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Lebensqualität bei Fabry-Patienten: Erhebung mit dem SF-36®Fragebogen Elisabeth Blohm Hintergrund: Der Morbus Fabry ist eine X-chromosomal vererbte, lysosomale Speichererkrankung bedingt durch den Mangel an dem Enzym α-Galaktosidase A. Die gesundheitsbezogene Lebensqualität von Fabry-Patienten ist im Vergleich zur Normalbevölkerung oder Patienten anderer chronischer Erkrankungen sowohl bei physischen als auch psychischen Aspekten reduziert. Es ist bekannt, dass für den Morbus Fabry typische Symptome, wie Schmerzen oder Dysfunktionen lebenswichtiger Organe, wie Herz- und Niereninsuffizienz, sowie frühzeitige Schlaganfälle zu einer signifikant verringerten gesundheitsbezogenen Lebensqualität beitragen. Fragestellung: Ziel dieser Arbeit war es, mit Hilfe des SF-36-Fragebogens die gesundheitsbezogene Lebensqualität einer großen Kohorte von Fabry-Patienten zum Zeitpunkt der ersten Vorstellung in einem spezialisierten Fabry Zentrum zu ermitteln. Gleichzeitig sollten begleitende Faktoren identifiziert werden, die mit den verschiedenen Dimensionen der psychischen und physischen Funktionsfähigkeit assoziiert sind. Dabei legten wir einen Schwerpunkt auf die Nierenfunktion. Methoden: Es wurden 99 Patienten mit Morbus Fabry eingeschlossen. Wir untersuchten die Daten des ersten Besuchs in unserem Fabry-Zentrum. Die Patientencharakteristika der Studienteilnehmer und die verschiedenen Skalen der HRQoL wurden über die CKD-Stadien unter Verwendung von ANOVA, Kruskal-Wallis-Test, χ²-Test und Fisher’s-exact-Test verglichen. Die mit den verschiedenen Dimensionen der HRQoL assoziierten Faktoren wurden mittels einer linearen Regressionsanalyse untersucht. Im multivariaten Modell wurden die folgenden Variablen in das Modell aufgenommen: Alter, Geschlecht, Nierenfunktion, Schmerzen, Schmerztherapie und vaskuläres Ereignis. Ergebnisse: Die meisten Patienten, besonders die meisten Frauen, hatten eine erhaltene Nierenfunktion, wohingegen Patienten mit eingeschränkter Nierenfunktion mit höherer Wahrscheinlichkeit männlich waren. Alle Patienten, die einer RRT erhielten, waren männlich; zwei von ihnen erhielten eine Nierentransplantation, sieben waren unter Dialyse. Eine eingeschränkte Nierenfunktion, besonders die Notwendigkeit einer RRT war über allen Skalen mit einer deutlichen Reduktion der HRQoL assoziiert. Desweiteren waren männliches Geschlecht, Schmerzen und Schmerztheapie signifikant und deutlich mit niedrigeren Werten in den SF-36-Skalen assoziiert. Im multivariaten Modell stellten sich eine eingeschränkte Nierenfunktion und Schmerzen als die Hauptfaktoren für reduzierte Werte in den physikalischen Kategorien heraus (körperliche Funktionsfähigkeit, körperliche Rollenfunktion, körperliche Schmerzen, allgemeine Gesundheitswahrnehmung und körperlicher Summenwert). Im Gegensatz dazu stellte sich heraus, dass die Notwendigkeit einer RRT mit reduzierter HRQoL in den psychischen und sozialen Kategorien assoziiert war. Schlussfolgerung: In dieser großen Kohorte von Fabry-Patienten aus einem Zentrum war die chronische Nierenerkrankung, besonders die Notwendigkeit einer RRT, ein entscheidender Faktor mir eine reduzierte HRQoL in physischen und psychisch/sozialen Aspekten des Lebens. Außerdem hatten Schmerzen eine unabhängige Beziehung mit niedrigeren Werten der physischen Skalen. Neben der Enzymersatztherapie könnten eine optimale Behandlung der Nierenerkrankung, sowie eine effektive Schmerztherapie helfen, die HRQoL von Fabry-Patienten zu verbessern. / Health Related Quality of Life in Patients with Fabry Disease: Investigation with the SF-36® questionnaire Elisabeth Blohm Background Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of the enzyme α-galactosidase A. Health related quality of life (HRQoL) in patients with Fabry disease is reduced when compared to the healthy population and to other chronic diseases in physical as well as mental aspects of well-being. Fabry specific symptoms such as pain, vital organ dysfunction including heart and renal failure or premature strokes are known to contribute significantly to impaired HRQoL Aims The purpose of the current study was to characterize HRQoL as assessed by the SF-36® questionnaire in a large cohort of patients with Fabry disease of a single center. We aimed to identify factors associated with the various dimensions of