Secondhand smoke (SHS) is a harmful mixture of over 4000 chemicals released from the burning of a cigarette. It has been classified as a Class A carcinogen and exposure to SHS has been proven to be related to negative health effects in humans. Children exposed to SHS are more susceptible to negative health effects because they have higher breathing rates and immature, developing bodies. SHS has been associated with many childhood diseases, including asthma, inner ear infections, and pneumonia. SHS exposure in confined areas, such as inside a motor vehicle, is of concern due to the increased toxicity level of the SHS. The purpose of this cross-sectional study was to assess the factors associated with those who smoke in a car containing children and to determine if the estimated prevalence of those who smoke in a vehicle with children has decreased since legislation was passed in Farmington Maine in 2008. Observations were taken at different times of the day and in different seasons. Each observation period consisted of a pair of researchers whom stood at the edge of the roadside, at 7 observations sites located throughout Farmington, Maine. When a vehicle passed, the researchers recorded the child passenger(s) estimated age(s), and the adult passenger(s) estimated age(s), gender, and smoking status. Site locations were chosen based upon ease of observation and neighborhood characteristics that were used as a proxy for socioeconomic status (SES) to the location. Adult data (n=3937) were used to calculate the estimated prevalence and factors of violation. Of all adult observations from 2008 to 2010, 8.26% were observed smoking in a vehicle containing a child, 63.38% of which were male. The estimated prevalence of those smoking in a vehicle containing children decreased from 13.08% (P < .0001), when the law was first enacted in the fall of 2008, to 7.40% (P < .0001) in the fall of 2010. Smoking in vehicles containing children was observed more frequently at sites that were estimated to have a lower SES near them, such as the fairgrounds [(OR=4.48, CI95 (2.49-8.09)] and at the tobacco store location [(OR=7.47, CI95 (4.29-13.01)]. In the final model, gender was found to be significantly associated with smoking in a vehicle containing a child, with males having increased odds of violation [OR=3.13, CI95 (2.44-4.01)]. However, when stratifying by gender, there were significant differences between site locations, dates, and time of the day that males or females were observed smoking. After adjusting for gender, site location, and age, adults observed in the Fall of 2008 were significantly more likely to be smoking in vehicle than those observed in the Fall of 2010 [OR=2.25, CI95 (1.64-3.09)]. The change in prevalence between dates indicates that smoking in a vehicle not only decreased over time, but also that season could have an effect on smoking in vehicle containing children behavior.

Effective nursing care can be threatened when nurses are not culturally attuned with their patients. Associate degree nursing (ADN) students receive information about diverse ethnicities in the nursing curriculum, but it may not be sufficient to provide the expertise necessary to care for patients of various cultural backgrounds. The purpose of this quantitative study was to explore the 2nd year ADN students' levels of cultural competence and their perceptions of self-efficacy in working with Caucasian, African American, Native American, Hispanic, and Asian ethnicities. The study used a cross-sectional survey design to determine if a relationship existed between the students' reported cultural competencies and their self-efficacy scores while providing care to patients of these diverse cultures. The process of cultural competence in the delivery of health care services was used as the theoretical framework for this study. A volunteer convenience sample of 64 2nd-year ADN students completed the Nurse Cultural Competence Scale and the Cultural Self-Efficacy Scale. The Pearson-Product Moment correlation revealed a significant negative, moderate relationship between self-efficacy and the students' perceptions of cultural competence. A project was designed to enhance skills and knowledge to improve the students' cultural competency while caring for patients of Asian, Native American, and Hispanic cultures because minimal familiarity of those cultures contributed most to the negative correlation. Research on methods to improve cultural competence among health care professionals should be continued. Positive social change will occur as nursing students gain proficiency in their abilities to provide culturally appropriate care to patients of diverse ethnic backgrounds.

