Background: Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany. Objectives: The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation. Methods: The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/ hyperactivity disorder (FBBHKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined. Results Overall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed. Conclusions: The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

McMaster University MASTER OF PUBLIC HEALTH (2020) Hamilton, Ontario (Health Research Methods, Evidence, and Impact) TITLE: Applying Machine Learning to Determine Nutrients Predictive of Cardiovascular Disease Using Canadian Linked Population-Based Data AUTHOR: Jason D. Morgenstern, B.Sc. (University of Guelph), M.D. (Western University) SUPERVISOR: Professor L.N. Anderson, NUMBER OF PAGES: xv, 121 / The use of big data and machine learning may help to address some challenges in nutritional epidemiology. The first objective of this thesis was to explore the use of machine learning prediction models in a hypothesis-generating approach to evaluate how detailed dietary features contribute to CVD risk prediction. The second objective was to assess the predictive performance of the models. A population-based retrospective cohort study was conducted using linked Canadian data from 2004 – 2018. Study participants were adults age 20 and older (n=12 130 ) who completed the 2004 Canadian Community Health Survey, Cycle 2.2, Nutrition (CCHS 2.2). Statistics Canada has linked the CCHS 2.2 data to the Discharge Abstracts Database and the Canadian Vital Statistics Death database, which were used to determine cardiovascular outcomes (stroke or ischemic heart disease events or deaths). Conditional inference forests were used to develop models. Then, permutation feature importance (PFI) and accumulated local effects (ALEs) were calculated to explore contributions of nutrients to predicted disease. Supplement-use (median PFI (M)=4.09 x 10-4, IQR=8.25 x 10-7 – 1.11 x 10-3) and caffeine (M=2.79 x 10-4, IQR= -9.11 x 10-5 – 5.86 x 10-4) had the highest median PFIs for nutrition-related features. Supplement-use was associated with decreased predicted risk of CVD (accumulated local effects range (ALER)= -3.02 x 10-4 – 2.76 x 10-4) and caffeine was associated with increased predicted risk (ALER= -9.96 x 10-4 – 0.035). The best-performing model had a logarithmic loss of 0.248. Overall, many non-linear relationships were observed, including threshold, j-shaped, and u-shaped. The results of this exploratory study suggest that applying machine learning to the nutritional epidemiology of CVD, particularly using big datasets, may help elucidate risks and improve predictive models. Given the limited application thus far, work such as this could lead to improvements in public health recommendations and policy related to dietary behaviours. / Thesis / Master of Public Health (MPH) / This work explores the potential for machine learning to improve the study of diet and disease. In chapter 2, opportunities are identified for big data to make diet easier to measure. Also, we highlight how machine learning could find new, complex relationships between diet and disease. In chapter 3, we apply a machine learning algorithm, called conditional inference forests, to a unique Canadian dataset to predict whether people developed strokes or heart attacks. This dataset included responses to a health survey conducted in 2004, where participants’ responses have been linked to administrative databases that record when people go to hospital or die up until 2017. Using these techniques, we identified aspects of nutrition that predicted disease, including caffeine, alcohol, and supplement-use. This work suggests that machine learning may be helpful in our attempts to understand the relationships between diet and health.

My dissertation is composed of an introductory chapter followed by three independent chapters focusing on two themes: health and retirement. The last chapter concludes. After the introductory chapter, the second chapter investigates whether self reported general stress is a mediator in the relationship between socio-economic status (SES) and health. I use a six-year long panel of the Canadian Survey of Labour and Income Dynamics and employ dynamic econometric modelling techniques to study men and women who are major income earners in their families. I find little evidence that general stress is a pathway from SES to health. While the results suggest a strong negative association between stress and health for both men and women, they provide little support to the hypothesis of a significant effect of income on stress, consistent with the direction of the SES-health gradient. The third chapter studies whether self-assessed health status (SAH) contains information about future mortality and morbidity, beyond the information that is contained in standard "observable" characteristics of individuals (including pre-existing diagnosed medical conditions). Using a ten-year span of the Canadian National Population Health Survey, we find evidence that SAH does contain private information for future mortality and morbidity. Moreover, the extra information in SAH is greater at older ages. Our results suggest that a shift from defined benefit to defined contribution pension arrangements may carry with it the cost of exacerbated adverse selection in the market for annuities, especially at older ages. That would make it more difficult for older individuals to insure longevity risk. The fourth chapter looks at whether differences in early retirement pathways are associated with differences in post-retirement outcomes of health, stress and dwelling tenure. I use a 5 ample of men from the Canadian Survey of Labour and Income Dynamics, years 1996 to 2004. I find that differences in pre-retirement health indicators (such as self-assessed health and disability), as pathways to early retirement, are likely to be associated with differences in post-retirement health and stress. In addition, the results suggest that "involuntary" retirees (men who may have retired because of health and/or health related coniitions) are more likely to experience worse post-retirement outcomes (in terms of health and stress) than men who retire "voluntarily". Retirement circumstances are found to have no statistically significant effect on dwelling tenure. / Thesis / Doctor of Philosophy (PhD)

