Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 40-49).

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1570. Advisers: Michael E. Scheurer; Jan M. Risser. Includes bibliographical references.

Canada’s 1991 ratification of the United Nations Convention on the Rights of the Child (CRC) means that policies to eliminate commercial sexual exploitation should be implemented equally for all children, without discrimination. However, Aboriginal peoples are disproportionately represented among Canada’s population of commercially sexually exploited children and youth. They are also more likely to experience the primary risk factors for commercial sexual exploitation – poverty, exposure to violence, and involvement in the child welfare system. I conducted a policy analysis examining the implementation in Canada of the CRC Articles related to the primary predictors of commercial sexual exploitation of children, to determine whether they are being implemented differentially for Aboriginal and non-Aboriginal children. The findings revealed that although Aboriginal and non-Aboriginal children obtained identical scores on the quantitative measures, the implementation of the relevant rights standards differed substantially across the two populations, as evident in differential funding and service provision for the two groups.

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Background: As many studies, women are more vulnerable to contract HIV through sex behavior than men from women. The low status of women also make women are more at risk of infecting with HIV. South Africa now is one of the most rapidly growing HIV epidemics in the world. In Africa, 74% of youth who get HIV/AIDS are young women and young girls. In 2005, there were 16.9 per cent women aged 15-24 years got HIV and only 4.4% men got HIV in South Africa. Objective: To identify the main internal risk factors and interventions/external factors of HIV/AIDS on young women in Africa. Data Source: Pub Med, Medline and Cochrane Library were searched for English articles from 1990 to 2011. (Keywords: HIV, AIDS, young women or girl or adolescent girl.) Results: Initial search produced 2888 articles. According to the inclusion and exclusion criteria, 9 articles were for the final systematic review. 5 papers were about risk factors of HIV/AIDS and 4 papers were about the interventions or the factors influenced the risk factors. We identified four risk factors: intimate partner violence (IPV) and relationship power inequity, number of partners and last sexual activities, age of partner, alcohol consumption before sex. Two interventions/external factors: Microfinance with gender and HIV training curriculum and SES neighborhoods (Community level). Conclusions: We have two policy implications. First, we should ensure that preventive services, including education of young women have more accessibility. Secondly, because many young women who with older men have sex were more likely to infect with HIV, Therefore, we should make greater efforts to encourage them to adopt safer behavior. As the man play leading role in Africa, our prevention programs should focus more on men. / published_or_final_version / Public Health / Master / Master of Public Health