Le multiparasitisme et surtout les associations qui en découlent, ont une grande influence sur l’écologie des parasites concernés. Elle est d’autant plus grande que les parasites peuvent interagir et ainsi modifier leurs effets sur les hôtes. Cependant, l’identification des associations et interactions de parasites est complexe au niveau populationnel. Notre objectif était de modéliser les associations et les interactions multiparasitaires, notamment dans le cadre des parasites d’importance médicale, vétérinaire ou agronomique. Nous avons tout d’abord réalisé une revue bibliographique sur les différentes causes et conséquences du multiparasitisme ainsi que sur les méthodes et outils disponibles pour comprendre les phénomènes qui le génèrent. Dans un second temps, nous nous sommes intéressés tout particulièrement à la détection des associations multiparasitaires. Nous avons développé une nouvelle méthode « de screening des associations » pour tester statistiquement la présence d’associations de parasites à une échelle globale. Nous avons utilisé cette méthode pour identifier les associations et pour révéler précisément les parasites associés au sein de diverses populations d’hôtes. Puis, nous avons étudié les interactions entre les parasites. Nous avons développé un modèle pour identifier les interactions entre deux parasites vectorisés et persistants chez un hôte, à partir de données issues d’études transversales. L’une des voies de progression de la connaissance sur les interactions est la prise en compte des facteurs de risque communs. La prise en compte des interactions contribue à améliorer le diagnostic, les traitements et la prévention des maladies infectieuses. / Multiparasitism and specifically statistical associations among parasites, have a strong influence on the ecology of parasites. This influence reinforced when parasites interact and thus modify their effect on hosts. However, the identification of associations and interactions between parasites is complex at the population level. Our aim was to model multi-parasite associations and interactions, in particular for parasites of medical, veterinary or agricultural importance. We first present a review of the literature on the different causes and consequences of multiparasitism and the methods and tools available to better understand the phenomena that generate them. In a second step we worked on the detection of multi-parasite associations. We developed a new approach « association screening » to statistically test the presence of multi-parasite associations on a global scale. We used this method to identify associations and to reveal precisely associated parasites in different host populations. Then, we focused on the study of interactions between parasites. We developed a model to identify the interactions between two vector-borne and persistent parasites in a host, using data from cross-sectional studies. One way to increase our capacity to detect parasite interactions in populations is the taking into account common risk factors. Taking into account interactions increases diagnosis, treatments and prevention of infectious diseases.

<p>A cross- sectional descriptive study using a self-administered close-ended questionnaire was conducted with pupils in standards four to seven (aged 10 &ndash / 17 years) in ten government primary schools in Meru District. The sample of 400 school pupils was obtained by a simple random sampling technique. Data analysis was done using Statistical Package for Social Sciences SPSS (version 15) computer software and the results were presented in frequencies using simple percentages, tables and graphs. The Chi-square test was used to assess the significance where a p-value of &lt / 0.05 was considered statistically significant. In conclusion, Primary school pupils in Meru district engage in several risky sexual behaviors including substance use, sexual coercion, early sexual debut and engaging in various sexual practices. This calls for a more comprehensive approach in the fight against HIV among primary school children in Tanzania, which could include life skill training at an early age, behaviour change communication interventions, advocacy activities to influence policy formulation, condom promotion and incorporating key stakeholders in the rollout of school based HIV programmes such as parents, community leaders and faith-based organizations leaders.</p>

The general aim of the thesis was to investigate potential differences in memory performance between participants across the adult life span with and without self-reported musculoskeletal pain. Chronic musculoskeletal pain is a major health related problem in our society. A common complaint related to chronic pain is about cognitive difficulties in attention, memory, and decision making. A number of studies have demonstrated that people with pain also perform wors on tasks measuring, for example episodic memory, semantic memory, and working memory. The present thesis aimed at replying these findings, by using a non-clinical population based sample. the potential differences in memory performance between people with and without pain were examined across the adult life span, in order to disentangle potential pain by age interactions. This was made by using both cross-sectional and longitudinal data. Study I aimed at studying differences in episodic memory performance, semantic memory performance, and implicit memory performance, between people with and without musculoskeletal pain. Differences were found for all three memory systems, but disappeared after controlling for years of formal education. In Study II an extension of the first study was made, in which performance on a range of cognitive tests were analysed. General differences were demonstrated , but yet again, years of education together with depression ruled out the effects. The most robust effects were found for word comprehension and construction ability. Finally, Study III used 5- and 10 year follow up studies to examine change over time in cognitive performance as a function of pain. The main finding from this study was that semantic memory for the oldest is impaired over time as a function of pain. An additional analysis showed similar patterns, regardless of age, for construction ability.

