Evaluation of email alerts in practice: Part 2. Validation of the information assessment method.

RATIONALE AND OBJECTIVE:. The information assessment method (IAM) permits health professionals to systematically document the relevance, cognitive impact, use and health outcomes of information objects delivered by or retrieved from electronic knowledge resources. The companion review paper (Part 1) critically examined the literature, and proposed a 'Push-Pull-Acquisition-Cognition-Application' evaluation framework, which is operationalized by IAM. The purpose of the present paper (Part 2) is to examine the content validity of the IAM cognitive checklist when linked to email alerts. METHODS: A qualitative component of a mixed methods study was conducted with 46 doctors reading and rating research-based synopses sent on email. The unit of analysis was a doctor's explanation of a rating of one item regarding one synopsis. Interviews with participants provided 253 units that were analysed to assess concordance with item definitions. RESULTS AND CONCLUSION: The content relevance of seven items was supported. For three items, revisions were needed. Interviews suggested one new item. This study has yielded a 2008 version of IAM.

Deviations of Governance In IT Multi-Sourcing: A Case Study

IT outsourcing (ITO) refers to the shift of IT/IS activities from internal to external of an organization. In prior research, the governance of ITO is recognized with persistent strategic importance for practice, because it is tightly related to ITO success. Under the rapid transformation of global market, the evolving practice of ITO requires updated knowledge on effective governance. However, research on ITO governance is still under developed due to the lack of integrated theoretical frameworks and the variety of empirical settings besides dyadic client-vendor relationships. Especially, as multi-sourcing has become an increasingly common practice in ITO, its new governance challenges must be attended by both ITO researchers and practitioners. To address this research gap, this study aims to understand multi-sourcing governance with an integrated theoretical framework incorporating both governance structure and governance mechanisms. The focus is on the emerging deviations among formal, perceived and practiced governance. With an interpretive perspective, a single case study is conducted with mixed methods of Social Network Analysis (SNA) and qualitative inquiries. The empirical setting embraces one client firm and its two IT suppliers for IT infrastructure services. The empirical material is analyzed at three levels: within one supplier firm, between the client and one supplier, and among all three firms. Empirical evidences, at all levels, illustrate various deviations in governance mechanisms, with which emerging governance structures are shaped. This dissertation contributes to the understanding of ITO governance in three domains: the governance of ITO in general, the governance of multi-sourcing in particular, and research methodology. For ITO governance in general, this study has identified two research strands of governance structure and governance mechanisms, and integrated both concepts under a unified framework. The composition of four research papers contributes to multi-sourcing research by illustrating the benefits of zooming in and out across the multilateral relationships with different aspects and scopes. Methodologically, the viability and benefit of mixed-method is illustrated and confirmed for both researchers and practitioners.

Predictors of knowledge creation performance. A quantitative qualitative comparative study of European doctorandi

