Women using addictive substances during pregnancy: the effects of substance abuse on the prenatal and postnatal development of child Blanka Nechanská Abstract Background: Substance abuse among pregnant women represents a public health issue internationally, associated with high costs to the society and at the personal level for the women and children involved. Aims: The aim of the study was to determine the basic socioeconomic characteristics of women with substance use disorder during pregnancy and selected characteristics neonatal outcomes their children. Another goal was to study the morbidity in children prenatally exposed to addictive substances by studying hospitalizations up to three years of age. Material and methods: Series of analysis within database-linkage study combining data on pregnancy and neonatal outcomes with data from in-patient treatment in CR in 2000-2014 was performed. The sample consisted of pregnant women diagnosed with substance use disorder during pregnancy and women from general population, and their children. Neonatal outcomes were gestational age, birth weight and length, preterm birth, and intrauterine growth restriction (Small-for-Gestational-Age, SGA). Information on the number of hospita- lizations, treatment time and diagnostic groups according to ICD-10 were outcomes of...

There is a lack of knowledge on how alternative forms of sports facility provision influences end user's sports and physical activity behaviour, and the consequent impact this has on their health, well-being and social capital. To address this knowledge gap, this thesis has undertaken a multi-level analysis of the sport delivery system. It examines if strategic priorities and objectives pursued by different types of sport and fitness facilities, that are being influenced by macro level forces, along with their characteristics and ownership, influences individuals sport participation behaviour with a potential consequent impact on the policy outcomes of health, well-being and social capital. In the UK recently, sport policy objectives have focussed on increasing the population s participation in sport and physical activity to enhance a range of outcomes including health, well-being and social capital. Over the last three decades, there has also been significant changes in sport provision with the growth of private sector facilities, and public sector facilities being outsourced to private management. However, there is no evidence of the effectiveness of these alternative arrangements in delivering the policy objectives. There is limited knowledge on how different agents and actors in the sport delivery system function collectively to achieve these objectives or not, and a multi-level analysis of the sport delivery system i.e., from policy, through facilities, to end users does not exist. This gap in knowledge is addressed in this thesis through the adoption of a mixed methods case study of Leicestershire and Rutland Sport-County Sport Partnership (LRS-CSP) region in the midlands of England. The sport participation of individuals who use differently owned and managed sport and fitness facilities in the LRS-CSP region is examined, and the impact this has on their health, well-being and social capital, from macro level (policy), meso level (facilities), and micro level (end users) perspectives. Data collected at these levels involves, semi-structured interviews with the regional managers (macro level) who are responsible for the development and provision of sport in the region, a quantitative survey involving the facility managers (meso level) who are responsible for the day-to-day activities of the facilities, and quantitative survey and focus groups of end users in the region (micro level). Surveys done at the meso and the micro level are matched to the facilities of a variety of different ownership and characteristics to explore the influence this might have on individuals participation frequency and the impact this has on their health, well-being and social capital. The results show that government and public sport agencies priorities towards the sports sector which operate at the macro level of the sport delivery system influence the strategic objectives pursued by different types of sport and fitness facilities that are responsible for sport provision at the meso level of the sport delivery system. Public sport agencies and government bodies through their policies seem to have a significant influence over public sector including LMC facilities strategic decision making. However, this is not the case for the private sector facilities. Neither the strategic objectives of facilities nor their ownership and characteristics are shown to have a significant difference on the users sport participation behaviour, nor on the sport policy outcomes of their health, well-being and social capital. The largest influence on sport participation seems to be when individuals engage in sport with those they meet at the facility, indicating that facilitation of the co-creation of social capital among individuals could play a bigger role in increasing participation levels. Along with this, results also show that sport participation has a direct positive influence on individuals health which then enhances their well-being and social capital. This thesis contributes towards the long-standing debate about the relative value of different ownership types that span the public, private, and LMCs and their relationship with performance . The findings of the thesis suggest that, providing general availability of space for sport and fitness activities and by facilitating a network of opportunities with others and across activities is important in achieving the policy outcomes of improved participation and the consequent positive impact this has on health, well-being and social capital, and should be given priority in sport provision.

Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

Background: Radical cystectomy (RC) still poses a significant risk for mortality and morbidity. Objectives: We compared in-hospital outcomes after RC in the United States and Germany using population-based data. Methods: We compared data from the US Nationwide Inpatient Sample to the German hospital billing database. Mortality and transfusion during hospital stay and length of stay (LOS) were evaluated. Results: In all, 17,711 (the United States) and 60,447 (Germany) cases were included. The share of robot-assisted RC increased to 20.5% in the United States vs. 2.3% in Germany (p < 0.001). In-hospital mortality was 1.9% (the United States) vs. 4.6% (Germany), transfusion rates were 34.2% (the United States) vs. 58.7% (Germany), and LOS was 10.7 (the United States) vs. 25.1 days (Germany; all p < 0.001). On multivariate analysis, higher patient age and lower annual hospital caseload were associated with increased mortality and longer LOS. Minimalinvasive surgery was associated with less blood transfusion and shorter LOS in the United States vs. hospital caseload and choice of urinary diversion in Germany. Conclusions: Healthcare systems might exert a relevant impact on outcomes of oncologic surgery. Increased in-hospital mortality rates in Germany seem to be partly explained by much longer LOS compared to those in the United States. Annual caseload seems to be influential on in-hospital outcomes raising the question of centralization of RC.

Although the female menopause has been extensively characterized as a well-defined symptomatic state of oestrogen deficiency, which responds relatively well to oestrogen replacement therapy, the symptomatic state of androgen deficiency in men is poorly defined and uncertainty exists whether it responds to testosterone replacement. It has been proposed that hypothalamic-pituitary-testicular (HPT)-axis function (responsible for the production of androgens) and regulation could be viewed as a ‘barometer’ of health status in older men and that potential alterations in HPT-axis function and regulation reflect subclinical and clinical deficits in function and health, which may result in an aged phenotype of human health and disease in older men. The HPT-axis constitutes a well-defined, tractable, clinically-relevant, biological system, which may permit insight into the mechanisms underlying the expression of ageing-related phenotypes of human health and disease. By using a different lens – such as the genetic background; the compensatory responses within the HPT-axis; the syndromes of androgen deficiency; the ethnic background of an individual or the life course trajectory of function and health from conception into older age – to magnify potential dysregulation in the HPT-axis will it be possible to visualize and understand the phenotypic expression of human male ageing as a gradient of functional and health outcomes. This will allow for a better understanding of the physiological mechanics underlying symptomatic expression of dysregulation in the HPT-axis.