The object of the dissertation is the interpersonal relationships between adult children and parents and their determinants. The main objective of the dissertation is to examine the differences of intergenerational relationships in various family types, using the theories of social constructionism and intergenerational relationships; to explore what meanings are employed to construct intergenerational relationships and identify the types of relationships; to identify the macro, mezzo and micro level determinants of intergenerational relationships. The first part of dissertation is dedicated to the analysis of sociological theories about interpersonal and intergenerational relationships (solidarity, conflict, ambivalence); a conceptual scheme of macro, mezzo and micro level determinants is provided. The second part of dissertation is dedicated to the discussion of methodological guidelines of empirical research. In the third part, using empirical research, intergenerational relationships and their determinants are analysed. The results of research reveal asymmetrical evaluations of intergenerational relationships which are related to kinship positions; types of family and gender of parents; unequal distribution of functional support. The determinants considered universal in the research of intergenerational relationships in Western societies have contradictory effects in the Lithuanian context. The construction of intergenerational relationships is based on the meanings of... [to full text] / Šio darbo objektas yra tarpasmeniniai santykiai tarp suaugusių vaikų ir tėvų bei juos lemiantys veiksniai. Pagrindinis disertacijos tikslas – besiremiant socialinio konstrukcionizmo ir tarpgeneracinių santykių teorijomis, ištirti tarpgeneracinių santykių skirtumus pagal šeimų tipus; išsiaiškinti, kokiomis prasmėmis konstruojami tarpgeneraciniai santykiai ir identifikuoti santykių tipus; nustatyti makro, mezo bei mikro lygmens tarpgeneracinius santykius lemiančius veiksnius. Pirma disertacijos dalis skirta teoriniam darbo pagrindui atskleisti: nagrinėjamos sociologinės tarpasmeninių santykių teorijos ir tarpgeneracinių santykių teorijos (solidarumo, konflikto, ambivalencijos); pateikiama konceptuali mikro, mezo ir makro lygmens veiksnių schema. Antra disertacijos dalis atskleidžia tyrimo metodologines gaires: pristatomi kiekybiniai ir kokybiniai metodai. Trečioje dalyje, remiantis gautais empiriniais duomenimis, analizuojami tarpgeneraciniai santykiai ir juos lemiantys veiksniai. Tyrimo rezultatai rodo tarpgeneracinių santykių asimetriškumą, kuris susijęs su giminystės pozicija; šeimos tipu bei tėvų lytimi; funkcinės paramos paskirstymu. Vakarų visuomenėse universaliais laikomi veiksniai Lietuvos kontekste turi prieštaringą poveikį, kuris atsiskleidžia prognozuojant solidarumo dimensijų veiksnius pagal šeimų tipus. Tarpgeneraciniai santykiai konstruojami naudojant skirtingus simbolinius mechanizmus, kurie susiję su lyčių vaidmenimis, prasmių apie išorinę tikrovę neatitikimu... [toliau žr. visą tekstą]

Gonorrhea is caused by the human pathogen Neisseria gonorrhoeae. More than 106 million new cases of N. gonorrhoeae infections occur each year worldwide. There is no vaccine available against gonococcal infections and treatment of gonorrhea with antibiotics is the only way to eradicate infection. The high prevalence of antibiotic resistance (AMR) in this microorganism makes the effective treatment of gonococcal infections increasingly problematic. The emergence of AMR, especially to extended spectrum cephalosporins (i.e. cefixime and ceftriaxone) which are the last possibilities for single dose treatment options for gonococcal infections, is a serious concern. Gonorrhea may become an untreatable infection in the near future. Saskatchewan (SK) has one of the highest rates of gonorrhea in Canada. In order to better characterize