Aquesta tesi forma part d'un projecte destinat a predir el rendiment acadèmic dels estudiants de doctorat portat a terme per l'INSOC (International Network on Social Capital and Performance). El grup de recerca INSOC està format per les universitats de Girona (Espanya), Ljubljana (Eslovènia), Giessen (Alemanya) i Ghent (Bèlgica). El primer objectiu d'aquesta tesi és desenvolupar anàlisis quantitatius comparatius sobre el rendiment acadèmic dels estudiants de doctorat entre Espanya, Eslovènia i Alemanya a partir dels resultats individuals del rendiment acadèmic obtinguts de cada una de les universitats. La naturalesa internacional del grup de recerca implica la recerca comparativa. Vam utilitzar variables personal, actitudinals i de xarxa per predir el rendiment. El segon objectiu d'aquesta tesi és entendre de manera qualitativa perquè les variables de xarxa no ajuden quantitativament a predir el rendiment a la universitat de Girona (Espanya). En el capítol 1, definim conceptes relacionats amb el rendiment i donam un llistat de cada una de les variables independents (variables de xarxa, personals i actitudinals), resumint la lliteratura. Finalment, explicam com s'organitzen els estudis de doctorat a cada un dels diferents països. A partir d'aquestes definicions teòriques, en els pròxims capítols, primer presentarem els qüestionaris utilitzats a Espanya, Eslovènia i Alemanya per mesurar aquests diferents tipus de variables. Després, compararem les variables que són relevants per predir el rendiment dels estudiants de doctorat a cada país. Després d'això, fixarem diferents models de regressió per predir el rendiment entre països. En tots aquests models les variables de xarxa fallen a predir el rendiment a la Universitat de Girona. Finalment, utilitzem estudis qualitatius per entendre aquests resultats inesperats. En el capítol 2, expliquem com hem dissenyat i conduït els qüestionaris en els diferents països amb l'objectiu d'explicar el rendiment dels estudiants de doctorat obtinguts a Espanya, Eslovènia i Alemanya. En el capítol 3, cream indicadors comparables però apareixen problemes de comparabilitat en preguntes particulars a Espanya, Eslovènia i Alemanya. En aquest capítol expliquem com utilitzem les variables dels tres països per crear indicadors comparables. Aquest pas és molt important perquè el principal objectiu del grup de recerca INSOC és comparar el rendiment dels estudiants de doctorat entre els diferents països. En el capítol 4 comparem models de regressió obtinguts de predir el rendiment dels estudiants de doctorat a les universitats de Girona (Espanya) i Eslovènia. Les variables són característiques dels grups de recerca dels estudiants de doctorat enteses com una xarxa social egocèntrica, característiques personals i actitudinals dels estudiants de doctorat i algunes carecterístiques dels directors. Vam trobar que les variables de xarxa egocèntriques no predien el rendiment a la Universitat de Girona. En el capítol 5, comparem dades eslovenes, espanyoles i alemnayes, seguint la metodologia del capítol 4. Concluïm que el cas alemany és molt diferent. El poder predictiu de les variables de xarxa no millora. En el capítol 6 el grup de recerca dels estudiants de doctorat és entès com una xarxa duocèntrica (Coromina et al., 2008), amb l'objectiu d'obtendre informació de la relació mútua entre els estudiants i els seus directors i els contactes d'ambdós amb els altres de la xarxa. La inclusió de la xarxa duocèntrica no millora el poder predictiu del model de regressió utilitzant les variales egocèntriques de xarxa. El capítol 7 pretèn entendre perquè les variables de xarxa no predeixen el rendiment a la Universitat de Girona. Utilitzem el mètode mixte, esperant que l'estudi qualitatiu pugui cobrir les raons de perquè la qualitat de la xarxa falla en la qualitat del treball dels estudiants. Per recollir dades per l'estudi qualitatiu utilitzem entrevistes en profunditat.

Brazilian migration to Guyana as livelihood strategy: a case study approach

Este estudo de caso de metodologia mista foi conduzido com foco na migração brasileira para a Guiana como uma estratégia de sobrevivência. O estudo examinou, descreveu e analisou o processo da migração e da adaptação, e os impactos socioeconômicos e ambientais físicos e as preocupações associadas com as atividades de sobrevivência destes migrantes na Guiana. Foram utilizados questionários, entrevistas, documentários, arquivos e observações (direta e participante) com o objetivo de obter um entendimento profundo do fenômeno em questão. O estudo confirma que através de um forte sistema de rede, os brasileiros de classes socioeconômicas e culturais mais baixas são capazes de adotar a migração como estratégia de sobrevivência, à medida que eles migram através de uma rota por passos (step-wise) prédefinida para a Guiana. Este sistema de rede permite aos migrantes responderem prontamente às novas atividades de sobrevivência tanto interna como internacionalmente. Na Guiana, a mineração e a prostituição são identificadas como as principais atividades de sobrevivência que tem gerado conseqüências socioeconômicas tanto positivas quanto negativas e impactos ambientais negativos.

Ecosystem service trade-offs and stakeholder claims - a meso-scale study from a Madagascar biodiversity hotspot

