4,002 research outputs found

    UMSL Bulletin 2023-2024

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    The 2023-2024 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1088/thumbnail.jp

    Graduate Catalog of Studies, 2023-2024

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    Measuring socioeconomic position in studies of health inequalities

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    There is a consistent finding that the higher the socioeconomic position (SEP), the better the health. The choice of SEP indicator is crucial in explaining these socioeconomic inequalities. However, a poorly motivated use of SEP indicators prevails in the literature on social health inequalities, hampering the transparency and comparability across studies. Its primary aim is to explore different ways of measuring SEP to identify social inequalities in health. The thesis focuses on the most common, objective SEP indicators (education, occupation, and income); subjective SEP; and childhood circumstances. This thesis consists of three papers. Papers I and III apply data from the Troms√ł Study, and Paper II is based on an online survey investigating people's views on SEP, conducted in Norway and Australia. Paper I investigates the potential to combine education and income into a composite score for SEP and how it predicts inequalities in health-related quality of life (HRQoL). Paper II assesses the relative importance of objective SEP indicators and childhood circumstances in estimating subjective SEP. Paper III explores the role of circumstances and lifestyle factors in estimating inequalities in HRQoL and self-rated health. While we found that the combination of education and income demonstrated a non-linear relationship with overall SEP, the composite SEP score was not superior as a predictor of HRQoL compared to including education and income separately. Furthermore, we found that childhood circumstances demonstrated a lasting, independent impact on subjective SEP. Paper III revealed that there were inequalities arising from circumstances, with substantial contributions from financial circumstances in childhood and education. This thesis demonstrates the need to motivate the choice of SEP indicator in studies of health inequalities. It also stresses the importance of early-life factors as determinants of adult health, advocating for policies targeting childhood circumstances in equalising early life chances.Et sv√¶rt vanlig funn p√• tvers av land, studiepopulasjoner og helseutfall er at desto h√łyere sosio√łkonomisk posisjon (SEP), desto bedre helse. Valg av SEP-indikator som skal reflektere de sosio√łkonomiske dimensjonene i helse er avgj√łrende for √• forklare disse helseulikhetene. Likevel er det slik at bruken av SEP-indikatorer i studier om sosial ulikhet i helse ofte preges av svak eller ingen begrunnelse med utgangspunkt i teori og hypoteser, noe som begrenser muligheten til sammenligning mellom studier. Denne avhandlingen bruker ulike tiln√¶rminger for √• m√•le SEP i studier av helseulikhet. Et overordnet form√•l er √• utforske ulike m√•ter √• m√•le sosial posisjon for √• identifisere sosiale ulikhet i helse, og hvordan livsstilsfaktorer i tillegg p√•virker dette forholdet. Fokuset vil v√¶re p√• de tre vanligste objektive SEP-indikatorene (utdanning, yrke og inntekt); subjektiv SEP; og indikatorer for barndomsforhold. Avhandlingen best√•r av tre artikler. Artikkel I og III er basert p√• data fra Troms√łunders√łkelsen, mens Artikkel II benytter data fra p√• en nettbasert sp√łrreunders√łkelse om folks betraktninger omkring SEP, som har blitt gjennomf√łrt i Norge og Australia. Alle de tre artiklene utforsker bruken av ulike SEP-indikatorer i en helseulikhetssammenheng. Artikkel I unders√łker potensialet for √• kombinere utdanning og inntekt til en samleindikator for SEP, samt hvordan denne samleindikatoren predikerer helse-relatert livskvalitet (HRQoL). Artikkel II m√•ler objektive SEP-indikatorer (utdanning, yrke og inntekt) og barndomsforholds relative betydning i √• estimere subjektiv SEP. Artikkel III utforsker hvordan variabler om barndomsforhold p√• den ene siden og livsstilsfaktorer p√• den andre estimerer HRQoL og selvrapportert helse, b√•de p√• et bestemt tidspunkt og over tid. Vi fant at kombinasjonen av utdanning og inntekt viste en sterk ikke-line√¶r sammenheng med total SEP, mens samleindikatoren for SEP viste seg √• ikke v√¶re bedre i √• predikere HRQoL sammenlignet med √• inkludere utdanning og inntekt separat. Videre fant vi at barndomsforhold s√• ut til √• ha en vedvarende p√•virkning p√• subjektiv SEP, som var uavhengig av objektiv SEP. Artikkel III viste at det var ulikheter i helse med r√łtter i barndomsforhold, med s√¶rlig p√•virkning fra √łkonomiske forhold i barndommen og egen utdanning. Denne avhandlingen viser behovet for √• gj√łre et faglig motivert valg av SEP-indikator i studier av helseulikhet. Den understreker ogs√• viktigheten av barndomsforhold som bestemmende faktorer for helseutfall senere i livet, og etterlyser dermed politikk rettet mot tidlige barndomsforhold for √• utjevne ulikheter og sikre gode livssjanser