physical and mental functioning, with a focus on kidney function. Methods 99 patients with Fabry disease were enrolled. We analyzed data from the first visit at our center. Characteristics of study participants and the different scales of HRQoL were compared across CKD stages (eGFR >60 ml/min vs. eGFR <60 ml/min vs. renal replacement therapy) using ANOVA, Kruskal-Wallis test, χ²- test, and Fisher’s exact test. Factors associated with the various dimensions of HRQoL were examined using linear regression analysis. In multivariate analyses, the following variables were included in the model: age, gender, kidney function, pain, pain-therapy, and vascular event. Results Most of the patients, in particular most women, had preserved kidney function, whereas patients with impaired kidney function were more likely to be male. All patients receiving RRT were of male gender, of which two underwent kidney transplantation and seven received dialysis. Impaired kidney function, particularly the need of RRT, was associated with markedly reduced HRQoL across all scales. Furthermore, male gender, pain and pain-therapy were significantly and meaningfully associated with lower scores on the SF-36 scales. In multivariate modeling, impaired kidney function and pain emerged as the main factors associated with lower scores in physical aspects of life (physical functioning, role physical, bodily pain, general health, PCS). In contrast, only the need for RRT was found to be associated with reduced HRQoL in mental/social parameter dimensions. Conclusion In this large cohort of Fabry patients recruited in a single center, chronic kidney disease, particularly the need of RRT, was a crucial factor for reduced HRQoL in physical and mental/social aspects of life. Furthermore, pain was independently related to lower scores on physical scales. Aside from enzyme replacement therapy, optimal treatment of kidney disease and an effective pain therapy may help to improve HRQoL in Fabry patients.

Work-related asthma surveillance is needed to improve management of occupational exposures, clinical recognition/diagnosis, and worker compensation policies. This work investigated asthma in relation to work by evaluating the utility of existing Canadian surveillance data in providing useful information about the burden of work-related asthma; estimating the burden of work-related asthma among Canada's adult population; and evaluating the effect of job risk on asthma after considering other potential risk factors for asthma. The working population formed samples from two Statistics Canada surveillance programs: Canadian Community Health Survey (CCHS), 2002/03 Cycle 2.1 and National Population Health Survey (NPHS), Longitudinal Component (1994/95-2002/03). Both surveys enquired about health professional-diagnosed asthma; NPHS additionally asked age at time of diagnosis, so adult-onset versus childhood-onset asthma was determined. Both surveys enquired about current job held; corresponding job codes were linked to an asthma-specific job exposure matrix to judge job risk for occupational asthma. CCHS only provided current job information, in contrast, NPHS longitudinal data was used to determine job held at time of asthma-onset. Statistical measures for asthma in relation to job risk were estimated. CCHS results were likely biased by the healthy worker effect, as it showed the opposite effect of job risk on asthma than the NPHS; higher asthma prevalence was shown for NPHS men and women in high risk jobs. NPHS results indicated a large burden of adult-onset asthma among men (19,000) and childhood-onset asthma among women (17,000) attributed to working in high risk jobs for occupational asthma. Using NPHS, adjusted and crude prevalence odds ratio estimates were compared to further assess effect of job risk on asthma. For adult-onset asthma, there was no difference between estimates (men: 1.8, women: 1.1); for childhood-onset asthma, adjusted estimates were larger than crude, respectively (men: 1.3 v 1.2, women: 2.0 v 1.7). Age of asthma-onset and job held at time of asthma-onset is necessary surveillance information for estimating work-related asthma. There may be increased risk of work" caused" asthma among men and work "exacerbated" asthma among women in high risk jobs. Considering other risk factors for asthma did not reduce effect of job risk on asthma.