The north-eastern escarpment of Madagascar has been labelled a global biodiversity hotspot due to its extremely high rates of endemic species which are heavily threatened by accelerated deforestation rates and landscape change. The traditional practice of shifting cultivation or "tavy" used by the majority of land users in this area to produce subsistence rice is commonly blamed for these threats. A wide range of stakeholders ranging from conservation to development agencies, and from the private to the public sector has therefore been involved in trying to find solutions to protect the remaining forest fragments and to increase agricultural production. Consequently, provisioning, regulating and socio-cultural services of this forest-mosaic landscape are fundamentally altered leading to trade-offs between them and consequently new winners and losers amongst the stakeholders at different scales. However, despite a growing amount of evidence from case studies analysing local changes, the regional dynamics of the landscape and their contribution to such trade-offs remain poorely understood. This study therefore aims at using generalised landscape units as a base for the assessment of multi-level stakeholder claims on ecosystem services to inform negotiation, planning and decision making at a meso-scale. The presented study applies a mixed-method approach combining remote sensing, GIS and socio-economic methods to reveal current landscape dynamics, their change over time and the corresponding ecosystem service trade-offs induced by diverse stakeholder claims on the regional level. In a first step a new regional land cover classification for three points in time (1995, 2005 and 2011) was conducted including agricultural classes characteristic for shifting cultivation systems. Secondly, a novel GIS approach, termed “landscape mosaics approach” originally developed to assess dynamics of shifting cultivation landscapes in Laos was applied. Through this approach generalised landscape mosaics were generated allowing for a better understanding of changes in land use intensities instead of land cover. As a next step we will try to use these landscape units as proxies to map provisioning and regulating ecosystem services throughout the region. Through the overlay with other regional background data such as accessibility and population density and information from a region-wide stakeholder analysis, multiscale trade-offs between different services will be highlighted. The trade-offs observed on the regional scale will then be validated through a socio-economic ground-truthing within selected sites at the local scale. We propose that such meso-scale knowledge is required by all stakeholders involved in decision making towards sustainable development of north-eastern Madagascar.

Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR): study protocol for a randomised clinical trial

Background Heart valve diseases are common with an estimated prevalence of 2.5% in the Western world. The number is rising due to an ageing population. Once symptomatic, heart valve diseases are potentially lethal, and heavily influence daily living and quality of life. Surgical treatment, either valve replacement or repair, remains the treatment of choice. However, post surgery, the transition to daily living may become a physical, mental and social challenge. We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after heart valve surgery. Methods A randomised clinical trial, CopenHeartVR, aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after heart valve surgery. The trial will randomly allocate 210 patients, 1:1 intervention to control group, using central randomisation, and blinded outcome assessment and statistical analyses. The intervention consists of 12 weeks of physical exercise, and a psycho-educational intervention comprising five consultations. Primary outcome is peak oxygen uptake (VO2 peak) measured by cardiopulmonary exercise testing with ventilatory gas analysis. Secondary outcome is self-assessed mental health measured by the standardised questionnaire Short Form 36. Also, long-term healthcare utilisation and mortality as well as biochemistry, echocardiography and cost-benefit will be assessed. A mixed-method design is used to evaluate qualitative and quantitative findings encompassing a survey-based study before the trial and a qualitative pre- and post-intervention study. Discussion The study is approved by the local regional Research Ethics Committee (H-1-2011-157), and the Danish Data Protection Agency (j.nr. 2007-58-0015).

Breastfeeding the very preterm hospitalized infant: An ethnographic study

Purpose. To develop a greater understanding of the experience—including the thoughts, feelings, and actions—of mothers' initiation and maintenance of lactation within the context of the NICU following the birth of a very preterm infant. ^ Design. Mixed method with dominant focused ethnographic approach. Setting: A 76-bed neonatal intensive care unit in the largest children's hospital located in a large metropolitan city in southeast Texas. ^ Sample. Purposeful sampling resulted in 23 interviews with 14 subjects. ^ Methods. Mixed method design with a dominant qualitative approach combined with a quantitative component to further identify and expand upon the investigation of the population in question. Open-ended semi-structured interviews and fieldwork were used to explore the experience of breastfeeding in the context of the NICU for mothers of very preterm infants. Longitudinal data obtained from each subject included in-depth interviews, demographic and clinical information, milk expression patterns (including pumping frequency, duration, and milk volumes obtained), and scores obtained from the Edinburgh Postpartum Depression Scale (EPDS). ^ Findings. Thematic analysis revealed that mothers of very preterm infants experienced an interruption in the process of becoming a mother, a paradoxical experience related to aspects of their milk expression routines and patterns, and negotiating the NICU environment. Sub-themes of becoming a mother-interrupted included: attribution, separation, connection, and navigation. Additional sub-themes related to the paradoxical experience included: the pump sometimes acting as a wedge or link to the infant; diversionary thoughts/activities during pumping; and perceptions of milk flow/volume. The process of negotiation included the environment, adaptive/maladaptive strategies related to milk expression, motivating factors related to the provision of breast milk, and learning their infant's feeding cues/abilities. EPDS scores did not reveal congruent differences in those mothers scoring high compared to those scoring low. ^ Conclusions. Understanding the experiences of the mothers in this study allows for a better perspective of breastfeeding the very preterm infant in the context of the NICU. Findings from this study validate the difficult and incremental process of attaining maternal identity and the significant burden placed on these women with regards to the provision of breast milk and breastfeeding during their infant's hospitalization. ^

