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Background: Although suicide seasonality has been well-documented, surprisingly little is known about its underlying mechanisms. Methods: In this thesis, data from three Swedish registers (Cause of Death Register, National Patient Register, Prescribed Drugs Register) and data from the Swedish Meteorological and Hydrological Institute were used. In Study I, the amplitude of suicide seasonality was estimated in completed suicides in 1992-2003 in individuals with different antidepressant medications or without antidepressants. In Study II, monthly suicide and sunshine data from 1992-2003 were used to examine the association between suicide and sunshine in groups with and without antidepressants. In Study III, the relationship between season of initiation of antidepressant treatment and the risk of suicidal behavior was explored in patients with a new treatment episode with antidepressant medication. In Study IV, the complex association between sunshine, temperature and suicidal behavior was investigated in patients with a new treatment episode with an antidepressant in two exposure windows (1-4 and 5-8 weeks) before the event. Findings: Study I: Higher suicide seasonality was found in individuals treated with selective serotonin reuptake inhibitors (SSRIs) compared with those given a different antidepressant treatment or those without any antidepressant treatment. Study II: In individuals treated with SSRIs, there was a positive association between sunshine and suicide, with the association stronger in men treated with SSRIs compared with men treated with other antidepressants. An effect modification by age was observed. Study III: The elderly (65+) had a higher risk of suicide when initiating antidepressant treatment in summer and a higher risk of suicide attempt when starting antidepressant therapy in spring and summer. Younger patients (0-24) demonstrated a higher risk of suicide attempt when treatment was initiated in autumn. Study IV: In the elderly (65+), a harmful association was observed between the risk of suicide attempt and the average daily temperature during the four weeks before the suicide attempt, as well as with average daily sunshine during both exposure windows (1-4 and 5-8 weeks) before the suicide attempt. Significance: Our results provide epidemiological support for the role of the serotonergic system in seasonality of suicide in which both medication and climate may be involved.

The thesis takes a normative, yet pragmatic approach, in examining how the protection of habitat and ecological functions can be improved through changing current uncoordinated, sectoral decision-making processes into a holistic, cooperative approach to guide planning at the local level. In rapidly growing regions on the urban/rural fringe such as the Sunshine Coast, towns, rural areas and large wildernesses form a complex matrix of land uses across the landscape which require the integration of provincial and local government planning. Thus, a case is made for a decision-making process that generates a conservation strategy, integrating local and provincial planning at the scale of regional districts in British Columbia. The literature is reviewed to identify principles for a conservation strategy approach to decision-making which include: a consensus-based process, cross-sectoral government coordination, broad-based public involvement, and non-governmental partnerships for implementation. Secondly, the literature pertaining to several regional approaches to conservation planning is reviewed including: parks system planning, landscape ecology and bioregional theory. From these two sources of literature, a hybrid model of the regional conservation planning strategy is formed. Using criteria derived from this hybrid model to evaluate the effectiveness of planning processes, the provincial conservation planning framework is evaluated. The policies of the Commission on Resources and Environment, the provincial government’s Land and Resource Management Planning process and the Protected Areas Strategy are evaluated according to the criteria. Fourthly, conservation planning on the Sunshine Coast is examined, and a case study of the Sechelt Inlets Coastal Strategy is evaluated against the criteria. By evaluating both the provincial planning framework and the local case study, conclusions can be drawn on the need for regional conservation planning strategy processes in rapidly developing areas at the urban/rural fringe. Finally, recommendations are made for changes to provincial and regional district policies to facilitate more effective conservation planning for the Sunshine Coast Regional District and other regions in British Columbia. / Applied Science, Faculty of / Community and Regional Planning (SCARP), School of / Graduate

