The aim of this thesis was to describe inequalities in the use of different health care services according to socioeconomic position (SEP) in Catalonia, Spain and Europe. In addition, we intended to assess whether the public coverage of the services, in particular dental health care, has an influence on the magnitude of inequalities in the use of such services. Finally, we aimed to determine the influence of population-based female cancer screening programmes on the prevalence of screening and on the extent of inequality. To accomplish these objectives four studies were carried out. The sources of information of the four studies were, respectively: several editions of the Catalan Health general practitioner (GP) services are equitable or manual classes use them to a greater extent. However, there are marked SEP inequalities in the use of outpatient specialist services, especially in dental care. Socioeconomic inequalities in use of dental care services exist throughout Europe, but they are larger in countries in which dental care is not covered at all by the public health care system than in countries in which dental care is partially covered. In Europe, socioeconomic inequalities in breast and cervical cancer screening are not found in countries with population-based screening programmes but they are found in those countries with only regional or pilot programmes and in those countries with opportunistic screening. / L'objectiu d'aquesta tesi era descriure les desigualtats en l'ús de diferents serveis sanitaris segons la posició socioeconòmica a Catalunya, Espanya i a Europa. A més a més, es volia avaluar si la cobertura pública dels serveis, en particular la dels serveis dentals, infuencia la magnitud de les desigualtats socioeconòmiques en l'ús d'aquests serveis. Finalment, es va voler determinar la influència dels programes poblacionals de cribratge dels càncers de mama i cèrvix en la prevalença de cribratge i en la magnitud de les desigualtats. Per tal d'assolir aquests objectius es van dur a terme 4 estudis. Les fonts d'informació d'aquests estudis van ser, respectivament: diferents edicions de l'Enquesta de Salut de Catalunya (ESCA), diferents edicions de l'Enquesta Nacional de Salut d'Espanya (ENS), l'Enquesta de Salut, Envelliment i Jubilació a Europa (SHARE) 2006 i dades dels països europeus que van participar a l'Enquesta Mundial de la Salut de l'OMS l'any 2002. Els dos primers estudis eren estudis de tendències mentre que els dos últims van ser transversals. En tots els estudis les desigualtats socioeconòmiques es van mesurar mitjançant índexos relatius (RII) i absoluts (SII) de desigualtat. Els resultats d'aquests estudis mostren que a Catalunya i a Espanya els serveis d'atenció primària són equitatius o fins i tot les persones de classes manuals en presenten una major proporció d'ús. Tanmateix, hi ha marcades desigualtats en visites a l'especialista, en especial en les visites al dentista. Les desigualtats socioeconòmiques en la utilització dels serveis dentals existeixen a tota Europa, però són més grans en aquells països on l'atenció dental no està coberta pel sistema públic de salut que en aquells països on aquesta està parcialment coberta. A Europa, no es troben desigualtats socioeconòmiques en el cribratge dels càncers de mama i cèrvix en aquells països amb programes poblacionals de cribratge, però sí que es troben en aquells països amb programes pilot o regionals o amb només cribratge oportunista.

Approximately 2000 daily aerosol samples were collected at Antalya (30&deg / 34&amp / #900 / 30.54 E, 36&deg / 47&amp / #8217 / 30.54N) on the Mediterranean coast of Turkey between 1993 and 2001. High volume PM10 sampler was used for the collection of samples on Whatman&amp / #8211 / 41 filters. Collected samples were analyzed by a combination of analytical techniques. Energy Dispersive X-Ray Fluorescence (EDXRF) and Inductively Coupled Plasma Mass Spectrometry (ICPMS) was used to measure trace element content of the collected samples from Li to U. Major ions, namely, SO42- and NO3-, were determined by employing Ion Chromatography (IC). Samples were analyzed in terms of their NH4+ contents by means of Colorimetry. Evaluation of short term trends of measured parameters have been shown that elements with marine and crustal origin are more episodic as compared to anthropogenic ones. Most of the parameters showed well defined seasonal cycles, for example, concentrations of crustal elements increased in summer season while winter concentrations of marine elements were considerably higher than associated values for summer. Seasonal Kendall statistic depicted that there was a decreasing trend for crustal elements such as Be, Co, Al, Na, Mg, K, Dy, Ho, Tm, Cs and Eu. Lead, As, Se and Ge were the anhtropogenic elements that decreasing trend was detected in the course of study period. Cluster and Residence time analysis were performed to find the origin of air masses arrving to Eastern Mediterranena Basin. It has been found that air masses reaching to our station resided more on Balkans and Eastern Europe. Positive Matrix Factorization (PMF) resolved eight factors influencing the chemical composition of Eastern Mediterranean aerosols as local dust, Saharan dust, oil combustion, coal combustion, crustal-anthropogenic mixed, sea salt, motor vehicle emission, and local Sb factor.

