Measles is resurging around the world, and large outbreaks have been observed in several parts of the world. In 2019 the Philippines suffered a major measles outbreak partly due to low immunization rates in certain parts of the population. There is currently limited research on how to identify and reach pockets of unvaccinated individuals effectively. This thesis aims to find important factors associated with non-vaccination against measles using a machine learning approach, using data from the 2017 Philippine National Demographic and Health Survey. In the analyzed sample (n = 4006), 74.84% of children aged 9 months to 3 years had received their first dose of measles vaccine, and 25.16% had not. Logistic regression with all 536 candidate features was fit with the regularized regression method Elastic Net, capable of automatically selecting relevant features. The final model consists of 32 predictors, and these are related to access and contact with healthcare, the region of residence, wealth, education, religion, ethnicity, sanitary conditions, the ideal number of children, husbands’ occupation, age and weight of the child, and features relating to pre and postnatal care. Total accuracy of the final model is 79.02% [95% confidence interval: (76.37%, 81.5%)], sensitivity: 97.73%, specificity: 23.41% and area under receiver operating characteristic curve: 0.81. The results indicate that socioeconomic differences determine to a degree measles vaccination. However, the difficulty in classifying non-vaccinated children, the low specificity, using only health and demographic characteristics suggests other factors than what is available in the analyzed data, possibly vaccine hesitation, could have a large effect on measles non-vaccination. Based on the results, efforts should be made to ensure access to facility-based delivery for all mothers regardless of socioeconomic status, to improve measles vaccination rates in the Philippines.

This thesis presents a case study of an open pit mine proposal in Kamloops, BC. During an integrated Environmental (Impact) Assessment (EA) process mandated by the Provincial and Federal governments, stakeholders addressed the mine’s environmental, social, heritage, economic, and health-related impacts. At the end of a 7-year process, the application was denied. My research sought to examine how health was conceptualized in the EA, and, specifically, had the mine been approved, how would the permit conditions have protected the public from adverse health effects. To that end, I conducted a review of health-related documents incorporated in the EA and studied the results through a Health Impact Assessment (HIA) lens based on guidance from the International Finance Corporation (IFC). As well as reviewing and analyzing the EA documents, I conducted interviews with participants in and outside the formal stakeholder group, as prescribed by the IFC HIA Guidance. Specifically, my analysis was based on the scoping phase of the assessment, and the baseline health profile that was included, using this internationally recognized HIA framework. My results show that the social determinants of health were not factored into the EA as per HIA best practice. Many in the formal stakeholder group, and outside of it, felt that institutional barriers prevented inclusion of the social determinants of health in the assessment. That finding raises questions about the reality of EA processes to protect public health. / Graduate

Fewer rural Congolese women complete 4 antenatal care (ANC) visits than do urban women, despite high maternal and child mortality rates. This quantitative cross-sectional survey applied Andersen's behavioral model of service utilization to examine whether the ANC facility type, provider type, provider gender, time to ANC facility, cost, and number of services can predict ANC compliance among rural women. The study was a secondary analysis of the 2015 Maternal and Child Health (MCH) survey, which comprised 1,280 eligible women selected through stratified random sampling. The analysis included bivariate and multivariate logistic regressions. The findings showed that women seen in private facilities, AOR = 2.220, 95% CI [1.384, 3.561], p < .01; women seen by female providers, AOR = 1.407, 95% CI [1.055, 1.877], p < .05; and women receiving 7 to 9 ANC services, AOR = 1.680, 95% CI [1.142, 2.472], p < .05, were more likely to complete 4 ANC visits. The cost of services and time to the ANC facility had no association with ANC compliance. Further analysis showed that private facilities provided more services (median of 6 vs. 5, p = .000) and had more women attended to by doctors (11% vs. 2%, p = .000) and female providers (72.9% vs. 58.4%, p < .001). These findings suggest that service quality and provider gender play a role in ANC compliance in rural areas. Therefore, Congolese health authorities should establish quality improvement programs and incentives to attract female providers to rural areas. This study contributes to positive social change by identifying ANC access barriers of rural populations and informing future efforts to close the urban-rural gap in MCH outcomes.

