Introduction: Hearing impairment is an emerging modifiable risk factor for dementia, but the relative predictive abilities of subjective and objective measures of hearing in dementia risk prediction algorithms are unclear. The objective was to develop and validate prediction models for 3-year incidence of dementia in older Canadians, and to evaluate the independent contribution of self-rated hearing impairment and audiometry-based moderate hearing loss. -- Methods: Baseline (2011 to 2015) and 3-year follow-up data from the Comprehensive cohort of the Canadian Longitudinal Study of Aging were used to build logistic regression models for 3-year incidence of dementia. Individuals who were under 55 years of age, reported physician-diagnosed dementia at baseline, and/or did not have data on dementia status at follow-up were excluded, producing a sample of 19,830 older Canadians. Hearing impairment was defined subjectively as self-reporting fair or poor hearing (versus excellent, very good, or good hearing) and was defined objectively as having a better-ear pure-tone average of the speech-frequencies (500, 1000, 2000, and 4000 Hz) above 40 dB with audiometry. -- Results: Both hearing measures were associated with dementia incidence after adjustment with other risk factors (self-rated fair/poor hearing adjusted odds ratio (aOR) 1.76, CI 0.96-3.23, audiometry-derived hearing loss aOR 2.60, CI 1.38-4.87). Audiometrically-derived hearing loss and self-rated hearing had similar population discrimination (c-statistic of model with self-rated hearing = 0.803, CI 0.752-0.859, c-statistic of model with audiometrically confirmed hearing loss = 0.808, CI 0.762-0.870) and similar calibration. -- Conclusion: Due to the accessibility of the self-reported hearing measure, the use of self-rated hearing in dementia risk prediction tools may have a larger clinical impact than audiometrically-defined hearing ability. Model performance within subgroups (e.g., older age groups, hypertension status, etc.) must be evaluated in future work to assess the magnitude of miscalibration, if any, in the use of self-reported hearing ability compared to audiometry.

Reducing the frequency of Salmonella in broiler flocks is important from both the standpoints of food safety consumer protection and industry viability. The goal of this dissertation is to provide a more complete identification, characterization and assessment of significance of the risk factors potentially associated with broiler flock Salmonella status as the flock progresses through sequential segments of the production continuum. The sequential segments of the continuum are: broiler breeders and hatchery, transportation from hatchery to grow-out farm, grow-out, transportation from farm to processing plant and processing. In this study broiler flocks were sampled through an entire grow-out production cycle, starting from the flock?s arrival from the hatchery to the grow-out farm, then, at the end of grow-out, upon arrival to the processing plant, and at the pre-chill and post-chill points of processing. Litter samples and drag swabs of the litter were collected in the grow-out house prior to placement and after the harvest of the flock. Epidemiological tools, questionnaires and checklists, were developed and utilized together with the company production records, soil, climatologic and other data to characterize potential risk factors of grow-out broiler flock Salmonella status. Regression modeling was used to investigate associations between the described risk factors and the sampled flock?s Salmonella status. Interrelationship of the flock and grow-out environment Salmonella status at the sequential production segments was studied as a risk factor. Models were built to describe the risk factors of Salmonella contamination of the litter and drag swabs collected in the grow-out house prior to placement of the birds. Following, models were built to identify the risk factors associated with broiler flock Salmonella status upon delivery from the hatchery to the farm and at the end of the grow-out.

This exploratory study examined risk factors for sexual coercion using data provided by 87 couples that were screened to participate in a couples treatment program for domestic violence. Risk factors examined included: level of alcohol use, anger, beliefs about wife beating, jealousy, dominance, depression, physical and psychological violence. Overall, 46.9% of the women reported that their partners were sexually coercive. Slightly over 46% of the women whose partners were severely violent reported that they also were sexually coercive and slightly less than 46% of the women whose partners engaged in minor aggression reported that their partners were sexually coercive. Almost 23% of the female participants reported that their partners raped them during the past year. Furthermore, results from correlational analyses indicate that level of male physical violence and male beliefs about wife beating are risk factors for sexual coercion within the context of a violent relationship. Level of alcohol use, anger, male depression, jealousy, dominance and psychological violence do not appear to be risk factors. These results have implications for further understanding and treatment of sexually coercive male batterers. / Master of Science