Chronic diseases such as diabetes have become increasingly prominent around the world. Diabetes care requires a combination of medication, exercise, diet, self-management education, and psychosocial care to reduce the risk of long-term complications. Following this strict regimen can have an adverse effect on the patient's quality of life. Quality of life is a broad concept that is difficult to define and study. This study focused on the health-related component of quality of life. Diabetes is reaching epidemic proportions in Kuwait. While the incidence of the disease is documented, little is known about its effect on the life of the Kuwaiti population. This is partly due to the lack of valid Arabic versions of health-related quality of life (HRQOL) instruments. The purpose of this study was to investigate the construct validity of two HRQOL measures in a sample of older adults in Kuwait with Type 2 diabetes. The two measures were the Short Form 36-Item Health Survey version 2.0, a generic measure, and the Problem Areas in Diabetes survey, a disease-specific measure. A total of 240 Kuwaiti citizens over the age of 55 years living in Kuwait City participated in this study. Participants were divided into two groups: the Diabetes Group included 120 older adults with diabetes and the Control Group included 120 older adults without diabetes. Three approaches were used to assess the construct validity of the Arabic versions of the SF-36v2 Health Survey and the Problem Areas in Diabetes survey: factor analysis, correlation, and known-group method. The results of this study support the use of the Arabic versions of the two surveys to measure HRQOL of older adults in Kuwait with Type 2 diabetes. Standards for construct validity were well met, with few exceptions. / Physical Therapy

<p>The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed.</p><p>Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used.</p><p>Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate.</p><p>Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension.</p><p>Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. </p><p>The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. </p><p>In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.</p>

<p>The purpose of this research is to study the effect of different demographic and socio economic factors on the contraceptive use among currently married women of age 15-49 in the two regions of Ethiopia, Amhara (17,214,056) and Oromiya (27,158,471). Data are obtained from the 2005 Ethiopian Demographic and Health Survey (EDHS). Information on contraceptive use was provided by current use 1334 (14.7), future use 4017 (52.0), unmet need for spacing 1817 (20.0) and limiting 1249 (13.3) currently married women aged 15&ndash / 49 interviewed in the 2005 Ethiopian Demographic and Health Survey (EDHS).</p>

The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed. Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used. Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate. Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension. Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.

<p>The purpose of this research is to study the effect of different demographic and socio economic factors on the contraceptive use among currently married women of age 15-49 in the two regions of Ethiopia, Amhara (17,214,056) and Oromiya (27,158,471). Data are obtained from the 2005 Ethiopian Demographic and Health Survey (EDHS). Information on contraceptive use was provided by current use 1334 (14.7), future use 4017 (52.0), unmet need for spacing 1817 (20.0) and limiting 1249 (13.3) currently married women aged 15&ndash / 49 interviewed in the 2005 Ethiopian Demographic and Health Survey (EDHS).</p>

Social comparison influences well-being, especially during psychological threat. Social comparison outcomes have been theorized to depend on motivation, frequency, contrast versus identification, with a better- versus worse-off other. To reduce this complexity in the theory, 94 senior-housing residents were interviewed and cluster analysis was conducted. Four clusters emerged. Half the interviewees formed a cluster using only adaptive social comparison methods. Adaptives were contrasted with a cluster of indiscriminate comparers, a cluster striving for improvement, and a cluster of participants disagreeing with most questions. Clusters differed especially in patterns of downward identification, upward and downward contrast. Self-evaluation and uncertainty-reduction also differed between clusters; self-enhancement and self-improvement motivations did not. Cluster membership had no direct effect on well-being, but moderation analysis demonstrated threat-buffering of high neuroticism in the adaptive cluster. The benefits were not due to self-esteem or educational level. By separating individuals rather than behaviors, cluster analysis provides a fresh perspective.

Social comparison influences well-being, especially during psychological threat. Social comparison outcomes have been theorized to depend on motivation, frequency, contrast versus identification, with a better- versus worse-off other. To reduce this complexity in the theory, 94 senior-housing residents were interviewed and cluster analysis was conducted. Four clusters emerged. Half the interviewees formed a cluster using only adaptive social comparison methods. Adaptives were contrasted with a cluster of indiscriminate comparers, a cluster striving for improvement, and a cluster of participants disagreeing with most questions. Clusters differed especially in patterns of downward identification, upward and downward contrast. Self-evaluation and uncertainty-reduction also differed between clusters; self-enhancement and self-improvement motivations did not. Cluster membership had no direct effect on well-being, but moderation analysis demonstrated threat-buffering of high neuroticism in the adaptive cluster. The benefits were not due to self-esteem or educational level. By separating individuals rather than behaviors, cluster analysis provides a fresh perspective.