    Spatial epidemiology of a highly transmissible disease in urban neighbourhoods: Using COVID-19 outbreaks in Toronto as a case study

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    The emergence of infectious diseases in an urban area involves a complex interaction between the socioecological processes in the neighbourhood and urbanization. As a result, such an urban environment can be the incubator of new epidemics and spread diseases more rapidly in densely populated areas than elsewhere. Most recently, the Coronavirus-19 (COVID-19) pandemic has brought unprecedented challenges around the world. Toronto, the capital city of Ontario, Canada, has been severely impacted by COVID-19. Understanding the spatiotemporal patterns and the key drivers of such patterns is imperative for designing and implementing an effective public health program to control the spread of the pandemic. This dissertation was designed to contribute to the global research effort on the COVID-19 pandemic by conducting spatial epidemiological studies to enhance our understanding of the disease's epidemiology in a spatial context to guide enhancing the public health strategies in controlling the disease. Comprised of three original research manuscripts, this dissertation focuses on the spatial epidemiology of COVID-19 at a neighbourhood scale in Toronto. Each manuscript makes scientific contributions and enhances our knowledge of how interactions between different socioecological processes in the neighbourhood and urbanization can influence spatial spread and patterns of COVID-19 in Toronto with the application of novel and advanced methodological approaches. The findings of the outcomes of the analyses are intended to contribute to the public health policy that informs neighbourhood-based disease intervention initiatives by the public health authorities, local government, and policymakers. The first manuscript analyzes the globally and locally variable socioeconomic drivers of COVID-19 incidence and examines how these relationships vary across different neighbourhoods. In the global model, lower levels of education and the percentage of immigrants were found to have a positive association with increased risk for COVID-19. This study provides the methodological framework for identifying the local variations in the association between risk for COVID-19 and socioeconomic factors in an urban environment by applying a local multiscale geographically weighted regression (MGWR) modelling approach. The MGWR model is an improvement over the methods used in earlier studies of COVID-19 in identifying local variations of COVID-19 by incorporating a correction factor for the multiple testing problem in the geographically weighted regression models. The second manuscript quantifies the associations between COVID-19 cases and urban socioeconomic and land surface temperature (LST) at the neighbourhood scale in Toronto. Four spatiotemporal Bayesian hierarchical models with spatial, temporal, and varying space-time interaction terms are compared. The results of this study identified the seasonal trends of COVID-19 risk, where the spatiotemporal trends show increasing, decreasing, or stable patterns, and identified area-specific spatial risk for targeted interventions. Educational level and high land surface temperature are shown to have a positive association with the risk for COVID-19. In this study, high spatial and temporal resolution satellite images were used to extract LST, and atmospheric corrections methods were applied to these images by adopting a land surface emissivity (LSE) model, which provided a high estimation accuracy. The methodological approach of this work will help researchers understand how to acquire long time-series data of LST at a spatial scale from satellite images, develop methodological approaches for atmospheric correction and create the environmental data with a high estimation accuracy to fit into modelling disease. Applying to policy, the findings of this study can inform the design and implementation of urban planning strategies and programs to control disease risks. The third manuscript developed a novel approach for visualization of the spread of infectious disease outbreaks by incorporating neighbourhood networks and the time-series data of the disease at the neighbourhood level. The findings of the model provide an understanding of the direction and magnitude of spatial risk for the outbreak and guide for the importance of early intervention in order to stop the spread of the outbreak. The manuscript also identified hotspots using incidence rate and disease persistence, the findings of which may inform public health planners to develop priority-based intervention plans in a resource constraint situation

    Communicating a Pandemic

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    This edited volume compares experiences of how the Covid-19 pandemic was communicated in the Nordic countries ‚Äď Denmark, Finland, Iceland, Norway, and Sweden. The Nordic countries are often discussed in terms of similarities concerning an extensive welfare system, economic policies, media systems, and high levels of trust in societal actors. However, in the wake of a global pandemic, the countries‚Äô coping strategies varied, creating certain question marks on the existence of a ‚ÄúNordic model‚ÄĚ. The chapters give a broad overview of crisis communication in the Nordic countries during the first year of the Covid-19 pandemic by combining organisational and societal theoretical perspectives and encompassing crisis response from governments, public health authorities, lobbyists, corporations, news media, and citizens. The results show several similarities, such as political and governmental responses highlighting solidarity and the need for exceptional measures, as expressed in press conferences, social media posts, information campaigns, and speeches. The media coverage relied on experts and was mainly informative, with few critical investigations during the initial phases. Moreover, surveys and interviews show the importance of news media for citizens‚Äô coping strategies, but also that citizens mostly trusted both politicians and health authorities during the crisis. This book is of interest to all who are looking to understand societal crisis management on a comprehensive level.‚ÄĮThe volume contains chapters from leading experts from all the Nordic countries and is edited by a team with complementary expertise on crisis communication, political communication, and journalism, consisting of Bengt Johansson, √ėyvind Ihlen, Jenny Lindholm, and Mark Blach-√ėrsten.‚ÄĮPublishe

    A Multi-level Analysis on Implementation of Low-Cost IVF in Sub-Saharan Africa: A Case Study of Uganda.