Introduction: In January 2005, a nationwide mandatory bicycle helmet law for children under the age of 15 was introduced in Sweden. In the current study, the effect of this law was evaluated by analyzing national trends in hospital admissions due to bicycle-related head injuries during the period 1998-2011. Methods: An interrupted time-series design with segmented regression analysis was used to evaluate the intervention effect on head injuries as a percentage of all injuries (%HI) among cyclists in age- and sex-specific groups. Effect was measured as a change in level and/or slope of the trend at the time of legislation. Results: A total of 35261 cyclists (0-54 years) were hospitalized due to a bicycle injury during the study period. Linear regression analyses of the entire study period (not segmented) showed significant year-to-year decreases in the %HI of 1.3-1.7% in all age and sex-specific groups (p < .0001). Results from the segmented regression analysis showed that, at the time of legislation, a significant drop in level occurred among males under 15 years (-4.5% [95% CI: -7.7% to -1.3%], p = .01) and a significant change in slope occurred among females aged 30-54 years (-1.6% [95% CI: -2.9% to -0.2%], p = .025). Conclusions: The law seems to have had an effect on males in the target population (<15 years). Although no significant changes were observed among females in this group as an immediate result of the law, the difference in %HI between genders was minimal at the end of the study period due to the steeper general decline among females. / Inledning: I Sverige infördes en cykelhjälmslag för barn under 15 år den första januari 2005. Syftet med denna studie var att studera effekten av denna lag genom att analysera nationella trender i andelen huvudskador bland svenska cyklister under tidsperioden 1998-2011. Metod: Segmenterad regressionsanalys applicerades på tidsseriedata (interrupted time-series design) för att utvärdera om ett trendbrott när det gäller andelen cykelrelaterade huvudskador sammanföll med lagens införande i olika köns- och åldersspecifika grupper. Effekt mättes som en skillnad i regressionslinjens riktning och nivå. Resultat: Inom åldersgruppen 0-54 år vårdades totalt 35261 cyklister under studieperioden. Linjära regressionsanalyser (ej segmenterade) visade att mellan 1998-2011 minskade andelen huvudskador årligen minskade med 1,3–1,7 % i samtliga studerade köns- och åldersspecifika grupper. Den segmenterade regressionsanalysen visade att samtidigt som cykelhjälmslagen infördes skedde en signifikant skillnad i regressionslinjens nivå bland pojkar under 15 år (-4,5 % [95 % CI: -7,7 % till -1,3 %], p = 0,01) och en signifikant skillnad i regressionslinjens riktning bland kvinnor i åldersgruppen 30-54 år (-1,6 % [95 % CI: -2,9 % till -0,2 %], p = 0,025). Slutsats: Den svenska cykelhjälmslagen verkar ha haft en betydande inverkan på trenden i cykelrelaterade huvudskador bland pojkar under 15 år. Även om något liknande fenomen inte framstod bland flickor i interventionsgruppen bör det noteras att skillnaden i andelen huvudskador mellan könen i slutet av studieperioden var minimal.