There is a paucity of longitudinal data investigating the role of vitamin D in the maintenance of health in ethnic minority groups. Specifically, little is known about the role of vitamin D on muscle strength, how this affected by emigrating from low to high latitudes. This PhD thesis provides insight into the relationship between vitamin D status and muscle strength in healthy adults migrating from sunny climates (45°N to 45°S to the equator) to higher latitude (Aberdeen, 57°N) (first study) and also sunlight behaviours in both low and high latitudes (second study). A total of 71 people of ethnic minority aged 19-42 years took part in the first study with 56% were seen within 3 months of arriving in Aberdeen (newcomers) and the remainder having been resident for any longer period than this (residents). Participants attended visits every 3 months for 15 months. At each visit, fasted blood samples were collected for analysis of serum 25-hydroxyvitamin D [25(OH)D] by dual tandem-mass spectrometry, parathyroid hormone (PTH), carboxy-terminal collagen crosslinks (CTX) and N-terminal propeptide of type I collagen (P1NP) by electrochemiluminescent immunoassay. Maximal voluntary contraction (MVC) was measured using a Takei digital grip dynamometer (both arms) and a Biodex dynamometer (right knee) for isometric knee extension and isokinetic knee extension and flexion. Mean baseline 25(OH)D concentrations were higher in the newcomers (35.2 nmol/L) than the residents (25.0 nmol/L, p<0.01). After adjusting for the season of measurement at baseline, there was a trend for higher vitamin D status only between newcomers arriving in spring (33.5 nmol/L) and residents (26.8 nmol/L, p=0.09), but not between the newcomers arriving in autumn (36.1 nmol/L) and residents in autumn (35.2 nmol/L, p=0.81). Notably, few newcomers (13%) and residents (7%) had 25OHD concentrations >50 nmol/L. There was a small seasonal variation in 25(OH)D concentration with the difference between zenith (summer/autumn) and nadir (winter/spring) was 5 nmol/L, 6 nmol/L, and 12 nmol/L among the newcomers arriving in spring, autumn and residents, respectively. There was no seasonal variation in bone turnover markers. There was a positive, albeit small, association between vitamin D and knee extensor isometric torque. Mixed modelling predicted that each 1 nmol/L increase in 25(OH)D would increase peak torque by 1 Nm (p=0.04). If extrapolated to higher 25(OH)D, the change in muscle strength would be clinically meaningful. In the second study, 117 Asians in Kuala Lumpur (3°N) and 110 non-Europeans (78% Asians) in Aberdeen were recruited and monitored for one year [every 3 months for participants in Aberdeen and during Southwest monsoon (SWM; July-Sept) and Northeast monsoon (NEM; Nov-Feb) in Kuala Lumpur]. Personal sunlight exposures were assessed by polysulphone film badges and a web-based questionnaire. Asians living in their usual environment (Kuala Lumpur) had similar sunlight behaviours to Asians living in Aberdeen. Sunlight was the major source of vitamin D in Kuala Lumpur during both seasons (median % cutaneous in SWM = 61%; NEM = 59%), but only during summer in Aberdeen (52%). Dietary intakes provided the most source of vitamin D in Aberdeen during autumn (94%), winter (97%) and spring (56%). This thesis has added evidence to the current limited observations on vitamin D and muscle strength, particularly in the cohort of young adults migrating from low to high latitudes. Intervention studies are yet to be conducted with a speculation that an increase in vitamin D status may show a positive impact on muscle strength. The extent of low sunlight behaviour among healthy adults in Kuala Lumpur is of concern.

In the past century, there has been an increasing trend in American government toward opening government procedures to the general public. The intention of these reforms was to improve government accountability and responsiveness, increase public education and involvement in government, and prevent corruption and undue influence by special interests. Conventional wisdom about open government, however, does not take into consideration many of the repercussions of opening up congressional proceedings to the glare of public scrutiny. Reforms in the 1970’s opened the deliberative process and made members of Congress more vulnerable to constituent and interest group pressure. These effects have had many negative impacts, in both the House Appropriations Committee and the Ways and Means Committees, for deliberative democracy and responsible budgeting.