Doctor of Philosophy / Department of Family Studies and Human Services / Sandra Stith / Recent literature has highlighted the importance of considering personal and relationship factors in predicting IPV perpetration. The present study sought to investigate whether trait mindfulness is associated with IPV, as well as the mechanisms by which mindfulness might predict IPV. Utilizing longitudinal data collected from 247 undergraduate students, the study tested a hurdle model of IPV occurrence and frequency at Time 3 being predicted by trait mindfulness at Time 1 and other known risk factors at Time 2. Results indicated that trait mindfulness at time 1 was associated with IPV perpetration at Time 3; however, when controlling for other known risk factors at time 1, the association between mindfulness at Time 1 and IPV at Time 3 was no longer significant. Finally, results from the mediational analysis revealed a significant indirect effect of trait mindfulness on IPV through relationship satisfaction and conflict resolution while all variables were measured at the same time point, but no indirect effect of trait mindfulness at time 1 on IPV at time 3.These results indicate that although mindfulness might not be a significant direct predictor of IPV when other known risk factors are controlled for, it is important since mindfulness indirectly predicts IPV through other relationship processes when measured at the same time point. Suggestions for future research and clinical intervention are offered.

Background: Childhood asthma has increased worldwide, although recent studies report a prevalence plateau in some western countries. Aims: To investigate the prevalence of asthma and the associated risk factor patterns from ages 7-8 to 11-12 with special emphasis on the hereditary component, and further to study prevalence trends at age 7-8 from 1996 to 2006 and the possible determinants of these trends. Methods: The studies involved two cohorts from Kiruna, Luleå and Piteå: one previously identified cohort of 3430 children age 7-8 followed by yearly questionnaires until age 11-12 with 97% yearly participation. Skin-prick tests for allergic sensitisation were performed at ages 7-8 and 11-12 in subsets of 2148 and 2155 children respectively (88% of invited). In 2006 a new cohort of 7-8-year-olds was identified and examined identically. 2585 (96% of invited) and 1700 (90% of invited) participated in the questionnaire and skin-prick tests, respectively. The questionnaire included questions about symptoms of asthma, allergic rhinitis and eczema, and possible risk factors. Results: In the 1996 cohort, from age 7-8 to 11-12 the prevalence of physician-diagnosed asthma increased (5.7%-7.7%, P<0.01) while current wheeze decreased (11.7%-9.4%, P<0.01), and 34.7% reported ever wheee at ≥one occasion. Remission was 10% of which half relapsed during the study. Remission was significantly lower among sensitised children. The strongest risk factors for current asthma at ages 7-8 and 11-12 were allergic sensitisation (OR 5) and family history of asthma (OR 3). Several other significant risk factors, e.g. respiratory infections, damp house and low birth weight, had lost importance at age 11-12. At age 7-8, parental asthma was a stronger risk factor (OR 3-4) than parental rhinitis or eczema (OR 1.5-2). Sibling asthma had no independent effect. Biparental asthma had a multiplicative effect (OR 10). Maternal and paternal asthma was equally important, regardless of the child’s sex and sensitisation status. From 1996 to 2006 the prevalence of current wheeze and asthma at age 7-8 did not increase (P=0.13, P=0.18), while lifetime prevalence of ever wheeze and physician-diagnosed asthma increased (P<0.01, P=0.01). Symptoms of rhinitis and eczema were unchanged, despite 45% increase (P<0.01) in allergic sensitisation. For current asthma the adjusted population attributable fractions of sensitisation and parental asthma increased (35%-41%, 27%-45%). This was however balanced by decreased exposure to infections, maternal smoking and home dampness, resulting in stable asthma prevalence. Stratification by sex revealed that current wheeze increased in boys (P<0.01) but tended to decrease in girls (P=0.37), seemingly due to symptom persistence in males. Several asthma indices followed this pattern. The boy-to-girl ratio in exposure to all studied risk factors increased, which may explain the sex-specific prevalence trends in wheeze. Conclusions: The prevalence of current asthma and wheeze did not increase statistically significantly. However, the risk factor pattern has changed considerably since 1996, which will presumably affect the clinical features of childhood wheeze in this region. Sex-specific trends in wheeze can be explained by changes in exposure, and trends in risk factors should be explored parallel to prevalence trends.