the gonorrhea epidemic in SK, the objectives of the present research were to determine the prevalence and trends of AMR and emerging AMR mechanisms in N. gonorrhoeae isolates. AMR mechanisms were ascertained for the first time in SK in order to identify genetic causes of resistance. This was completed by determining and analyzing the DNA sequences of various genes - penA, mtrR, porB ponA, gyrA, parC mtrR, 23S rRNA alleles and erm –implicated in gonococcal AMR. The population dynamics of the N. gonorrhoeae isolates in SK was investigated by DNA based molecular methods to determine strain distribution, evolution of AMR phenotypes, and association between strain types (STs) and AMR genotypes and phenotypes. N. gonorrhoeae isolates (n=427) from Saskatchewan (2003-2011) were susceptible to antibiotics now recommended for treatment - cefixime, ceftriaxone and spectinomycin. Over 95% of the isolates tested were also susceptible to penicillin (96%) and ciprofloxacin (95.5%), antibiotics no longer recommended for treatment, and azithromycin (99.4%). Tetracycline resistance was also high (50.1%). N. gonorrhoeae isolates that were resistant to the antibiotics tested and also those isolates with MICs ≥0.003 mg/L to cefixime and ceftriaxone were analyzed (n=146) to determine their resistance mechanisms. This analysis revealed that reduced susceptibility to ceftriaxone and cefixime and resistance to penicillin is mediated by specific mutations in penicillin binding protein 2 (PBP2), in the promoter and dimerization domains of MtrR and porin protein (PorB). Novel mutations and combinations of mutations were noted. Ciprofloxacin resistant N. gonorrhoeae isolates carried double mutations in GyrA (S91F and D95G/N) and a S87R or S88P substitution in ParC. Isolates resistant to azithromycin had specific mutations in all the four alleles of 23S rRNA as well as in the DNA binding domain of MtrR. Most resistance was chromosomally mediated while plasmid-mediated resistance to penicillin (0.93% of penicillin resistant isolates) and tetracycline (3.3%) was low. DNA based strain typing methods such as porB-DNA sequencing, N. gonorrhoeae multi-antigen sequence typing (NG-MAST) and multilocus sequence typing (MLST) showed that the gonococcal population in SK differs appreciably from both other Canadian provinces and from strains reported internationally. MLST analysis, which ascertains the evolution of isolates over time, demonstrated that penicillin and tetracycline resistant isolates in SK evolved through spontaneous mutations in established lineages. Ciprofloxacin and azithromycin resistant N. gonorrhoeae isolates, on the other hand, were introduced into SK from outside the province. Significant associations between particular mutation pattern combinations in resistance determining genes and specific NG-MAST STs were identified e.g. NG-MAST ST 25 was associated with specific combined mutation patterns in PBP2, MtrR and PorB and antibiotic susceptibility; and, NG-MAST ST 3654 was associated with another PBP2/MtrR/PorB mutation pattern, chromosomal resistance to penicillin and tetracycline and elevated MICs to cefixime. This research shows the importance of regional antimicrobial susceptibility monitoring. In the context of SK, this means that local surveillance of gonococcal AMR may be used to develop policies for regional treatment guidelines which promote the prudent use of antimicrobials for treatment, including those antibiotics which may no longer be used in other regions due to higher AMR rates. Further, the significant association between particular AMR mutation pattern combinations and specific STs indicates that AMR might be predicted. These results should assist in the development of non-culture-based tests for the diagnosis of gonococcal AMR similar to nucleic acid amplification tests used to diagnose N. gonorrhoeae infections.

