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Aesthetic surgery is available to a small number of patients on the National Health Service (NHS) in Scotland, chosen from a large number of individuals who are referred for various procedures. The most popular and most frequently requested of all aesthetic procedures in the Scottish health board NHS Lothian is breast reduction surgery. This thesis examines the duration of the health benefits of breast reduction surgery in those who undergo it. It contains a detailed introduction to the clinical syndrome of breast dissatisfaction and a description of the Scottish Government's Exceptional Referral Protocol that governs the Lothian aesthetic surgery pathway. A systematic review follows of the published studies that report on the duration of benefits of breast reduction surgery. A cross-sectional study is described that used the validated patient reported outcome measure (PROM) BREAST-Q to assess the body image, quality of life and satisfaction of patients who underwent breast reduction surgery in NHS Lothian up to thirteen years ago. It is hoped that the findings of the literature review and study that are described here will help clinicians, healthcare managers and policy makers alike reconsider the current approach to providing surgical care for those who suffer from the symptoms associated with having excessively large breasts.

Introducción y objetivos: Los telómeros son regiones no codificantes localizadas al final de los cromosomas de células eucariotas, y su acortamiento se ha visto relacionado con la enfermedad cardiovascular y sus factores de riesgo. El objetivo de este estudio es evaluar la asociación entre el índice de salud cardiovascular ideal y el riesgo de telómero corto en una población de sujetos de edad avanzada de la cohorte Seguimiento Universidad de Navarra (SUN). Métodos: Se valoró a 886 adultos mayores de 55 años (645 varones y 241 mujeres). La longitud telomérica se midió utilizando qPCR (quantitative protein chain reaction) en tiempo real y reacción única. El índice de salud cardiovascular «Life’s simple 7» se definió según la American Heart Association mediante la puntuación de 7 ítems con valores de 0 a 2 para cada uno: tabaquismo, actividad física, dieta, índice de masa corporal, presión arterial, colesterol total y glucosa en sangre. La máxima puntuación del índice corresponde a 14 puntos. Se categorizó en terciles: pobre (0-9 puntos), intermedio (10-11 puntos) e ideal (12-14 puntos). El riesgo de telómero corto se definió como una longitud telomérica por debajo del percentil 20. Resultados: Sujetos con altos valores en el índice de salud cardiovascular ideal tenían menos riesgo de telómero corto (OR ajustada = 0,60; IC95%, 0,34-1,05; p de tendencia lineal = 0,052). Esta asociación fue significativa en varones (OR ajustada = 0,37; IC95%, 0,17-0,83; p de tendencia lineal = 0,025), pero no en mujeres. Conclusiones: En varones mayores de 55 años, existe una asociación inversa entre el índice de salud cardiovascular y el riesgo de tener telómeros cortos.

