INTRODUÇÃO: O processo saúde-doença está intrinsecamente conectado com as condições concretas de vida e com as diversas realidades sociais, acarretando o forte vínculo entre a situação de saúde e os fatores históricos, sociais, econômicos, culturais e biológicos. A formulação sobre Determinantes Sociais da Saúde (DSS) busca ampliar o enfoque sobre as condições de vida e bem-estar, salientando a distribuição de renda, as condições de vida e trabalho, as redes de suporte social, entre outros, como fatores que afetam a qualidade de vida. Os DSS buscam, assim, evitar a análise fragmentada, englobando a concepção de Determinantes Estruturais. Estes procuram compreender as condições de distribuição de riqueza, poder e prestígio na origem dos problemas de saúde. Assim, a estrutura de classes sociais, a distribuição de renda e o preconceito de gênero e raça são considerados na proposição de políticas de saúde. OBJETIVO: Sistematizar o conhecimento a respeito dos DSS e seus componentes Estruturais e Intermediários, segundo o potencial para contribuir na elaboração de políticas sociais e de saúde. MÉTODO: Trata-se de uma pesquisa de revisão de escopo (Scoping Review), metodologia que amplia e aprofunda o mapeamento e a síntese do conhecimento. As etapas foram: identificação da questão de pesquisa e dos estudos relevantes; seleção dos estudos; extração de dados; separação, sumarização, relatório e comunicação dos resultados. Foram pesquisadas as seguintes bases de dados eletrônicas: Web of Science, CINAHL, Scopus, LILACS e Pub-Med, que engloba o MEDLINE. Adicionalmente, foi realizado levantamento específico nas revistas: International Journal of Epidemiology, Journal of Epidemiology and Community Health, American Journal of Public Health e American Journal of Epidemiology. RESULTADOS: Após a retirada das duplicatas, foram localizados 752 artigos; e após a triagem, 19 artigos foram analisados em profundidade. Dentre os países nos quais as pesquisas selecionadas foram desenvolvidas, destacaram-se Estados Unidos e Inglaterra com seis e quatro publicações respectivamente (31,6% e 21%) seguidos de três publicações no Canadá (15,7%), duas no Brasil (10,5%), duas na Nova Zelândia (10,5%), duas na Austrália (10,5%) e uma no México (5,2%). As discussões sobre os Determinantes Estruturais da saúde são mais recentes. A análise permitiu tratar das diferenças entre termos comumente utilizados, como desigualdade, disparidade e iniquidade. Os marcadores sociais da diferença mais problematizados na formulação dos DSS Estruturais foram: racismo gênero, classe social e situação migratória. Por serem os marcadores sociais mutuamente construídos, a perspectiva teórica da interseccionalidade foi apresentada como recurso metodológico para entender suas inter-relações. CONCLUSÃO: Foi possível identificar neste trabalho uma agenda síntese que perpassa ações na área econômica, propondo a redistribuição da riqueza; políticas públicas intersetoriais e mudanças no arcabouço jurídico, destacando que os determinantes sociais são mais bem compreendidos quando se reconhece a dialética entre contextos específicos e os macrodeterminantes políticos e econômicos, identificando os diferentes significados e consequências para a saúde / INTRODUCTION: The health-disease process is intrinsically connected with concrete conditions of life and with the diverse social realities, which brings about the strong ties between the health situation and historical, social, economical, cultural, and biological factors. The formulation of Social Determinants of Health (SDH) seeks to broaden the focus on conditions of life and well-being, emphasizing the distribution of income, the work and life conditions, the net of social support, among other factors that affected the quality of life. SDH seek, in this way, to avoid a fragmented analysis, embodying the conception of Structural Determinants, which seek to comprehend the conditions of distribution of wealth, power, and prestige in the origins of health problems. Thus, the structure of social classes, the distribution of income, and the prejudice of gender and race are taken into account in the proposition of health policies. OBJECTIVE: systematizing knowledge about the SDH and their structural components, according to the potential to contribute in the elaboration of social and health policies. METHODOLOGY: The following research employs the Scoping Review Methodology, which enlarges and deeps the mapping and the synthesis of knowledge. The phases of our work were the following: identification of the research issue and relevant studies; selection of the studies; extraction of data; division, summarization, reports, and communication of results. The following electronic databases were researched: Web of Science, CINAHL, Scopus, LILACS, and Pub-Med, which comprehends MEDLINE. Additionally, specific journals