Health inequality conflates a huge number of economic, social, and political issues. These issues, together described as social determinants, determine a population's health through influencing health status and life expectancy. The research purpose of this study was to examine how social determinants affected the life expectancy of the women of Edo State, based on secondary data from Nigeria's 2008 demographic and health survey (NDHS). The theories that guided the study were self-efficacy beliefs of the social cognitive theory and physical self-concept of the health belief model. This quantitative cross-sectional study examined the associations between socioeconomic status, nutritional status, literacy/educational attainment, access to household sanitation facilities, and life expectancy. The dependent variables were health status and life expectancy (assessed using parity and age at first delivery). The independent variables were employment, ability to read and write, listening to the radio, type of place of residence, and persons responsible for reproductive health decisions. The analysis was based on data from 950 completed face-to-face interviews in the 2008 NDHS covering 846 households in Edo State selected using a stratified 2-stage cluster sampling design. Regression analyses showed that listening to the radio, persons responsible for decisions on reproductive health issues, employment, and type of place of residence had significant positive effects on parity and age at first delivery. Employment was the best predictor of both dependent variables. Ability to read and write had a negative relationship with the age at first delivery. The social change implications include the attainment of longer lives in Edo State, Nigeria, through effective policies on employment and education.

INTRODUCTION. La charge mondiale des maladies cardiovasculaires (MCV) ne cesse d’augmenter. Une population particulièrement vulnérable à ces maladies est celle des adultes âgés ayant une maladie neurologique : l’épilepsie. Plusieurs études démontrent que les adultes âgés atteints d’épilepsie ont un risque plus élevé de développer une MCV par rapport à la population générale. Cette association est étonnamment peu étudiée chez cette population. Afin de développer des programmes de soins de santé pour prévenir l’apparition de comorbidité de MCV chez les personnes atteintes d’épilepsie, dresser un portrait précis des adultes âgés atteints d’épilepsie est nécessaire. OBJECTIFS. Afin de combler les lacunes de la littérature scientifique sur les causes du fardeau élevé des MCV chez les adultes âgés atteints d’épilepsie, l’objectif de ce mémoire est d’étudier la répartition des facteurs sociaux, mode de vie et comportements, ainsi que des maladies chroniques connues comme étant des facteurs de risque de MCV chez les adultes âgés atteints d’épilepsie comparée à la population générale. En outre, nous visons à mesurer l’association transversale entre l’épilepsie et les MCV chez les adultes âgés, avec et sans ajustement pour des antécédents d’accidents vasculaires cérébraux (AVC), ainsi qu’à trouver des preuves d’interactions entre l’épilepsie et les facteurs de risque de MCV. MÉTHODES. Nous avons analysé les données de 44 817 participants de l’Étude longitudinale canadienne sur le vieillissement (ÉLCV), une cohorte d’étude longitudinale composée d’individus âgés d’au moins 45 ans et plus dont plus de 700 personnes ont des antécédents d’épilepsie autodéclarés au cours de leur vie. En ajustant pour l’âge, le sexe et le statut d’AVC, nous avons utilisé la régression log-binomiale pour modéliser les associations transversales entre les facteurs de risque de MCV, l’épilepsie et les MCV telles que les maladies cardiaques, les maladies vasculaires périphériques et les infarctus du myocarde. Nous avons comparé le fardeau des MCV attribuable par les AVC dans la population avec et sans épilepsie. Des modèles de régression multivariés ont également été stratifiés en fonction du statut d’épilepsie afin d’observer des différences dans ces associations entre les personnes atteintes d’épilepsie et les personnes non atteintes d’épilepsie. Finalement, nous avons testé l’existence d’interactions entre les facteurs de risque de MCV et l’épilepsie, et leur association avec le statut de MCV. Nous avons utilisé l’imputation multiple pour remplacer les données manquantes. RÉSULTATS. La majorité des caractéristiques sociodémographiques, mode de vie et comportements et maladies chroniques, sélectionnées comme facteurs de risque de MCV dans notre étude, étaient significativement plus prévalentes chez les personnes atteintes d’épilepsie comparée à la population générale non atteinte d’épilepsie. Le fardeau des MCV attribuable par les AVC chez les personnes atteintes d’épilepsie n’était que de 36 %, soit un taux similaire à celui de la population générale qui lui s’élevait à 32 %. Même après l’ajustement du statut d’AVC, ainsi que de l’âge et du sexe, les personnes atteintes d’épilepsie présentaient une prévalence significativement plus élevée de maladies cardiaques [ratio de prévalence (PR) = 1,27 (IC à 95 % : 1,02-1,57)] et de maladies vasculaires périphériques [PR = 1,88 (IC à 95 % : 1,50-2,36)]. Bien qu’elle ne soit plus significative, la tendance vers une augmentation de la prévalence des infarctus du myocarde chez les personnes atteintes d’épilepsie était maintenue [PR = 1,19 (IC à 95 % : 0,89-1,60)]. Finalement, parmi tous les facteurs de risque de MCV, seuls l’âge, l’hypertension et la maladie pulmonaire chronique obstructive ont été associés à une augmentation significative de la prévalence d’une ou plusieurs