Dissertations / Theses on the topic 'Health aspects of Eggs'

Post-translational modifications (PTMs) of proteins play significant roles in regulation of biological activities and signal transduction. Examining their diversity is critical for understanding the mechanisms of cellular regulations. Among the various techniques employed for identification of PTMs, mass spectrometry has become a more and more important tool for detecting and mapping these covalent modifications and quantifying their changes. The two projects described in this dissertation focus mainly on the method development for characterization of two major PTMs, disulfide bonds and glycosylation. In the first project, the disulfide bond pattern of a rhamnose-binding lectin SEL24K from the Chinook salmon Oncorhynchus tshawytscha was assigned unambiguously based on a multi-enzyme digestion strategy in combination with MALDI-TOF mass spectrometry analysis. The disulfide bond pattern was found to be symmetrical in the tandem repeat sequence of SEL24K. More importantly, an interesting phenomenon of gas-phase scrambling of disulfide bonds was observed during MALDI mass spectrometry analysis and a possible mechanism for this surprising scrambling was proposed. To the best of our knowledge, this is the first report of disulfide bond scrambling in the gas phase during MALDI-MS analysis. This observation has important ramifications for unambiguous assignment of disulfide bonds. In the second project, the glycosylation of a glycoprotein ZPA from the vitelline envelope of Xenopus laevis was determined by applying a strategy of general proteolysis coupled with mass spectrometry. The vitelline envelope glycoproteins were first separated through SDS-PAGE. A nonspecific in-gel pronase digestion was performed on the excised band of ZPA to produce informative small glycopeptides. Lectin affinity chromatography was used for the enrichment of these glycopeptides. An in-gel PNGase F digestion was also carried out to release the N-linked glycans from ZPA. The enriched glycopeptides and glycans were finally analyzed by MS and MS/MS techniques on MALDI-TOF and MALDI-TOF/TOF instruments.

Tese de Doutoramento em Ciências Veterinárias, especialidade Sanidade Animal
Successful hatching of strong, healthy chicks with a potential for good productive and reproductive performance depends on the assurance of as normal and ideal as possible embryonic development. The latter, however, can be negatively affected by a series of factors intrinsic to either the egg, its handling, or the incubator. This project aimed at collecting and interpreting essential and extensive information regarding embryonal response to physical challenges (temperature, relative humidity and carbon dioxide concentration) in the incubation environment, to infectious challenge with vertically transmitted Salmonella serovars Enteritidis and Typhimurium and, ultimately, to apply the knowledge obtained to a field survey of a commercial hatchery. For this purpose, eggs were incubated under different, controlled environments or after infection with a vertically transmitted pathogen, and an extensive list of parameters used to monitor subsequent changes in embryonic behavior, metabolism, growth and viability. The information gathered was then applied to a sample of non-viable eggs incubated at a major hatchery. Overall, the effects of manipulating temperature were more prominent than those of manipulating humidity and carbon dioxide. The most significantly affected parameters pertained to embryo metabolism, embryo weight, mortality and malformation rates. Changes in the development of the lymphoid follicles in the bursa of Fabricius and of the glandular epithelium of the gizzard were also found. Vertical infection with Salmonella was associated with higher embryonic mortality rates. No changes in performance or growth were observed in infected but viable embryos. The results obtained during the field survey did not directly correlate to the variables studied. However, the issues detected allowed for the designation of critical control points and opportunities for performance improvement that could have otherwise gone undetected at the hatchery and at the breeder farm, highlighting the importance of embryodiagnosis in the monitoring of hatchery and flock health.
A operação eficiente e lucrativa de uma exploração industrial produtora de espécies aviárias (Gallus gallus) depende, entre outras coisas, do acesso a pintos saudáveis e com bom potencial produtivo, obtidos por incubação artificial de ovos de um bando reprodutor. É com a incubação destes ovos, levada a cabo em grande escala por máquinas altamente especializadas, que se inicia o desenvolvimento das aves, tendo esta influência directa sobre a viabilidade e futura performance do pinto eclodido. Vários factores podem intervir negativamente no sucesso da incubação, estando estes relacionados com o ovo em si, com o seu manuseamento ou com a própria incubadora. Por essa razão, este trabalho teve por objectivo adquirir, coligir e interpretar informação essencial sobre a resposta embrionária a alterações físicas do ambiente de incubação (temperatura, humidade relativa (RH) e concentração de dióxido de carbono), assim como à infecção com agentes patogénicos com transmissão vertical conhecida (Salmonella enterica vars. Enteritidis e Typhimurium). Estes ensaios foram conduzidos em laboratório, em ambiente cuidadosamente controlado. Numa segunda fase, o conhecimento obtido através de experimentação laboratorial foi aplicado na análise de uma amostra de ovos incubados provenientes de um centro de incubação industrial, com o objectivo de verificar a compatibilidade dos dados experimentais com os dados obtidos em situação real. Com vista a estudar a influência de alterações no ambiente de incubação sobre o desenvolvimento embrionário, procedeu-se à incubação de 2300 ovos specificpathogen free, dividos em dez grupos diferentes. O primeiro grupo foi incubado sob condições controlo (temperatura - 37.8ºC; RH - 50-55% durante os primeiros 18 dias de incubação e 60-65% durante os últimos 3 dias) e os restantes cinco grupos incubados sob: A) temperatura elevada constante (38.9ºC) e RH padrão; B) temperatura inferior constante (36.7ºC) e RH padrão; C) temperatura e RH padrão com um período (3 h) de elevação da temperatura (38.9ºC) aos dias 3 e 18 de incubação; D) temperatura e RH padrão com um período (3 h) de redução da temperatura (36.7ºC) aos dias 3 e 18 de incubação; E) humidade relativa elevada constante (63%) e temperatura padrão; F) humidade relativa inferior constante (43%) e temperatura padrão; G) humidade relativa e temperatura padrão com um período (3 h) de elevação da RH (63%) aos dias 3 e 18 de incubação; H) temperatura padrão com um período (3 h) de redução da RH (43%) aos dias 3 e 18 de incubação; I) ausência de renovação de ar/concentração de CO2 elevada constante durante incubação sob temperatura e RH padrão. Para investigar a influência da infecção com microrganismos transmitidos verticalmente, foram utilizados 576 ovos specific-pathogen free, divididos por oito grupos, quatro grupos controlo e quatro grupos inoculados. O primeiro grupo tratado foi inoculado com 105 CFU/ml de uma cultura de referência de S. enterica var. Enteritidis (CECT-4300) em NaCl (0,9%) estéril. O segundo grupo foi inoculado com 102 CFU/ml (dose de inoculação semelhante à concentração destas bactérias previamente reportada em ovos naturalmente infetados) da mesma cultura de referência. O terceiro grupo foi inoculado com 105 CFU/ml de uma cultura de referência de S. enterica var. Typhimurium (CECT-443) em NaCl (0,9%) estéril. Finalmente, o quarto grupo foi inoculado com 102 CFU/ml da mesma cultura de referência. Cada grupo tratado foi incubado juntamente com um grupo controlo inoculado com NaCl (0.9%) estéril. A presença ou ausência de Salmonella em cada grupo foi confirmada através de PCR multiplex convencional. Em todos os ensaios, foi retirada uma amostra de ovos da incubadora a cada 48 horas de incubação para análise dos efeitos das diferentes manipulações sobre o desenvolvimento embrionário. Uma extensa lista de parâmetros relacionados com o comportamento, metabolismo, crescimento e viabilidade dos embriões foi depois analisada. Em relação ao estudo de campo, foi efetuada análise morfológica, histológica e microbiológica de uma amostra de 51 ovos não viáveis, obtidos após 21 dias de incubação, num centro de incubação industrial. Relativamente aos ensaios de manipulação do ambiente físico de incubação, os resultados obtidos permitiram concluir que as alterações de temperatura, em qualquer direção, exerceram efeitos mais marcados sobre o desenvolvimento embrionário do que as alterações na humidade relativa ou na concentração de CO2 no interior da incubadora, enquanto que estas duas últimas variáveis produzem efeitos na sua maior parte sobreponíveis. Dos parâmetros monitorizados, aqueles que mais consistentemente apresentaram alterações encontravam-se relacionados com o comportamento e metabolismo embrionários, nomeadamente com a diminuição do metabolismo embrionário como consequência do stress induzido pela manipulação. O crescimento embrionário, representado pelo peso do embrião e por parâmetros alométricos, foi igualmente afetado, tendo-se verificado que as alterações de temperatura resultaram em embriões mais leves, enquanto as alterações de humidade relativa e CO2 produziram embriões de tamanho semelhante mas peso superior aos dos restantes tratamentos. À análise histológica, os embriões sujeitos a alterações contínuas de temperatura apresentaram ainda atraso na formação do tecido linfoide da bolsa de Fabricius e alterações celulares com distorção da arquitetura do epitélio glandular da moela, estas últimas em embriões sujeitos a aumentos de temperatura). Os embriões sujeitos a modificações da humidade relativa produziram efeitos temporários sobre o desenvolvimento do tecido hepático. As lesões microscópicas encontradas em animais mortos durante a incubação não permitiram o diagnóstico fiável da(s) causa(s) imediata de morte. Nenhum dos tratamentos produziu elevação significativa dos níveis de mortalidade, à exceção da incubação sob temperaturas inferiores ao normal. Dos restantes tratamentos, a elevação da humidade relativa resultou num aumento da mortalidade no final do período de incubação. Ainda relativamente à viabilidade embrionária, verificou-se que apenas as manipulações da temperatura de incubação resultaram num aumento significativo na incidência de malformações espontâneas. Finalmente, é de notar que, para todas as variáveis estudadas, a alteração contínua de uma variável produziu efeitos mais pronunciados e duradouros, enquanto a alteração pontual e temporária de uma variável produziu efeitos mais limitados, tanto em amplitude como em duração. Ao contrário dos ensaios de manipulação do ambiente de incubação, a inoculação de ovos specific-pathogen free não incubados com serovars de Salmonella enterica e sua posterior incubação não produziu alterações significativas no comportamento, metabolismo ou desenvolvimento embrionários. A inoculação de S. Enteridis, tanto em inóculo alto como em inóculo baixo, resultou num aumento significativo da taxa de mortalidade, sendo que esta se encontrou limitada aos primeiros 7 dias de incubação. A inoculação com qualquer dos inóculos de S. Typhimurium produziu, igualmente, níveis de mortalidade superiores comparados com os controlos, limitados aos primeiros dias de incubação, mas inferiores aos produzidos por S. Enteritidis. As lesões microscópicas observadas em animais encontrados mortos não permitiram o diagnóstico fiável da(s) causa(s) imediata de morte, sendo que a única diferença significativa encontrada se restringiu a alteração da afinidade tintoral dos tecidos provenientes de embriões infetados, indicativa de decomposição mais acelerada provavelmente devido a maior proliferação bacteriana. Contudo, nenhum dos embriões viáveis inoculados apresentou qualquer alteração macroscópica ou histológica significativa e em nenhum destes animais se observaram agregados bacterianos à análise microscópica, apesar da presença de infeção confirmada por métodos de biologia molecular. Os resultados obtidos sugeriram, ainda, que ambos os serovars de Salmonella utilizados apresentam tropismo para o embrião, possuindo a capacidade de não só sobreviver dentro do ovo, mas também de atravessar compartimentos orgânicos em direção ao embrião. Estas observações evidenciam algumas das razões para a eficiência demonstrada por estes serovars (e particularmente S. Enteritidis) na transmissão vertical e estabelecimento de portadores assintomáticos. Em relação ao estudo de campo, a análise dos ovos não viáveis não evidenciou diminuição de performance ou viabilidade embrionária devido a qualquer das variáveis estudadas em laboratório. Contudo, o exame externo, macroscópico dos ovos, assim como a sua análise microbiológica evidenciaram problemas na seleção e calibração dos ovos para incubação, assim como na possível higiene e práticas de recolha dos ovos na exploração de reprodutores, sinalizando potenciais pontos de intervenção futura com vista ao melhoramento da performance de incubação que de outra forma não seriam detetados. Finalmente, este trabalho permitiu a aquisição de informação essencial para a compreensão da resposta embrionária aos desafios da incubação, permitindo ainda confirmar a importância do embriodiagnóstico na monitorização da saúde da incubadora e do bando.

