cohorts of healthy donors.First, we aim at robust characterization of major cellular components of the immune system. We report a computational pipeline, called FlowGM, which minimizes operator input, is insensitive to compensation settings, and can be adapted to different analytic panels. A Gaussian Mixture Model (GMM) - based approach was utilized for initial clustering, with the number of clusters determined using Bayesian Information Criterion. Meta-clustering in a reference donor, by which we mean labeling clusters and merging those with the same label in a pre-selected representative donor, permitted automated identification of 24 cell populations across four panels. Cluster labels were then integrated into Flow Cytometry Standard (FCS) files, thus permitting comparisons to human expert manual analysis. We show that cell numbers and coefficient of variation (CV) are similar between FlowGM and conventional manual analysis of lymphocyte populations, but notably FlowGM provided improved discrimination of "hard-to-gate" monocyte and dendritic cell (DC) subsets. FlowGM thus provides rapid, high-dimensional analysis of cell phenotypes and is amenable to cohort studies.After having cell counts across a large number of cohort donors, some further analysis (for example, the agreement with other methods, the age and gender effect, etc.) are required naturally for the purpose of comprehensive evaluation, diagnosis and discovery. In the context of the MI project, the 1,000 healthy donors were stratified across gender (50% women and 50% men) and age (20-69 years of age). Analysis was streamlined using our established approach FlowGM, the results were highly concordant with the state-of-art gold standard manual gating. More important, further precision of the CD16+ monocytes and cDC1 population was achieved using FlowGM, CD14loCD16hi monocytes and HLADRhi cDC1 cells were consistently identified. We demonstrate that the counts of these two populations show a significant correlation with age. As for the cell populations that are well-known to be related to age, a multiple linear regression model was considered, and it is shown that our results provided higher regression coefficient. These findings establish a strong foundation for comprehensive evaluation of our previous work.When extending this FlowGM method for detailed characterization of certain subpopulations where more variations are revealed across a large number of samples, for example the T cells, we find that the conventional EM algorithm initiated with reference clustering is insufficient to guarantee the alignment of clusters between all samples due to the presence of technical and biological variations. We then improved FlowGM and presented FlowGMP pipeline to address this specific panel. We introduce a Bayesian mixture model by assuming a prior distribution of component parameters and derive a penalized EM algorithm. Finally the performance of FlowGMP on this difficult T cell panel with a comparison between automated and manual analysis shows that our method provides a reliable and efficient identification of eleven T cell subpopulations across a large number of samples.

The objective of this thesis is to find patterns trends and assumptions for mortality vs. age prediction. Based on the analysis of trends in the already extinct cohorts, the most suitable models for estimating the future development of mortality among surviving cohorts are selected. This thesis compares real data extinct cohorts with balanced data Gompertz-Makehamovy function. The research and analysis is focused on the specifics of cohort mortality from the age of 90. The last part of this thesis illustrates comparison between real data of extinct cohorts with DeRaS model outputs. The selection of Kannisto and Thatcher as the optimal model is presented in the form of graphical outputs indicating the cohort life expectancy of men and women aged 90 years.

[pt] As mudanças ocorridas nos últimos anos no Brasil, no que tange avanços tecnológicos de comunicação, novos meios de realização de transações comerciais e, consequentemente, novas atitudes dos consumidores em geral, de alguma forma impactam o setor de investimentos. Novos perfis atitudinais podem resultar em diferentes percepções e comportamentos em relação a marcas de gestores de ativos financeiros, a exemplo do Banco do Brasil e Itaú, mais tradicionais, e a XP Investimentos e o Nubank, mais modernas. A eventual diferença de percepção e a potencial preferência por essa ou aquela marca podem estar relacionadas à faixa etária dos públicos investidores, ou seja, suas gerações, influenciadas pelo ambiente onde se desenvolveram, pela intensidade do uso de meios tecnológico e pelos processos de compra de bens e serviços a que vêm sendo submetidos em suas vidas. O trabalho avalia a utilidade (peso) de diferentes atributos que influenciam a escolha de fundos de ações, tais como marca gestora, índice de retorno, perfil de risco, taxa de administração e critério de composição de ações de empresas com perfil de responsabilidade ambiental, social e transparência (ASG). O método é a análise conjunta, aplicado sobre 2 grupos de investidores, simulando investimentos em variados perfis de fundos. Os pesos (utilidades) atribuídos às variáveis selecionadas são comparados com base na idade (geração/cohort) dos participantes. Um questionário complementar busca dados que auxiliam na explicação dos resultados encontrados por meio das simulações. Apesar de relevantes, os aspectos associados a risco e retorno não foram suficientes para explicar inteiramente o processo de decisão dos investidores em fundos de ações, possivelmente, estes sejam influenciados por questões emocionais, afetivas, atitudinais que ilustraram a importância atribuída aos critérios marca e presença do critério ASG na composição da carteira dos fundos de investimentos. / [en] The changes that have taken place in Brazil in the last few years, regarding technological advances in communication, new means of carrying out commercial transactions and, consequently, consumers’ new attitudes impact the investment sector somehow. New attitudinal profiles can result in different perceptions and behaviors in relation to the brands of financial asset managers such as the most traditional, Banco do Brasil and Itaú, such as the most modern XP Investimentos and Nubank. The possible difference in perception and the potential preference for this or that brand may be related to the age group of the investing public, that is, their generations, influenced by the environment in which they developed, by the intensity of the use of technological means and by the purchase processes of goods and services to which they have been subjected in their lives. The work evaluates the usefulness (weight) of different attributes that influence the choice of equity funds, such as management brand, return index, risk profile, management fee and criteria for the composition of shares of companies with an environmental responsibility profile, and transparency (ESG). The method is the conjoint analysis, applied on 2 groups of investors, simulating investments in different profiles of funds. The weights (utilities) assigned to the selected variables are compared based on the age (generation/cohort) of the participants. A complementary questionnaire seeks data that helps to explain the results found through simulations. Although relevant, the aspects associated with risk and return were not enough to fully explain the decision process of investors in equity funds, possibly these are influenced by emotional, affective and attitudinal aspects that illustrated the importance attributed to Brand criteria and presence of the ESG Criteria in the composition of the investment fund portfolio.