<p>Health security is increasingly being seen as integral to any poverty reduction strategy. Health is viewed not only as an end in itself but also as an indispensable input into the development process because there is a positive link between health and development. Of all the risks facing poor households, health risks probably pose the greatest threat to their lives and livelihoods. Against this background, this research examines the vital subject of participation in mutual health insurance as a poverty reduction strategy at the rural community level. It has been accepted that community-based initiatives play important roles in improving poor people s risk-sharing arrangements. The extent to which these community-based initiatives are able to address the problem of social exclusion in local communities is far from being clear.</p>

Trypanosomosis is a parasitic disease in man, domestic and wild animals and is of major economic importance in many parts of the world, particularly in Sub-Saharan Africa. Trypanosoma congolense, T vivax and T brucei brucei are the major pathogenic trypanosomes infecting cattle in sub-Saharan Africa. The parasite itself is not directly responsible for the disease, but rather causes illness through the release of pathogenic factors. One of the major pathogenic factors released by trypanosomes is proteinases. Trypanotolerant cattle produce antibodies against a trypanosomal proteinase, congopain, that inhibit congopain activity. Congopain thus has vaccine potential. This study describes the mapping of immunogenic epitopes of congopain to identify peptide regions of the protein that induce enzyme inhibitory antibodies for inclusion in a trypanosome vaccine. This vaccine approach targets the disease, rather than the parasite by focusing on a pathogenic factor. These peptides also have potential for use in diagnostic assays. Peptides from the catalytic domain of a trypanosomal cysteine proteinase, congopain, were selected using an epitope prediction program. Peptides selected were from the two forms of congopain called CP1 and CP2. Antibodies against peptide-carrier conjugates were produced in chickens. The antibodies recognised native congopain, recombinant CP2 and the recombinant catalytic domain (C2). This suggests that the peptides selected have promise for use in vaccines. The peptides were also used to determine whether they are natural immunogenic epitopes of CP2 and thus have potential for use in diagnostic assays. Antibodies in the sera from T. congolense infected cattle recognised all the peptides in an ELISA. Antibodies in the sera from C2-immunised, non-infected cattle recognised most of the peptides in an ELISA. In order to distinguish between T. congolense and T vivax infection, two different peptides from the C-terminal extensions of CP2 and vivapain were used in ELISA tests with sera from infected cattle. Although anti-peptide antibodies produced against the two C-terminal extension peptides were specific for their respective peptides, thereby indicating the discriminatory power of the peptides selected, there was cross-reactivity by the sera from T. congolense and T. vivax infected cattle. Optimal antibody binding peptide sequences of these two peptides need to be identified by testing modified sequences of these two peptides to improve the sensitivity of this assay. In addition to attempting to define the epitopes of congopain, preliminary studies to increase the immunogenicity of congopain were also undertaken. Alpha 2-macroglobulin is a natural host inhibitor of proteinases. Inhibition occurs by entrapment of an active proteinase within the alpha 2-macroglobulin cage. In addition, it has been demonstrated that antigen complexed with alpha 2-macroglobulin becomes more immunogenic, resulting in enhanced antigenic presentation of an entrapped antigen. This study reports the interaction between congopain and alpha 2-macroglobulin. The preliminary results of this study showing congopain-alpha 2-macroglobulin interaction could be used to explore the possibility of increasing the immunogenicity of congopain and congopain epitopes by complexing these to alpha 2-macroglobulin. Congopain epitopes complexed with alpha 2-macroglobulin could be used to form a peptide-based vaccine. / Thesis (M.Sc.)-University of Natal, Pietermaritzburg, 2003.

African animal trypanosomosis or nagana is a tsetse fly-transmitted disease, caused by Trypanosoma congolense, T. vivax and to a lesser extent T. brucei brucei. The disease causes major losses in revenue in many livestock-producing African countries. The available control methods, including chemotherapeutic drugs and insecticidal spraying, have become environmentally unacceptable. Antigenic variation displayed by the parasites has hindered vaccine development efforts. In this context, rather than focusing solely on the parasite itself, efforts in vaccine development have shifted towards targeting pathogenic factors released by the parasites during infection. Congopain, the major cysteine protease of T. congolense, has been shown to act as a pathogenic factor in the disease process. Analysis of the immune response of trypano-tolerant cattle revealed that these animals have the ability to control congopain activity in vivo. Therefore, congopain is an attractive vaccine candidate. To test the protective potential of congopain, immunisation studies had been conducted in cattle using the baculovirus-expressed catalytic domain of congopain (C2) in RWL, a saponin-based proprietary adjuvant from SmithKline-Beecham. Immunised animals were partially protected against a disease caused by an infection with T.congolense. Unfortunately, subsequent attempts to reproduce these results were disappointing. It was hypothesised that this failure could be due to the different expression system (P. pastoris) used to produce the