To ensure that the resources of the health care sector are used effectively, new technologies need to be evaluated before implementation to examine if they generate health outcomes at an acceptable cost. This information can be collected by performing health economic evaluations in which the costs and health outcomes of different technologies are compared. To estimate the effect on health care budgets, there is also a need for information about the prevalence of the specific disease. Health outcomes in health economic evaluations are often measured in quality-adjusted life years (QALYs), which are calculated by multiplying the remaining life years after an intervention by a weight representing the health-related quality of life (HRQoL) during those years. This thesis aims to provide deeper knowledge of the health economic aspects of diabetic retinopathy (DR), an eye complication that affects patients with diabetes and may in the worst case lead to blindness. The focus is on three empirical and two methodological health economic research questions. The empirical research areas cover prevalence, costs, and HRQoL related to patients with DR. The methodological research questions explore the performance of different methods for estimation of QALY weights. This is of interest since it has been argued that the most common methods for estimating QALY weights may not capture all relevant vision-related aspects of quality of life. The analyses comprehend the validity of different methods for estimating QALY weights among patients with DR and if the results of one of the specific methods for estimating QALY weights, the time trade-off (TTO) exercise, are affected by patients’ subjective life expectancy (SLE). The empirical results demonstrate that DR is seen in approximately 40% and 30% of patients with type I and type II diabetes respectively, indicating that the prevalence of DR has decreased in both of these patient groups. Healthcare costs vary considerably between different severity levels of the disease, being estimated at €26, €257, €216, and €433 per patient per year for background retinopathy, proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), and PDR combined with DMO respectively. Blindness due to DR is associated with an increased use of transportation services, caregiving services, and assistive technologies as well as productivity losses. This suggests that preventing the progression of DR may lower healthcare costs. Patients with vision impairment due to DR have lowered HRQoL in various dimensions, but the diagnosis of DR in itself has only a limited effect on HRQoL. The results on the methodological research questions show that different methods for estimating QALY weights seem to give different results. In comparison to EQ-5D, the Health Utilities Index Mark 3 (HUI-3) is the most sensitive method for detecting differences in QALY weights due to DR, and if decisions are to be made based on values from the general public, it can be recommended for use in cost-utility analyses of interventions directed at DR. Neither of the direct methods, TTO and the visual analogue scale, seems to be sensitive to differences in visual function, and more research is needed concerning the role of vision in people’s responses to the TTO exercises. In TTO exercises with time frames based on actuarial life expectancy, the patients’ SLE has an effect on their willingness to trade off years for full health. Thus, applying time frames deviating from patients’ SLE may result in biased QALY weights. Such bias may appear stronger within patient populations than within the general public. In conclusion, this thesis offers estimates for prevalence, costs, and QALY weights that can be used in economic evaluations of interventions directed at DR and as benchmarks for future DR research in order to follow up consequences of changes in diabetes care. In addition, it demonstrates that the choice of method for estimating QALY weights may have an impact on whether an intervention is considered cost-effective.

