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Understanding how proximal, intermediate, and distal determinants of Indigenous peoples’ health in Canada, relate to the physical and mental health of First Nations, Métis, and Inuit, can shed light on how to allocate health-related resources to address well documented health disparities in these groups. This dissertation contributes to the literature by addressing two population-level quantitative research questions pertaining to Indigenous peoples’ physical and mental health, and a qualitative case study examining what factors maintain and improve Indigenous community health workers’ mental wellness and access to mental health supports. First, this thesis establishes a link between being Indigenous and health-related quality of life using multivariate regressions, as well as decomposition techniques. Second, the relationship between having an ancestor who survived the Residential School System, and five physical and mental health outcomes, controlling for determinants of health are estimated using multivariate ordered logistic and logistic regressions. Third, given that Indigenous self-government is an important determinant of health and wellbeing, an explanatory single-case study design is used to explore what factors maintain and improve, or create barriers to mental wellness and access to mental health supports for Indigenous community health workers in an Indigenous-governed health system. These chapters build on each other, and use a variety of methodological approaches, to identify if and to what degree observable determinants of health account for the physical and mental health of Indigenous peoples living in Canada. Substantively, this thesis evaluates empirically, the relationship between determinants of health and health outcomes for Indigenous peoples. Findings could be used to advocate for adequate and sustained investment in programs and services responsive to the contexts and needs of Indigenous men and women living in Canada. Methodologically, novel applications of statistical/econometric methodologies, furthers understanding of quantitative relationships examined with respect to Indigenous peoples’ physical and mental health at the population-level. In terms of a theoretical contribution, this dissertation contributes by lending further insight into the empirical relationships between determinants of Indigenous peoples’ health and health outcomes, and by introducing a framework for conceptualizing factors that strengthen mental wellness of Indigenous community health workers in remote Northern contexts in Canada. / Thesis / Doctor of Philosophy (PhD) / First Nations, Métis, and Inuit make up 4.3% of the Canadian population and together represent the three distinct identities of Indigenous peoples living in Canada. Indigenous peoples’ experiences of colonization have had impacts on their physical and mental health. Additionally, experiences of colonization have also affected many determinants of Indigenous peoples’ health ranging from access to food and clean drinking water, to the availability of appropriate education, social, and healthcare services. The following chapters explore how certain experiences of being Indigenous in Canada are associated with physical and mental health outcomes, taking into consideration determinants of health. Even after controlling for all of the things known to be related to Indigenous peoples’ physical and mental health, and that are typically used to explain any differences in health between groups, there is still a difference in health outcomes between Indigenous and non-Indigenous peoples in Canada. There is also still a difference in physical and mental health outcomes between Indigenous adults with and without an ancestor who attended the Residential School System. The effects of colonization also influence Indigenous community health workers’ mental wellness, and access to mental health supports while living and working in a remote, Northern community.

This thesis discloses findings from a scoping review of Social and Structural Determinant of Health (SSDOH)-related academic and grey literature from neurosurgery and fields with neurosurgical overlap. The purpose of this thesis is to identify which social determinants have been assessed, for which surgical procedures they were evaluated, and what disparities were found. To identify studies to include or consider for this systematic review, the review team worked with a medical librarian to develop detailed search strategies for each database. Studies were screened by title and abstract independently by two reviewers. Disagreements between reviewers were resolved by a third reviewer, blinded to the decisions of the primary reviewers. The scoping review of the SSDOH in neurosurgical outcomes identified 99 studies from the year 1990 to 2020. Identified studies were targeted predominantly toward spine surgery patients, evenly distributed in analyses of gender, race and economic stability. The relatively low volume of neurosurgical papers focused on the SSDOH and emphasis on one subspecialty demonstrates the need for an expanded interest in the SSDOH in neurosurgery. / Urban Bioethics

