Psychological Aspects in Children and Adolescents With Major Thalassemia: A Case-Control Study

Background: Thalassemia is an inherited blood disease. It is a serious public health problem throughout the Mediterranean region, the Middle East and the Indian subcontinent, as well as in Southeast Asia. Objectives: Thalassemia is an inherited blood disease. It is a serious public health problem. In this study we assessed psychological aspects in Iranian children and adolescents with thalassemia major. Patients and Methods: In this case-control study sixty healthy subjects aged 7-18 years and Sixty Patients with confirmed diagnosis of major thalassemia were enrolled. After obtaining informed consent from parents of all participating thalassemia patients and healthycontrols, we assessed psychological aspects and quality of life by Pediatric Quality of LifeTM (PedsQL™), Strengths and Difficulties Questionnaires (SDQ), State and Trait Anxiety, Children's Depression Inventory (CDI). Results: The results of this study indicate that there are significant changes in depression, anxiety, QOL and behavioral screening between children with thalassemia major compared with healthy subjects by means of both parents and children reports. According to the results, children with thalassemia major have more psychological problems than healthy ones. Patients with thalassemia have a lower QOL than their peers (P = 0.001), the rate of depression is higher in this group (P = 0.015), Also behavioral problems in these children are more than healthy subjects (P = 0.009). Conclusions: We recommend appropriate treatment and counseling procedures in addition to specific treatment of thalassemia. According to the results we suggest to establish pediatric psychiatric clinics beside thalassemic clinics to cure psychological aspects of the disease.

EVALUATING THE OIL SANDS RECLAMATION PROCESS: ASSESSING POLICY CAPACITY AND STAKEHOLDER ACCESS FOR GOVERNMENT AND NON-GOVERNMENTAL ORGANIZATIONS OPERATING IN ALBERTA’S OIL SANDS

By employing interpretive policy analysis this thesis aims to assess, measure, and explain policy capacity for government and non-government organizations involved in reclaiming Alberta's oil sands. Using this type of analysis to assess policy capacity is a novel approach for understanding reclamation policy; and therefore, this research will provide a unique contribution to the literature surrounding reclamation policy. The oil sands region in northeast Alberta, Canada is an area of interest for a few reasons; primarily because of the vast reserves of bitumen and the environmental cost associated with developing this resource. An increase in global oil demand has established incentive for industry to seek out and develop new reserves. Alberta's oil sands are one of the largest remaining reserves in the world, and there is significant interest in increasing production in this region. Furthermore, tensions in several oil exporting nations in the Middle East remain unresolved, and this has garnered additional support for a supply side solution to North American oil demands. This solution relies upon the development of reserves in both the United States and Canada. These compounding factors have contributed to the increased development in the oil sands of northeastern Alberta. Essentially, a rapid expansion of oil sands operations is ongoing, and is the source of significant disturbance across the region. This disturbance, and the promises of reclamation, is a source of contentious debates amongst stakeholders and continues to be highly visible in the media. If oil sands operations are to retain their social license to operate, it is critical that reclamation efforts be effective. One concern non-governmental organizations (NGOs) expressed criticizes the current monitoring and enforcement of regulatory programs in the oil sands. Alberta's NGOs have suggested the data made available to them originates from industrial sources, and is generally unchecked by government. In an effort to discern the overall status of reclamation in the oil sands this study explores several factors essential to policy capacity: work environment, training, employee attitudes, perceived capacity, policy tools, evidence based work, and networking. Data was collected through key informant interviews with senior policy professionals in government and non-government agencies in Alberta. The following are agencies of interest in this research: Canadian Association of Petroleum Producers (CAPP); Alberta Environment and Sustainable Resource Development (AESRD); Alberta Energy Regulator (AER); Cumulative Environmental Management Association (CEMA); Alberta Environment Monitoring, Evaluation, and Reporting Agency (AEMERA); Wood Buffalo Environmental Association (WBEA). The aim of this research is to explain how and why reclamation policy is conducted in Alberta's oil sands. This will illuminate government capacity, NGO capacity, and the interaction of these two agency typologies. In addition to answering research questions, another goal of this project is to show interpretive analysis of policy capacity can be used to measure and predict policy effectiveness. The oil sands of Alberta will be the focus of this project, however, future projects could focus on any government policy scenario utilizing evidence-based approaches.

Organized Labor and U.S. Foreign Policy: The Solidarity Center in Historical Context

During the Cold War the foreign policy of the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), was heavily criticized by scholars and activists for following the lead of the U.S. state in its overseas operations. In a wide range of states, the AFL-CIO worked to destabilize governments selected by the U.S. state for regime change, while in others the Federation helped stabilize client regimes of the U.S. state. In 1997 the four regional organizations that previously carried out AFL-CIO foreign policy were consolidated into the American Center for International Labor Solidarity (Solidarity Center). My dissertation is an attempt to analyze whether the foreign policy of the AFL-CIO in the Solidarity Center era is marked by continuity or change with past practices. At the same time, this study will attempt to add to the debate over the role of non-governmental organizations (NGOs) in the post-Cold War era, and its implications for future study. Using the qualitative “process-tracing” detailed by of Alexander George and Andrew Bennett (2005) my study examines a wide array of primary and secondary sources, including documents from the NED and AFL-CIO, in order to analyze the relationship between the Solidarity Center and the U.S. state from 2002-2009. Furthermore, after analyzing broad trends of NED grants to the Solidarity Center, this study examines three dissimilar case studies including Venezuela, Haiti, and Iraq and the Middle East and North African (MENA) region to further explore the connections between U.S. foreign policy goals and the Solidarity Center operations. The study concludes that the evidence indicates continuity with past AFL-CIO foreign policy practices whereby the Solidarity Center follows the lead of the U.S. state. It has been found that the patterns of NED funding indicate that the Solidarity Center closely tailors its operations abroad in areas of importance to the U.S. state, that it is heavily reliant on state funding via the NED for its operations, and that the Solidarity Center works closely with U.S. allies and coalitions in these regions. Finally, this study argues for the relevance of “top-down” NGO creation and direction in the post-Cold War era.

Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

Background: Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings: We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation: During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

Background: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. Methods: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence - defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs - in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. Findings: We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4-7·0) in 1980 to 9·0% (7·2-11·1) in 2014 in men, and from 5·0% (2·9-7·9) to 7·9% (6·4-9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Interpretation Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults aff ected, has increased faster in low-income and middle-income countries than in high-income countries.

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On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

PDF Pre-Preface

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

PDF Preface

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

DOC X Preface

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

DOC X Pre-Preface

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

PDF Introduction

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

DOC X Introduction

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

PDF Language of the Journal

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

PDF Abbrev Notes

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.

DOC X Abbrev Notes

On the 15th of April, 1897, a 19 year-old European resident of Baghdad, named Alexander Richard Svoboda, set out on a long journey to Europe by caravan, boat and train. From a large and influential family of merchants, artists, and explorers settled in Ottoman Iraq since the end of the 18th century, Alexander traveled in the company of his parents and a departing British diplomat accompanied by his retinue. They followed a circuitous route through the Middle East to Cairo and thence to Europe on a three and a half month journey which Alexander described day-by-day in a journal written in the Iraqi Arabic of his time.