Retina is a unique site in the human body where the microcirculation can be imaged directly and non-invasively, allowing us to study in vivo the structure and pathology of the human microcirculation. Retinal images can be quantitatively assessed with computerized imaging techniques, enabling us to measure several different quantitative traits derived from the retinal vasculature. Arterial and venular calibres are the most extensively studied traits of the retinal microvasculature and numerous epidemiological studies demonstrated promising associations with systemic and ocular diseases as well as with disease markers. However, there has been a lack of research into pathophysiological processes leading to retinal vascular signs, and how they link retinal microcirculation with coronary and cerebral microvasculature change. Information about genetic determinants underlying retinal vascular structure is therefore important for understanding the processes leading to microvascular pathophysiology. Two genome wide association studies have been published so far revealing four loci associated with retinal venular calibre and one locus with arteriolar calibre. Here the results from the genome-wide association analysis of 10 different retinal vessel traits in two population based cohorts are presented. Retinal images were measured in non-mydriatic fundus images from 808 subjects in the Orkney Complex Disease Study (ORCADES) and 390 subjects from the Croatian island of Korcula, using the semi-automated retinal vasculature measurement programme SIVA and VAMPIRE. Using pairwise estimates of kinship based on genomic sharing, heritability was calculated for each trait. Estimates of tortuosity measure and fractal dimensions present first published reports of heritability estimates for those traits. In addition correlation analysis with systemic risk factor was also completed, confirming already published results as well as revealing some new associations. A genome wide association analysis of retinal arteriolar width revealed a genome wide significant hit (1.8x10-7) in a region of chromosome 2q32 (within TTN gene). Replication was sought in a further independent Scottish population (LBC) and additional 400 retinal images were graded. The result did not replicate, however the direction of the effect was consistent and a larger sample size is required. Analysis of the remaining traits did not yield genome wide significant result,s and will also require larger sample sizes. Genetic analysis of a binary retinal trait was also explored in a case control study of retinal detachment, which is an important cause of vision loss. A two-stage genetic association discovery phase followed by a replication phase in a combined total of 2,833 RRD cases and 7,871 controls was carried out. None of the SNPs tested in the discovery phase reached the threshold for association. Further testing was carried out in independent case-control series from London (846 cases) and Croatia (120 cases). The combined meta-analysis identified one association reaching genome-wide significance for rs267738 (OR=1.29, p=2.11x10-8), a missense coding SNP and eQTL for CERS2 encoding the protein ceramide synthase 2. Additional genetic risk score, pathway analysis and genetic liability analysis were also carried out.

Bakgrund: Urinvägsinfektion (UVI) är en av de vanligaste infektionerna hos äldre kvinnor. Escherichia coli (E-coli) är den vanligaste bakterien vid UVI. Äldre kvinnor lider när de är drabbade av UVI och det är sjuksköterskans uppgift att bland annat förebygga sjukdom och lindra lidande. Syfte: Att beskriva riskfaktorer och förebyggande omvårdnadsåtgärder mot UVI hos äldre kvinnor. Metod: Litteraturstudie, med databassökning genom databaser speciellt inriktade på vård och omvårdnad, CINAHL, PubMed, WEB OF SCIENCE och Medline. 15 artiklar har använts till resultatet. Resultat: Recidiverande UVI, diabetes, urininkontinens, smittspridning och förstoppning är riskfaktorer att drabbas av UVI. God hygien och regelbunden tillförsel av vätska ses som god evidensbaserad omvårdnadsåtgärd mot UVI. Ökad tillförsel av vätska förkastas, Tranbärstillägg behöver ytterligare forskning. Slutsats. Hög hygieniskstandard genom de basala hygienrutinerna är en viktig förebyggande åtgärd mot UVI. / Background: Urinary tract infection (UTI) is one of the most common infections for elderly women. Escherichia coli (E-coli) is the most commonly found bacteria when screening for UTI. Older women suffer when they have UTI and it’s up to the nurse to prevent sickness and to ease the pain. Aim: To describe risk factors and nursing care prevention against UTI for elderly women. Method: Based on science articles received from databases specified on care and nurse caring. CINAHL, PubMed, WEB OF SCIENCE and Medline. 15 articles is used for the results. Results: A prior history of UTI, diabetic, urinary incontinence, and constipation is risk factors to developed UTI. High hygienic standard is a good prevention against UTI. Regular infusion of liquid is good prevention to not develop UTI. Cranberry for prevention against UTI needs further research. Conclusion High hygienic standard through basic hygiene is an important prevention against UTI.