Elasmobranchs are among the oldest and most successful predators in the ocean, yet one of the most vulnerable to the direct and indirect effects of fishing. Many populations are rapidly declining around the world, and an increasing number is listed as threatened or endangered. The broader ecosystem consequences of these declines, and whether other marine predators can replace sharks, are open questions. In this thesis, I used a diverse set of data and modeling techniques to analyze long-term changes in elasmobranch populations in the Mediterranean Sea, and the consequences of shark declines on marine ecosystems. Because of its long history of fishing, the Mediterranean offers a unique perspective on the response of marine communities to exploitation over long time scales. Here, I reconstructed the history of elasmobranch exploitation over the past 200 years in pelagic, coastal and demersal communities. Results were combined meta-analytically to derive a general pattern of change for the entire region. Overall, I detected multiple cases of regional species extirpations, a strong correlation between historical intensity of exploitation and the stage of community degradation, and some cases of compensatory species increases. My results suggest that compared to other marine ecosystems worldwide, the Mediterranean Sea might be in an advanced stage of overexploitation. To gain more general conclusions about the patterns and consequences of shark declines in the ocean, I reviewed and reanalyzed documented changes in exploited elasmobranch communities around the world, and synthesized the effects of sharks on their prey and wider communities. This work revealed that sharks are abundant and diverse in little exploited or unexploited marine ecosystems but vulnerable to even light levels of fishing. The decline in large sharks has reduced natural mortality in a range of their prey, contributing to changes in abundance, distribution, and behaviour of marine megafauna that have few other predators. In some cases, this has resulted in cascading changes in prey populations and food-web structure. Overall, my thesis greatly enhanced our knowledge about the critical state of elasmobranchs in the Mediterranean Sea and the consequences of the declines of these important marine predators on marine ecosystems.

Objectif: Cette étude vise à examiner l’issue de la grossesse des mères-nées haïtiennes pour la prématurité, la naissance de faible poids (NFP) et le retard-de-croissance intra-utérine (RCIU) et étudier leur tendance temporelle au Québec. Méthode: Étude populationnelle sur les naissances vivantes simples au Québec de 1981-2006 (N = 2 193 637). À l’aide des modèles de régression logistique, prenant comme référence les mères-nées canadiennes, les associations entre l’issue défavorable de grossesse et les mères-nées haïtiennes étaient étudiées. Résultats: Les proportions de prématurité, de NFP et du RCIU sont plus fréquentes chez les mères-nées haïtiennes (8,5%, 7,5% et 12,6% respectivement) que chez les Canadiennes (5,8%; 5,1% et 11,5% respectivement). Ajustés pour les variables de confusions potentielles (âge maternel, éducation, parité, statut matrimonial, sexe, période-de-naissance), les susceptibilités de prématurité, NFP et RCIU demeuraient plus élevés chez les mères-nées haïtiennes (RC 1,44 IC 95% [1,36-1,52] ; RC 1,40 IC 95% [1,32-148] ; RC 1,09 IC 95% [1,04-1,14] respectivement). Les susceptibilités de prématurité, de NFP et du RCIU augmentaient avec le temps chez les mères-nées haïtiennes. Conclusion : Les mères-nées haïtiennes ont une issue de grossesse défavorable pour la prématurité, NFP et RCUI comparée aux mères-nées canadiennes. Des recherches sur les facteurs responsables de ces associations et des interventions pour améliorer la santé périnatale des immigrants haïtiens, diminuer les inégalités de santé sont nécessaires au Québec. / Objective: This study aimed to examine birth outcomes among Haitian-born mothers specifically prematurity, low birth weight (LBW) and small for gestational age (SGA) births and their trends over time in Quebec. Method: Analysing for a 25 years period a cohort of 2 193 637 singleton live births from the Quebec birth file. Multiple logistic regression models were used to examine adverse birth outcomes for Haitian-born relative to Canadian-born mothers. Results: Haitian-born mothers had higher proportions of preterm birth, LBW and SGA (8.5%, 7.5% and 12.6% respectively) outcomes than Canadian-born mothers (5.8%, 5.1% and 11.5% respectively). In models accounting for maternal age, education, marital status, gravidity, infant sex and period, Haitian-born had a greater odds of premature births, LBW and SGA (OR 1.44 CI 95% [1,36-1,52]; OR 1.40 95% [1,32-148]; OR 1.09 95% [1,04-1,14] respectively) relative to Canadian-born mothers. When examined over time the odds of premature birth, LBW and SGA increased with time among Haitian-born mothers in Québec. Conclusion: Haitian-born mothers have a greater likelihood of adverse birth outcomes relative to Canadian-born mothers. Research on the factors underlying these associations and interventions to improve prenatal health and reduce health disparity among Haitian-born minority are needed in Quebec.