were surveyed: International Journal of Epidemiology, Journal of Epidemiology and Community Health, American Journal of Public Health, and American Journal of Epidemiology. OUTCOMES: After removing the duplicates, 752 articles were found, and after the screening 19 articles were analyzed in depth. Among the countries in which the selected researches were conducted, the following are noteworthy: England and the USA with four and five publications respectively (21% and 26,3%), followed by three publications in Canada (15,7%), two in Brazil (10,5%), two in New Zealand (10,5%), two in Australia (10,5%) and one in México (5,2%). The discussions on Structural Determinants of Health are more recent. The analysis allowed us to treat the differences among terms commonly used, such as inequality, disparity, and inequity. The social markers of difference more problematized in the formulation of the Structural SDH were racism, gender, social class, and migration situation. For being social markers mutually built, the theoretical perspective of intersectionality was presented as a methodological resource to understand its inter-relations. CONCLUSION: This work was able to identify a synthesis-agenda, which passes through actions in the economical field, proposing the redistribution of wealth, intersectoral public policies, and changes in the juridical frame, emphasizing that the social determinants are better comprehended when the dialectics between specific contexts and the political-economical macro-determinants are acknowledged, identifying the different meanings and consequences for Health

The purpose of this study was to investigate the determinants of high neonatal mortality rates in Migori County, Kenya. The neonatal mortality cases were utilised as the target population to the study. A quantitative, descriptive, cross-sectional, non-experimental research design was used. A systematic sampling technique was employed to draw a sample of 201 archived neonatal cases out of 420 neonatal mortality medical records, which constituted the study population. Data were collected by means of a developed questionnaire. The Statistical Package for Social Sciences (SPSS) Version 21 was used to analyse data. The main findings revealed the leading determinants of neonatal mortality were early neonatal period, prematurity, poor 1st Apgar score, low birth weight and neonates with intrapartum complications. Obstetrical haemorrhage and HIV were the main maternal complications associated to neonatal mortalities, while the leading direct causes of death in this study were birth asphyxia and sepsis. Other determinants were gender, rural residence, lowly educated and informally employed mothers. To reduce mortalities, a multifaceted approach is needed to establish quality improvement in neonatal intensive care, reduce preterm birth incidences, and empower mothers socio-economically. / Health Studies / M.A. (Nursing Science)

A partir do referencial teórico marxista e da centralidade do trabalho, estudamos como o campo da Saúde Coletiva e o Sistema Único de Saúde (SUS) vêm abordando a questão do trabalho. Partimos da hipótese de que o trabalho é fator central na determinação social da saúde, mas que a atuação estatal sobre essa questão é precária e insuficiente; ao mesmo tempo, entendemos que o campo da Saúde Coletiva vem se afastando do debate sobre o trabalho em uma perspectiva emancipatória. Realizamos revisão narrativa de 53 artigos publicados em três periódicos do campo, sendo 34 propriamente teóricos e 19 referentes a políticas públicas. Apresentamos o debate organizado por categorias, seguido de balanço crítico. Identificamos que é pouco abordada a relação entre o campo denominado Saúde do Trabalhador e o campo da Saúde Coletiva. Notamos a relativa ausência do debate sobre a determinação social da saúde, ao mesmo tempo que o termo determinantes sociais da saúde aparece com frequência. Constatamos que as obra de Marx e da Sociologia do Trabalho são relativamente pouco citadas, embora possam contribuir para a compreensão do trabalho em perspectiva emancipatória. Avaliamos que o debate sobre a Rede Nacional de Atenção Integral à Saúde do Trabalhador aparece nos artigos de forma descritiva, abordando pouco a precariedade e a insuficiência da atenção à saúde dos trabalhadores no SUS. O papel da Atenção Primária à Saúde é mencionado sem levar em conta que a população trabalhadora já é atendida por esses serviços, como se as questões de Saúde do Trabalhador constituíssem uma nova atribuição. Os desafios estruturais do SUS são abordados de forma fragmentada e superficial. A atuação desarticulada dos setores do Estado sobre a questão do trabalho é retratada, mas não se analisa as contradições de forma mais ampla. Consideramos que é necessário retomar a articulação entre a Reforma Sanitária Brasileira e a perspectiva