MCV. CONCLUSION. La grande taille de l’échantillon et l’étendue des informations sur la santé saisies par l’ÉLCV (c’est-à-dire démographiques, sociales, physiques, psychologiques, économiques, physiologiques) nous ont permis de modéliser une analyse approfondie et de présenter un reflet juste d’une population d’adultes âgés. Le mémoire présenté démontre que les facteurs de risque de MCV sont plus fréquemment observés chez les personnes atteintes d’épilepsie et l’association entre l’épilepsie et les MCV est indépendante de l’association entre l’épilepsie et les AVC. Ces résultats constituent une première étape importante pour mieux comprendre les origines des MCV chez les personnes atteintes d’épilepsie. L’analyse de médiation aurait pu être un moyen d’approfondir mes analyses. Cela n’a pas été possible avec l’analyse actuelle étant donné que nous n’avions aucun moyen d’établir la séquence temporelle de nos données. Les adultes âgés constituent une population vulnérable à laquelle les prestataires de soins de santé doivent accorder une attention particulière. Mener des études longitudinales sur les personnes dont les crises d'épilepsie viennent d'être diagnostiquées et qui présentent une maladie chronique, des caractéristiques sociodémographiques et un mode de vie entièrement caractérisé (avant et après le diagnostic d'épilepsie) sont nécessaires. / INTRODUCTION. The global burden of cardiovascular disease (CVD) is steadily increasing. A population particularly vulnerable to these diseases are the older adults with a neurological condition: epilepsy. Several studies show that older adults with epilepsy have a higher risk of developing CVD when compared to the general population. This association is surprisingly poorly studied among people with epilepsy. In order to develop health care programs to prevent the onset of CVD comorbidity in people with epilepsy, creating an accurate portrait of older adults with epilepsy is required. OBJECTIVES. In order to fill the gaps in the scientific literature on the causes of the high burden of CVD in older adults with epilepsy, the purpose of this thesis is to investigate the distribution of social factors, lifestyle and behaviors, as well as chronic disease CVD risk factors, in people with epilepsy as compared to the general population. In addition, we aim to measure the cross-sectional association between epilepsy and CVD in older adults, with and without adjustments for a history of stroke as well as looking for evidence of interactions between epilepsy and CVD risk factors. METHODS. We analysed data for 44,817 participants in the Canadian Longitudinal Study on Aging (CLSA), a longitudinal study cohort of individuals aged at least 45 years and where more than 700 individuals have a lifetime self-reported history of epilepsy. Adjusting for age, sex and stroke, we used log-binomial regression to model the cross-sectional associations between CVD risk factors, epilepsy, and CVD such as heart disease, peripheral vascular disease, and myocardial infarction. We compared the CVD burden attributable to stroke in the population with and without epilepsy. Multivariable regression models were also stratified across levels of epilepsy status to observe for differences in these associations between epilepsy and people without epilepsy. Finally, we tested the existence of interactions between CVD risk factors and epilepsy and their association with CVD status. We used multiple imputation to replace missing data. RESULTS. The majority of the sociodemographic characteristics, lifestyle and behavior and chronic diseases, selected as CVD risk factors in our study, were significantly more prevalent in people with epilepsy as compared to the general population without epilepsy. The CVD burden attributable to stroke in people with epilepsy was only 36%, similar to the general population which reached 32%. Even after adjusting for a history of stroke, as well as age and sex, people with epilepsy had a significantly higher prevalence of heart disease [prevalence ratio (PR) = 1.27 (95% CI: 1.02, 1.57)] and peripheral vascular disease [PR = 1.88 (95% CI: 1.50, 2.36)]. Although no longer significant, the trend towards an increase in the prevalence of myocardial infarction in people with epilepsy was maintained [PR = 1.19 (95% CI: 0.89, 1.60)]. Finally, among all the CVD risks factors, only age, hypertension, and chronic obstructive pulmonary disease were associated with significant increases in the prevalence of one or more of the CVD. CONCLUSION. The large sample size and breadth of health information captured by the CLSA (i.e. demographic, social, physical, psychological, economic, physiological) allowed us to model in-depth analysis and present a fair reflection of an older adult population. The presented thesis demonstrates that CVD risk factors are more frequently seen in people with epilepsy and that the association between epilepsy and CVD is independent of the association between epilepsy and stroke. These findings are important first steps in more comprehensively understanding the origins of CVD in people with epilepsy. Mediation analysis could have been a way of further examining my analysis. This was not possible with the current analysis given that we had no way to establish the temporal sequence of our data. Older adults are a vulnerable population in which health care providers should pay particular attention. Conducting longitudinal studies of individuals with newly diagnosed epilepsy seizures and fully characterized chronic disease, sociodemographic characteristics and lifestyle (prior to and post a epilepsy diagnosis) are needed.