Thesis (Ph.D. (Industrial Sociology))--North-West University, Potchefstroom Campus, 2008.

Transportation and installation of offshore wind turbines (Tower, Nacelle and Rotor) is a complete process conducted over several phases, usually in sequence. There are several factors that can turn this process into a challenge. These factors can either be due to offshore site conditions or the technical limitations of the installation vessels. Each project has its own characteristic parameters and requires a unique optimum solution. This paper identifies the dynamics of the installation process and analyzes the effects of each phase on the progression of events.The challenges in wind turbine installations due to offshore environment were investigated, the effects of each were explained and their significances were stressed. Special installation vessels were examined and their technical specifications were analyzed in terms of working conditions, dimensions, service performances, and crane capacities as well as projecting future design trends. Several offshore wind farm projects were analyzed; their installation methods were specified, and compared to each other to determine advantages and disadvantages of different pre-assembly concepts. The durations of the sub-phases of the process were defined in terms of different variables such as site conditions and individual vessel performance. These definitions were used for making time estimations, and conducting further analyses regarding the effects of different site specific parameters on the overall project duration.In conclusion, this study considered the main operation parameters in an offshore wind turbine installation context: the benefits and drawbacks of different pre-assembly methods were researched and evaluated resulting in new knowledge and a productive contribution for optimizing “the offshore turbine transportation and installation process”, based on actual time usage.

Thesis (Ph.D. (Industrial Sociology))--North-West University, Potchefstroom Campus, 2008.

Il est connu que le vieillissement de la population canadienne va augmenter la demande d’aide à domicile et qu’un soutien insuffisant du secteur public accroît l’implication des réseaux informels et privés. En s’appuyant sur les données de l’Enquête nationale sur la santé de la population (ENSP) et de l’Enquête sur la santé dans les collectivités canadiennes (ESCC), cette recherche analyse les tendances et déterminants de l’utilisation de l’aide à domicile subventionnée par le gouvernement au Canada et en Ontario entre 1996-1997 et 2009-2010. Il en ressort que la proportion de bénéficiaires âgés de 65 ans et plus est en diminution, passant de 9,9% à 9,2% au Canada (1996-1997 à 2005) et de 10,2% à 8,8% puis 9,6% en Ontario (1996-1997, 2005, 2009-2010). Les compressions sont particulièrement ressenties dans les services de maintien à domicile, dont l’aide pour les travaux ménagers (de 51% à 34% en Ontario). Les personnes âgées, les femmes, les gens vivant seuls ou qui ont besoin d’assistance pour accomplir certaines activités de la vie quotidienne (AVQ) ou activités instrumentales de la vie quotidienne (AIVQ) reçoivent de moins en moins d’aide publique à domicile. En conclusion, le présent système de santé, qui semble se concentrer sur les soins de santé plutôt que sur les services de maintien, ne répond pas aux besoins des personnes âgées. Par ailleurs, le cas ontarien évoque l’impact que peuvent avoir les décisions politiques sur l’utilisation de l’aide à domicile. Les résultats suggèrent qu’entre 1996-1997 et 2005, ce sont surtout les personnes âgées de 18 à 64 ans et ceux nécessitant des soins qui bénéficièrent des programmes publics. Durant la période suivante (2005 à 2009-2010), il semble y avoir un intérêt plus marqué pour les 65 ans et plus dont la proportion d’utilisateurs s’accroît plus rapidement. / It is known that the aging of the Canadian population will increase the demand for home care and that insufficient support from the public sector increases the implication of the informal and private networks. Using cross-sectional data from the National Population Health Survey (NPHS) and the Canadian Community Health Survey (CCHS), this research analyzes the trends and predictors of subsidized home care in Canada and Ontario between 1996/97 and 2009/10. It shows that the proportion of care receivers aged 65 and older is decreasing, going down from 9.9% to 9.2% in Canada (1996/97 to 2005) and from 10.2% to 8.8% then 9.6% in Ontario (1996/97, 2005, 2009/10). Government cuts are particularly felt in terms of home support services, like support for housework (from 51% to 34% in Ontario). Older persons, women, people living alone or those who need assistance to perform some activities of daily living (ADLs) or instrumental activities of daily living (IADLs) are receiving less and less subsidized home care. In conclusion, the actual health system, that appear to focus on health care instead of home support services, do not meet the needs of older persons. Furthermore, the Ontario case evokes the effect that policies can have on home care utilization. Results suggest that between 1996/97 and 2005, it is mostly persons aged from 18 to 64 years old or needing health care that benefited from the public program. During the next period (2005 to 2009/10), there seems to be a greater interest for the 65 and older, whose proportion of users increases more rapidly.