Production traits and disease resistance are believed to be under the control of many genes, i.e. quantitative trait loci (QTL). The objective of the present study was to establish a methodology for identifying DNA markers which are associated with QTL in chickens using an alternative approach to the traditional linkage analysis. A systematic screening approach was designed to search a chicken liver cDNA library for clones which revealed polymorphisms associated with traits. In the first stage of the experiment, a total of 92 cDNA clones were subjected to restriction fragment length polymorphism (RFLP) analysis. About 33% and 22% of the clones revealed DNA polymorphisms at MspI and TaqI restriction sites, respectively. Subsequently, DNA polymorphisms which responded to selection were identified by comparing RFLP frequencies in divergently selected strains of chickens. About 60% of the RFLPs responded to selection for egg production traits and/or Marek's disease (MD) resistance. Trait associations of these RFLPs were then studied by selectively genotyping individuals at the extremes of trait distributions, followed by an analysis of individuals in the entire population and statistical evaluation. Finally, RFLP regions of DNA markers were characterized and PCR assays for rapid RFLP screening were developed. DNA markers in two genes were identified and characterized by this methodology. One was a marker in the chicken mitochondrial genome which arose from a nucleotide substitution (T to C) in the NADH subunit IV gene. Statistical analysis for typing random individual samples from the strains showed that this DNA polymorphism was associated with mature body weight and egg specific gravity which is a strong indicator for egg shell thickness. Other analyzed markers were located in the chicken mitochondrial phospho-enolpyruvate carboxykinase (PEPCK-M). Using the cDNA of this gene as a probe, southern blotting revealed a highly polymorphic band pattern. Statistical analy

Salmonella is a common enteric pathogen and is the most frequently reported bacterial infection in the United States. The two most commonly reported serotypes causing human illness in the United States are Salmonella serotype Typhimurium and Salmonella serotype Enteritidis (SE). The incidence and number of foodborne outbreaks of SE started to increase in the 1970s and by 1994, SE was the most common Salmonella serotype reported to the Centers for Disease Control and Prevention (CDC). SE has been most commonly associated with consumption of shell eggs. Outbreak reports were obtained from the Foodborne Disease Outbreak Surveillance System (FDOSS) and analyzed. The number of outbreaks of SE has declined by 67% since 1990, likely as a result of the combined effect of on-farm interventions, public health policies, and food safety education messages. In addition to the decline in SE outbreaks, study findings demonstrate that there have been changes in the geographical distribution of SE outbreaks in the US. “Simple egg” foods and retail food settings have been the most commonly and consistently associated vehicles and food consumption and preparation settings with SE outbreaks in the US from 1973 to 2008.

Today’s working life has led to new requirements and conditions at the workplace, and additional factors may be of importance for employees’ health. Most earlier research has taken place in stable organizations, and has not taken changes in organizations into account. The way in which psychosocial work conditions affect employees’ health and well-being has been the topic of several studies but mental ill health is still one of the most common causes of sick leave in Sweden. Little attention is given to the importance of the workplace and organizational context for employees’ health. The overall aim of this thesis is to investigate how different aspects of health are associated with psychosocial work conditions in today’s working life. This thesis comprises two empirical studies. The first study is a longitudinal study, based on questionnaire data from 1010 employees at the Swedish Labour Market Administration. The second study is designed as a prospective cohort study, based on questionnaire data from 8430 employees in ten organizations, participating in the LOHP project. Linear and logistic regressions were performed to investigate associations between psychosocial work conditions and different aspects of health. Multilevel analysis was performed in one paper. The main findings in Paper I are that traditional job stress models are better for predicting ill health than good health. Different psychosocial work conditions may however, be useful for measuring different aspects of health, depending on whether the purpose is to prevent ill health or to promote health. In Paper II, psychosocial work conditions and symptoms of burnout were found to differ between different hierarchical levels, and different psychosocial work conditions were associated with symptoms of burnout at different hieratical levels. Paper III showed that psychosocial work conditions predict voluntary job mobility, and this may be due to two forces for job mobility: job dissatisfaction and career development. In Paper IV, a strong association between high work ability and better performance was found. Clear goals and expectations may result in improved psychosocial work conditions and work ability, which in turn affects employees’ performance. This thesis has provided knowledge regarding different aspects of health and psychosocial work conditions. Conditions at the organizational and workplace level set the prerequisites for if and how employees use their resources and their ability to act. Access to resources and the capacity to use them may vary depending on the employees’ hierarchal position. Occupational health research needs to focus on differences in psychosocial work conditions at different hierarchical levels. Organizations with clear goals and expectations may create more favourable conditions at work, supporting employees’ room for manoeuver, social capital and their ability to cope with working life, hence promoting health. Health promotion has a holistic approach and considers the work environment, the individual and the interplay between them. However, most health interventions at workplaces are directed to employees’ health behaviour rather than improvements in organizational and work conditions. To develop a good work environment it is necessary to identify conditions at work that promote different aspects of health. These conditions need to be tackled at the organizational, workplace and individual level, as good health is shaped by the interplay between the employee and the conditions for work.

Principles of business management are increasingly being used to analyze health care systems. Conceptualizing health care as business networks offers the possibility to apply the ARA model of Actors, Resources and Activities to understand the functioning of the system. We have used this model to study the phenomenon of networking in cross-border care using Uppsala University Hospital as a research case. The aim of the study was to understand actor’s perceptions of networking activities and how these related with international sales of health care services. We collected primary data through five interviews with managers involved in internationalization and a survey study with 26 managers at the hospital. Secondary data on patient flows and research activity was collected from hospital and university records. The main actors identified in the health care networks are doctors with professional identity being an important facilitating factor. Patient´s role as active participators in the system is increasing while researchers, innovators and key opinion leaders are also important. Networking activities consist of knowledge transfer via lecturing, meetings and external consulting activities. Resources in the form of supporting clinics, research centers and administrative services correlate positively with the level of internationalization. The study identifies networking activities as important for internationalization and cross-border sales of health care services. We conclude that the ARA model is a valuable instrument for analyzing cross border activities and internationalization of health care.

Extending Descriptions Logics (DLs) with a temporal dimension to aid in the ability to model meaningful temporal information is an active and popular research area that has gathered a lot of attention over recent years. DLs underpin the Web Ontology Language (OWL) which offers a way to describe ontologies for the semantic web. Representing temporal information in ontologies plays an important role, specifically for those ontologies where time information is inherently embedded in the information they describe. This is very common for ontologies in the bio-health domain, for example ontologies that describe the development of anatomies of biological entities, stage based development, evolution of diseases and so on. As expressive as DLs are, given that they are fragments of First Order Logic, they are static in nature and are limited in what they can express from a temporal view point, hence the surge in temporal extensions to DLs over recent years. In this thesis we investigate the use of temporal extensions of DLs as suitable representations for the temporal information required for bio-health ontologies. We first set out to find out exactly what types of temporal information need to be modelled, before going on to evaluate current temporal extensions and representations to determine their suitability. We then go on to introduce several new temporal extensions to DLs and evaluate their suitability.

This survey collected information on aspects of health amongst an employed population, employees in 14 different organisations in the West Midlands Regional Health Authority; and was a stratified sample of senior managers, middle managers and operatives. Nine hundred and sixty questionnaires were distributed asking for both quantitative and qualitative information on 58 questions covering health, work, family, leisure activities and life-style. A response rate of 48% (459 returned questionnaires) came from 290 men (63%), 165 women (36%) and four people (1%) who did not answer the gender question. The initial findings from this study are unique in that there has not been a specific review of the health of people at work. In answer to the main research questions, 92% felt they were healthy. Compared to others of a similar age, 34% felt their health was `above average', 58% `average', and 7&37 `below average'. Thirty two percent of respondents had visited their GP in the past 1-2 months; the highest reason given was disorders of the respiratory system, 20%. People's perceptions on the effects of work on their health were: good effect, 13% fair effect, 20% no effect, 27% poor effect, 27% and bad effect, 7%. The effects of leisure activities on health were thought to be more positive: good effect, 46% fair effect, 20% no effect, 21% poor effect, 3% and bad effect, 2%. The perceptions of effects of life-style on health were considered to be: good effect, 32% fair effect, 32% no effect, 20% poor effect, 9% and bad effect, 1%. In this survey, leisure and life-style were seen by employees to have more beneficial effects on health than work. Future implications include a review of occupational health as a major policy development area within primary care. There is a need to influence the education and training of health care practitioners in order to affect their ability to practise effectively in this new and challenging area of work.