revolucionária de superação do capitalismo, ao menos em termos teóricos. / Based on the Marxist theory and on the theoretical reference of the centrality of work, we study how the field of Collective Health and the Brazilian Unified Health System (UHS) have been approaching the issue of work. We start from the hypothesis that work is a central factor in the social determination of health, but that state action on this issue is precarious and insufficient. At the same time, we understand that the field of Collective Health has been moving away from the debate about work in an emancipatory perspective. We carried out a narrative review of 53 articles published in three journals of the field, 34 of which are theoretical and 19 are related to public policies. We present the debate organized by categories, followed by critical review. We identify that the relationship between the field called Occupational Health and the field of Collective Health is little discussed. We note the relative absence of the debate on the social determination of health, while the term social determinants of health appears frequently. We find that the work of Marx and the Sociology of Work are relatively little cited, although they may contribute to the understanding of work in an emancipatory perspective. We evaluate that the debate about the National Network of Integral Attention to Workers\' Health appears in the articles in a descriptive way, addressing little the precariousness and insufficiency of health care of workers in the UHS. The role of Primary Health Care is mentioned without taking into account that the working population is already served by these services, as if Workers\' Health issues constituted a new assignment. The structural challenges of UHS are addressed in a fragmented and superficial way. The disjointed performance of the state sectors on the issue of work is portrayed, but contradictions are not analyzed more broadly. We consider that it is necessary to resume the articulation between the Brazilian Sanitary Reform and the revolutionary perspective of overcoming capitalism, at least in theoretical terms.

OBJETIVO: Desenvolver e validar um instrumento de medida das percepções sobre discriminação racial interpessoal no contexto dos serviços de saúde brasileiros. METODOLOGIA: Estudo do tipo metodológico conduzido com base na Teoria Clássica dos Testes para elaboração e validação psicométrica de instrumento. Para o desenvolvimento do pool de itens inicial, três fontes foram utilizadas: revisão de literatura sobre escalas já existentes; estudo qualitativo; e, sugestões de especialistas sobre racismo/desigualdades em saúde. O instrumento inicialmente proposto (versão 1) constava de 50 itens. Buscou-se verificar as evidências de validade de conteúdo e constructo e, para isso, a coleta de dados foi dividida em duas etapas. A primeira etapa consistiu na avaliação do instrumento proposto junto ao comitê de especialistas e a segunda etapa consistiu no preenchimento do instrumento pela população-alvo. A análise dos dados foi realizada no R e Stata 14.2. RESULTADOS: Na validação de face e conteúdo, a versão 1 foi submetida à avaliação por comitê de especialistas composto por um metodologista, um profissional de língua portuguesa, três especialistas em relações étnico-raciais e três membros da população-alvo. Dos 50 itens elaborados originalmente, foram excluídos 28 e restaram 22 (versão 2). O CVR (razão de validade de conteúdo) médio dos itens que restaram foi 0,74. Com relação à concordância entre os especialistas, o PABAK foi 0,30, considerado razoável. Entretanto, dos 22 itens que compuseram a versão 2, dois foram desmembrados, o que gerou a versão 3, com 24 itens. A versão 3 foi construída na plataforma digital Research Eletronic Data Capture (REDCap) e foi divulgada entre setembro e dezembro de 2017 por meio de um link (via redes sociais como Facebook e Whatsapp) que direcionou os respondentes para o instrumento. Ao todo, 480 pessoas acessaram o link, mas apenas 158 finalizaram o preenchimento do instrumento. A maior parte dos respondentes foi do sexo feminino (87,0%), autoclassificada como de raça/cor preta ou parda (97,5%) e pertencente ao grupo econômico A e B (61,4%). Prosseguiu-se com a avaliação da validade de constructo por meio da análise fatorial exploratória. KMO (Kaiser-Meyer-Okin) foi 0,736; o teste de esfericidade de Bartlett foi p<0,001; todas as cargas fatorias estiveram entre 0,3 e 0,9; e as comunalidades abaixo de 0,4. A avaliação do índice de confiabilidade Ômega de Mcdonald total foi 0,87, valor considerado bom. Dessa forma, produziu-se a versão 4, denominada DRISS, com 19 itens no total e seis dimensões, que são: sintomas somáticos, preparo, expressão emocional, percepção social, reação, consequências emocionais. Não foi observada diferença estatisticamente significativa nas médias