China has experienced high foreign direct investment (FDI) inflows for the past 30 years since it opened its door to foreign investors especially after the early 1990s. As a result, with more and more foreign invested enterprises in China, China has experienced dramatic changes in its economy and society. This study conducts an empirical analysis on the determinants of FDI regional and sectoral distribution in China and evaluates the impact of FDI on Chinese domestic investment. The dataset used for this study spans from 1990-2008 and involves both regional-level and sector-level data in China. The key findings of this thesis can be summarised into four points. First, on regional level, foreign investors base their investment decisions by tax rates, geography, labour costs and market size. Moreover, tax incentive effects are proved to be greater in the eastern areas than in the western areas. Second, at sectoral level, foreign investors are affected market size, employment, wage rate, exchange rate and state ownership degree, but not by the level of openness degree. Third, FDI has a significant crowding out effects on domestic investment on national level and in particular the eastern area, but has a crowding in effect in the middle area and no effect for the western area. Fourth, there is no significant evidence that FDI crowds out domestic investment on individual sector level. This study provides some valuable insights into foreign investors’ decision making and the economic costs/benefits of FDI, which have important implications for scholars, practitioners and policy makers alike.

The primary purpose of this study was to examine the correlation between depression and the personal characteristics of Asians who are 50 years or older. The secondary objective was to determine whether Asians 50 years or older living in the United States are more likely to be depressed than other ethnicities. The information for this study was secured from the National Health Interview Survey, spanning the years 2001 to 2010. In this study, I utilized the SAS-Callable SUDAAN statistical system. Multivariate regression was used to predict and determine significant correlations. The results indicated that Asians 50 and older living in the U.S. and who experience functional limitations, poor vision, hypertension, poor health, not married, and unemployed in previous year were in general more prone to depression. Furthermore, the study indicated that Asian elderly living the U.S. showed lower rates of depression than all non- Asian ethnicities. However when controlled for personal characteristics only Whites and Hispanics had higher depression incidences than Asian elderly. Recommendations for future studies include: conducting more micro and macro studies of Asian elders, such as in-depth case studies for each ethnicity, longitudinal studies of various Asian subgroups, and studies of Asian elderly with hypertension who have committed suicide.

M.Med. Faculty of Health Sciences, University of the Witwatersrand, 2008 / Objectives: Characterization of HIV-1 from slow progressors (SP) is important to facilitate vaccine and antiviral drug development. In order to identify virus attenuations that may contribute to slower rates of disease progression, the full viral genomes from primary isolates of six slow progressing HIV-positive children were sequenced. Methods: Primary virus biological phenotypes were determined by growth in CCR5- and CXCR4-expressing U87.CD4 cell lines. Proviral DNA was isolated from co-cultured PBMCs, and the near full-length genomes and LTR regions were PCR amplified, sequenced and analysed. Predicted amino acid (aa) sequences for all the HIV-1 proteins were extensively analyzed. Results: All primary HIV-1 isolates utilized CCR5, and were determined to be HIV-1 subtype C by phylogenetic analysis. Predicted aa sequence analysis revealed open reading frames for all HIV-1 genes which encoded for proteins of the expected length, with several exceptions. For example, isolate LT5 had a 2 aa insertion in the Vpr mitochondriotoxic domain. Isolate LT21 contained an additional 5aa in the C-terminus of tat exon 2, while the integrase enzyme in isolate LT39 had an additional 3aa at the Cterminus. Rev from isolates LT45 and LT46 did not have the characteristic subtype C 16aa truncation, and in addition, had a further 3aa. In addition, altered functional domains was noted in several isolates, such as the cAMP-dependent kinase PKA phosphorylation site in Nef (LT5), a Vpr mutation involved in decreasing pro-apoptotic activity (LT42), and the Nef ExxxLL motif involved in the interaction with AP-1 and AP-2 (LT46). Conclusions: The slower HIV disease progression in these six children may be attributed to altered protein functions. For example, LT46 Nef is unable to bind AP-1 and AP-2 and therefore inactive on CD4 endocytosis. The biological relevance of these findings requires further investigation.

