Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke. / Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship

Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke. / Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship

Thesis (M.Sc.). / Written for the Faculty of Dentistry, [Dept. of Dental Sciences]. Title from title page of PDF (viewed 2009/07/08). Includes bibliographical references.

Thesis (Ph. D.)--University of Illinois at Urbana-Champaign, 1994. / Vita. Includes bibliographical references (leaves 145-154).

Dissertation (Ph.D.)--University of South Florida, 2006. / Title from PDF of title page. Document formatted into pages; contains 216 pages. Includes vita. Includes bibliographical references.

In 2013 Burma, the country of origin for many refugees of whom have resettled in the U.S. was in the top three countries for notification of suspected Latent Tuberculosis Infection (LTBI). Approximately 5%-10% of individuals diagnosed with LTBI are at risk of developing active tuberculosis (TB) disease; the highest risk occurs within two years following the diagnosis. Burmese refugees face a high potential of developing LTBI during resettlement in the U.S. and are at high risk for subsequent TB. Currently, we have limited knowledge of the Burmese Chin refugees' explanatory model (EM) of LTBI. Understanding the EM of these refugees is important because one's EM facilitates the recognition and response to illness, including early diagnosis and treatment. In the context of LTBI, this relates to the potential prevention of active TB disease. The purpose of this ethnographic study was to discover the Burmese Chin refugees' EM of LTBI and to describe the barriers experienced in receiving LTBI treatment. Kleinman's EM provided a conceptual framework to guide this study. A Burmese refugee gatekeeper assisted with community immersion and participant recruitment. Purposive and snowball sampling were used to recruit participants. Data were collected through participant observation and semi-structured interviews. Three data analysis strategies for ethnography that were used included domain, taxonomic, and componential analyses. Domain analysis began after open, inductive coding of the data. Data saturation was reached and the research questions were answered with eight participants. Data from 15 key informant interviews were abstracted into three domains: EM of LTBI, Fear and Stigmatization, and Barriers to Receiving LTBI Treatment. The over-arching theme, LTBI: My Shadowbox was derived from these three domains, 11 categories, and 25 subcategories through iterative and inductive data analysis. The analysis revealed the participants' language, behavior patterns, beliefs, values and health seeking experiences of LTBI in the U.S. The findings from this study will help to inform culturally tailored interventions to reduce LTBI and TB health disparities among Burmese Chin refugees and potentially other Burmese refugee subgroups in the U.S. Knowledge of the Burmese Chin refugees' EM of LTBI can inform health policy for reducing LTBI treatment barriers.

abstract: Native American communities face an ongoing challenge of effectively addressing cancer health disparities, as well as environmental racism issues that may compound these inequities. This dissertation identified the shared cultural knowledge and beliefs about cancer in a southwest American Indian community utilizing a cultural consensus method, an approach that combines qualitative and quantitative data. A community-based participatory research (CBPR) approach was applied at all stages of the study. The three phases of research that were undertaken included: 1) ethnographic interviews - to identifying the themes or the content of the participants' cultural model, 2A) ranking of themes - to provide an understanding of the relative importance of the content of the cultural model, 2B) pile sorts - identify the organization of items within specific domains, and 3) a community survey - access whether the model is shared in the greater community. The cultural consensus method has not been utilized to date in identifying the collective cultural beliefs about cancer prevention, treatment or survivorship in a Native American community. Its use represents a methodological step forward in two areas: 1) the traditional ethnographic inferences used in identifying and defining cultural meaning as it relates to health can be tested more rigorously than in the past, and 2) it addresses the challenge of providing reliable results based on a small number of community informants. This is especially significant when working with smaller tribal/cultural groups where the small sample size has led to questions concerning the reliability and validity of health-related research. Results showed that the key consultants shared strong agreement or consensus on a cultural model regarding the importance of environmental and lifestyle causes of cancer. However, there was no consensus found among the key consultants on the prevention and treatment of cancer. The results of the community survey indicated agreement or consensus in the sub-domains of descriptions of cancer, risk/cause, prevention, treatment, remission/cure and living with cancer. Identifying cultural beliefs and models regarding cancer could contribute to the effective development of culturally responsive cancer prevention education and treatment programs. / Dissertation/Thesis / Ph.D. Anthropology 2011