Inactivation of MAPK with the MEK1/2 inhibitor U0126 simultaneously parthenogenetically activates eggs, disrupts spindle-cortex docking and destabilizes spindle organization, yielding parthenogenotes that resemble mos-/- oocytes. Inactivation of MPF with the Cdk1 inhibitor roscovitine also parthenogenetically activates eggs, some of which resemble mos-/- oocytes, suggesting a reciprocal role for MPF in modulating MAPK activity. MAPK inactivation with U0126 was quick (1 h) and preceded the fall in MPF activity whereas MAPK inactivation after roscovitine treatment was similar to that of fertilization (5-7 h), suggesting the presence of a physiological inactivating mechanisms. A severe phenotype developed after U0126 and roscovitine co-treatment, characterized by incomplete cleavages and ball of actin that follows the drifting spindle. Development of the severe phenotype suggests MPF and MAPK inactivation have a synergistic effect on spindle dynamics and that the timing of inactivation is important for normal egg activation.

Relationships of negative psychological conditions with general status of cell-mediated and humoral immune systems were investigated. A unique approach was utilized in that indexes representing multiple aspects of each branch of the immune system were employed to better indicate general immunological status. Differences in emotion-immune interactions between males and females were demonstrated. Results indicated a positive relationship between Trait Anger and Cell-Mediated Immunological Index. Particular criticisms of previous psychoneuroimmunological research were met by addressing sex differences and differences in various conditions of anger and depression, as well as through assessment of cumulative effects of negative emotions on immune system status. Directions for future research in eddressing similar issues are suggested. In general, results provide support for validity of mindbody interactionism and imply the need for revision of standard medical and psychological treatment.

The consensus view is that cardiac hypertrophy is an adaptive response to increased work caused by a variety of stimuli. While hypertrophy can be defined as an increase in cell mass without an increase in cell number, not all increases are equivalent in type and amount of protein accumulated. Our goal in this study was to identify the common steps in the process of cardiac hypertrophy. Our working hypothesis was that in all forms of cardiac hypertrophy glucose utilization increases and that the percentage of energy derived from fatty-acid oxidation decreases. The first part of this study entailed the development and characterization of a neonatal rat heart cell model. The model had to provide uniform culture conditions for rapid development of hypertrophy by agents acting at different sites in the cardiomyocytes. The second part of this study was composed of an assessment of hypertrophy caused by four pharmacologically distinct agents: norepinephrine, angiotensin-II, endothelin-I and tetradecylglycidic acid. In this part we compared the quantity of protein accumulation and quality of hypertrophy cause by each agent. This task was accomplished by examining the effect of each agent on selected mRNA messages and alteration in DNA content of cardiomyocytes. Here we also examined the effect of protein kinase-C, endothelin-I and angiotensin-II inhibitors on hypertrophy caused by each agent. In the final part of this study, metabolic alteration in hypertrophy caused by each agent was assessed for a potential common pathway to hypertrophy. As part of this analysis, we examined changes in glucose and palmitate oxidation, glucose uptake and role of pentose pathway in hypertrophy resulting from treatment of cardiomyocyte by each agent.

Canada's health system is based on the firmly-held belief that the receipt of care should be based on need and not ability to pay. This thesis examines three aspects of this equity goal: provincial variations in equity in the receipt of care; the role of private prescription drug insurance in explaining inequity in the use of physician services; and the equity implications of subjective unmet need. Canada's provinces are responsible for planning and funding most publicly insured health services, hence there is variation in health system characteristics across the country. In the context of such variation, the first empirical analysis examines equity in the use of health services across the provinces. The analysis reveals some evidence of inequity in the likelihood of a GP visit, and the likelihood and number of specialist and dentist visits; some variations can also be found across the provinces. The second empirical analysis investigates the role of complementary insurance for prescription drugs in explaining inequity in the use of publicly-funded physician services. Due to the complementary relationship between prescription drugs and physician services, and the unequal distribution of private insurance coverage across income groups, inequity in physician utilisation partly can be explained by the interaction with insurance. The third empirical analysis assesses the equity implications of subjective unmet need. It finds that there are different utilisation patterns among the different types of unmet need, which raises methodological and conceptual challenges. The concluding chapter positions the three empirical studies within the broader policy context, offers an in-depth discussion of their methodological and policy implications, and proposes areas for future research.

The present study was designed to address the issue of the potential harm of workaholism. It specifically examined the relationships between workaholism, self-acceptance, psychological well-being, and physical symptoms. Furthermore, participants completed a form to rate their perceptions of their parents work behaviors, and thus relationships between perceived parental workaholism, physical symptoms, psychological well-being, and self-acceptance, were also explored.Three hundred forty seven students from a Midwestern university completed a survey measuring the above constructs. Of these 347 surveys, 279 were utilized for analysis. It was hypothesized that students' workaholism would correlate negatively with the students' psychological well-being and self-acceptance, and positively with physical health complaints. It was expected that student workaholics would report less psychological well-being, more physical complaints, and less self-acceptance than nonworkaholic students. Furthermore it was hypothesized that there would be no relationship between perceived parental workaholism and students' workaholism. While it was hypothesized that students who perceive their parents as workaholic would report less psychological well-being and self-acceptance than students with perceived nonworkaholic parents, it was not expected that they would report more physical health complaints.Results supported the majority of the hypotheses. A negative relationship was found between students' workaholism and the students' psychological well-being and self-acceptance, while a positive relationship was found between students' workaholism and physical health complaints. Students in the medium to high risk workaholic group were found to have significantly more physical health complaints, and lower self-acceptance and psychological well-being than students scoring in the low risk workaholic group. Furthermore, students with perceptions of parental workaholism falling within the medium to high risk range, had significantly lower levels of psychological well-being and self-acceptance than parents falling within the low risk range. No differences were expected in these two groups in terms of physical health complaints, however students' with perceptions of parental workaholism in the medium to high risk range had significantly more physical symptoms than students' with lower perceptions of parental workaholism. Furthermore, while no correlation was expected between perceived parental workaholism and student workaholism, a significant positive correlation was found.
Department of Counseling Psychology and Guidance Services

Background: Unhealthy lifestyle are important contributors to chronic illness in Hong Kong and worldwide. Lifestyle modification, particularly improving healthy diet and physical activity, can prevent the development of various chronic illnesses, improve disease conditions, reduce the risk of complications and enhance the quality of life. Many behavioural models have been applied to achieve lifestyle modification, but the major limitation was that they mainly treated human behaviours as individual behaviours that were subsequent to rational thinking. Nudge theory, an advanced behavioral concept, proposed to change individual’s motivation, incentives and decision making through non-direct suggestion and non-forced reinforcement. However, the application of Nudge theory has been challenged on the lack of evidence to prove its effectiveness, and its controversial framework for ethical analysis. Objectives: This review was to synthesize the empirical findings about the effectiveness of using nudge theory for lifestyle modification including healthy diet and physical activity. Methodology: Interventional and experimental studies that were conducted based on Nudge theory to change diet or physical activity was identified from the published literature. The studies were divided into two large groups according to outcome measured: healthy diet and physical activity, and they were systematically synthesized. The “nudges” used in these studies were categorized as six types of “nudges” summarized by “nudge unit” as “MINDSPACE” for further discussion. The type of “nudges” that were used in the studies and their effectiveness on changing diet and physical activity was abstracted. Results: Totally, nine articles that met the inclusion criteria were included. Five nudges were identified from the included studies, including Priming (P), Default (D), Salience & Affect (SA), Incentives (I) and Messenger & Norms (MN). It is found that the strategies and methods applied on the same nudge may have different effectiveness. Seven studies applied Priming (P) as nudge to motivate change in diet, which used two major strategies: “availability” and “accessibility”. The evidence was strong that altering the availability of food presence could be effective to change food selection. The results of studies using accessibility were heterogeneous and contradictive with each other. Another three studies used different nudges including Default, Salience & Affect and Incentive. The effectiveness of Default (D) as nudge seemed to be blurry, and the sustainability remained questionable. The ethical consideration is always the primary pillar for applying nudging theory. As long as the applications are stick to necessary ethical concerns, the nudging model can be beneficial through mild “manipulation” rather than harmful. Conclusion: It has potential opportunity to carry out “libertarian paternalism” in Hong Kong. However, it is still a long way to take application of nudging model into regulation, legislation and daily practice. The evidences for each type of nudge were not consistent and enough. Besides, the monitoring and evaluation are not available yet. Future research can be focused on transferring these applications into real practice with an effective monitoring and evaluation system.
published_or_final_version
Public Health
Master
Master of Public Health