Nausea and vomiting are commonly experienced by women in pregnancy (NVP). Symptoms are usually limited to the first trimester, but can persist until birth. Both mild and more severe symptoms can have negative effects for the mother, her unborn child, and the family. Despite the frequency of NVP and associated distress, the exact cause is unknown and the condition remains poorly understood.<p> This secondary analysis explores nausea and vomiting in pregnancy, as determined by the Nausea and Vomiting in Pregnancy Instrument (NVPI), in a cohort of Canadian pregnant women at two gestational time points. The data analyzed in this study were originally from a longitudinal and epidemiological study of depression in pregnancy and into the postpartum. A population health approach has been used to examine psychosocial determinants of nausea and vomiting in pregnancy.<p> During the second trimester, the prevalence of nausea and vomiting in this sample of 551 women was 63.3%, with 24% of women reporting moderate nausea and vomiting and 18.9% reporting severe symptoms. These rates are similar to other studies of women during the first and second trimester of pregnancy. In the final model, nausea and vomiting in pregnancy was associated with gestation (weeks), antiemetic medication use, employment status, worry, and symptoms of major depression.<p> During the third trimester, the prevalence of NVP in this sample of 575 women was 45.4%, with 8.2% reporting moderate nausea and vomiting and 14.3% reporting severe symptoms. These results exceed previous reports on prevalence beyond 20 weeks in pregnancy. In the final model, nausea and vomiting in pregnancy was associated with antiemetic medication use, worry, and symptoms of major depression. The presence of support and maternal smoking were found to have a protective effect.<p> The co-morbidity of nausea and vomiting, worry, and symptoms of major depression in this sample of pregnant women represents a significant public and mental health problem. Care providers need to screen pregnant women for nausea and vomiting and also screen women for depression in the presence of more severe NVP symptoms. Supportive measures that address both conditions may be necessary in order to improve the quality of life of pregnant women, their families, and to protect the unborn child from the effects of both nausea and vomiting and depression in pregnancy.

Nausea and vomiting are commonly experienced by women in pregnancy (NVP). Symptoms are usually limited to the first trimester, but can persist until birth. Both mild and more severe symptoms can have negative effects for the mother, her unborn child, and the family. Despite the frequency of NVP and associated distress, the exact cause is unknown and the condition remains poorly understood.<p> This secondary analysis explores nausea and vomiting in pregnancy, as determined by the Nausea and Vomiting in Pregnancy Instrument (NVPI), in a cohort of Canadian pregnant women at two gestational time points. The data analyzed in this study were originally from a longitudinal and epidemiological study of depression in pregnancy and into the postpartum. A population health approach has been used to examine psychosocial determinants of nausea and vomiting in pregnancy.<p> During the second trimester, the prevalence of nausea and vomiting in this sample of 551 women was 63.3%, with 24% of women reporting moderate nausea and vomiting and 18.9% reporting severe symptoms. These rates are similar to other studies of women during the first and second trimester of pregnancy. In the final model, nausea and vomiting in pregnancy was associated with gestation (weeks), antiemetic medication use, employment status, worry, and symptoms of major depression.<p> During the third trimester, the prevalence of NVP in this sample of 575 women was 45.4%, with 8.2% reporting moderate nausea and vomiting and 14.3% reporting severe symptoms. These results exceed previous reports on prevalence beyond 20 weeks in pregnancy. In the final model, nausea and vomiting in pregnancy was associated with antiemetic medication use, worry, and symptoms of major depression. The presence of support and maternal smoking were found to have a protective effect.<p> The co-morbidity of nausea and vomiting, worry, and symptoms of major depression in this sample of pregnant women represents a significant public and mental health problem. Care providers need to screen pregnant women for nausea and vomiting and also screen women for depression in the presence of more severe NVP symptoms. Supportive measures that address both conditions may be necessary in order to improve the quality of life of pregnant women, their families, and to protect the unborn child from the effects of both nausea and vomiting and depression in pregnancy.

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The purpose of this study is to describe findings of the 2006 Aboriginal Peoples Survey that was conducted by Statistics Canada. They collected data on the living conditions and lifestyles of Aboriginal peoples living off-reserve in Canada. The thesis describes diabetes, co-morbidities, and social determinants of health that affect this population through the lens of intersectionality and Dr. Nancy Krieger's Eco-Social theory. / Graduate / 0766 / 0573