antigen (C2), or the different adjuvant, ISA206 (Seppic), used, thus hinting towards an epitope presentation problem. Congopain had been shown to dimerise at physiological pH in vitro. Sera from trypano-tolerant cattle preferentially recognised the dimer conformation, advocating for protective epitopes to be dimer associated. For that reason, the present study aimed at improving the antigenicity of congopain through firstly, the elucidation of the protective epitopes associated with the dimer, secondly, the determination of the 3-D structure of the protease in order to map protective epitopes to later design mimotopes, and thirdly improve the delivery of congopain to the immune cells while maintaining the conformation of the protease by using a molecular adjuvant, BiP. A dimerisation model was proposed, identifying the amino acid residues forming the dimerisation motif of congopain. In the present study, particular amino acid residues located in the dimerisation motif were mutated by PCR-based site-directed mutagenesis to generate mutants with different dimerisation capabilities. The congopain mutants were expressed in yeast and their dimerisation capability was assessed by PhastGel® SDS-PAGE. The mutations altered both the electrophoretic mobility of the mutants and their enzymatic characteristics compared to wild-type congopain. This advocated for the involvement of these amino acid residues in the dimerisation process, although they seem not to be the only partakers. Wild-type C2 and mutant forms of C2 were heterologously expressed in P. pastoris and purified to crystallisation purity levels. Crystallisation of these proteins is currently underway, but the results are still unknown. While awaiting the crystallisation results, in silico homology modelling was employed to gain insight into the 3-D structure, using cruzipain crystal structure as a template. The modelled 3-D structure of congopain followed the common framework of cathepsin L-like cysteine proteases. Due to time constraints and awaiting the crystal-derived 3-D structure, the 3-D model of congopain was not exploited to design mimotopes with the potential to provide protection against the disease. As it was shown that protective epitopes are likely to be dimer-specific, maintaining the native conformation of congopain is essential for stimulating a protective immune response in animals. Chemically formulated adjuvants usually contain high salt concentration, at acidic or basic pH, thus might change the conformation of the protease. Adjuvants capable of efficiently delivering the antigen to immune cells while maintaining the conformation of the protease were sought. Proteins belonging to the HSP70 family are natural adjuvants in higher eukaryotes. A protein belonging to the HSP70 family was previously identified in T. congolense lysates and is homologous to mammalian BiP. Congopain was genetically fused with T. congolense BiP in order to improve antigen delivery and production of congopain activity-inhibiting antibodies. The chimeric proteins were successfully expressed in both bacteria and yeasts. The low yields of recombinantly expressed chimeras in yeast and problems associated with renaturation and purification of bacteria-expressed chimeras prevented immunisation studies in mice. However, the groundwork was laid for producing BiP-congopain chimeras for use in an anti-disease vaccine for African trypanosomosis. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

Canada, like other countries around the world, has health inequities. The literature on social accountability and responsibility urges medical schools to be grounded in the needs of communities to address health inequities. The Canadian professional and regulatory bodies promote the CanMEDS Competencies of which one, the Health Advocate Competency, speaks of addressing community issues. Yet medical schools face challenges actualizing social responsibility and teaching the Health Advocate Competency. Therefore it is important to understand how the teaching of health advocacy and social responsibility is incorporated into the undergraduate curricula of self-defined socially responsible medical schools in Canada. In this study, mixed methods were used beginning with a semi-structured questionnaire administered to undergraduate Course Directors at two medical schools in Canada with a response rate of 74% (n=60). This was followed by a series of open-ended interviews with eleven equity leaders to bring their perspective into the data collection and establish knowledge about frontline intersectional equity work. The major theoretical lens encircling this work was intersectionality which examines historical oppression and how the intersection of gender, race, and class compound health inequities. Questionnaire results made it clear that biomedical ideology and the CanMEDS Medical Expert Competency were privileged in the undergraduate curriculum at the expense of other knowledge such as health advocacy and social responsibility. The objective biomedical discourse ignores or marginalizes important social influences on health which are highlighted by using an intersectional lens. The semi-structured interviews provided rich data about working in an intersectional equity framework highlighting the impact of the intersections of race, gender, class and other identities on health inequities. These interviews also demonstrate the importance of health advocacy in improving health care outcomes and addressing social responsibility. Incorporating intersectionality into previously accepted assessment tools for physicians adds an important dimension to the health care encounter. Explicitly embedding social responsibility and health advocacy in the medical school mission and curriculum is essential to their acceptance. A series of supporting recommendations are offered.