This thesis explores mental health literacy (MHL) and mental health difficulties in at-risk populations. Young people, particularly males, are vulnerable to the onset of mental health difficulties, failing to access support and increased risk of suicide. Supporting people with mental health difficulties and improving prognosis is an important area of public health concern. Chapter one is a systematic review of gender differences in MHL of young people (ages 12-25 years). 14 studies were identified and critically assessed. The nature of gender differences in MHL of young people is complex but most consistently reported in depression. Females tended to have higher levels of MHL than males. The implications for public health interventions and future research are discussed. Methodological components of MHL research, such as the use of case vignettes are also considered. Chapter two is a qualitative research study of male professional footballers’ lived experiences of mental health difficulties and help-seeking using interpretative phenomenological analysis. One superordinate theme emerged from the data; Survival. This is discussed through six subordinate themes and alongside existing literature pertaining to identity, transition, personality and emotional development. The clinical implications of the findings are discussed, as well as suggestions for future research. Chapter three is a reflective paper considering the use of Cognitive Analytic Therapy as a tool for reflexivity in qualitative research. The opportunities and limitations of this approach are considered, alongside reflections on the research process.

This work is concerned with the application of scintigraphy in studies of foregut motility in paediatric patients; notably oesophageal transit during swallowing, gastro oesophageal reflux (GOR) and stomach emptying as measured by the gastric contents 30 and 120 minutes after deglutition of liquid. Relevant anatomy, physiology, pathophysiology and non-radioisotopic methods of gastro oesophageal examination are outlined. The extremely important question of dose deposited by ionising radiation in paediatric patients is also considered. Because currently available estimations of absorbed dose after swallowing non- absorbable radionuclides are unsatisfactory and often contradictory, a new model was derived. It is based on more physiological principles than previous models, with a continuously varying exponential passage between four compartments in the gastrointestinal tract. From a review of previous work and our experience, a standard method of examination was developed. There is emphasis on normal physiological manoeuvres. The broad extent of useful information available in the study stems from the positions in which the patient is investigated, the quantity of labelled fluid swallowed, its physiological nature and observations of oesophageal transit, GOR, gastric emptying and pulmonary aspiration after two hours. The wide range of paediatric problems amenable to investigation by this means is described, including those of a life-threatening nature. Also, the importance of using this examination to determine the likelihood of successful surgical intervention in the gastro oesophageal region is explained. By using the observations made during swallows in neonates, the closure of the lower oesophageal sphincter (LOS) was observed during a short series of rapid deglutitions. This extends previous knowledge of the function of the neonatal LOS. These findings were very clearly demonstrated by the condensed image technique. A comparison between the abilities of radiology and scintigraphy to detect GOR in paediatric patients, with and without oesophagitis, gives unequivocal results in favour of scintigraphy. Two independent clear correlations between oesophageal transit time and the severity of GOR and age are demonstrated by variance and correlation analysis. The mean duration of GOR, maximum height of a GOR, gastric contents 30 and 120 min after deglutition, the effect of the nature of liquid swallowed and age are also examined and their relations are described. The application of the method to assess drug response is illustrated by the paediatric use of cisapride, an experimental drug which increases acetylcholinesterase release. The deductions from this work include values of the radiation dose deposited in paediatric patients of various ages, after swallowing non- absorbed Tc-99m compounds. Other contributions are a scintigraphic means to allow recognition of the importance of oesophageal dysmotility in paediatrics, especially in the absence of GOR and its relevance to the efficacy of surgery in cases of apparent GOR. Also, this gastro oesophageal scintigraphic study provided information on the paediatric use of cisapride, the relevance of GOR to repeated respiratory problems and the recognition of a new paediatric syndrome analogous to the diffuse oesophageal spasm syndrome of adulthood. It has been demonstrated that a routine, uncomplicated, paediatric scintigraphic examination, useful for investigating a wide range of problems in both a first and third world setting is possible for a nuclear medicine practitioner with normally available radiopharmaceuticals, equipment and radiographical expertise.

Intimate partner violence is endemic in the United States. According to the American Medical Association (1992), one-fifth to one-third of women will sustain violence from a partner or ex-partner in their lifetime. The relevant literature was organized by ICD-9-CM categories. This study examined the health consequences of partner abuse in a sample of community women using a sample consisting of 564 women in three ethnic groups. Because prior research has failed to account for variations by type of abuse on health consequences, this study assessed psychological abuse, violence and sexual aggression by women's partners. To determine whether or not different types of abuse had an effect on women's health, hierarchical regression analyses were conducted. The regression equations were calculated for women within each ethnic group to facilitate identification of similarities and differences and to control for ethnic differences in risk for specific diseases. The results were consistent with past research on health consequences of abuse and extended the prior literature by showing that psychological abuse had a pervasive effect on health conditions, distress and use of health care resources. Additionally, ethnic differences emerged. As expected, ethnicity appeared to function as a moderator. Clinical implications and recommendations are made for future research, suggesting the development of a new assessment tool for partner abuse screening.

In common with other areas of public services, recent years have seen a shift in the National Health Service (NHS), with increased power and authority transferring from professionals towards the users of services. As a result, user involvement has come to form a central element of government policy on public services, and health in particular, with a series of specific policy commitments to give users a stronger voice and to involve them in the health service having been published by both the Westminster and Scottish parliaments. These seek to increase users’ involvement in making decisions about their own care and treatment, in examining and improving the quality of services and in policy and planning activity. In doing so, this policy aspires to respond to the changing culture of personal and societal expectations of health and the health service; to build democratic participation in the difficult targeting and rationing decisions faced by health agencies and, thus, to help renew public trust and strengthen confidence in the NHS. These are ambitious aims with far-reaching implications as they represent a transformation in the interaction between users, health professionals and health policy makers. This thesis examined how this policy has been understood and implemented in the NHS by exploring the scope, relevance and quality of the user involvement processes available in three health service settings. In order to develop a better understanding of the issues in user involvement it explored the nature of user participation; the character of user representation and the barriers and facilitators to user involvement in maternity, gynaecological oncology and mental health services. The study examined the response to this policy within these three settings; the functioning of existing user involvement mechanisms and their capacity to involve users in determining their individual health care and in shaping health services and policy to their definition of need. From this examination it defined the key features of a model process for user involvement within the professional service culture and organisational ethos of the NHS. The study then drew conclusions on the capacity of these current user involvement processes to deliver on the policy directive to develop both individual treatment and health services in ways that are responsive and accountable to users. Finally, the thesis identified those areas that require further research before proposing the lessons for the further development of this significant and potentially influential policy directive.