La ecografía es una técnica ampliamente utilizada para evaluar las lesiones tendinosas en los caballos, hasta este momento no se ha realizado ningún estudio sobre la ecogenicidad y el área de los tendones flexores y ligamentos de la zona metacarpiana del Pura Raza Español (P.R.E). El objetivo de nuestro estudio es determinar el área y la ecogenicidad de los tendones flexores y ligamentos de la zona del metacarpo, y determinar si tiene algún efecto la edad, el sexo, la extremidad y la zona de corte a ecografiar sobre estos parámetros en el caballo PRE.De este trabajo podemos concluir que la edad y la zona del metacarpo donde se realiza el examen tienen un efecto tanto en la ecogenicidad como en el área. Mientras que la extremidad sólo influye en los valores del área. Sin embargo, no se encontró ninguna diferencia entre machos y hembras ni en la ecogenicidad ni en los valores del área. / The ultrasonographic assessment of tendon injuries can be based on several criteria. The purposes of this study were to establish normal values for CSA and ME of flexor tendons and ligaments of the metacarpal region of Andalusian horses; to determine the normal relation between the different tendons and ligaments; to determine the normal relation between the male and female for each tendon and ligament; to determine the normal relation between the left and right limbs for each tendon and ligament and to determine the normal relation between different age (young, adult and senile) for each tendon and ligament.In conclusion, this work suggests that the age and level have an effect on CSA and ME of the tendons and ligaments. The limb has also an effect on CSA of each tendon and ligament. Differences in CSA or ME of each tendon were not found between males and females.

This thesis is based on cross-sectional data analyses by using Ordinary Least Squares (OLS) Method in order to determine the main drivers of the environmental performance and specifically the effects of environmental audits conducted by Supreme Audit Institutions (SAIs) on sustainable development. Two general models are employed throughout the study that have the Environmental Performance Index (EPI) as dependent variable and various sub-models for different income groups are produced to observe the individual and interactive effects of explanatory variables. First model includes 150 countries regressing their EPI scores on income, population, literacy rate and indicators of the strength of institutional structure such as corruption perceptions index or government effectiveness score. Then, second model which comprises 52 countries introduces the number of environmental audit reports as a new explanatory variable. Principal Component Analysis (PCA) is also applied to highly correlated variables and the models are reestimated. The results indicate that well functioning environmental management systems and resulting positive effects on the environmental performance can only be attained through strengthened governmental institutions with high transparency and accountability as well as rigid implementation of the related regulations. More specifically, environmental audit reports generated by SAIs are of vital importance for especially improving the environmental management systems of the developing countries.

The scope of this thesis is to process and analyze statistically Magnetic Resonance Images (MR-T1) from Parkinson’s disease patients in order to detect brain areas that exhibit brain change which is caused by the disease. Parkinson’s disease is an idiopathic disease which means that its cause is yet unknown. It is a chronic neurodegenerative disorder of the central nervous system which causes the progressive death of specific brain neurons that leads to motor impairments (tremor, bradykinesia, muscle rigidity) and non motor ones (cognitive, sleep, sensation disturbances). Magnetic Resonance Images (T1-weighted) were acquired from both Parkinson’s patients and healthy subjects (Controls) at intervals of 0 and 5 years. The data have undergone longitudinal (two-time-point), cross sectional (single-time-point) and statistical analysis with the use of FSL software library. Evidence of atrophy among Parkinson’s patients aroused, in brain areas near the ventricles and the middle temporal gyrus, after statistical analysis / Ο σκοπός αυτής της εργασίας είναι η επεξεργασία και στατιστική ανάλυση μαγνητηκών τομογραφιών (MR-T1) από ασθενείς με Πάρκινσον για την ανίχνευση περιοχών του εγκεφάλου που παρουσιάζουν μεταβολές που οφείλονται στην ασθένεια. Η ασθένεια Πάρκινσον είναι ιδιοπαθής, δηλαδή ασθένεια της οποίας η αιτία παραμένει ακόμη άγνωστη. Είναι μια χρόνια δυσλειτουργία λόγω εκφυλισμού των νευρώνων του κεντρικού νευρικού συστήματος η οποία προκαλεί τη σταδιακή νεκρωση συγκεκριμένης ομάδας εγκεφαλικών νευρώνων. Αυτή η νέκρωση οδηγεί σε κινητικές δυσλειτουργίες (τρέμουλο, βραδυκινησία, και μυϊκή δυσκαμψία και σε μή κινητικές όπως γνωστικές, διαταραχής ύπνου,διαταραχές αφής κ.α. Μαγνητικές τομογραφίες (τύπου Τ1) ασθενών και υγιών ελήφθησαν σε διαστήματα 0 και 5 ετών. Τα δεδομένα αναλύθηκαν με δυο μεθόδους (longitudinal και cross-sectional) και εν συνεχεία έγινε στατιστική επεξεργασία των αποτελεσμάτων. Έγινε χρήση της βιβλιοθήκης FSL Μετά από στατιστική ανάλυση προέκυψαν ενδείξεις ατροφίας στους ασθενείς με Πάρκινσον σε περιοχές του εγεκφάλου κοντά στις εγκεφαλικές κοιλίες (ventricles) και στη μέσο-κροταφική έλικα (middle temporal gyrus).