Abstract: Background: Psychological resilience is a dynamic process of positive adaptation in the face of adversity or trauma. Multiple Sclerosis (MS), a chronic neurological disease, engenders adversity because of its progressive, uncertain and variable course. Resilience in persons with MS depends on the balance between their resources, such as a supportive social network, and their vulnerabilities, such as physical disability. Studies on resilience in those with MS demonstrate its association with better quality of life, social support and mental health. To better understand how resilience in those with MS might be strengthened it is important to identify factors associated with greater resilience and to understand how persons with MS experience resilience resources and vulnerabilities in their daily lives. Purpose: The aims of this body of work were to: 1) assess the degree of resilience amongst persons with MS and determine which sociodemographic, clinical and psychosocial factors are associated with greater resilience (study 1); 2) explore the factor structure and psychometric properties of a widely used measure of resilience, the Connor-Davidson Resilience Scale (CD-RISC), in persons with MS (study 2); and 3) explore how persons with MS describe their experiences of four components of resilience: adapting, coping, social support and wellness (study 3). Methods: Study 1 – Participants with MS completed a cross-sectional survey that included the CD-RISC and sociodemographic, clinical and psychosocial measures. The average resilience score was reported, and general linear models were built to determine the factors associated with greater resilience. Study 2 – Participants of Study 1 formed the study sample. Exploratory and confirmatory factor analyses were conducted on the CD-RISC, internal consistency was assessed using Cronbach’s alpha, and construct validity was assessed through correlations among the CD-RISC score and sub-scales emerging from the factor analysis and health-related quality of life (Health Utilities Index Mark 3 (HUI3): multi-attribute and emotion subscales) and psychological well-being (Psychological Well-Being Checklist (PWB) subscales). Study 3 – For this qualitative study twelve participants were recruited from Study 1. Semi-structured interviews were conducted about four components of resilience: adapting to MS, coping with MS, social support and wellness. The interview data were analyzed using a qualitative description approach. Results: Study 1 – There were 358 surveys completed and returned. The average score on the CD-RISC was 72.4/100 (standard deviation 14.7). Nine factors were associated with greater resilience: older age, greater use of acceptance and cognitive/palliative (learning/faith) coping strategies, greater hope (goal setting and goal planning/execution), and better psychological well-being (autonomy, environmental mastery, personal growth and self-acceptance). Study 2 – Five factors emerged from the factor analysis of the CD-RISC: positive acceptance of change, personal competence, secure in oneself and others, perseverance, and spiritual influences. Internal consistency was 0.93 with 95% Confidence Intervals (CI) of 0.92-0.94. The CD-RISC scores showed correlations of 0.39-0.67 with the HUI3 and PWB subscales, and factors 1-4 showed correlations of 0.27-0.69 with the HUI3 and PWB. Factor 5, spiritual influences, was not significantly correlated with any of the HUI3 or PWB sub-scales. Study 3 – Participants described adapting to MS as changing their self-expectations, living differently, navigating roles and responsibilities, and adjusting to continually changing abilities. Coping with MS was described as acceptance, perspective, knowledge seeking, denial (when first diagnosed with MS) and faith. Social support was described as leaning on others, community and seeking expertise, but often involved strained connections and needing to maintain a distance from others. Wellness was described as managing symptoms and finding a path. Conclusions: The CD-RISC is a reliable measure of resilience in MS. Some of the factors associated with greater resilience are potentially modifiable, such as coping strategies. Longitudinal studies are needed to determine the temporal associations between these factors and resilience. Participants’ mix of both positive and negative experiences in relation to adapting, coping, social support and wellness, highlights the importance of recognizing and acknowledging the difficulties or challenges that arise even in those aspects typically thought of as resources. This thesis work adds to our understanding of factors associated with resilience in MS, and how persons with MS describe their experiences of resilience. These findings can inform further research looking into the strengthening of resilience resources and lessening of resilience vulnerabilities, and the impact such changes may have on the health and well-being of persons with MS.

Aim: The purpose of this study was to look at the differences in fat-related diet habits of college students of varying BMI statuses and sex at a large mid-western public University. Sample: It was a quantitative study with cross-sectional design. Convenient sampling was used. Materials: An online survey was conducted via filling out a fat-related diet habits questionnaire. Statistical analysis: Demographic data was summarized and presented in table of distribution frequencies, mean and standard deviations. To test the hypotheses, multifactorial two-way ANOVA was used for the main part of the questionnaire. Any pvalue ≤ 0.05 was considered significant. Outcomes: The p-values of the summary scores for sex, and different BMI categories was 0.48 and 0.31 respectively. The scores fell between “often” and “sometimes”. Similar patterns were observed between males and females and varying BMI categories. There were no significant differences found in the fat-related diet habits between sex and varying BMI statuses. Conclusion: This study demonstrated that no differences were observed between fatrelated diet habits of college students between males and females, and between varying BMI statuses. However, it also provides evidence of improvement in the nutritional status and dietary habits, especially fat consumption of young adults.

Background:Infectious diseases are associated with an increase in the risk of developing insulin resistance and subsequent diabetes mellitus due to a possible role of chronic inflammation. While this relationship is well established for viral infections like hepatitis C or hepatitis B, little is known about the association of herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) with diabetes mellitus. Methods: We conducted a cross-sectional study using the data from the 2007-2016 cycle of the National Health and Nutrition Examination Survey. Participants from the age group of 18-49 years with valid diabetes mellitus and HSV-1 and HSV-2 results and who completed the interview and examination were eligible for the analysis. HSV-1 and HSV-2 were defined by type specific enzymatic immunodot assay as positive or negative. Diabetes status was defined by glycohemoglobin level (HbA1c) as euglycemic (≤5.6%), prediabetes (5.7-6.4%), and diabetes (≥6.5%); participants who self-reported being diabetic were considered as having diabetes regardless of their HBA1c levels. We conducted logistic regression analysis to estimate the crude and adjusted odds ratio and 95% confidence interval of diabetes mellitus comparing participants with positive HSV-1 and HSV-2 to those with negative HSV-1 and HSV-2. Results: The prevalence of HSV-1 among participants with diabetes was 67.2% (95% CI 62.3,72.0), and the prevalence of HSV-2 among participants with diabetes was 26.9% (95% CI 23.2,30.7). The prevalence of diabetes among participants with HSV-1 infection was 5.7% (95% CI 5.1,6.3), and the prevalence of diabetes among HSV-2 infection was 7.9% (95% CI 6.8,8.9). After adjusting for confounding factors, the odds of diabetes versus euglycemia among participants with HSV-1 was 1.05 (95% CI 0.9,1.2), and odds of diabetes versus euglycemia among participants with HSV 2 was 1.1 (95% CI 0.9,1.2). Conclusion: After controlling for potential confounders, HSV-1 and HSV-2 infections are not associated with diabetes mellitus in the US population aged 18-49 years, 2007-2016

