This study examined maternal depression status from month 1 to 36 after birth using data from the NICHD Study of Early Child Care and Youth Development. Maternal depression was assessed with the Center of Epidemiological Studies Depression Scale. The prevalence of maternal depression was highest at 1 month, decreased at 6 months, and then kept fairly stable to 36 months. The prevalence was higher in blacks than other races, in 18-24 than 25-46 years old, and in single mothers than non-single mothers. Mothers with better physical health, social support, or employed had a lower prevalence than their counterparts. Mothers in poverty, receiving public assistance, or who had more parental stress had a higher prevalence. Social support and parental stress had a statistically significant relationship with maternal depression even after adjusting for other variables. In conclusion, this longitudinal study found that several maternal, child, and family factors were associated with maternal depression.

Family members who provide care to their loved ones experience changes in their own health. The caregiver health model (CGHM) is a new model that identifies health holistically and identifies four determinant(s) that contribute to the health status of the family caregiver. The purpose is to introduce the CGHM: Hypothesis 1: the determinants of health in the CGHM contribute to the health of the Caregiver, Hypothesis 2: the determinants of health contribute to changes in the caregivers’ health at 8 and 16 weeks, and Hypothesis 3: a change in health occurs from baseline to 8 and 16 weeks. Methods: A descriptive, longitudinal design used three data collection points and five survey instruments. Community recruitment (N = 90) occurred through word of mouth and newspapers. Inclusion criteria consisted of being a family caregiver, living in a rural residence, and providing care to elders with necessary activities of daily living (ADLs) and/or instrumental ADLs (IADLs). Following a participant generated phone call to provide consent, caregivers received an initial study packet, additional packets were sent upon return of the previous packet. Analysis for the three hypotheses included multiple backwards stepwise linear regression, generalized estimating equations (GEE), and analysis of variance (ANOVA) α = 0.05. Results: A significant decrease in mental (p < 0.01) but not physical health at 8 weeks (p = 0.38) and 16 weeks (p = 0.29) occurred over time. Two determinants displayed significant (p < 0.05 or less) changes in mental and/or physical health at one or more time points. Study limitations include caregiver entry at varying times and self-report of elder nursing needs and medical conditions. Conclusions: Findings support two of the four determinants contributing to caregiver health

This research study examined the prevalence rates and longitudinal course of eating disorder risk among undergraduate females at BYU, and compared the identified prevalence rates at BYU with identified rates at other colleges and universities. Almost 2,000 undergraduate females, in three cohort groups, filled out the Eating Attitudes Test (EAT) once a semester for four to eight semesters. Clinical cut-off scores were used to determine what percentage of participants were at high risk for eating disordered behaviors and symptomology. Overall eating disorder risk prevalence rates at BYU ranged from 9-11%. These rates were significantly lower than identified rates at other colleges and universities. The results also showed notable decreases in the percentages of women who fell in the at-risk range as participants progressed through their college years. Freshmen women had the highest risk for disordered eating behaviors.