Problem and background. Caregiving for elderly family members can be viewed as a part of and extension of supportive behaviors between individuals. Consequently, there are cultural undertones to caregiving and what is supportive in one culture may not be in another. Mexican American caregiving has not been well studied; however, Mexican Americans are reported to be more likely to use family as resource for solving problems than non-Hispanic whites. Purpose. Guided by caregiving framework developed by Bowers (1987), Wilson (1989) and Nolan et al. (1995, 1996, & 1997) this study employed grounded theory to formulate a conceptual model of intergenerational caregiving among Mexican American families focusing on characteristics of the temporal axis which defines caregiving in terms of (1) family structure or generational attitudes (historical time); (2) what and how shared understandings with elders and among family members influence who assumes the caregiver role and when (kin time); (3) how entry into the caregiving role affects the entire family (intergenerational development time); and (4) how entry into the caregiving role affects the caregivers' peer relationships (peer time). This study also builds theory about how acculturation influences family care giving. Design, methods. This exploratory study was guided by grounded theory methodology where interviews were taped and analyzed using grounded theory's constant comparative method of analysis. Sample. The sample consisted of Mexican American caregivers (n = 10) of various generations over the age of 21 who provided at lest one intermittent service (without pay at least once a month) to an elder, related through consanguinal or acquired kinship ties. Results. Grounded theory of Role Acceptance comprised of four phases: (1) Introduction: Early Caregiving Experiences; (2) Role Reconciliation; (3) Role Imprint; and (4) Providing/Projecting Care. Significance. This study provides a Mexican American intergenerational caregiving model that can be utilized to study varied generations of Mexican American caregivers. It also provides a framework for comparison with other groups of caregivers. Results of this study also inform health professionals about ways in which Mexican American caregivers view caregiving. This information has potential to increase cultural competence in delivery of health care to elders and their families.

Purpose: This study aimsto analyze managerial aspects of governance within Icelandic healthcare institutions, particularly regarding job descriptions and policy-making plans. Method: We used a qualitative research method and content analysis to examinedata collected from semi-structured interviews Ten participants (5 malesand 5 females) who worked as senior managers, middle-management executives in the healthcare service, and Ministry of Welfare officials. The participants reflected a breadth of experience and education across the spectrum of age, length of service, and work experience in both hospitals and primary care. Results: Data analysis revealed three main categories including policy-making plans in healthcare, which identified a considerable gap between managers and executives on one side and the Ministry of Welfareon the other, especially regarding strategy. Incidental control and effect of politicians on healthcare operation. Second, inrelation to the Ministry of Welfareand healthcare institutions we observed unstructured, onerous, and remote communications and organization that focused too little on professional issues. The Ministry of Welfare tended to interfere with managers’ responsibilities and scope of work. Third, we observeds trengths and weaknesses in management. Strengths includedad ministrators’ enthusiasm, ideas of empowerment, short lines of communications, and often straightfor ward interactions, compared withweaknesses in the workprocesses within healthcare institutions and toward the Ministryo f Welfare, and also in job descriptions and vague definitions of the institutions’role. Conclusion: The indications reported here suggestun clear policy-making plansfor healthcare institutions. Although managers and executives maintained that visions for the futureare vague, the Ministry of Welfare stated that the strategy was clear. The study identified a need of strengthening and restructuring the way of communications, as well as clarifying managers’ role toward the Ministry of Welfare

ISBN 978-91-982282-7-4

The aim of operations management in health care is to enhance the provision of services to patients and to decrease costs. Overall worldwide health care expenditures represent around 10.5% of the global GDP and are projected to increase at an annual rate of 5.3% from 2015 to 2017 [74]. In order to investigate how to curb health care costs, I study the English NHS, a health care system that provided universal care to around 54 million people in 2014 [243]. The NHS has launched many initiatives to improve the performance of hospital operations such as the "QIPP" program, which has the objective to save £20 billion of costs by 2015 [98]. Given this framework, this research aims to contribute to the theory that is guiding these operational changes, using data on all admissions to hospitals and focussing on the inguinal hernia, one of the most common surgical procedures [86]. In the next chapters, this research describes inguinal hernia care delivery in the English NHS, examines the impact of spillovers and complementarities on costs, and investigates the effects of length of stay reduction on risk of re-admission and risk of death. The findings of this thesis indicate that one of the possible problems in the delivery of inguinal hernia care in the NHS is the decrease in the number of elective operations performed and the increase in readmission rates. They also clarify how decisions on allocation of resources can affect hospital expenditures by showing that loss in focus can increase health care costs and by pointing out that there is little evidence to support the theory of spillovers and complementarities in the surgical context. Finally, the results of this research can be used to suggest the logic of a policy to decrease length of stay that can inform hospital decisions and can decrease hospital costs.

As you probably know, to board the B777-300ERi in Geneva for Anchorage via London, is not just that simple. With your ticket you bought several days before, you come to the airport, check in, pay airport's fees, go through the customs and security checks, walk in the terminal following signs, maybe you stop in the duty free shops, and finally find your gate. By this time, you are ready to board, about one hour after you enter the airport.
We will be essentially interested in air law that is why, the purpose of this master's thesis is to consider the legal aspect of facilitation in civil aviation. The term facilitation refers to the process that passengers, crew, luggage, cargo and mail have to go through when they cross borders to fly from a point A to a point B.
Recently, an aspect of facilitation took an outstanding importance: health issues. At the end of last year, the Severe Acute Respiratory Syndrome (SARS) outbreak was a real threat to international civil aviation because passengers (and crews) could have been exposed to an infected person inside the terminal or on board the plane, also, aircrafts were considered a fast vector of this disease through the world. The economic consequences for airlines and airports were very painful.
iBoeing 777-300 Extended Range.

Bipolar disorder (BD) is one of the leading causes of disability worldwide and has a detrimental impact on health-related quality of life (HRQoL), and personal and social functioning. Despite this, there is insufficient knowledge of the costs, HRQoL implications relevant to BD, and the cost-effectiveness of current treatments for BD in the UK. This thesis aims to inform decisions about local and national service provision by applying a variety of health economic tools to build an economic case for BD. First, economic evaluations of BD management strategies are systematically reviewed. A cost-of-illness study is then conducted to estimate the societal burden of BD in the UK and explore the factors that drive variations in these costs. The appropriateness of applying the EQ-5D-3L outcome measure in BD is assessed, and the feasibility of mapping disease-specific measures to the EQ-5D-3L is explored. Finally, a cost-utility analysis (CUA) is conducted to bring together evidence on the costs and outcomes associated with alternative psychological interventions in BD management. This thesis makes critical contributions to multiple research domains, informing the allocation of scarce healthcare resources in this context. There is a sheer dearth of evidence on cost-effectiveness strategies for the long-term management of BD in the UK, especially the evidence for psychological therapies is limited. The annual societal costs associated with BD in the UK are estimated to be £5.14 billion, demonstrating the significant economic burden associated with this disease. The EQ-5D-3L instrument is found to be useful in measuring HRQoL in BD patients who predominantly experience depressive symptoms but is not sensitive enough to detect changes in individuals with mania. More psychometric evidence is therefore required before this instrument can be widely applied in economic evaluations of BD-related interventions. Finally, the CUA indicates that a novel structured psychoeducation intervention in individuals on remote mood monitoring in the UK is not cost-effective.

The aim of this thesis is to in various ways explore protein expression in human normal tissue and in cancer and to apply that knowledge in biomarker discovery. In Paper I the prognostic significance of RNA-binding motif protein 3 (RBM3) is explored in malignant melanoma. To further evaluate the prognostic significance of RBM3 expression was assessed in 226 incident cases of malignant melanoma from the prospective populationbased cohort study Malmö Diet and Cancer Study using tissue microarray technique (TMA). RBM3 was shown to be down regulated in metastatic melanoma and high nuclear expression in the primary tumor was an independent marker of prolonged over all survival. As a tool to facilitate clinical biomarker studies the Human Protein Atlas has created a tissue dictionary as an introduction to human histology and histopathology. In Paper II this work is introduced. A cancer diagnosis can be a complex process with difficulties of establishing tumor type in localized disease or organ of origin in generalized disease. Immunohistochemically assisted diagnosis of cancer is common practice among pathologists where its application combined with known protein expression profiles of different cancer types, can strengthen or help dismiss a suspected diagnosis. In Paper III the diagnostic performance of 27 commonly used antibodies are tested in a predominantly metastatic, multicancer cohort using TMA technique. Overall these 27 diagnostic markers showed a low sensitivity and specificity for its intended use, highlighting the need for novel, more specific markers. Breast, ovarian, endometrial and ovarian cancers affect predominantly women. Differential diagnostics between these cancer types can be challenging. In Paper IV an algorithm, based on six different IHC markers, to differentiate between these cancer types is presented. A new diagnostic marker for breast cancer, namely ZAG is also introduced. In Paper V the transcriptomic landscape of the adrenal gland is explored by combining a transcriptomic approach with a immunohistochemistry based proteomic approach. In the adrenal gland we were able to detect 253 genes with an elevated pattern of expression in the adrenal gland, as compared to 31 other normal human tissue types analyzed. This combination of a transcriptomic and immunohistochemical approach provides a foundation for a deeper understanding of the adrenal glands function and physiology.