Canada, like other countries around the world, has health inequities. The literature on social accountability and responsibility urges medical schools to be grounded in the needs of communities to address health inequities. The Canadian professional and regulatory bodies promote the CanMEDS Competencies of which one, the Health Advocate Competency, speaks of addressing community issues. Yet medical schools face challenges actualizing social responsibility and teaching the Health Advocate Competency. Therefore it is important to understand how the teaching of health advocacy and social responsibility is incorporated into the undergraduate curricula of self-defined socially responsible medical schools in Canada. In this study, mixed methods were used beginning with a semi-structured questionnaire administered to undergraduate Course Directors at two medical schools in Canada with a response rate of 74% (n=60). This was followed by a series of open-ended interviews with eleven equity leaders to bring their perspective into the data collection and establish knowledge about frontline intersectional equity work. The major theoretical lens encircling this work was intersectionality which examines historical oppression and how the intersection of gender, race, and class compound health inequities. Questionnaire results made it clear that biomedical ideology and the CanMEDS Medical Expert Competency were privileged in the undergraduate curriculum at the expense of other knowledge such as health advocacy and social responsibility. The objective biomedical discourse ignores or marginalizes important social influences on health which are highlighted by using an intersectional lens. The semi-structured interviews provided rich data about working in an intersectional equity framework highlighting the impact of the intersections of race, gender, class and other identities on health inequities. These interviews also demonstrate the importance of health advocacy in improving health care outcomes and addressing social responsibility. Incorporating intersectionality into previously accepted assessment tools for physicians adds an important dimension to the health care encounter. Explicitly embedding social responsibility and health advocacy in the medical school mission and curriculum is essential to their acceptance. A series of supporting recommendations are offered.

Bed bugs are making a large international comeback. While people from all economic and social backgrounds can experience a bed bug infestation, the social impacts on the lives of low-income people are potentially far greater given the condition of their living accommodations as well as the financial costs associated with dealing with an infestation. Utilizing the Community Economic Development and Social Determinants of Health approaches, this thesis argues that the experience of a bed bug infestation poses a significant threat to inner-city residents—economically, socially, and in terms of human health. Interviews with 16 inner-city residents, 2 landlords, 1 property manager, 2 By-Law Enforcement Officers, and 5 representatives of inner-city agencies in Winnipeg are drawn upon in developing this argument. In addition, relevant policy documents and other secondary sources are utilized to assess the effectiveness of policies and practices in place to respond to this issue and to offer a more comprehensive approach for responding to the social impacts of bed bugs in the city of Winnipeg.

Disertacijos tikslas yra ekologiškai ūkininkaujančiuosius suklasifikavus pagal jų skirtingus veiklos prioritetus, nustatyti veiksnių reikšmingumą ekologinio ūkininkavimo vystymui. Tai pasiekta išanalizavus sistemų teorijos, ekologinio ūkininkavimo, darnaus žemės ūkio vystymosi ir kaimo plėtros, aplinkosaugos, maisto kokybės bei saugos ir motyvacijos teorijos krypčių perspektyvas, identifikavus ekologinio ūkininkavimo veiksnius, atlikus empirinių tyrimų modelių ir jų pritaikomumo Lietuvos kontekstui analizę. Sukurtas ir empiriniu tyrimu patikrintas ekologinio ūkininkavimo veiksnių vertinimo teorinis modelis leido nustatyti veiksnių reikšmingumą strateginiam ūkininkų sprendimui dėl ekologės gamybos būdo plėtotės pagal dvi veiklos prioritetų požiūriu homogeniškas ekologiškai ūkininkaujančiųjų respondentų grupes (orientuotų į pelno didinimą ir į ekologinę gyvenseną). Disertacijos rezultatai suteikia naujų žinių apie ekologinį ūkininkavimą lemiančius veiksnius, leidžia sistemiškiau nei iki šiol vertinti ekologinio ūkininkavimo veiksnius. Tyrimo rezultatai gali būti pagrindas ekologinio žemės ūkio (siaurąja prasme) ir žemės ūkio darnaus vystymosi (plačiąja prasme) racionalios politikos formavimui Lietuvoje ir kitose naujosiose Europos Sąjungos šalyse, o konkretiems ūkininkams, ypač besiruošiantiems priimti strateginius sprendimus dėl ekologinio ūkininkavimo, suteikia