Emotional suffering in old age is largely caused by a variety of psychiatric disorders which are often, however, undertreated and underrecognized. This leads to reduced quality of life and functional status and increased morbidity and mortality. Dementia, delirium and depression are common disorders in the very old, and are similar in several ways. All have multiple causes and are diagnosed by means of symptomatic criteria, are challenging to diagnose and difficult to differentiate from each other in the very old. They often coexist in the same individual, and may have common risk factors. The overall aim of this thesis was to add to our knowledge about threats to successful aging, by investigating the prevalences of dementia, depression and delirium, and factors associated with these three disorders. Further aims were to measure change over time in the prevalence of dementia and depression, respectively, and to investigate the risk factors for incident depression. This thesis uses the population-based Umeå85+/GErontological Regional DAtabase (GERDA) material. In 2000-2002, every other 85-year-old, all 90-year-olds and all people ≥95 years living in six municipalities in Västerbotten, Sweden were invited to participate, and in 2005-2007 the process was repeated, with the additional inclusion of the corresponding populations of two municipalities in Österbotten, Finland. A third data collection was carried out in 2010-2012. Trained assessors carried out assessments in the form of structured interviews during one or more home visits, recorded current medication and reviewed medical records obtained from general practitioners and hospitals. In 2000-2002 the prevalence of dementia was 17% among 85-year-olds, 24% among 90-year-olds and 46% among those aged ≥95 years. In 2005-2007 dementia prevalence reached 28% among 85-year-olds, 40% among 90-yearolds and 45% among those aged ≥95 years. The prevalence of dementia in the total sample was 27% in 2000-2002 and 37% in 2005-2007 (p=0.001). In 2000-2002 the prevalence of depressive disorders was 24% among 85-yearolds, 34% among 90-year-olds and 31% among those aged ≥95 years. In 2005-2007 the prevalence of depressive disorders was 33% among 85-year-olds, 39% among 90-year-olds and 38% among those aged ≥95 years. The prevalence of depressive disorders in the total sample was 29% in 2000-2002 and 37% in 2005-2007 (p=0.025). Among participants not depressed at baseline, 26% had developed depression after five years. Factors independently associated with new cases of depression at follow-up were hypertension, a history of stroke and a higher score on the 15-item Geriatric Depression Scale at baseline. The thirtyday prevalence of delirium in 2005-2007 was 17% among 85-year-olds, 21% among 90-year-olds and 39% among participants aged ≥95 years. Delirium prevalence among individuals with dementia was higher than among those without dementia (52% vs. 5%, p&lt;.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression, heart failure, living in an institution and prescribed antipsychotics. There was a high prevalence of dementia, depression and delirium in the papers comprising this thesis, and 55% had at least one of the three disorders. The prevalence of dementia and depression also increased between 2000-2002 and 2005-2007, after controlling for age and sex. Dementia and depression were important associated factors for delirium and half of those with dementia were depressed. The increasing age-specific prevalence of depression seems to be associated with the increasing age-specific prevalence of dementia. The papers presented are among the first to report a significantly increasing age-specific prevalence of dementia and depression among very old people. More knowledge about associated factors and risk factors concerning these disorders may be helpful for carers and decision-makers, as well as providing reference values for studies in other regions. Further efforts are needed in both care and research to better prevent, screen for, diagnose and treat dementia, depression and delirium, especially considering the growing number of very old people. / Umeå85+/GERDA

<p>A cross- sectional descriptive study using a self-administered close-ended questionnaire was conducted with pupils in standards four to seven (aged 10 &ndash / 17 years) in ten government primary schools in Meru District. The sample of 400 school pupils was obtained by a simple random sampling technique. Data analysis was done using Statistical Package for Social Sciences SPSS (version 15) computer software and the results were presented in frequencies using simple percentages, tables and graphs. The Chi-square test was used to assess the significance where a p-value of &lt / 0.05 was considered statistically significant. In conclusion, Primary school pupils in Meru district engage in several risky sexual behaviors including substance use, sexual coercion, early sexual debut and engaging in various sexual practices. This calls for a more comprehensive approach in the fight against HIV among primary school children in Tanzania, which could include life skill training at an early age, behaviour change communication interventions, advocacy activities to influence policy formulation, condom promotion and incorporating key stakeholders in the rollout of school based HIV programmes such as parents, community leaders and faith-based organizations leaders.</p>