Electronic waste or `e-waste' is a rapidly growing form of solid waste worldwide. The heavy metals present in various electronic components demand attention because such metals may leach and pose significant health and environmental hazards (U.S. EPA, 2007). Knowledge of the potential of heavy metal leaching from e-waste represents an important contribution for developing U.S. standards for classifying e-waste as hazardous waste. Hazardous elements which leach from a variety of electronics wastes were assessed in laboratory batch studies. Electronic components evaluated included PC cathode ray tubes, PC motherboards, PC mice, television remote controls, and cellular phones. Each component was disassembled and digested using the Toxicity Characteristic Leaching Procedure (TCLP), EPA Method 1312, Method EA NEN 7371 (Dutch Environmental Agency), and Method DEV-S4 (Germany). The extracts were analyzed for lead, cadmium, chromium, silver, and cobalt. The TCLP consistently leached the greatest amounts of all metals; TCLP-soluble lead was extracted well beyond federal limits for several electronic devices.
Department of Natural Resources and Environmental Management

Studies have shown that pregnant women do understand and value information of their unborn child. However, those providing health promotion services often focus on medical procedures and health education messages, ignoring the cultural, socio-economic and psychological dimensions that impact on women's health. This research aimed to look at a specific component of health promotion, i.e. health promotion messages shared with pregnant women attending Stellenbosch and Klapmuts Community Health Centre Antenatal Health Promotion Programme and their perceptions of how they apply messages in their daily lives.

Background: Improving the sexual health of young people is a key policy focus in Scotland. As the influence of the internet has grown within a rapidly changing health information landscape, so have opportunities for both sexual health promotion, and concerns about the challenges faced by young people in navigating this online environment. This study explores young people’s sexual health literacy (SHL), primarily within this online context. Methods: Paired interviews with friendship groups and observational online activities were used to explore young people’s experiences of finding, understanding and evaluating online sexual health information. A purposive sample of 49 participants (aged 16-19), diverse in terms of gender, sexuality and religion, were recruited from across Scotland from areas that varied in terms of deprivation and urban/rural classification. Findings: Participants varied in their confidence and ability to find and identify reliable information, and typically regarded identifying and filtering reliable sources as challenging. Barriers to accessing information on websites included: inaccessible language; inappropriate or non-relatable information; and websites that were difficult to navigate or did not function correctly. Concerns about stigma and ‘being seen’ seeking sexual health information was a key barrier. Stark differences, often mediated by gender, sexuality and educational circumstances, emerged in perspectives towards accessing sexual health information and support online. Findings suggest that different social media platforms present different opportunities and challenges; for example, social content sharing services such as YouTube may be useful venues for developing critical SHL, while social networking sites such as Facebook, may be less suitable to user’s active engagement in identity construction. Dissatisfaction with school-based sexual health education appears to be a catalyst for online information-seeking, but school-based sexual health education did little to equip young people to use the online environment effectively. Conclusions: Gender, sexual identity, stigma, structural factors and social support converge and intersect around young people’s SHL. A broad range of targeted interventions are needed to improve SHL, focusing on overcoming stigma, presenting positive messages and developing interactive and critical skills. Schools could do more to develop SHL skills, including teaching the digital and critical skills to seek and appraise online information. Expanding online sexual health services may effectively complement traditional services and encourage uptake, but it is essential that research establishes a robust, comprehensive conceptualisation of SHL, and develops measurement tools specific to SHL such that interventions can be evaluated and refined.

The Earth’s atmosphere supports microorganisms and they include potential pathogens and microbial allergens. Whilst indoor environments have been well studied, relatively little is known of bio-aerosols in outdoor locations and their potential influence on human health, particularly with regard to urban development. Hong Kong provides an ideal model system for testing hypotheses related to the impact of urbanization on bio-aerosols, with a well-defined gradient of urbanization and large population. This thesis describes work to establish the biodiversity and spatio-temporal dynamics of outdoor bio-aerosols in Hong Kong. A comprehensive study of multi-domain microbial diversity and allergen levels in urban aerosols over a contiguous annual timescale and along a gradient of urbanization was carried out. A comprehensive suite of climatic and pollutant variables were also recorded during the sampling interval. Terminal restriction fragment length polymorphism (T-RFLP) was employed to investigate variations in bacterial and eukaryal assemblages, followed by phylogenetic assessment using high-throughput sequencing. The results revealed a strong seasonality in both bacterial and eukaryal assemblages, with Archaea forming a negligible part of the urban bio-aerosols. The most abundant bacteria were proteobacteria but community shifts were seen due to increases in algae in summer, and betaproteobacteria and cyanobacteria in winter. This was most parsimoniously explained by considering the backward trajectory analysis of air mass. A greater abundance of marine-associated phylotypes such as Bacillariophyta and Chlorophyta were identified when the dominant air mass arriving in Hong Kong in the summer originated from oceanic sources. In contrast, betaproteobacteria, which indicated soil sources were prevalent when the origin of air mass was from terrestrial sources. A trend in fungal phylotypes was also apparent, with summer samples dominated by basidiomycetous Agaricales, and winter samples by the ascomycete genus Cladosporium. This was likely due to favourable climatic conditions during wetter summer months enhancing release of fungal basidiospores. A range of airborne human pathogens was also detectable at low levels including pathogenic bacteria such as Acinetobacter baumannii, Clostridium perfringens, Escherichia coli O157:H7, and Ricinus communis, and the pathogenic fungus Aspergillus terreus. Microbial allergens including bacterial endotoxins and fungal glucans were also quantified with immunological assays. These generally followed variations in biomass, and during some months were recorded at levels that may impact human health upon chronic exposure. Carbon dioxide levels were the only climatic or pollutant variable that correlated with allergen levels. Conversely changes in microbial assemblages were strongly correlated to several climatic variables including temperature, rainfall, air pressure and relative humidity, but not with the degree of urbanization or airborne pollutants. This study highlights the importance of including microbial assessments in future bio-surveillance of urban aerosols.
published_or_final_version
Biological Sciences
Doctoral
Doctor of Philosophy

Hazardous waste management practices at ten medical institutions in Cape Town were studied and tests undertaken to determine concentrations of specific chemicals and radioactivity in liquid effluent outflows, as well as emissions from incinerators. To investigate the sewage outflow for Chemical Oxygen Demand (COD), N, pH and heavy metals, a continuous sampler was installed at two hospitals and a Medical School. Samples were analysed by atomic absorption spectrometry for As, Hg, Cd, Co, Cr, Cu, Mn, Ni, Pb, Zn and Fe. Mercury levels ranged from l-70μg l⁻¹, exceeding the Environmental Target Quality of 0.04μg l⁻¹, and the South African General Effluent Standard of 20μg l⁻¹ . All other heavy metals were below General Effluent Standard Limits. In addition, a sludge sample from the Athlone Wastewater Plant was tested for Hg, realising 6mg kg⁻¹ on a dry weight basis, which was within Department of Health (DOH) Guidelines of 10 mg kg⁻¹. Samples of incinerator bottom ash analysed for heavy metal content gave Hg concentrations of 1.1-4.0mg kg⁻¹, and Zn concentrations of 5.1-11.0g kg⁻¹. Incinerator ash was also analysed for radio-activity and substantial levels of ¹²⁵I (332-650 bq kg⁻¹ ), and Ga⁶⁷ (9186bq kg⁻¹) recorded, which exceeded the South African limits of 200bq kg⁻¹. In Cape Town, hospital incinerators are old, burn large amounts of plastics and produce toxic emissions. They are all situated in residential or inner-city areas, and even though there is legislation dealing with emissions and chemical waste, these laws are not being enforced. Based on the above results, an investigation was carried out to assess attitudes to and knowledge of hazardous waste in the ten institutions. One thousand questionnaires were administered to staff, and the data from the 80% response rate statistically analysed. Results suggest that there is an urgent need for an holistic approach to toxic waste management, encompassing enforceable legislation coupled with on-going educational programmes and strong support from top management and all levels of staff.