naujų žinių. / The dissertation aim is to assess the significance of the determinants of organic farming to its development when the respondents are classified by priority of their activity. This has been achieved through the analysis of trends and perspectives of the system theory, organic farming, sustainable development of agriculture, rural development, protection of the environment, food quality and safety and the motivation theory while identifying the determinants of organic farming, and through the analysis of empiric models and their applicability in the context of Lithuania. The established and empirically tested theoretical research model for the modelling the determinants of organic farming enabled to assess the significance of the determinants to the strategic farmers’ decision whether or not to undertake the practice of organic farming according to two homogenous groups of organic respondents depending on the activity priorities (profit-oriented and organic-oriented lifestyle). The dissertation provides with new knowledge about organic farming and enables to assess the factors of organic farming more systematically than before, the research results could be a basis for the rational policy-making in the development of organic agriculture (in a narrow sense) and sustainable agriculture (in a broad sense) in Lithuania and other new countries of the European Union, and provide with new knowledge the farmers, especially those who are preparing to make the strategic decisions... [to full text]

This thesis is based on studies in Butajira district in the south central part of Ethiopia and one study in the Ethio-Swedish Children's Hospital in Addis Ababa. The Butajira project has a continuous demographic surveillance system, established in 1987 in a sample of 10 communities with a total baseline population of about 30,000. The project includes the development and evaluation of a system for continuous registration of vital events and provides a baseline population and sampling frame for health related research activities. The thesis used different study designs within the surveillance system. A carriership study was undertaken to determine the potential bacterial respiratory pathogens among under-five children. A clinical study was done to investigate aetiological agents among young infants (below 3 months) with pneumonia, sepsis and meningitis in a hospital setting. Interview studies were carried out on mothers' perceptions of illness and practices in the care of children with acute respiratory infections. Within the surveillance system, patterns of under-five mortality were analysed. A nested case-referent design was applied to assess public health and behavioural determinants of mortality. A cohort study was performed among under-fives in three communities to estimate the magnitude of illness burden, particularly from ARI, as well as to assess determinants of ARI morbidity. Among 1126 under-five children, 85% were found to harbour H. influenzae, 83% M. catarrhalis and 90% S. pneumoniae in the nasopharynx. The hospital-based study isolated S. pneumoniae, Streptococcus group A, Salmonella group B, E. coli and H. influenzae in the age group below 3 months. The study of mothers' perceptions and practices, showed that mothers do know the symptoms of measles and whooping cough, while they do not recognize pneumonia as an illness entity and are not aware of fast breathing as an important sign of pneumonia. The mortality studies showed a high infant and under-five mortality rate. ARI was responsible for one fifth of the under-five mortality and almost one third of the infant mortality rate. Cause of death in the case-referent study was determined using a validated verbal autopsy method. Breast-feeding and supplementary feeding were demonstrated to be strongly protective when controlling for parental and environmental determinants of mortality. A one year prospective home surveillance study showed that illness was reported in 5.8% of 1,216 person-years. ARI contributed half of this illness load and was particularly associated with parental factors. Among sanitation factors, the absence of piped water was an important determinant of morbidity. Among housing factors, the type of roof and lighting source for the house, and among parental factors, illiteracy of either parents and having a farmer as a father, were found to be independently associated with increased morbidity. Among health and behavioural factors, preterm delivery and lack of immunization were associated with increased morbidity. The results of the studies of this thesis have been utilized to design an intervention case management package. The intervention study and evaluation of its impact is now on-going. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1994, härtill 7 uppsatser.</p> / digitalisering@umu.se