abstract: Identifying modifiable causes of chronic disease is essential to prepare for the needs of an aging population. Cognitive decline is a precursor to the development of Alzheimer's and other dementing diseases, representing some of the most prevalent and least understood sources of morbidity and mortality associated with aging. To contribute to the literature on cognitive aging, this work focuses on the role of vascular and physical health in the development of cognitive trajectories while accounting for the socioeconomic context where health disparities are developed. The Assets and Health Dynamics among the Oldest-Old study provided a nationally-representative sample of non-institutionalized adults age 65 and over in 1998, with biennial follow-up continuing until 2008. Latent growth models with adjustment for non-random missing data were used to assess vascular, physical, and social predictors of cognitive change. A core aim of this project was examining socioeconomic and racial/ethnic variation in vascular predictors of cognitive trajectories. Results indicated that diabetes and heart problems were directly related to an increased rate of memory decline in whites, where these risk factors were only associated with baseline word-recall for blacks when conditioned on gender and household assets. These results support the vascular hypotheses of cognitive aging and attest to the significance of socioeconomic and racial/ethnic variation in vascular influences on cognitive health. The second substantive portion of this dissertation used parallel process latent growth models to examine the co-development of cognitive and functional health. Initial word-recall scores were consistently associated with later functional limitations, but baseline functional limitations were not consistently associated with later word-recall scores. Gender and household income moderated this relationship, and indicators of lifecourse SES were better equipped to explain variation in initial cognitive and functional status than change in these measures over time. Overall, this work suggests that research examining associations between cognitive decline, chronic disease, and disability must account for the social context where individuals and their health develop. Also, these findings advocate that reducing socioeconomic and racial/ethnic disparities in cognitive health among the aging requires interventions early in the lifecourse, as disparities in cognitive trajectories were solidified prior to late old age. / Dissertation/Thesis / Ph.D. Sociology 2011

O objetivo geral desta tese foi avaliar o Procad, desde a sua criação, em 2000, até o lançamento da última edição, ocorrida em 2013, refletindo em que medida foram alcançados seus objetivos de promoção da melhoria da qualidade dos programas de pós-graduação stricto sensu, por meio do estímulo à formação de redes cooperativas. Apesar de o Programa ter mais de 15 anos de existência e o Plano Nacional de Pós-Graduação – PNPG 2011-2020 ter recomendado sua continuidade, ele não conta ainda com um processo permanente de avaliação. A metodologia proposta caracteriza-se como um estudo exploratório e descritivo, quanto a sua natureza e utilizou tanto a abordagem qualitativa, quanto a quantitativa, levando em consideração a complementaridade de tais abordagens (MINAYO, 2012). Os dados qualitativos foram estudados por meio da Análise de Conteúdo, de acordo com Bardin (2011). Com relação aos meios, foram elaborados dois instrumentos de consulta, que foram enviados, por correio eletrônico, aos coordenadores gerais dos projetos Procad e aos avaliadores dos referidos projetos. O primeiro instrumento objetivou à avaliação do Programa sob o ponto de vista de seus executores e o segundo teve o propósito de avaliar o Procad sob o ponto de vista de seus avaliadores. Além disso, foram tratados os resultados da análise dos pareceres emitidos pelos avaliadores de projetos Procad, por ocasião da avaliação intermediária. Os resultados obtidos nesta tese estão sendo apresentados em dois artigos e um manuscrito. No primeiro artigo foi abordado o levantamento das respostas obtidas por meio do questionário enviado aos 603 coordenadores gerais dos projetos Procad das Edições de 2005 a 2009. Responderam à pesquisa 236 coordenadores. Verificou-se que 79% dos respondentes consideraram que o Procad tinha alcançado os principais objetivos que nortearam a sua criação. Apesar disso, esses coordenadores apontaram dois aspectos que merecem maior atenção por parte da Capes: a superestimação de metas por parte dos beneficiários de projetos e a morosidade da Capes na divulgação dos resultados da análise das prestações de contas. No segundo artigo, os dados apresentados expressaram as respostas dos avaliadores de projetos, integrantes das comissões avaliativas relativas às edições Procad, lançadas no período de 2005 a 2009. Responderam à consulta 100% dos avaliadores consultados, o que demonstrou o reconhecimento, por parte desses respondentes, da importância de tal política pública. Observou-se que 91% dos respondentes consideraram que o Procad tem atingido os principais objetivos que orientaram a sua criação. Entretanto, indicaram a necessidade de rever os prazos de duração das missões de estudo e de instituir um processo de acompanhamento e avaliação do Programa. No manuscrito foram apresentados os dados relativos à análise dos 706 pareceres emitidos pelos consultores que participaram de processos avaliativos intermediários do Procad, correspondentes às edições de 2000 a 2009. Desse total, 646 (91,5%) foram favoráveis à renovação dos projetos e 60 (8,5%) foram desfavoráveis à renovação do apoio concedido pela Capes, demonstrando que a maior parte dos projetos teve sucesso no desenvolvimento das atividades propostas para os dois primeiros anos de execução. Observaram, entretanto, que houve a implementação de uma quantidade maior de missões de trabalho em relação às missões de estudo. Sugeriram a flexibilização da duração das missões de estudo para estimular a ampliação dessas missões. Com base na pesquisa realizada, verificou-se que é preciso instituir um processo sistemático de acompanhamento e avaliação do Procad e de outras ações e linhas de apoio da Capes, aumentando a eficiência dessas políticas e a transparência na execução dos gastos públicos. São propostos, também, outros possíveis caminhos para o aperfeiçoamento do Programa. / The purpose of this thesis was to evaluate the Procad since its creation in 2000 until the release of the latest edition in 2013, reflecting on in its objectives for promoting quality improvement of graduate programs, through the incentive of formation of cooperative networks. Although the program has over 15 years of existence and the National Graduate Plan - PNPG 2011-2020 PNPG have recommended its continuation, he still has not a permanent process of evaluation. The proposed methodology is characterized as an exploratory and descriptive study, as its nature and used both qualitative approach, as the quantitative nature taking into account the complementarity of these approaches (MINAYO, 2012). Qualitative information was studied through content analysis, according to Bardin (2011). It was developed two research instruments which were sent by e-mail, the projects general coordinators of Procad and evaluators of these projects. The first instrument aimed to assess the program from the point of view of its managers and the second aimed to evaluate the Procad from the point of view of their evaluators. In addition, were analyzed the opinions issued by the projects evaluators of Procad, at the intermediate evaluation. The results obtained in this thesis are presented in two articles and a manuscript. In the first article was approached the survey responses obtained through the questionnaire sent to 603 project general coordinators of Procad of 2005 to 2009. 236 project coordinators answered the research. It was found that 79% of respondents consider that the Procad has achieved the main objectives. Nevertheless, these coordinators considered that two aspects deserve more attention from the Capes: the establishment of goals too optimistic by the project beneficiaries and the delay of Capes in disseminating the analysis results of accountability. In the second article, the data presented express the responses of project evaluators, members of evaluation committees concerning Procad editions, released from 2005 to 2009. The questionnaire was responded to 100% of project evaluators consulted, which demonstrated the recognition by these respondents the importance of such public policy. It was observed that 91% of respondents considered that the Procad have achieved the main objectives. However, they pointed out the need to review the long periods of study missions and the need to create the monitoring and evaluation of Procad. In the manuscript were presented data on the analysis of 706 opinions issued by the consultants who participated in the intermediate Procad evaluation processes, corresponding to the 2000 editions to 2009. Of this total, 646 (91.5%) were favorable to renovation projects and 60 (8.5%) were unfavorable to the renewal of support by Capes, showing that most of the projects had success in the development of the proposed activities for the first two years of implementation. They observed, however, that there was an implementation of an increased amount of work missions in relation to the study missions. They suggested that the duration of study missions might be more flexible to encourage the expansion of such missions. Based on this research, it was found that it is necessary to establish a systematic process for monitoring and evaluation of Procad and other actions and support lines Capes, increasing the efficiency of these policies and transparency in the execution of public spending. Proposed are also other possible ways to improve the program.