Dans cette Thèse, trois cas pratiques sont étudiées dans le domaine de la gestion des fonds où les risques d’investissement semblent mal perçus du fait d’ambiguïtés dans la mesure de risque. Ces ambiguïtés sont analysées comme une erreur élémentaire où une trop forte simplification de la réalité qui peut aboutir à une approche confuse. Les trois études sont développées dans un contexte usuel d’investissement, et portent sur les actions pour la première, sur les obligations pour la seconde et sur les devises pour la troisième. Elles s’inscrivent dans les conventions traditionnelles de la théorie de la finance. Les trois études, qui font l’objet de chapitres distincts, montrent comment la perception de risque peut être troublée dès les premiers traitements des données financières et avant même une éventuelle évaluation des risques. Plusieurs mesures de risque, pourtant courantes dans la finance, apparaissent réductrices ou mal adaptées aux circonstances dans lesquelles elles sont utilisées. Nous décrivons comment, dans certains cas, des mauvaises décisions d’investissement peuvent être prises du fait d’erreur de mesure, ou comment dans d’autres cas le débat dans la littérature économique a été orienté vers de mauvaises directions. Les études soulignent que l’appréciation des risques financiers est loin d’être triviale, même dans les domaines habituellement considérés comme maîtrisés. Une approche systématique a été adoptée pour établir à quel moment précis les analyses intègrent une mauvaise perception du risque. / Three situations are studied in the field of fund management where investment risk may be misperceived due to an ambiguity in the way risk is being measured. The case studies involve equity, bonds and currencies respectively, and are inscribed in the traditional conventions of finance theory. It is shown how the perception of risk can fail immediately in the initial data processing stage even before a propoer analysis. Several risk measures that are frequently used in finance are shown to be defunct or badly adapted for the circumstances in which they tend to be used. We described how in certain cases sub-optimal investment decisions are taken based on an error in measurement, or how in certain cases the debate in the economic literature has been disorientated. The studies underline that the appreciation of financial risk is far from trivial, even in the realms that are generally considered as well-established.

A common problem following general anesthesia is postoperative sore throat (POST) and postoperative hoarseness (PH). Symptoms directly correlated with less satisfaction according to the patients. The overall aim of this thesis was to describe patients' postoperative sore throat and hoarseness after general anesthesia with endotracheal intubation or laryngeal mask airway. As well as to investigate the risk factors that are associated with the symptoms, and to test methods that may prevent sore throat and hoarseness after a general anaesthetics. A total of 889 patients are included in the four studies. Incidence of POST varied from 21% up to 52 % depending on endotracheal tube (ETT) size in women (I-IV) and in men was the incidence 32-38% (III-IV). There were no gender difference in POST in study III and IV. The overall incidence of PH varied from 42- 59% (I-IV) in all patients, with no gender differences (III-IV). Following a laryngeal mask airway (LMA) 19% of the patients had POST and 33% of the patients reported PH. Patients with POST do seem to be able to localize their pain in the throat (IV). Different risk factors are shown to contribute to both POST and PH in men and women (II-III). To intubate with a smaller ETT size, 6.0 vs. 7.0 decreased POST in women in the early postoperative period as well as their discomfort from their POST (I). Only 6% of men who needed a laryngeal mask airway had POST compared to 26% of women. The symptoms are more discomforting after an ETT vs. an LMA up to 24 hours (IV). More patients have sore throat and hoarseness in the early postoperative period, but the symptoms can remain up to almost 5 days postoperatively (I, IV). In summary, sore throat and hoarseness following general anesthesia, affects many patients postoperatively. To intubate women with endotracheal size 6.0 decreases both sore throat and hoarseness postoperatively. Women are more likely than men to have a sore throat when a laryngeal mask airway is used.

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