Combining an enterprise resource planning system and informality:a study of efficiency and flexibility complmentarity [sic]

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT One of the current research trends in Enterprise Resource Planning (ERP) involves examining the critical factors for its successful implementation. However, such research is limited to system implementation, not focusing on the flexibility of ERP to respond to changes in business. Therefore, this study explores a combination system, made up of an ERP and informality, intended to provide organisations with efficient and flexible performance simultaneously. In addition, this research analyses the benefits and challenges of using the system. The research was based on socio-technical system (STS) theory which contains two dimensions: 1) a technical dimension which evaluates the performance of the system; and 2) a social dimension which examines the impact of the system on an organisation. A mixed method approach has been followed in this research. The qualitative part aims to understand the constraints of using a single ERP system, and to define a new system corresponding to these problems. To achieve this goal, four Chinese companies operating in different industries were studied, all of which faced challenges in using an ERP system due to complexity and uncertainty in their business environments. The quantitative part contains a discrete-event simulation study that is intended to examine the impact of operational performance when a company implements the hybrid system in a real-life situation. Moreover, this research conducts a further qualitative case study, the better to understand the influence of the system in an organisation. The empirical aspect of the study reveals that an ERP with pre-determined business activities cannot react promptly to unanticipated changes in a business. Incorporating informality into an ERP can react to different situations by using different procedures that are based on the practical knowledge of frontline employees. Furthermore, the simulation study shows that the combination system can achieve a balance between efficiency and flexibility. Unlike existing research, which emphasises a continuous improvement in the IT functions of an enterprise system, this research contributes to providing a definition of a new system in theory, which has mixed performance and contains both the formal practices embedded in an ERP and informal activities based on human knowledge. It supports both cost-efficiency in executing business transactions and flexibility in coping with business uncertainty.This research also indicates risks of using the system, such as using an ERP with limited functions; a high cost for performing informally; and a low system acceptance, owing to a shift in organisational culture. With respect to practical contribution, this research suggests that companies can choose the most suitable enterprise system approach in accordance with their operational strategies. The combination system can be implemented in a company that needs to operate a medium amount of volume and variety. By contrast, the traditional ERP system is better suited in a company that operates a high-level volume market, while an informal system is more suitable for a firm with a requirement for a high level of variety.

Something to talk about: Content and Language Integrated Learning in Modern Languages in British Higher Education. A case study of German at Aston University

This thesis investigates Content and Language Integrated Learning (CLIL) in German undergraduate programmes in the UK. At its core is a study of how one German department integrates the teaching of language and content in its undergraduate programmes and how instructors and students experience this approach. This micro-context is embedded in the wider macro-context of UK Higher Education and subject to outside forces - be they political, economic, socio-cultural - whose effects will manifest in more or less obvious ways. Data was collected via an online survey of Heads of German at British universities to determine the status quo of CLIL in UK Higher Education and to investigate how certain institutional parameters determine the introduction of CLIL in Higher Education. This project employs a mixed-method case study approach and is based on student questionnaires and semi-structured interview with German teaching staff. The study brings to light a number of significant aspects. For example, contrary to popular belief, content provision in the L2 is rather common at British universities, which is currently not reflected in the research. Student data indicates that German students perceive clear advantages in the university’s approach to CLIL. They consider German-taught content classes challenging yet beneficial for their language development. Staff interviews have yielded intriguing information about perceived advantages and disadvantages of CLIL, about its implications for classroom practice, and about instructors’ attitude towards teacher training, which echo findings from similar investigations in European contexts. Finally, the results of the macro-analysis and the case study are compared and contrasted with findings from European research on ICLHE/CLIL to determine differences and similarities with the British context, a set of recommendations is made regarding CLIL practice at the case study institution, and some implications these indings may have for the future of CLIL in British higher education are discussed.