The Tibetan Buddhist approach to healing, health and death is rooted in the sacred. Its teachings and techniques create a road map guiding the practitioner through the process of purification called sacred healing. It encompasses foundational Buddhist teachings, sacred Buddhist medicine, and the esoteric healing pathways found in tantra and yoga, which together constitute a detailed and technical guide to healing. The mind is central to all aspects of Tibetan Buddhism. The ability to focus the mind through meditation during life enables the practitioner to prepare for death by experiencing the subtle aspects of the body and mind through the chakras. Both Tibetan spiritual teachers and doctors practise healing and help practitioners learn to focus their minds in preparation for death. The moment of death presents the greatest opportunity for attaining sacred health, but healing can also occur after death. The objective of this thesis is to present the Tibetan Buddhist understanding of sacred healing in relation to life, death, the bardos and suicide through its texts, teachings and techniques.

Particularly in the health domain, humans thrive to reach an equilibrium between maximizing pleasure and minimizing harm. I propose that a cognitive strategy people employ to reach this equilibrium is the activation of Compensatory Health Beliefs (CHBs). CHBs are beliefs that the negative effects of an unhealthy behavior can be compensated for, or "neutralized," by engaging in another, healthy behavior. "I can eat this piece of cake now because I will exercise this evening" is an example of such beliefs. This thesis presents a theoretical framework which aims at explaining why people create CHBs and how they employ CHBs to regulate their health behaviors. The model extends current health behavior models by explicitly integrating the motivational conflict that emerges from the interplay between affective states (i.e., cravings or desires) and motivation (i.e., health goals). The first study includes a psychometric scale that measures CHBs in the general population and provides data on its reliability and validity. The results showed that scores on the scale were uniquely associated with health-related risk behaviors and symptom reports and could be differentiated from a number of related constructs. Holding CHBs may hinder individuals from acquiring healthier lifestyles, for example lose weight or exercise. The second large-scale study of this thesis aimed at studying CHBs in adolescents with type 1 diabetes. It is proposed that in this population, CHBs might interfere with treatment adherence. If compensatory behaviors fail to compensate for the maladaptive behaviors, poor blood glucose control and related health problems may arise. To investigate this further, I developed and validated a CHB scale specific to type 1 diabetes. The scale was validated in a sample of adolescents with type 1 diabetes. Results showed that holding maladaptive compensatory health beliefs was associated with poorer blood glucose control and poorer adherence to self-care behaviors while adaptive CHBs were associated with better blood glucose control and better adherence to treatment behaviors. Specifically targeting CHBs in an intervention could improve adherence to treatment and therefore the long-term health of this population. Future research as well as the implications for possible interventions are explicitly being discussed.

The primary goal of this dissertation was to examine the crossover effects of an individual's job demands on the perceived health of the spouse. Using a sample of grocery store employees and their partners, crossover relationships were examined for 90 dyads using Structural Equation Modeling. Although the models had good fit, the proposed direct crossover relationships of job demands on health were not supported. Job demands of one partner did not significantly predict health outcomes in the other partner; although follow-up analyses found significant crossover of women's job satisfaction on men's mental health scores. An additional crossover relationship was supported with the finding that crossover of health between spouses (i.e. physical and mental health components of general health) was significant. The second goal of the present dissertation study was to develop a typology of crossover research. All crossover studies to date were reviewed and categorized in a discussion of the proposed typology.

During the last decades, the interest in corrosion of metals and alloys from an environmental and health perspective has increased rapidly as a consequence of stricter environmental and human exposure legislations, their extensive use as implant materials and an increasing understanding related to occupational and/or daily exposure to airborne particles. Corrosion-induced metal release, however, needs to be understood in detail and to include knowledge related to chemical speciation, i.e. the oxidation state, complexation and chemical form of released metals, parameters of high importance when considering toxicity. In this licentiate work, corrosion-induced metal runoff from roofing materials (copper, zinc, and chromium(III)-, and chromium(VI) surface treated galvanized steel) has been investigated from an environmental perspective with focus on chemical speciation of released metals (Papers I-II). From these papers it was evident that the total concentration measured in the runoff water is not sufficient for any environmental risk assessment. The environmental fate including changes in chemical speciation and hence metal precipitation has to be considered. For example, it was shown that the copper concentration decreased by three orders of magnitude already in the internal drainage system of a shopping centre with a copper roof, to a concentration lower than storm water collected from a nearby parking space (Paper I). Also, speciation measurements can explain corrosion, metal release and surface processes of chromium surface treated galvanized steel at different sites (urban and marine). Any environmental risk assessment has to be done by considering all metal species released, and compared with ecotoxic values. For example, when most chromium(VI) (the most toxic species) was released, significantly less zinc was released at the same time which decreased the overall ecotoxicity of the runoff water significantly (Paper II). When assessing environmental risks by standard laboratory tests, it is important to understand all mechanisms which are possibly influenced by individual experimental parameters and which often are different for different test substances. Some metals released, as seen in the case of iron, may precipitate with time and be pH-, solution- and buffering dependent. This behavior can lead to strongly underestimated measured metal concentrations (Paper III). When particles of metals or alloys are to be investigated (Papers III-VI), it is essential to conduct a thorough particle characterization, since the surface properties cannot be defined. In addition, the surface properties (oxide layer properties) change with varying particle size (Paper VI) and with other experimental parameters such as dispersion (Paper VI). All iron-, and chromium-based particles investigated (Papers III-VI) revealed large differences between alloy particles and pure metals. Particles of pure iron and nickel released significantly more metals compared with particles of the investigated alloys, whereas particles of pure chromium released less metals compared with the alloys. Particles of stainless steel (AISI 316L), ferro-chromium and ferro-silicon-chromium released very low amounts of metals (Papers III-VI). The released quantity increased with increased acidity (Papers III-VI) and also in the presence of complexing agents (ongoing research). The manufacturing process is of high importance, as observed for stainless steel particles when compared with a side product from stainless steel production with similar composition that released significantly more metals (Paper III). Particles of metal oxides, i.e. chromium(III)oxide and iron(II,III)oxide, released very low amounts of metals due to their thermodynamic stability. Ongoing research activities focus on the specific influence of complexing agents and proteins on the metal release process from massive sheet and particles of metals and alloys. The applicability and the possibility to use different analytical tools are investigated and elaborated for small-sized particles. A detailed understanding of the correlation between material and particle characteristics, the metal release process, the chemical speciation in interaction with proteins and/or cells, and the particle/cell interaction is essential to enable any correlation between material/particle characteristics and toxicity. The aim of this licentiate summary is – in contrast to the six included scientific papers – to explain the importance of chemical speciation for corrosion processes from a health and environmental perspective in a popular way to reach a broad non-academic audience. The summary is hence written as a guidance document for stakeholders and the regulatory community working with environmental and health risk assessment.
QC 20101006