Work-related asthma surveillance is needed to improve management of occupational exposures, clinical recognition/diagnosis, and worker compensation policies. This work investigated asthma in relation to work by evaluating the utility of existing Canadian surveillance data in providing useful information about the burden of work-related asthma; estimating the burden of work-related asthma among Canada's adult population; and evaluating the effect of job risk on asthma after considering other potential risk factors for asthma. The working population formed samples from two Statistics Canada surveillance programs: Canadian Community Health Survey (CCHS), 2002/03 Cycle 2.1 and National Population Health Survey (NPHS), Longitudinal Component (1994/95-2002/03). Both surveys enquired about health professional-diagnosed asthma; NPHS additionally asked age at time of diagnosis, so adult-onset versus childhood-onset asthma was determined. Both surveys enquired about current job held; corresponding job codes were linked to an asthma-specific job exposure matrix to judge job risk for occupational asthma. CCHS only provided current job information, in contrast, NPHS longitudinal data was used to determine job held at time of asthma-onset. Statistical measures for asthma in relation to job risk were estimated. CCHS results were likely biased by the healthy worker effect, as it showed the opposite effect of job risk on asthma than the NPHS; higher asthma prevalence was shown for NPHS men and women in high risk jobs. NPHS results indicated a large burden of adult-onset asthma among men (19,000) and childhood-onset asthma among women (17,000) attributed to working in high risk jobs for occupational asthma. Using NPHS, adjusted and crude prevalence odds ratio estimates were compared to further assess effect of job risk on asthma. For adult-onset asthma, there was no difference between estimates (men: 1.8, women: 1.1); for childhood-onset asthma, adjusted estimates were larger than crude, respectively (men: 1.3 v 1.2, women: 2.0 v 1.7). Age of asthma-onset and job held at time of asthma-onset is necessary surveillance information for estimating work-related asthma. There may be increased risk of work" caused" asthma among men and work "exacerbated" asthma among women in high risk jobs. Considering other risk factors for asthma did not reduce effect of job risk on asthma.

Work-related asthma surveillance is needed to improve management of occupational exposures, clinical recognition/diagnosis, and worker compensation policies. This work investigated asthma in relation to work by evaluating the utility of existing Canadian surveillance data in providing useful information about the burden of work-related asthma; estimating the burden of work-related asthma among Canada's adult population; and evaluating the effect of job risk on asthma after considering other potential risk factors for asthma. The working population formed samples from two Statistics Canada surveillance programs: Canadian Community Health Survey (CCHS), 2002/03 Cycle 2.1 and National Population Health Survey (NPHS), Longitudinal Component (1994/95-2002/03). Both surveys enquired about health professional-diagnosed asthma; NPHS additionally asked age at time of diagnosis, so adult-onset versus childhood-onset asthma was determined. Both surveys enquired about current job held; corresponding job codes were linked to an asthma-specific job exposure matrix to judge job risk for occupational asthma. CCHS only provided current job information, in contrast, NPHS longitudinal data was used to determine job held at time of asthma-onset. Statistical measures for asthma in relation to job risk were estimated. CCHS results were likely biased by the healthy worker effect, as it showed the opposite effect of job risk on asthma than the NPHS; higher asthma prevalence was shown for NPHS men and women in high risk jobs. NPHS results indicated a large burden of adult-onset asthma among men (19,000) and childhood-onset asthma among women (17,000) attributed to working in high risk jobs for occupational asthma. Using NPHS, adjusted and crude prevalence odds ratio estimates were compared to further assess effect of job risk on asthma. For adult-onset asthma, there was no difference between estimates (men: 1.8, women: 1.1); for childhood-onset asthma, adjusted estimates were larger than crude, respectively (men: 1.3 v 1.2, women: 2.0 v 1.7). Age of asthma-onset and job held at time of asthma-onset is necessary surveillance information for estimating work-related asthma. There may be increased risk of work" caused" asthma among men and work "exacerbated" asthma among women in high risk jobs. Considering other risk factors for asthma did not reduce effect of job risk on asthma. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

acase@tulane.edu / Background As a region, Francophone sub-Saharan Africa (SSA) continues to have among the highest fertility rates and lowest contraceptive prevalence rates in the world. As of the latest Demographic and Health Survey (DHS) data available for each country, total fertility rates range from 4.1 (Gabon 2012) to 7.6 births per woman (Niger 2012). Modern contraceptive prevalence rates for married women range from a low of 3.3% (Guinea 2012) to a high of 20.1% (Senegal 2014). Methods Three analyses were completed utilizing nationally representative DHS data available for each Francophone SSA country. For each paper, bivariate and multivariate analyses were performed with weighted data to take into account the two-stage cluster sampling design of the DHS survey. In paper one, we determine whether being Muslim and/or being in a polygynous union impacts the use of modern contraceptives. In paper two, we provide detailed information on the characteristics that define users of specific contraceptive methods in this region. In the final paper, we provide a clearer picture of the reproductive health dynamic in young never married women in Francophone SSA. Results In paper #1, we found that religion and marital type generally were not predictive of modern contraceptive use. The typical predictors – education, age, residence (urban/rural) – were consistently significant across the included countries. In paper #2, profiles of users of the most common contraceptive methods in each country were created. For example, condom users had the most consistent profile across the 12 countries, with marital status, parity and education being clearly associated with condom use. For paper #3, education level was found to be the key predictor of both sexual activity and becoming pregnant for young, never married women in this region. In general, those with primary or secondary and higher education were more likely to be sexually active than those with no education. Conclusion These findings provide valuable information to government, private and nongovernmental organizations working toward increasing the numbers of contraceptive users in Francophone SSA. / 1 / Margaret Farrell