Research on risk factor for suicidal behaviors has been broadly conducted to enhance knowledge of suicide prevention. However, there are still challenges for risk factor research. Four major research gaps have been identified: (1) uncertain effectiveness of the population approach versus the high-risk approach for suicide prevention; (2) lack of a valid and convenient Chinese-version screening tool for the severity of suicidal ideation among adolescents; (3) demand for testing the prospective associations of risk factors with suicidal ideation using a longitudinal designed population-based sample; and (4) necessity of pathway analysis to explore and confirm how risk factors interact with each other and lead to suicidality. This thesis aims to address these gaps through a combination of five studies. Study 1 introduces an illness and death model to suicide prevention research. Elasticity and sensitivity analyses were performed. The findings revealed that the control of suicide incidence among the healthy population is the most effective prevention strategy whereas treatment of mental illness appears to be the least effective approach to suicide prevention. Study 2 validates the psychometric properties of the Chinese versions of Reynolds’s Suicidal Ideation Questionnaire (SIQ) and Suicidal Ideation Questionnaire Junior (SIQ-JR, a short version of the SIQ) in a sample of Hong Kong adolescents. A short, four-item version of the SIQ-JR has been suggested as an alternative to the SIQ and the SIQ-JR. Study 3 identifies the history of psychiatric treatment, depression, anxiety, hopelessness, unstable marital status, poor economic circumstance, and a recent death of a first-degree relative as significant risk factors for the incidence of suicidal ideation. The associations of change in risk factors with the development of suicidal ideation have been tested. There are gender and age differences in the patterns of such associations. Study 4 focuses on psychological factors associated with the first-ever incidence of suicidal ideation. Psychological factors have been detected generally to differ in their associations with the incidence and persistence of suicidality. The idea that depression partially mediates the effect of average life distress on the persistence of suicidal ideation has clinical value. Study 5 introduces and tests a stressor and illness model as a theoretical framework reference for future risk factor research. Risk factors are classified into stressor, illness, and pattern factors. Both the simple and complex models are tested. Evidence supported the proposed mediating role of mental disorders between negative life events and severity of suicidal ideation. A gender-specific pattern of associations between stressors, illness, and severity of suicidal ideation has also been detected. This thesis has made substantial theoretical, psychometric, and empirical contributions to the existing knowledge of suicide research. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Objectives To evaluate the association between exposures to the main chemical contaminants released by the industry in freshwater and the rise in cancer cases among the population in China. Methods A systematic review was undertaken of the scientific literature compiled in the MEDLINE (via PubMed©), Google scholar, Web of Knowledge. The descriptors used were "cancer", "water pollution”, “industry” and “chemical", limited to studies that relevant to the research questions. Articles selected were of any type in English, from the inception of the indexing of the primary source until July 28th of 2013. With the quantitative data, Health impact assessment formulas are developed and then applied to subsequent data to make estimate. Results The search generated 306 articles, from which 10 were selected after applying the inclusion and exclusion criteria. The analysis of freshwater contaminants that attributed to industry in this review included aromatic amine, vinyl chloride, benzene, hexavalent Chromium, dioxin, and others of industrial origin. The majority of the studies find a significant link between exposure to drinking water contaminants and the increase in cancer cases, especially in the rural areas. In some of the studied populations a significant dose-response relationship was observed. Discussion After reviewing the included studies and the estimation of health impact assessment, I concluded that the association between cancer risks and industrial contamination in freshwater resources in China does indeed exist. While there are several other factors that interact the cancer risks, such as agriculture related water pollution and rapid growth of population. Taking into account that most of the articles were located in western countries, more Chinese studies are required in order to know the effect of freshwater contamination on cancer risks, in particular among those who lived in rural industry area. Conclusion This study provides the first estimated health impacts based on the relationship between industrial freshwater pollution and cancer risks, supporting decision makers to formulate public health recommendations to ensure a safer and healthier environment in the future. However, further study is critically needed for the prevention of this form of contamination. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Although some classic risk factors of NPC such as salted fish, tobacco and vegetable consumption were established a few decades ago, no convincing evidence that the decreasing trend in NPC incidence and mortality rates seen in most parts of the world could be explained by the changes of these consumption. As different histological types and age groups may have distinct risk factor profile in NPC development, it is important to look at incidence and mortality trends across different jurisdictions before any further individual studies are carried out worldwide. Objectives: With the focus on both high and low risk areas, this study aimed to 1) examine the descriptive epidemiology of NPC, including the secular trends of age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR) and age-specific incidence and mortality rate by sex; 2) perform an ecologic analysis between ASIR, ASMR and classical exposures. This included a multi-jurisdiction comparison between ASIR, ASMR and salted fish, cigarette and vegetable consumption per capita and 3) investigate the secular trend of ASIR and ASMR by sex, age and histologic subtype. Methods: NPC ASMR was obtained from the WHO cancer mortality database and ASIR, age-subtype specific incidence and mortality rates were provided by various cancer registries. All age and subtype specific rates were plotted in every 5 calendar years. Per capita consumption of salted fish, tobacco and vegetables in 8 regions (Hong Kong, China, Finland, Japan, Portugal, Singapore, United Kingdom and United States) were obtained from the Food and Agriculture Organization of the United Nation (FAO) and from different corresponding governmental departments. Pearson correlation coefficients and multivariate regression analysis were performed to examine both crude and adjusted associations. Results: There were markedly decreasing trends of NPC ASIR and ASMR in most of the high risk areas over the past three decades, while only some declines in incidence and mortality rates was observed in low risk areas. No association was found between salted fish, vegetable consumption and ASMR or ASIR in any region, except in Hong Kong where lag year cigarette consumption in males was correlated with ASIR (Pearson r for 10 lag year = 0.680; 15 lag year = 0.739 and 20 lag year = 0.747, all p<0.05). Multivariate regression analysis did not show association with any of the consumption in Japan, Portugal, the US and the UK. An earlier age of onset around 45-50 was observed with non-keratinizing carcinoma as the dominant subtype in high risk areas, while in low risk area the peak age was not seen until after 60 years old with most of the cases being keratinizing NPC. Conclusions: There were distinct differences in risk profile between NPC age-standardised and age-subtype specific rates between high and low risk areas. With the general secular trends of NPC incidence and mortality rates by age and tumour type being revealed in this study, further exploration in other jurisdictions with different potential risk or protective factor is warranted. / published_or_final_version / Public Health / Master / Master of Philosophy