[pt] Esta tese tem como objetivo investigar a eficácia e a equidade em uma instituição privada de natureza filantrópica e de reconhecido prestígio acadêmico, localizada na cidade de Juiz de Fora – MG. O referencial teórico foi elaborado a partir dos conceitos de equidade de Rawls (2003) e Dubet (2004, 2008) e de justiça escolar e de discriminação positiva propostos, respectivamente, por Crahay (2000) e Dubet (2008). De maneira complementar, recorreu-se a estudos que abordam o tema da eficácia e da equidade escolar no contexto brasileiro. A pesquisa apresenta desenho longitudinal e faz uso de dados de perfil e dos resultados dos estudantes nas três medidas de desempenho do Programa de Ingresso Seletivo Misto da Universidade Federal de Juiz de Fora – PISM-UFJF, avaliação aplicada ao final de cada ano letivo do Ensino Médio. Os resultados dos estudantes foram organizados em cinco grupos de comparação: o grupo de interesse, composto por estudantes de baixo nível socioeconômico que recebem bolsas integrais para cursar o Ensino Médio na escola filantrópica, e outros quatro grupos de comparação, um formado pelos estudantes pagantes da escola filantrópica e três constituídos por estudantes de escolas públicas. No tratamento dos dados foram utilizados métodos mistos: quantitativos e qualitativos. Os primeiros envolveram modelos de regressão para estimação dos efeitos do nível socioeconômico sobre o desempenho dos alunos no PISM e sobre as escolhas de carreiras. Complementarmente, análises qualitativas foram produzidas a partir de entrevistas semiestruturadas realizadas com bolsistas e gestores da escola filantrópica, cujos roteiros foram elaborados em diálogo com as características de escolas eficazes verificadas para o Brasil por Alves & Franco (2008). Os resultados da pesquisa confirmam a significativa correlação entre o nível socioeconômico e a proficiência dos estudantes verificada em outras pesquisas e apontam para evidências de eficácia escolar e de equidade promovidas pela escola filantrópica. As análises quantitativas mostraram que os alunos bolsistas obtiveram maiores proficiências que os estudantes de características semelhantes dos grupos de comparação matriculados nas outras quatro escolas. Os resultados também foram interpretados com base em análises qualitativas e, em linha com as pesquisas brasileiras em eficácia escolar, identificaram condições intraescolares que atuam como fatores importantes de eficácia, notadamente a infraestrutura escolar, o clima acadêmico, a gestão, a ênfase pedagógica e a atuação dos professores. O estudo também aponta para uma questão que merece ser melhor investigada: o peso da origem social na escolha dos bolsistas de carreiras universitárias de menor prestígio acadêmico, mesmo em se tratando de estudantes que frequentaram o Ensino Médio em uma escola eficaz, promotora de equidade e reconhecida socialmente como uma escola de excelência. / [en] The present study aims to investigate effectiveness and equity in a private institution with a philanthropic nature and recognized academic prestige, located in the city of Juiz de Fora – MG. The theoretical framework was drawn up based on the concepts of equity by Rawls (2003) and Dubet (2004, 2008) and of school justice and positive discrimination proposed by Crahay (2000) and Dubet (2008), respectively. In a complementary manner, studies that approach the issues of effectiveness and school equity in the Brazilian context were also implemented. The research resorts to a longitudinal drawing and uses profile and results data from students in the three measures of development of Universidade Federal de Juiz de Fora - UFJF s Programa de Ingresso Seletivo Misto - PISM-UFJF, an exam that is applied at the end of each academic year of High School. The students results were organized in five comparison groups: the interest group, composed by students with a low socio-economic status that receive a scholarship to attend the philanthropic school, and other four comparison groups, one consisting of paying students of the philanthropic school and three consisting of students from public schools. In the data analysis, mixed methods were used: quantitative and qualitative. The first ones involved regression models to measure the effects of the socio-economic status on the students development on PISM and on career choices. Furthermore, qualitative analysis were developed from semi-structured interviews with scholarship-holding students and the philanthropic school s managers, the scripts of which were elaborated in relation with the characteristics of effective schools identified for Brazil by Alves and Franco (2008). The research findings confirm the significant correlation between socioeconomic status and the students proficiency identified in other research and points to the evidence of educational effectiveness and equity promoted by the philanthropic school. The quantitative analysis showed that scholarship-holding students achieved higher proficiency than students with similar characteristics from the comparison group enrolled in the other four schools. The results were also interpreted according to qualitative analysis and, in accordance with the Brazilian studies about school effectiveness, identified that internal school conditions such as infrastructure, academic environment, management, pedagogic emphasis and teacher performance are important effectiveness factors. The study also points to an issue that deserves a better investigation: the weight of the social origin on the scholarship-holding students choices of lower academic prestige careers, even if they attended an effective equity promoter and socially acknowledged excellence school during High School.