Workplace mental health is a major concern in Canada. The primary objective of this research is to describe the relationship between work and mental health, paying particular attention to work stressors and further explore moderators and mediators of any relationships, that might be targeted in future intervention strategies. The source of the data is the two cycles of the Canadian Community Health Survey conducted by Statistics Canada. All estimates produced from the data were weighted to represent the target Ontario population using the weights provided by Statistics Canada. Estimates of the prevalence of the mental disorders and substance dependence and mean scores of work stressors, according to different groups of workers, were calculated. To examine health care use, we treated consultation with a mental health professional, use of medication-antidepressants and utilization of any resource as dependent variables. Bivariate relationships between mental health disorders and other variables explored the correlates of mental health disorders. Logistic regression was used to examine moderators and mediators of work stressors in relation to mental health disorders by including some socio-demographic variables and behavioral variables as covariates and we also included terms of their interactions with work stressors. Since the level of work stressors varied by occupation and was likely determined in part by occupation, we did not include both variables in regression analyses. Further regressions with health care utilization as the dependent variable were conducted with work stressors and occupation as independent variables and other variables as covariates and in interaction terms for people with mental health disorders. The results of the study suggest that there is strong association between work and mental health problems. The findings regarding work stressors and occupation as predictors of mental health problems suggest that work health and safety practitioners must continue to pay attention to the psychosocial conditions of work. We also explored what factors predicted whether people consulted a mental health professional (CCHSl.l) or whether they used any resource available to deal with their problem (CCHS1.2). / Thesis / Master of Science (MS)

While modernising influences affect many facets of the lives of millions of Indian families, there remain deep-rooted socio-cultural practices and traditions that survive and become engendered in new institutional mechanisms. Labour market policy is but one example where age-old ethnic affiliations distort governmental efforts and find new ways of expressing themselves. Efforts over the past decade to slow the rate of population growth, by encouraging adoption of modern family planning methods have failed to tackle son preference and have caused the sex ratios at birth to be worse than at any other time in the nation's history. This is particularly so in urban India, even among the more educated populace, and it is worsening. This thesis sets out to assess the way in which such gender considerations affect family formation decisions, primarily concerning the quantity and quality of children, with an appreciation of the dynamic nature of the problem. First we assess how fertility preferences and past child outcomes affect the demand for family planning and how behaviours associated with the greater autonomy of women impact upon this process. The empirical work makes use of data from the latest round of the National Family Health Survey (NFHS) for India, 1999, for the state of Uttar Pradesh, in a simultaneous equation framework, in an effort to take account of the joint determination of many of the variables inherent in modelling such dynamic processes with cross-sectional data. We find that although women's autonomy has been held up as a means of achieving lower fertility, the two do not necessarily go hand in hand, unless coupled with the wider participation of women. Unless the primary social and economic motivations for preferring sons are tackled and dismantled through legislation and through changes to social attitudes, superficial policies to promote the well-being of women will have little real impact and may lead to worsening female child outcomes. One of the policies heralded to achieve the deeper goal of gender equality has been the promotion of education of female children, who as a group lag well behind their male counterparts on both literacy and numeracy rates. We thus turn our attention to investigating the way in which household time allocation decisions are made, focusing on the parental choice of each child's main activity; to go to school, to work in the home, or in the formal labour market, in an effort to understand how the household's opportunities and resource constraints, along with social norms impact such decisions. While some state governments are offering cash incentives to families to keep their female children in school and unmarried, significant labour market discrimination against women continues and constrains the value of this government investment. Making use of the same NFHS data for Uttar Pradesh, we estimate each child's trinomial time allocation with competing speci cations and then compare the results. The standard multinomial logit model is estimated initially but imposes some fairly tight assumptions on behaviour and the resultant data, that are unlikely to hold in the present application. A Mixed Logit model is then estimated that is able to bring greater flexibility and descriptive richness than is possible with the standard Logit model. Estimation results are compared and con firm the ability of the Mixed Logit to capture more fully the unobserved heterogeneity inherent in the data and to allow for correlation in the errors across children of the same family that is not permitted within the standard logit setup.