Background: Vitamin D deficiency is prevalent among Chinese adults in Hong Kong and ignorance and confusion about vitamin D is common throughout the Hong Kong population. Health literacy is a crucial factor that influences the health actions and outcomes of individuals; however, little is known about the relationship between health literacy and behavior of supplementing vitamin D through sunlight exposure. Objective: The aim of the current study was to identify the factors associated with the health literacy of Chinese older adults and to investigate the relationship between health literacy and the behavior of supplementing vitamin D through sunlight exposure. Method: From May 2011 to January 2012, a cross-sectional survey was conducted among cognitively intact Chinese adults aged 60 or above. Recruitment of participants was through 23 residential care homes and 7 elderly community centers. A questionnaire elicited demographic and health literacy information and explored their knowledge about vitamin D, their attitude towards sunlight exposure, and their behavior related to sunlight exposure. Linear regression identified the factors associated with the health literacy among Chinese older adults. Path analysis investigated the relationship between health literacy and the behavior of participants regarding sunlight exposure. Results: Participants and analysis included 648 Chinese adults. Among the population, respondents identified as having inadequate health literacy numbered 52.5%. Five factors, including age, marital status, educational attainment, residential status, and duration of living in residential care homes, had significant association with health literacy. In addition, health literacy had a direct relationship to respondents’ exposure to sunlight (direct effect = .075) and an indirect relationship through their knowledge about vitamin D and their attitude towards sunlight exposure (indirect effect = .015). However, knowledge about vitamin D and attitude towards sunlight exposure did not mediate the association between health literacy and behaviors concerning sunlight exposure. Discussion and Conclusion: The results of this study showed that not only age, marital status, and educational attainment affected health literacy but also residential status and duration of living in residential care homes offered an effect. The study revealed that health literacy had both a direct and indirect relationship to health behavior (e.g., supplementing vitamin D through sunlight exposure). Health care professionals should note the relationship between health literacy and health behavior. Health education intervention about vitamin D supplement should focus training on individuals’ health literacy rather than their knowledge about vitamin D or attitude towards sunlight exposure. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

For over a century Florida's Tampa Bay area has been extolled for its abundant seashores and moderate climate. The success of early twentieth-century St. Petersburg as a tourist destination was due to a consistent method of self-promotion highlighting the natural and physical features of peninsular Pinellas County. Warmed by balmy Tampa Bay breezes, St. Petersburg had been dubbed the "Health City." This tiny 1890 coastal town of less than three hundred inhabitants, now blessed with a slogan, new train tracks, and a railway pier, was an ideal setting for tourism. By 1902, boosters declared St. Petersburg a city second to none. Over the next half-century -- from the Building Boom to the Baby Boom -- St. Petersburg exploded. Ranked twenty-seventh nationally in 1940, prewar Sunshine State was the South's least-populated state, but boosters like John Lodwick, "Tin-Canners," and World War II brought many changes, few of which escaped St. Petersburg. This thesis examines elements of St. Petersburg that almost every historian has emphasized, but few have seriously analyzed: boosterism and tourism. More than almost any other Florida city, St. Petersburg relied upon an endlessly repeated message in postcards, newspapers editorials, print advertisements, and radio/television commercials.The city marketed itself as the nation's playground, a southern garden of perpetual well-being. That St. Petersburg was the first American city to hire a public relations director and the first to initiate a successful advertising budget speaks to the magnitude of this message. In the late 1940s, while northern newspaper subscribers were teased with wintertime ads sending "Warm Wishes from Sunny St. Pete," a series of city-funded films were released. These quasi-documentaries, shown in countless lodges and auditoriums, portrayed the "Sunshine City" as the city of fun and sun. Without reserve, the films marketed St. Petersburg as the ideal destination for the nation's soon-to-be senior citizens.Through analysis of news media coupled with interviews, personal memoirs, and interdisciplinary studies, this thesis explores a recurring marketing theme and more importantly, places it within the context of Florida's tourism history and the city's goal of Selling St. Petersburg.

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