Syfte och frågeställningar: Syftet med studien var att beskriva skador och träningsvanor hos löpare som uppsöker sjukgymnast på stora träningscenter i Stockholmsområdet. Frågeställningarna var: Vilka löprelaterade skador förekommer? Hur ser träningsvanor hos dessa löpare ut? Hur många har haft tidigare löprelaterade skador? Hur ser skillnaden i löpmängd ut mellan kvinnor och män samt mellan knäskadade och icke-knäskadade? Metod: En enkät utformades och lämnades ut till 18 sjukgymnaster som arbetar på 12 träningscenter i Stockholmsområdet. Frågorna i enkäten baserades på en tidigare enkät och modifierades och anpassades efter tillgänglig litteratur och studiens syfte. Enkäten var indelad i 4 delar och innehöll frågor om demografi, löpning, andra träningsvanor och skador. Personer 18 år och äldre med smärta i benet som uppkommit i samband med löpning inkluderades i studien. Totalt samlades 40 enkäter in under perioden 2014-01-29 till och med 2014-06-27. Deskriptiv statistik användes i form av antal och procent samt medelvärde och standarddeviation för normalfördelad data och median och interkvartilt avstånd (IQR) för icke-normalfördelad data. Analytisk statistik i form av student t-test för normalfördelad data och Mann Whitney-U för icke-normalfördelad data användes för de jämförande analyserna. Resultat: Av 40 deltagare var 19 st kvinnor och 21 st män. Knäskada var den mest förekommande skadan, vilket totalt 52.5 % angav. Meniskskada var den vanligaste diagnosen vilket 20 % av deltagarna hade följt av löparknä/iliotibialt smärtsyndrom (17.5 %) och achillestendinos (12.5 %). Asfalt var det vanligaste underlaget att springa på. Långdistans var den mest frekventa löpträningen följt av intervall och backträning. De flesta deltagarna styrketränade (78 %). Av de 40 deltagarna hade 23 st (57.5 %) haft en tidigare löprelaterad skada och endast 12 st blev besvärsfria ifrån denna tidigare skada. Det fanns ingen signifikant skillnad i löpmängd mellan knäskadade och icke-knäskadade. Dock fanns en tendens till signifikant skillnad mellan knäskadade och icke-knäskadade gällande löphastighet (p = 0.05). Det fanns en signifikant skillnad mellan kvinnor och män gällande löphastighet (p = 0.02), men inte gällande antal sprungna kilometer per vecka, antal minuter löpning eller antal löptillfällen per vecka. Slutsats: Studien visar att knäskada är den vanligaste skadan och meniskskada den vanligaste diagnosen följt av löparknä/iliotibialt smärtsyndrom och achillestendinos hos löpare som uppsöker sjukgymnast på de utvalda träningscentrena i Stockholmsområdet. Mer än hälften av deltagarna har haft en tidigare löprelaterad skada.  Framtida studier med fler deltagare behövs för att kunna undersöka och dra generella slutsatser om samband mellan löpmängd och olika löprelaterade skador samt om träning såsom styrketräning kan användas i skadeförebyggande syfte. / Aim: The purpose of the study was to describe injuries and training characteristics in runners who consult a physical therapist at a large training center in the County of Stockholm. Research questions: What running related injuries (RRI) do they have? What are the training characteristics of these runners? How many have had earlier RRIs? How does running volume in this sample differ between men and women as well as between knee-injured and non-knee injured runners? Method: A questionnaire was designed and handed to 18 physical therapists who work at 12 different training centers in the County of Stockholm. The questions in the questionnaire were based on a previous questionnaire then modified based on previous studies and adjusted to fit the purpose of the study. The questionnaire was divided into 4 parts with questions about demographics, running, other forms of training and injuries. People, 18 years and older, with pain from the hip down, that started during running were included in the study. A total of 40 questionnaires were collected from 2014-01-29 to 2014-06-27. Descriptive statistics were used as number of observations and percent as well as mean and standard deviation for normally distributed data and median and inter quartile range (IQR) for non-normally distributed data. Statistical analysis was performed using student t-test for normally distributed data and Mann Whitney-U test for non-normally distributed data. Results: There were a total of 40 participants, 19 female and 21 male. Knee injury was the most common injury which 52.5 % of the participants stated. Meniscal injury was the most common diagnosis with 20 % of the participants followed by runner’s knee/iliotibial band syndrome (17.5 %) and achillestendinosis (12.5 %). Asphalt was the most commonly used running surface. Long distance running was the most common type of running followed by interval and hill training. Most of the participants were performing strength training (78 %). 23 (57.5 %) of the 40 participants have had a previous running related injury. There was not a significant difference in running volume between participants with knee injury and non-knee injury. There was a tendency towards a significant difference in running speed between runners with knee injury and non- knee injury (p = 0.05). There was a significant difference between women and men regarding running speed (p = 0.02) but not regarding number of kilometers, number of minutes or number of occasions of running per week.  Conclusions: The study demonstrates that knee injury is the most common running injury and that meniscal injury is the most common diagnosis followed by runner’s knee/iliotibial band syndrome and achillestendinosis in runners diagnosed by a physical therapist at the chosen training centers in the County of Stockholm. More than 50% have had a previous running related injury. Future studies with more participants are needed in order to draw conclusions on relationships between running volume and RRIs and if strength training can be used as prevention of RRIs. / <p>Presenterat vid OMT/FYIM Kongress/Årsmöte Täby Park hotell 20-21 mars 2015</p>