A study of the relationship between educational placement and the achievement of urban low socioeconomic Hispanic middle school students with and without specific learning disabilities

Public schools traditionally have been held accountable for educating the majority of the nation’s school children, and through the years, these schools have been evaluated in a variety of ways. Currently, evaluation measures for accountability purposes consist solely of standardized test scores. In the past, only test scores of general education students were analyzed. Laws governing the education of students with disabilities, however, have extended accountability measures not only to include those students, but to report their scores in a disaggregated form (No Child Left Behind Act, 2001). The recent emphasis on accountability and compliance has resulted in the need for schools to carefully examine how programs, services, and policies impact student achievement (Bowers & Figgers, 2003). ^ Standard-based school reform and accountability systems have raised expectations about student learning outcomes for all students, including those with disabilities and minority students. Yet, overall, racial/ethnic minority students are performing well below their White non-Hispanic peers in most academic areas. Additionally, with respect to special education, there exists an enduring problem of disproportionate representation of racial/ethnic minority students (National Research Council, 2000). ^ This study examined classroom placement (inclusive versus non-inclusive) relative to academic performance of urban, low socioeconomic Hispanic students with and without disabilities in secondary content area classrooms. A mixed method research design was used to investigate this important issue using data from a local school district and results from field observations. The study compared performance levels of four middle school Hispanic student subgroups (students with disabilities in inclusive settings, students without disabilities in inclusive settings, students with disabilities in resource settings, and student without disabilities in general education settings) each in their respective placements for two consecutive years, exploring existing practices within authentic settings. ^ Significant differences were found in the relationship of educational placement and achievement between grade level and disability in the areas of math and reading. Additionally, clear and important differences were observed in student-teacher interactions. Recommendations for further researchers and stakeholders include soliciting responses from teams at the schools composed of general education and special education teachers, administrative personnel, and students as well as broadening the study across grade levels and exceptionalities. ^

Complexity of risk: Mixed methods approach to understanding youth risk and insecurity in post-conflict settings

In settings of intergroup conflict, identifying contextually-relevant risk factors for youth development in an important task. In Vukovar, Croatia, a city devastated during the war in former Yugoslavia, ethno-political tensions remain. The current study utilized a mixed method approach to identify two salient community-level risk factors (ethnic tension and general antisocial behavior) and related emotional insecurity responses (ethnic and non-ethnic insecurity) among youth in Vukovar. In Study 1, focus group discussions (N=66) with mother, fathers, and adolescents 11 to 15-years-old were analyzed using the Constant Comparative Method, revealing two types of risk and insecurity responses. In Study 2, youth (N=227, 58% male, M=15.88 SD=1.12 years old) responded to quantitative scales developed from the focus groups; discriminate validity was demonstrated and path analyses established predictive validity between each type of risk and insecurity. First, community ethnic tension (i.e., threats related to war/ethnic identity) significantly predicted ethnic insecurity for all youth (β=.41, p<.001). Second, experience with community antisocial behavior (i.e., general crime found in any context) predicted non-ethnic community insecurity for girls (β=.32, p<.05), but not for boys. These findings are the first to show multiple forms of emotional insecurity at the community level; implications for future research are discussed.

Can You Hear the Eco? : A Study of How Swedish Municipalities Can Market their CSR-Activities

Background: In an increasingly globalised world, municipalities more than ever have to compete with each other. Thus, the need to create a brand image has become vital for municipalities. Place branding is the tool that has enabled municipalities to create a brand image in order to attract stakeholders such as potential visitors, residents and businesses. The sustainability phenomenon Corporate Social Responsibility (CSR) has recently become an attractive factor within place branding. Although, the concept of CSR is most commonly implemented within the private sector, CSR initiatives within the public sector are recognised as an integral part. Therefore, the issue of how municipalities can market and communicate their CSR-actives has arisen.  Purpose: The aim of this research is to explore how Swedish municipalities can market their CSR-activities, in order to gain competitive advantages as attractive cities. In further details, this research focuses on how municipalities can use place branding to market their CSR-activities and how they can communicate this to current and potential stakeholders. Method: In order to fulfil this purpose, an interpretivist methodology was adopted with an abductive approach. In regard to this, an exploratory design was developed. More specifically, it was conducted with a mixed method, using a quantitative content analysis and qualitative indepth interviews with knowledgeable experts within CSR from the most relevant departments in the municipalities. Conclusion: The findings indicate that the use of place branding can help municipalities with a sustainable profile to gain competitive advantages. Furthermore, it became apparent that the use of place branding strategies, such as slogan, logotypes, events and cooperation with stakeholders, could enhance the brand image of municipalities and enable them to attract potential stakeholders. In regards to the communication channels, the findings suggest municipalities to communicate their CSR-activities through websites, social media, press conferences, seminars and events.