The primary purpose of this study was to examine the strength of the relationship between childhood playfulness and adult playfulness. The relationship between adult playfulness and adult creativity was also examined along with the relationship between child playfulness and adult creativity. Exploratory interviews were conducted with a purposive sample of individuals to provide insight into subjects' perceptions of their own playfulness as well as life experiences they perceived to be related to stability or change in their own playfulness. Specifically, the researcher interviewed one subject in each of four categories: (1) low childhood playfulness scores but high adult playfulness scores (2) low childhood playfulness scores and low adult playfulness scores (3)high childhood playfulness scores but low adult playfulness scores and (4) high childhood playfulness scores and high adult playfulness scores. The Adult Behaviors Inventory (ABI) and the Student Self-Evaluation of Creativity (SSEC) were completed by 27 young adults from a pool of 103 subjects who had participated in a previous study in the period from 1985-1987, more than 15 years ago. The Adult Behaviors Inventory, an adaptation of the Child Behaviors Inventory (CBI) that was used to rate these subjects between 1985-1987, was completed by 31 mothers for a son or daughter. The total sample (n = 36) for this study consisted of 17 females (47.2%) and 19 males (52.8%). The mean age of the subjects was 20.32 at the time of the follow-up study. Participants were from well-educated middle class families, and 96.2% of the participants were enrolled in college or had completed a college degree. Pearson correlation coefficients computed to determine the strength of the relationships among variables of interest and they yielded these results: (a) Childhood playfulness during the preschool years as rated by mothers using the CBI was not significantly related to maternal ratings on the ABI, self-ratings on the ABI, or self-ratings on the SSEC. (b) Adult playfulness as self-reported by the same participants (now young adults) using the Adult Behaviors Inventory (ABI) was significantly related to maternal ratings on the ABI and self-ratings on the SSEC. Self-rated ABI scores were not significantly related to maternal or teachers' ratings on the CBI. (c) Adult creativity scores obtained from self-reports using the Students Self-Evaluation of Creativity Scale was not related to maternal or teachers' ratings on the CBI. Creativity scores on the SSEC were significantly related to both maternal and self-ratings on the ABI. (d) Adult playfulness as reported by each participant's mother was significantly related to self-ratings on the ABI and SSEC. Short structured interviews with a purposive sample of subjects representing low or high playfulness in childhood and adulthood indicated that the interviewees were able to accurately identify their own playfulness classification even though the survey questionnaire was designed so as not to make it obvious that playfulness was the focus of the study. Interview data pointed to possible links between life events and playfulness. / Master of Science

Background: The COVID-19 pandemic disrupted access to healthcare services in Canada, but little is known about the magnitude of unmet healthcare needs and characteristics associated with increased risk of unmet needs in the adult population. Objectives: First, to describe unmet healthcare needs, including COVID-19 testing access, and to evaluate the association of the social determinants of health (SDOH) and chronic conditions with unmet healthcare needs. Secondly, to evaluate the association between symptoms of depression and anxiety with unmet healthcare needs, and test if the interaction was modified by sex. Methods: The data of 23,972 adults who completed the Canadian Longitudinal Study on Aging COVID-19 Questionnaire Study exit survey (Sept.–Dec. 2020) was analyzed. Three outcomes were evaluated: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. For objective 1, a prospective cohort study was conducted. For objective 2, a cross-sectional study was conducted. RESULTS: Overall, 25% of adults in Canada reported challenges accessing healthcare, 8% did not go to a hospital or see a doctor when needed, and 4% experienced barriers to COVID-19 testing. Several SDOH, including sex, immigrant status, racial background, education and income, were associated with unmet needs. The odds of reporting all three outcomes declined with age. Pre-pandemic unmet needs were strongly associated with higher odds of all three outcomes, while the presence of chronic conditions was associated with higher odds of the first two outcomes. Symptoms of depression and anxiety were strongly associated with all three outcomes. Interaction with sex was found for the first outcome, with stronger associations in females. Conclusions: This thesis identified groups that experienced difficulties accessing healthcare services during the pandemic. Future research may assess consequences of unmet needs, evaluate mechanisms that cause unmet needs and determine ideal interventions. / Thesis / Master of Public Health (MPH) / The COVID-19 pandemic in Canada affected how individuals were able to access healthcare services. To understand which groups experienced a greater level of difficulties, we examined the experience of unmet healthcare needs during the first year of the pandemic using a sample of 23,972 adults that had completed the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (Sept. – Dec. 2020). We found evidence that the experience of unmet healthcare needs varied by several sociodemographic characteristics, such as sex, immigrant status, racial background, education and income. Younger adults were more likely to report unmet needs. Individuals with chronic conditions and those had reported unmet healthcare needs prior to the pandemic were also more likely to report unmet needs during the pandemic. Individuals with symptoms of depression and anxiety were also more likely to report unmet healthcare needs. These results can be used to inform interventions that improve access to healthcare services for vulnerable groups.