dos escores em relação à idade, escolaridade, grupo econômico e outras variáveis sociodemográficas. CONCLUSÕES: Este estudo produziu uma escala que mede a percepção sobre discriminação racial interpessoal no contexto dos serviços de saúde, denominada DRISS, que apresenta adequadas propriedades psicométricas. O DRISS é direcionado especificamente às/aos usuárias/os dos serviços de saúde. Em nível populacional, produzirá dados relevantes para a tomada de decisões programáticas com foco na redução da discriminação racial nos serviços de saúde e consequente diminuição das iniquidades raciais em saúde. / OBJECTIVE: To develop and validate an instrument to measure perceptions about interpersonal racial discrimination in Brazilian healthcare facilities context. METHODOLOGY: This is a methodological study based on Classical Theory of Tests. For the development of the initial items pool, three sources were used: literature review on existing scales; qualitative study; and, expert on racism health inequalities suggestions. Initially, the version 1 was composed by 50 items. In order to test content and construct validity evidence, data collection was divided into two steps. The first step consisted of the analysis of version 1 instrument to an expert committee and the second step consisted of the submission of the instrument to the target population. Data analysis was performed with R and Stata 14.2. RESULTS: Face and content validation of version 1 was performed by expert committee composed by a psychometrist, a Portuguese language expert, three experts in ethnic-racial relations and three members of the target population. From the 50 originally drafted items, 28 were excluded and 22 remained (version 2). The average CVR (content validity ratio) of the items was 0.74. Regarding the agreement among the experts, PABAK was 0.30, considered reasonable. Two items from version 2 were dismembered, which generated version 3, with 24 items. Version 3 was included on the Research Eletronic Data Capture (REDCap) digital platform and was released between September and December 2017 in a link (via social networks like Facebook and Whatsapp). Altogether, 480 people accessed the link, but only 158 completed the instrument. Most respondents were female (87.0%), self-classified as black or brown (97.5%) and were at economic group A and B (61.4%). We proceeded with the evaluation of construct validity through exploratory factorial analysis. KMO (Kaiser-Meyer-Okin) was 0.736; Bartlett Sphericity Test was p <0.001; all factor loads were between 0.3 and 0.9; and commonalities below 0.4. The McDonalds Omega Total reliability rating was 0.87, which is considered good. In this way, version 4, named DRISS, was produced with a total of 19 items and six dimensions, that are: somatic symptoms, preparation, emotional expression, social perception, reaction, and emotional consequences. No statistically significant difference was observed in the means of the DRISS scores in relation to age, schooling, economic group and other sociodemographic variables. CONCLUSIONS: This study produced a scale that measures the \'perception about interpersonal racial discrimination in the healthcare facilities context, called DRISS, with adequate psychometric properties. DRISS is specifically targeted to the health services users. At the population level, it may produce relevant data for programmatic decision-making focused on reducing racial discrimination in healthcare facilities, and as a consequence, racial inequities in health.

本研究探討台灣新上市股票是否有超額報酬之存在，並進一步探討超額報酬與其影響因素之關係：是否因為內部人持股比例高低，公司最近三年平均每股盈餘，負債比例高低，承銷價格高低，公司總資產大小，公司最近三年淨利變化，上市之後一年之內是否辦理現金增資而有所差異。本研究主要探討新上市公司，其新上市短期與長期異常報酬的解釋因素。 / This sutdy mainly employs empirical methodology. The sample period convers from 1987 to 1995, including 195 samples. The unerpricing regress against EPS (earnings per share), average earning growth rate, debt/equity ratio, firm's size , changes in ownership structure, seasoned new issues within one year subsequent to the IPO (dummy variable), and lottery rate. The findings indicate that the underpricing significantly (95% significant level) correlates with EPS, firm's size, and lottery rate.

<p>This thesis explores and explains the existence of a best practice model to optimise the transfer of funds (&ldquo / the transfer funding process&rdquo / ) between funders and service providers in the public sector. Using ideas about best practice in a specific context, the Health environment, it investigates the perceptions of managers about the transfer of funds between the Provincial Government of the Western Cape and the Local Authority of the City of Cape Town, the existence of a formula that will indicate appropriate amounts to transfer to service providers, and how information systems might assist with the process and the formula.</p>

No description available.