ABSTRACT ASSOCIATION BETWEEN THE CONSUMPTION OF SUGAR-SWEETENED BEVERAGES AND POOR MENTAL HEALTH AMONG ADULTS IN THE UNITED STATES. By ONYANEHI AJUMA UGBABE APRIL, 2019 INTRODUCTION: Mental health disorders are significant public health problems in the United States due to their association with increased morbidity. Available evidence suggests a relationship between nutritional quality and mental health outcomes. This relationship is in line with emerging evidence that diet is essential in the treatment and management of psychiatric disorders. Diet is directly linked with obesity which in turn is a major risk factor for several chronic diseases, including psychiatric disorders. Given the current obesity epidemic in the US population, it is important to understand how various nutritional behaviors potentially contribute to the burden of mental health disorders in the United States. However, little is known regarding the association between sugar-sweetened beverage (SSB) consumption and the risk of poor mental health in adults 18 years or older. AIM: To examine the association between the consumption of sugar-sweetened beverage and poor mental health among U.S. adults, and to determine the role of obesity in any potential association between SSB consumption and risk of poor mental health. METHODS: Cross-sectional data from the 2017 Behavioral Risks Factor Surveillance System (BRFSS) was used for this study. Poor mental health was based on self-report of diagnosis and symptoms within the past 30 days. SSB intake was quantified as the number of times regular soda, or fruit drinks were consumed within a 30-day period, while obesity status was calculated based on the subject’s measured weight and height. Using multivariable logistic regression, adjusted odds ratios (aOR) for the association between frequency of SSB intake and poor mental health was calculated controlling for age, gender, race and other variables (smoking, physical activity, hypertension, etc.). RESULTS: Drinking 1 or more sugar-sweetened beverages per day was associated with increased odds of poor mental health (OR= 1.41, 95% CI=1.21-1.63) after adjusting for covariates. The presence of obesity resulted in a similar trend of poor mental health outcomes upon consumption of 1 or more sugar-sweetened beverages per day (OR= 1.42, 95% CI=1.23-1.64) DISCUSSION/CONCLUSION: This study indicates that sugar sweetened beverages are associated with poor mental health. A public health message on the detrimental effects of consumption of sugar-sweetened beverages may help alleviate the burden of mental health disorders.

Design thinking ability is vital for engineers who are tasked with solving society's toughest sustainable development challenges. Prior research identified that the percentage of design thinkers among freshmen engineering students is greater than the percentage among the general population. However, engineering education's lack of attention to fostering creative ability may cause the design thinking ability of senior engineering students to suffer. The research addressed in this thesis compares the design thinking ability of engineering students across age groups, and compares design thinking ability between the design disciplines of engineering and architecture. To draw design thinking comparisons between these groups, a survey with a nine item design thinking instrument was distributed nationally to freshmen engineering students (n= 2,158), senior engineering students (n= 1,893), and senior architecture students (n= 336). The survey instrument was validated by conducting confirmatory factor analysis on the senior engineering and senior architecture samples' data. The Analysis of Variance (ANOVA) test was utilized to statistically compare scores across sample groups. Both the freshmen engineering students (2.80) and senior architecture students (3.30) scored significantly higher on the design thinking scale than senior engineering students (2.59). These results have important implications for engineering educators as engineering education may contribute to a decrease in design thinking among senior engineering students. A lower design thinking score among seniors was consistent across all engineering sub-disciplines and should be of concern to engineering educators, since design thinking skills are critical for the development of engineering solutions to grand societal challenges.

Genetic factors may interact with physical activity levels to modify obesity risk. Our aim was to explore the effect of rs1801260 SNP (3111T/C) of CLOCK gene, on obesity risk and to examine their interaction with lifestyle factors in an elderly population of the SUN Project. Subjects (n=903, aged 69±6) were recruited from the SUN (“Seguimiento Universidad de Navarra”) Project. DNA was obtained from saliva and lifestyle and dietary data were collected by validated self-reported questionnaires. Genotyping was assessed by RT-PCR plus allele discrimination. A significant interaction between the 3111T/C SNP of CLOCK gene and sex for overweight/obesity risk was observed (p for interaction [Sex*CLOCK] interaction