Pregnancy and childbirth are critical life events and women and their families require physical as well as emotional support and care. The concepts continuity of care, choice and a sense of control are prominent in the literature on women’s satisfaction with as well as outcomes of care. Midwives have globally been identified as important role players in women-centred care for low risk pregnant women. To be able to offer their women safe, supportive care they need not only a certain degree of autonomy, but also the support of other health care professionals such as obstetricians to whom they can refer women with risk factors or complications. Maternity care has become “medicalised” and the overuse of interventions such as caesarean section is prevalent in many countries. South African women make use of either the public or private health sector for care during pregnancy and birth. The public sector is overburdened and women do not have a high level of continuity of care. The private sector is mainly obstetrician-led and intervention-driven, even for low risk women. The estimated caesarean section rate is higher than 70%. Private midwife-led care is available in South Africa, but is concentrated in the major cities. Private midwives practise at hospitals, birth centres, “active birth units” and women’s homes. No evidence could be found on the outcomes of private midwife-led care in South Africa. The objectives of this study were to explore and describe the outcomes of births attended by private midwives in Gauteng over a two year period and to compare these outcomes with the latest Cochrane review on midwife-led care. A retrospective cohort design was chosen to audit the birth registers of private midwives in Gauteng and conduct quantitative analyses. Gauteng midwives’ patients, when compared with the Cochrane review that juxtaposes midwife-led care with other models of care, had a significantly lower percentage of interventions such as induction of labour (9.6% versus 18.6%) but caesarean sections were performed significantly more frequently (19.3% for the women in Gauteng versus 12.5% for the women in the review). Women in Gauteng also made significantly less use of medications in labour. Maternal and neonatal outcomes were reassuring. Significantly more Gauteng women had intact perineums (53.4% versus 31.4%). A higher percentage of postpartum haemorrhage was found in the Gauteng sample (7.9% versus 6.2%). The difference is significant, although, only three women were admitted to high care units as a result of postpartum haemorrhage. Overall foetal loss (4.3% versus 6.7%) and neonatal ICU admissions (0.3% versus 2.9%) occurred significantly less frequently in the Gauteng sample. The study findings indicate that private midwife-led care in Gauteng compared well with that in the rest of the world in terms of intervention rates and outcomes. / MCur, North-West University, Potchefstroom Campus, 2015

Pregnancy and childbirth are critical life events and women and their families require physical as well as emotional support and care. The concepts continuity of care, choice and a sense of control are prominent in the literature on women’s satisfaction with as well as outcomes of care. Midwives have globally been identified as important role players in women-centred care for low risk pregnant women. To be able to offer their women safe, supportive care they need not only a certain degree of autonomy, but also the support of other health care professionals such as obstetricians to whom they can refer women with risk factors or complications. Maternity care has become “medicalised” and the overuse of interventions such as caesarean section is prevalent in many countries. South African women make use of either the public or private health sector for care during pregnancy and birth. The public sector is overburdened and women do not have a high level of continuity of care. The private sector is mainly obstetrician-led and intervention-driven, even for low risk women. The estimated caesarean section rate is higher than 70%. Private midwife-led care is available in South Africa, but is concentrated in the major cities. Private midwives practise at hospitals, birth centres, “active birth units” and women’s homes. No evidence could be found on the outcomes of private midwife-led care in South Africa. The objectives of this study were to explore and describe the outcomes of births attended by private midwives in Gauteng over a two year period and to compare these outcomes with the latest Cochrane review on midwife-led care. A retrospective cohort design was chosen to audit the birth registers of private midwives in Gauteng and conduct quantitative analyses. Gauteng midwives’ patients, when compared with the Cochrane review that juxtaposes midwife-led care with other models of care, had a significantly lower percentage of interventions such as induction of labour (9.6% versus 18.6%) but caesarean sections were performed significantly more frequently (19.3% for the women in Gauteng versus 12.5% for the women in the review). Women in Gauteng also made significantly less use of medications in labour. Maternal and neonatal outcomes were reassuring. Significantly more Gauteng women had intact perineums (53.4% versus 31.4%). A higher percentage of postpartum haemorrhage was found in the Gauteng sample (7.9% versus 6.2%). The difference is significant, although, only three women were admitted to high care units as a result of postpartum haemorrhage. Overall foetal loss (4.3% versus 6.7%) and neonatal ICU admissions (0.3% versus 2.9%) occurred significantly less frequently in the Gauteng sample. The study findings indicate that private midwife-led care in Gauteng compared well with that in the rest of the world in terms of intervention rates and outcomes. / MCur, North-West University, Potchefstroom Campus, 2015