中國大陸自1978年確定改革開放政策，天津自改革開放初期的經濟發展面對資金和技術不足的問題。1990年末期，因為外商企業在天津長期投資，對天津產業技術提升及企業管理發揮積極作用，使天津市擠身中國大陸最吸引外來投資之地區之一。1992年鄧小平南巡再次確認中國大陸積極對外開放政策後，天津之外來投資呈現倍數之高度成長。2010年度，天津之外來投資金額更是突破百億美元大關。本文之研究目的冀討論天津在1990年第至2010年，影響各國家地區對天津投資之決定因素。本文採用天津此1990年至2010年累計最高投資金額之前九個國家地區之資料，利用固定效果模型估計，結果顯示決定因素有相對實質匯率、相對每人國內生產毛額、工資率及時間趨勢，另外各國家地區對於天津之地理距離透過分析亦可知其自發性投資呈現負相關。為降低實證模型發生錯誤，將各種統計量之檢定方法加以檢定，皆獲得通過。 / China has adopted and confirmed the so-called Open Door Policy since 1978. Tianjin faced the shortage of capital and technology in the early period of the implement of the Policy. However, in the end of 1990, Tianjin became one of the most attracting foreign investment cities in China because the foreign direct investment had played an important role and positively influenced industries upgrade and business management in the city. The amount of foreign direct investment in Tianjin has a high speed growth after Deng Xiaoping’s southern trip in 1992 to confirm the determination of China’s open door policy again. In 2010, the amount of foreign direct investment in Tianjin was impressively over ten billion US dollars. The purpose of this study is to investigate the determinants of foreign direct investment from different countries and districts in Tianjin from 1990 to 2010. The study adopted fixed-effect model to investigate the determinants of foreign direct investment in Tianjin with the top nine countries and districts in the period of 1990 to 2010. The results revealed relative currency rate, relative GDP per capita, relative wage rate and time trend are the most important factor in attracting foreign direct investment in Tianjin in the period. Another result showed the geographical distance has a negative relationship to foreign direct investment in Tianjin by fixed effect analysis. In order to reduce the occurrence of mistakes, the model and result results also have been tested through related tests methods.

Despite a well-documented gender pattern of adolescent mental health, public health research investigating possible influencing factors from a gender-theoretical approach is scarce. This study aimed to explore what factors and circumstances are related to adolescent mental health and to apply a gender analysis to the findings in order to improve the understanding of the relationships between life circumstances and the gendered patterning of mental health among young people.   The study population was 16-19-year-old Swedish students and data was collected by means of focus groups (N=29) and self-administered questionnaires (N=1,663, 78.3% response rate) in school settings. Mental health problems were defined in a broad sense including the adolescents’ own understandings, perceived stress, psychological distress and deliberate self-harm.   The mental health problems of perceived stress, psychological distress and deliberate self-harm were twice as common among girls as boys. The findings suggest that adolescent mental health is associated with the life circumstances of social relationships, demands and responsibility taking and experiences of violence and harassment.  Supportive relationships with friends, family and teachers were found to be of importance to positive mental health, whereas poor social relationships, loneliness and lack of influence were associated with mental health problems.  Perceived demands and responsibility taking regarding school work, relationships, future plans, appearance and financial issues were strongly related to mental health problems, particularly among girls regardless of social class. The results indicate that physical violence, sexual assault, bullying and sexual harassment are severe risk factors for mental health problems in young people. Boys and girls experienced different types of violence, and the victim-perpetrator relationships of physical violence differed. These diverging experiences appeared to influence the associations with mental health problems in boys and girls.   A gender analysis provides the tools to gain knowledge about the ways that boys’ and girls’ lives are shaped by gender relations and constructions at different levels in society and how these life circumstances represent risk- or protective factors for mental health. For example, unequal power structures and the ways girls are expected to ‘do’ femininity likely influence their life circumstances in ways that place them at greater risk of mental health problems. Hegemonic constructions of masculinity and advantaged positions likely contribute to life circumstances that are positive for mental health but are also implying risk factors for poor mental health among boys, e.g., violence. It is also important to recognise how the intertwined cultural and structural aspects of gender and social class influence the lives and mental health of boys and girls. In conclusion, gendered and class-related mechanisms at the different levels in society influence the distribution of risk factors unevenly among boys and girls, which could be a possible explanation for the gender differences in reports of perceived stress, psychological distress and deliberate self-harm.   