Credible or not : A study on the factors influencing consumers' credibility assessment of product placements on Instagram

Background: To align with the new trend of using social media in the marketing mix, product placement has been adapted to social media platforms as one strategy to create attention. Especially on Instagram, product placements have gained popularity among companies. While scholars have focused on measuring the effectiveness of the strategy, suggesting that credibility is one component necessary for success, a gap in the research is illuminated when focusing on what makes a product placement on Instagram credible. Previous studies regarding credibility and its relation to traditional media have concluded that there are some factors essential in consumers’ credibility evaluation process. Since social media differs from traditional media, there was a need to investigate the applicability of credibility to the social media platform Instagram. Purpose: The purpose of this thesis was to examine key factors of product placement on Instagram that influence credibility. Method: To meet the purpose of this thesis a study with a mixed method research design was conducted. The qualitative data was collected through semi-structured interviews with the intention to discover how consumers evaluate credibility. The scales and items developed from the findings of the qualitative study were tested using a questionnaire to identify which factors that have the most influence on consumers’ credibility assessment. Conclusions: The overall findings indicate that consumers evaluate credibility based upon source, message and receiver characteristics. The empirical evidence suggests that the Expertise of influencer, Professionalism of picture, Trustworthiness of influencer, Connection to influencer and Causes of irritation are the factors that have the most influence on consumers’ credibility assessment of product placement on Instagram. The findings further implies that it is not only the factor itself that influence, credibility can additionally be transferred from one factor to another.

Augmented Dissent: The Affordances of ICTs for Citizen Protest (A Case Study of the Ukraine Euromaidan Protests of 2013-2014).

This dissertation research project uses the Euromaidan protests in Ukraine to inform and shape a theory of augmented dissent to help explain the complex ways in which protest participants guided by the political, social, and cultural contexts engage in dissent augmented by ICTs in a reality where both the physical and the digital are used in concert. The purpose of this research is to conceptualize the use and perception of ICTs in protest activity using the communicative affordances framework. Through a mixed-method research approach involving interviews with protest participants, as well as qualitative and thematic analysis of online content from social media pages of several key Euromaidan protest communities, the research project examines the role ICTs played in the information and media landscape during the Euromaidan protest. The findings of the online content analysis were used to inform the questions for the 59 semi-structured, open-ended interviews with Euromaidan protest participants in Ukraine and abroad. The research findings provide in-depth insights about how ICTs were used and perceived by protest participants, and their role as vehicles for information and civic media content. The study employs the theoretical framework of social media affordances to interpret the data gathered during the interviews and content analysis to better understand how digital media augmented citizens’ protest activity through affording them new possibilities for dissent, and how they made meaning of said protest activity as augmented by ICTs. The findings contribute towards shaping a theory of digitally augmented dissent that conceptualizes the complex relationship between citizens and ICTs during protest activity as an affordance-driven one, where online and offline tools and activity merge into a unified dissent space and extend or augment the possibilities for action in interesting, and sometimes unexpected ways. Such a conceptual model could inform broader theories about civic participation and digital activism in the post-Soviet world and beyond, as ICTs become an inseparable part of civic life.

Skeletal maturity and socio-economic status in portuguese children and youths: the Madeira growth study

Skeletal maturity is used to evaluate biological maturity status. Information about the association between socio-economic status (SES) and skeletal maturity is limited in Portugal. Aims: The aim of this study is to document the skeletal maturity of youths in Madeira and to evaluate variation in maturity associated with SES. Subjects and methods: The study involved 507 subjects (256 boys and 251 girls) from the Madeira Growth Study, a mixed-longitudinal study of five cohorts (8, 10, 12, 14 and 16 years of age) followed at yearly intervals over 3 years (1996–1998). A total of 1493 observations were made. Skeletal age was estimated from radiographs of the hand and wrist using the Tanner–Whitehouse 2 method (TW2). Social class rankings were based on Graffar’s (1956) method. Five social rankings were subsequently grouped into three SES categories: high, average and low. Results: Median for the radius, ulna and short finger bones (RUS scores) in the total sample of boys and girls increased curvilinearly across age whereas median for the 7 (without pisiform) carpal bones (Carpal scores) increased almost linearly. The 20-bone maturity scores demonstrated distinctive trends by gender: the medians for boys increased almost linearly while the medians for girls increased curvilinearly. SES differences were minimal. Only among children aged 10–11 years were high SES boys and girls advanced in skeletal maturity. Madeira adolescents were advanced in skeletal maturity compared with Belgian reference values. Conclusion: The data suggests population variation in TW2 estimates of skeletal maturation. Skeletal maturity was not related to SES in youths from Madeira.