Background: In 1946, a proposal was made for a law on national pensions with the aim of reforming the pension system and giving pensioners better finances, which later was implemented at 1948. The theory of the social determinants of health suggests that income is an important factor that has an impact on health. The study aim was therefore to investigate whether the general pension reform implemented in 1948 could account for any differences in death rates for those aged 67 and older, and the research question was to examine if there was change in death rates for those aged 67 and older after 1948 that could be explained by an increase in income from the pension reform  Method: The study design was a quantitative inductive method. Data used in the study was death rates for those aged 67-90 years in Sweden between 1933-1962, as well as statistics from the Statistical Yearbook for Sweden to obtain data on income from the pension system. To investigate whether the pension reform has had any significant effects on the health of people of old ages, an interrupted time series analysis was used to measure changes in death rates for those aged 67-90 years between 1933 and 1962 in Sweden.  Results and conclusion: The results showed that there was an increase in the average pension by 461% for men and 442% for women between the years of 1947 and 1948. The study suggests that for women there was a significant change in death rates since the reform started, but that the reform of 1948 might not have had a significant effect on men’s death rates. Overall my study indicates that the changes in death rates for women in the pension age in 1948 and after could be explained by an increase in income from the pension reform, and that the pension reform seems to be a sustained policy effect that have accumulated over time.

No description available.

Background: Urban green spaces (UGS) have been shown to benefit both social cohesion and health outcomes. A new framework by Jennings and Bamkole (2019) suggests that social cohesion might act as a social determinant of health mediating the health benefits provided by UGS. Aim: To investigate associations between UGS, social cohesion, and self-rated health (SRH) in Swedish adults. Methods: A cross-sectional survey for adults living in Västerås (n=106) was conducted. Questions about UGS covered type, visit frequency, proximity, time spent, and UGS quality. Social cohesion was measured using a 13-item scale developed by de Vries et al. (2013). SRH was assessed with one Likert-scale item. Results: A t-test showed that forests were associated with higher social cohesion (M=46.44, SD=8.25) compared to parks (M=42.34, SD=6.56; p=.006), while logistic regressions revealed higher social cohesion was associated with better SRH when adjusted for age (OR = 1.10, 95% CI = 1.03 - 1.18, p = .008). No relationships between UGS and SRH were identified, and social cohesion did not affect that relationship further. Discussion: The small sample size, convenience sampling, and limited assessment of possible confounders have to be considered. Conclusion: The results from this study partially support Jennings and Bamkole’s (2019) framework, indicating its merits and confirming the need to investigate social cohesion as a central factor in the relationship between UGS and health outcomes further.

No description available.

The SARS-CoV-2 pandemic disrupted health professions education on a number of different levels. Many health professions and pre-health professions students lost access to real-world clinical experience which has lead to disruptions in the healthcare workforce pipeline. At the University of Montana a diverse group of health professions educators designed an innovative experiential learning program, called Griz Health, that would allow UM students to engage in healthcare experiences while helping the campus with COVID-19 response. Because of the overwhelmingly positive response from students and community members that participated in this program, the Griz Health program was shifted from a volunteer response program to a year-long course. Students in the Griz Health course will work in small, interprofessional teams to engage in the innovation process to tackle local healthcare issues in underserved communities.