The likelihood of gender and socioeconomic differences in mental health problems should be taken into account in prevention and health promotion strategies at all levels in society. A greater awareness about gender relations and the gendered social circumstances under which young people live is required. The school environment is an important arena with respect to prevention and health promotion. There is also a need for a joint action against violence and harassment at all levels in society. Implications do not only concern young people; social policy and legislation should focus on reducing gender and class inequalities in general. / Sammanfattning Svensk titel: Livsvillkor och ungdomars psykiska hälsa: uppfattningar, associationer och en genusanalys.   Trots ett väldokumenterat genusmönster i ungdomars psykiska hälsa finns det en kunskapslucka i den folkhälsovetenskapliga forskningen avseende genusteoretiska analyser av sambanden mellan ungas livsvillkor och psykisk hälsa. Föreliggande studie syftade till att undersöka vilka faktorer och omständigheter som är relaterade till psykiska problem, samt att analysera fynden ur ett genusperspektiv för att fördjupa förståelsen av relationerna mellan ungas livsvillkor och genusmönster i psykiska hälsa.   Studiepopulationen var gymnasielever i åldern 16-19 år. Studien genomfördes i skolmiljö och data insamlades genom fokusgrupper (N=29) och en enkätstudie (N=1,663, 78.3% svarsfrekvens). En bred definition av psykisk ohälsa tillämpades vilken representerades av ungdomarnas egen förståelse, samt de psykiska problemen upplevd stress, psykiska besvär samt självskadebeteende.   Resultaten visade att stress, psykiska besvär och självskadebeteende var dubbelt så vanligt bland flickor som bland pojkar. Psykiska problem var relaterade till livsvillkoren sociala relationer, krav och ansvarstagande samt utsatthet för våld och trakasserier. Stödjande relationer med vänner, familj och lärare var av stor betydelse för psykisk hälsa medan dåliga relationer, ensamhet och brist på inflytande var relaterat till psykiska problem. Psykiska problem var starkt kopplade till erfarenheter av höga krav och ansvarstagande avseende skolarbete, relationer, framtidsplaner, utseende och ekonomi, i synnerhet bland flickor oavsett socioekonomisk bakgrund. Resultaten indikerar att olika former av våld och trakasserier är allvarliga riskfaktorer för psykiska problem och att flickors och pojkars skiljda erfarenheter av olika former av våld samt relationen till förövaren, kan vara relaterade till skillnader i psykiska problem.   Genusanalysen av resultaten föreslår att flickors livsvillkor påverkas av ojämlika maktstrukturer och konstruktioner av femininitet och att dessa livsvillkor bidrar till en ökad risk för psykisk ohälsa bland flickor. Livsvillkor kopplade till manlig överordning och hegemoniska konstruktioner av maskulinitet influerar sannolikt pojkars psykiska hälsa positivt. Dessa villkor kan dock också innebära risk faktorer för psykiska problem, t.ex. i fråga om våld. Studien uppmärksammar även hur kulturella och strukturella aspekter av både genus och social klass kan påverka livsvillkor och psykisk hälsa för pojkar och flickor. Studiens slutsats är att genusifierade och klassrelaterade mekanismer på olika nivåer i samhället bidrar till en skev fördelning av riskfaktorer för psykiska problem vilket kan vara en möjlig förklaring till skillnaderna mellan pojkar och flickor i fråga om upplevd stress, psykiska besvär och självskadebeteende.   Genus- och socioekonomiska skillnader i psykiska problem bör tas i beaktande i preventivt och hälsofrämjande arbete på alla nivåer i samhället. Detsamma gäller för en ökad medvetenhet om hur ungas livsvillkor är relaterade till psykisk hälsa och hur dessa villkor är genus- och klassrelaterade. Studien uppmärksammar skolan som en viktig arena för preventivt och hälsofrämjande arbete samt att gemensamma insatser krävs på olika arenor för att motverka våld och trakasserier. Implikationer av studien omfattar även generella samhällspolitiska insatser för minskad ojämlikhet. Nyckelord: Stress; psykiska besvär; självskadebeteende; gymnasieelever; maskulinitet; femininitet; sociala determinanter; sociala relationer; krav; ansvarstagande; våld och trakasserier; skola. / Forskarutbildningsämne: Hälsovetenskap.

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.