The dissolved silicon (DSi) has a crucial role for growth of a large group of primary producers – diatoms and, hence, impact on functioning of the aquatic food web. This thesis contributes to an increased understanding of the modifications of the DSi cycling in the Baltic Sea. The results provide new information about spatial and temporal changes in DSi concentrations and nutrient ratios for the period 1970-2001 as well as during the 20th century. For the period 1970-2001, the declining DSi trends were found at the majority of monitoring stations all over the Baltic Sea. This decrease is assumed to be mainly due to the ongoing eutrophication. It is supported by the increasing trends of inorganic nitrogen and phosphorus. The trends have implications for the nutrient ratios, DSi:DIN and DSi:DIP, which are important indicators of the state of an ecosystem. The long-term retrospective DSi budget has shown that the DSi concentrations before major hydrological alterations and eutrophication were about twice the present ones. This decrease is related to both eutrophication and anthropogenic perturbations in the catchment. The occurrence of DSi concentrations close to the potentially limiting levels has been also analysed. While DSi concentrations are still high in the northern regions of the Baltic, other areas may be at risk of developing Si limitation if the decrease in DSi concentrations persists. The results depict the Baltic Sea journey from being water body with DSi levels sufficient to support diatom production to one that may experience Si limitation and its adverse ecological consequences. / Löst kisel (DSi) har en viktig roll för tillväxten av en stor grupp av primärproducenter – kiselalger, och därmed även påverkar hela den akvatiska näringskedjan. Denna avhandling bidrar till en ökad förståelse av förändringarna i DSi kretsloppet i Östersjön. Resultaten tillhandahåller ny information om rumsliga och tidsmässiga förändringar i DSi koncentrationer såväl för perioden 1970-2001 som för hela 1900-talet. För perioden 1970-2001 återfanns minskade DSi koncentrationer på mätstationer över hela Östersjön. Minskningen antas främst bero på den pågående övergödningen. Detta antagande stöds av stigande halter av oorganiskt kväve och fosfor. Sammantaget har dessa trender en inverkan på ekosystemets tillstånd och näringsämnenas kvoter, DSi: DIN och DSi: DIP. Ur ett längre tidsperspektiv kan man se att innan övergödningen och de stora hydrologiska ombildningar i Östersjöområdet var DSi koncentrationerna ungefär dubbelt så höga som idag. Dagens förekomst av DSi koncentrationer som ligger nära de potentiellt begränsande nivåerna har också analyserats. DSi koncentrationerna är fortfarande höga i norra delar av Östersjön, men är i andra områden i riskzonen för att utveckla Si begränsning om minskningen av DSi koncentrationer fortsätter. Resultaten skildrar Östersjöns resa från att vara ett havsområde med DSi halter som är tillräckliga för att understödja kiselalgernas produktion till ett sådant som kan uppleva Si begränsning och dess negativa ekologiska konsekvenser.