BACKGROUND: Over recent decades, the nationwide prevalence of chronic disease among children and adolescents has been on the rise. Conditions such as obesity pose a significant risk to the physical and mental health of individuals in youth as well as in adulthood, as these health risks track into later years and increase in severity. Low-income and racial/ethnic minorities are disproportionately affected by chronic conditions. In particular, African American (AA) youth are reported to have a higher prevalence of fair/poor health than their Caucasian peers. Compounding the effects of this racial disparity in health is the disparity AA youth face in SES, as many live in poverty. The individual and environmental influences associated with factors of race and SES contribute to negative health behaviors leading to poor health status among AA youth living in disadvantaged communities. Health disparities have been shown to manifest in the earliest years of life, therefore the monitoring of at-risk populations of children and adolescents is essential to identifying, addressing, and reducing poor health outcomes throughout the course of life. OBJECTIVE: To determine the health status of AA children and adolescents living in a low-income community using multiple health measures, examine the relationships between these health measures in AA youth, as well as to identify barriers to participation in a family-oriented health promotion program. METHODS: A total of 111 AA boys and girls attending a community fine arts program located in a low-income suburb of Chicago participated in the study. Data from anthropometric measurements, the 20-m Shuttle Run Test, and curl-ups were collected and analyzed to assess the health measures of Body Mass Index (BMI) and BMI Percentile, Cardiorespiratory Fitness (CRF), and Muscular Fitness (MF), respectively. Data pertaining to barriers encountered in attending a health promotion program were collected from 13 families who were active members of the community fine arts program and had participated in health promotion program. The cross-sectional survey consisted of questions pertaining to the different components of the intervention program as well as to family demographic information. RESULTS: The prevalence of overweight and obesity in the entire study population was 34.2%, with 31.6% of boys and 34.8% of girls being classified as overweight/obese. 16.2% of youth categorized specifically as obese, with 26.3% of boys and 15.2% of girls being obese. 43.9% of study participants aged 10-18 years needed improvement in CRF, all of whom were girls. All but one boy reached the healthy fitness zone for curl-ups. Significant positive correlations were found between BMI and age as well as curl-ups and age, and significant negative correlation was found between CRF and age as well as BMI and CRF for AA youth. Of reported barriers, scheduling conflicts and time constraints were consistently most listed by survey respondents. CONCLUSION: Within the at-risk population of AA youth studied, despite high levels of MF, a large proportion presented with problematic health as indicated by the high levels of poor CRF and weight status observed, suggesting a need for intervention in order to address these health issues. An intervention program targeting youth within this and similar communities should take into consideration attenuating excessive program-associated expenses as well as offering more scheduling options and information on efficient food preparation and exercise.