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    Introduction: Globally, infertility is a major reproductive disease that affects an estimated 186 million people worldwide. In Sub-Saharan Africa, the burden of infertility is considerably high, affecting one in every four couples of reproductive age. Furthermore, infertility in this context has severe psychosocial, emotional, economic and health consequences. Absence of affordable fertility services in Sub-Saharan Africa has been justified by overpopulation and limited resources, resulting in inequitable access to infertility treatment compared to developed countries. Therefore, low-cost IVF (LCIVF) initiatives have been developed to simplify IVF-related treatment, reduce costs, and improve access to treatment for individuals in low-resource contexts. However, there is a gap between the development of LCIVF initiatives and their implementation in Sub-Saharan Africa. Uganda is the first country in East and Central Africa to undergo implementation of LCIVF initiatives within its public health system at Mulago Women’s Hospital. Methods: This was an exploratory, qualitative, single, case study conducted at Mulago Women’s Hospital in Kampala, Uganda. The objective of this study was to explore how LCIVF initiatives have been implemented within the public health system of Uganda at the macro-, meso- and micro-level. Primary qualitative data was collected using semi-structured interviews, hospital observations informal conversations, and document review. Using purposive and snowball sampling, a total of twenty-three key informants were interviewed including government officials, clinicians (doctors, nurses, technicians), hospital management, implementers, patient advocacy representatives, private sector practitioners, international organizational representatives, educational institution, and professional medical associations. Sources of secondary data included government and non-government reports, hospital records, organizational briefs, and press outputs. Using a multi-level data analysis approach, this study undertook a hybrid inductive/deductive thematic analysis, with the deductive analysis guided by the Consolidated Framework for Implementation Research (CFIR). Findings: Factors facilitating implementation included international recognition of infertility as a reproductive disease, strong political advocacy and oversight, patient needs & advocacy, government funding, inter-organizational collaboration, tension to change, competition in the private sector, intervention adaptability & trialability, relative priority, motivation &advocacy of fertility providers and specialist training. While barriers included scarcity of embryologists, intervention complexity, insufficient knowledge, evidence strength & quality of intervention, inadequate leadership engagement & hospital autonomy, poor public knowledge, limited engagement with traditional, cultural, and religious leaders, lack of salary incentives and concerns of revenue loss associated with low-cost options. Research contributions: This study contributes to knowledge of factors salient to implementation of LCIVF initiatives in a Sub-Saharan context. Effective implementation of these initiatives requires (1) sustained political support and favourable policy & legislation, (2) public sensitization and engagement of traditional, cultural, and religious leaders (3) strengthening local innovation and capacity building of fertility health workers, in particular embryologists (4) sustained implementor leadership engagement and inter-organizational collaboration and (5) proven clinical evidence and utilization of LCIVF initiatives in innovator countries. It also adds to the literature on the applicability of the CFIR framework in explaining factors that influence successful implementation in developing countries and offer opportunities for comparisons across studies

    Sociodemographic, nutritional and health status factors associated with adherence to Mediterranean diet in an agricultural Moroccan adult's population

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    Background. Numerous studies have demonstrated beneficial effects of adherence to the Mediterranean diet (MD) on many chronic diseases, including chronic kidney disease (CKD). Objective. The aim of this study was to assess the adherence of a rural population to the Mediterranean diet, to identify the sociodemographic and lifestyle determinants and to analyze the association between adherence to MD and CKD. Material and Methods. In a cross-sectional study, data on sociodemographic, lifestyle factors, clinical, biochemical parameters and diet were collected on a sample of 154 subjects. Adherence to MD was assessed according to a simplified MD score based on the daily frequency of intake of eight food groups (vegetables, legumes, fruits, cereal or potatoes, fish, red meat, dairy products and MUFA/SFA), using the sex specific sample medians as cut-offs. A value of 0 or 1 was assigned to consumption of each component according to its presumed detrimental or beneficial effect on health. Results. According to the simplified MD score, the study data show that high adherence (44.2%) to MD was characterized by intakes high in vegetables, fruits, fish, cereals, olive oil, and low in meat and moderate in dairy. Furthermore, several factors such as age, marital status, education level, and hypertension status were associated with the adherence to MD in the study population. The majority of subjects with CKD have poor adherence to the MD compared to non-CKD with a statistically insignificant difference. Conclusions. In Morocco, maintaining the traditional MD pattern play crucial role for public health. More research is needed in this area to precisely measure this association
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