Introdução As recentes mudanças nos arranjos familiares e o envelhecimento populacional acarretam em novas demandas de saúde. Conhecer os arranjos familiares nos quais estão inseridos os idosos e a sua relação com o uso de serviços de saúde para a prevenção de doenças é de extrema importância para o planejamento de serviços e políticas públicas. Objetivo - Descrever os arranjos familiares aos quais pertencem os idosos do Município de São Paulo, SP, segundo características sociodemográficas e de saúde. Metodologia Estudo de base populacional com dados do Inquérito de Saúde de São Paulo ISA-Capital 2008. Participaram 920 idosos residentes da área urbana do Município de São Paulo. As variáveis de análise foram sociodemográficas, o tipo de arranjo familiar e uso de serviço de saúde consulta odontólogica; serviço de saúde; realização de papanicolau; mamografia; exame para prevenção câncer de próstata; exame para prevenção de câncer de intestino. A análise dos dados se deu por meio do teste de Chi-Quadrado de Pearson através dos softwares SPSS 18.0, módulo Complex Sample e STATA 11.0, módulo Survey. Resultados 31,4 por cento dos idosos moravam com cônjuge e descendência; 26,0 por cento só com cônjuge; 19,8 por cento só com descendência; 14,8 por cento sozinhos. Os idosos que moravam com cônjuge e descendência e só com o cônjuge foram os que mais realizaram exames preventivos para câncer de próstata e intestino, consultaram mais serviços odontológicos e de saúde na ausência de morbidades. Discussão - Idosos que moravam somente com descendentes foram que apresentaram piores condições socioeconômicas e os que menos fizeram exames preventivos, sugerindo que devem ser alvo de mais atenção e de campanhas para prevenção de doenças e agravos. / Background: Recent changes in family structure and population aging lead to new health demands. Cognize the family arrangements in which are embedded the elderly and its relationship to the use of health services for disease prevention is extremely important for service planning and public policies. Objective: Describe family arrangements which elderly belong in the city of São Paulo, according to sociodemographic and health characteristics. Methods: Population-based study with data from Health Survey in São Paulo, ISA-Capital 2008. The study was carried out with 920 elderly residents in São Paulo urban area. Analysis variables were sociodemographic, types of family arrangements and the use of health service for \'dental appointment\', \'health service\', \'Pap smear\', \'mammography\', \'prostate cancer prevention test\'; \'bowel prevention cancer test\'. Data analyses were conducted by Chisquare Test, SPSS 18.0 software, Complex Sample and STATA 11.0, Survey. Results: 31.4 per cent of the elderly used to live with spouse and offspring, 26.0 per cent with spouse only, 19.8 per cent with only offspring, 14.8 per cent alone. Elderly living with spouse and offspring, and only with their spouse performed more preventive screenings for prostate cancer and bowel, searched for more dental and health services when in absence of comorbidities. Discussion: Elderly living alone with offspring presented worst socioeconomic conditions and also performed less preventive tests, suggesting that they should be targeted for more attention and diseases prevention campaigns.

<p>This thesis described socioeconomic inequalities in fruit and vegetable consumption in Stockholm County.<strong> </strong>A comparative descriptive analysis was carried out with the use of secondary data from the 2006 Stockholm County Public Health Survey. The data was analyzed through cross tabulations that were conducted in SPSS.<strong> </strong>The findings showed that people with high socioeconomic position consumed fruit and vegetables more frequently than those of low socioeconomic position. Differences in fruit and vegetable consumption were found for the three measures of socioeconomic position; education, occupation and income. These differences were pronounced to a larger extent across different education levels compared to levels of occupation and income. Further research is needed to investigate which factors may explain the observed differences.</p>