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Two randomized controlled trials were conducted to find out whether a new treatment for asthma has a significant effect on the patients. These were multi-center trials with a parallel design, the control arm receiving a Placebo. The data were collected over a period of about 20 days before administering the intervention and for almost 80 days after the intervention. Thus, each patient has many observations recorded, making the data longitudinal. The data are summarized using first descriptive statistics and graphical displays. Then, a continuation ratio model with a lagged covariate to account for the longitudinal aspect is used to model the data. Finally, Generalized Estimating Equations methods are used. These methods have acquired popularity in recent years to account for longitudinal correlation structures. To apply the continuation ratio, the data have to be appropriately restructured. Then, the logistic regression is used to model the symptoms. The results of this procedure show that the treatment is statistically significant. However, the goodness of fit tests show that the model is inadequate. This issue is explored in the last subsection of Chapter 3. Using Generalized Estimating Equations to analyze the number of times rescue medication was used, we concluded that there is no statistically significant difference between the Active and Control groups. However, we noticed that the use of rescue medication decreased with time from the start of treatment. / Thesis / Master of Science (MS)

Objectives: Sarcopenia is defined using a variety of different muscle variables, muscle mass adjustment techniques and cut offs for each variable. The objectives of this thesis were to assess how operational differences in sarcopenia definitions impact the agreement between definitions and the association between sarcopenia and health outcomes such as falls. Methods: A list of sarcopenia definitions was developed which captured the combinations of muscle variables, muscle mass adjustment techniques, and cut offs used in the literature based on a systematic review conducted for this thesis. These definitions were applied to participants taking part in the Canadian Longitudinal Study on Aging, a national study of participants aged 45 to 85 years at baseline. The agreement between the definitions and the association of each definition with falls was assessed. Findings: Both the combination of muscle variables as well as the different muscle mass adjustment techniques generally had limited agreement. Sarcopenia definitions including muscle mass and muscle strength were associated with falls in males, but none of the sarcopenia definitions were associated with falls in females. Area under the curve analyses revealed that even sarcopenia definitions associated with more than two times the odds of falling in males, had a small impact on identifying fallers with values ≤0.56. Conclusions: The results of this thesis show that the existing range of definitions used to define sarcopenia are not equivalent based on the limited agreement and inconsistent association of sarcopenia with falls. The results also show that sarcopenia may have limitations as clinically useful diagnosis for identifying fallers with area under the curve values for all definitions showing that the identification of fallers based on sarcopenic status was at best, modestly better than chance alone. / Thesis / Doctor of Philosophy (PhD) / Definitions for sarcopenia differ in terms of which muscle variables are included, how muscle mass is adjusted, and which cut offs to use for each variables. This thesis assessed the impact of different methods of operationalizing sarcopenia on the proportion of sarcopenic participants, agreement between definitions, and the strength of the association between sarcopenia and falls. The variables used to operationalize sarcopenia as well as different techniques for adjusting muscle mass resulted in poor agreement between definitions. In males, these factors impacted which definitions were significantly associated with falls, and in females, sarcopenia was not associated with falls for any definition. For all definitions, sarcopenia status poorly discriminated between those that would or would not fall. Together, these results show that different sarcopenia definitions are not equivalent and that a standard definition is required. However, this thesis also shows that more work is required to determine the clinical utility of sarcopenia.