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For a sample of 53 developing countries, the results show that women's employment among private firms is significantly higher in countries that mandate paternity leave versus those that do not. A conservative estimate suggests an increase of 6.8 percentage points in the proportion of women workers associated with the mandating of paternity leave.

Publisher's version (útgefin grein) ; Objective: To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. Methods We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n=20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. Results: The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10-8; and LINC00539/ZDHHC20, p = 5.82 × 10-9. Both have been associated with blood pressure (BP)-related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p[BI] = 9.38 × 10-25; p [SSBI] = 5.23 × 10-14 for hypertension), smoking (p[BI]= 4.4 × 10-10; p [SSBI] = 1.2 × 10 -4), diabetes (p[BI] = 1.7 × 10 -8; p [SSBI] = 2.8 × 10 -3), previous cardiovascular disease (p [BI] = 1.0 × 10-18; p [SSBI] = 2.3 × 10-7), stroke (p [BI] = 3.9 × 10-69; p [SSBI] = 3.2 × 10 -24), and MRI-defined white matter hyperintensity burden (p [BI]=1.43 × 10-157; p [SSBI] = 3.16 × 10-106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p ≤ 0.0022), without indication of directional pleiotropy. Conclusion: In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significant modifiable, causal risk factor for BI. ; CHAP: R01-AG-11101, R01-AG-030146, NIRP-14-302587. SMART: This study was supported by a grant from the Netherlands Organization for Scientific Research–Medical Sciences (project no. 904-65–095). LBC: The authors thank the LBC1936 participants and the members of the LBC1936 research team who collected and collated the phenotypic and genotypic data. The LBC1936 is supported by Age UK (Disconnected Mind Programme grant). The work was undertaken by The University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross-council Lifelong Health and Wellbeing Initiative (MR/K026992/1). The brain imaging was performed in the Brain Research Imaging Centre (https://www.ed.ac.uk/clinical-sciences/edinburgh-imaging), a center in the SINAPSE Collaboration (sinapse.ac.uk) supported by the Scottish Funding Council and Chief Scientist Office. Funding from the UK Biotechnology and Biological Sciences Research Council (BBSRC) and the UK Medical Research Council is acknowledged. Genotyping was supported by a grant from the BBSRC (ref. BB/F019394/1). PROSPER: The PROSPER study was supported by an investigator-initiated grant obtained from Bristol-Myers Squibb. Prof. Dr. J.W. Jukema is an Established Clinical Investigator of the Netherlands Heart Foundation (grant 2001 D 032). Support for genotyping was provided by the seventh framework program of the European commission (grant 223004) and by the Netherlands Genomics Initiative (Netherlands Consortium for Healthy Aging grant 050-060-810). SCES and SiMES: National Medical Research Council Singapore Centre Grant NMRC/CG/013/2013. C.-Y.C. is supported by the National Medical Research Council, Singapore (CSA/033/2012), Singapore Translational Research Award (STaR) 2013. Dr. Kamran Ikram received additional funding from the Singapore Ministry of Health's National Medical Research Council (NMRC/CSA/038/2013). SHIP: SHIP is part of the Community Medicine Research net of the University of Greifswald, Germany, which is funded by the Federal Ministry of Education and Research (grants no. 01ZZ9603, 01ZZ0103, and 01ZZ0403), the Ministry of Cultural Affairs, as well as the Social Ministry of the Federal State of Mecklenburg–West Pomerania, and the network "Greifswald Approach to Individualized Medicine (GANI_MED)" funded by the Federal Ministry of Education and Research (grant 03IS2061A). Genome-wide data have been supported by the Federal Ministry of Education and Research (grant no. 03ZIK012) and a joint grant from Siemens Healthineers, Erlangen, Germany, and the Federal State of Mecklenburg–West Pomerania. Whole-body MRI was supported by a joint grant from Siemens Healthineers, Erlangen, Germany, and the Federal State of Mecklenburg–West Pomerania. The University of Greifswald is a member of the Caché Campus program of the InterSystems GmbH. OATS (Older Australian Twins Study): OATS was supported by an Australian National Health and Medical Research Council (NHRMC)/Australian Research Council (ARC) Strategic Award (ID401162) and by a NHMRC grant (ID1045325). OATS was facilitated via access to the Australian Twin Registry, which is supported by the NHMRC Enabling Grant 310667. The OATS genotyping was partly supported by a Commonwealth Scientific and Industrial Research Organisation Flagship Collaboration Fund Grant. NOMAS: The Northern Manhattan Study is funded by the NIH grant "Stroke Incidence and Risk Factors in a Tri-Ethnic Region" (NINDS R01NS 29993). TASCOG: NHMRC and Heart Foundation. AGES: The study was funded by the National Institute on Aging (NIA) (N01-AG-12100), Hjartavernd (the Icelandic Heart Association), and the Althingi (the Icelandic Parliament), with contributions from the Intramural Research Programs at the NIA, the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute of Neurological Disorders and Stroke (NINDS) (Z01 HL004607-08 CE). ERF: The ERF study as a part of European Special Populations Research Network (EUROSPAN) was supported by European Commission FP6 STRP grant no. 018947 (LSHG-CT-2006-01947) and also received funding from the European Community's Seventh Framework Programme (FP7/2007–2013)/grant agreement HEALTH-F4-2007-201413 by the European Commission under the programme "Quality of Life and Management of the Living Resources" of 5th Framework Programme (no. QLG2-CT-2002-01254). High-throughput analysis of the ERF data was supported by a joint grant from Netherlands Organization for Scientific Research and the Russian Foundation for Basic Research (NWO-RFBR 047.017.043). Exome sequencing analysis in ERF was supported by the ZonMw grant (project 91111025). Najaf Amin is supported by the Netherlands Brain Foundation (project no. F2013[1]-28). ARIC: The Atherosclerosis Risk in Communities study was performed as a collaborative study supported by NHLBI contracts (HHSN268201100005C, HSN268201100006C, HSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C), R01HL70825, R01HL087641, R01HL59367, and R01HL086694; National Human Genome Research Institute contract U01HG004402; and NIH contract HHSN268200625226C. Infrastructure was partly supported by grant no. UL1RR025005, a component of the NIH and NIH Roadmap for Medical Research. This project was also supported by NIH R01 grant NS087541 to M.F. FHS: This work was supported by the National Heart, Lung and Blood Institute's Framingham Heart Study (contracts no. N01-HC-25195 and no. HHSN268201500001I), and its contract with Affymetrix, Inc. for genotyping services (contract no. N02-HL-6-4278). A portion of this research utilized the Linux Cluster for Genetic Analysis (LinGA-II) funded by the Robert Dawson Evans Endowment of the Department of Medicine at Boston University School of Medicine and Boston Medical Center. This study was also supported by grants from the NIA (R01s AG033040, AG033193, AG054076, AG049607, AG008122, and U01-AG049505) and the NINDS (R01-NS017950, UH2 NS100605). Dr. DeCarli is supported by the Alzheimer's Disease Center (P30 AG 010129). ASPS: The research reported in this article was funded by the Austrian Science Fund (FWF) grant nos. P20545-P05, P13180, and P20545-B05, by the Austrian National Bank Anniversary Fund, P15435, and the Austrian Ministry of Science under the aegis of the EU Joint Programme–Neurodegenerative Disease Research (JPND) (jpnd.eu). LLS: The Leiden Longevity Study has received funding from the European Union's Seventh Framework Programme (FP7/2007–2011) under grant agreement no. 259679. This study was supported by a grant from the Innovation-Oriented Research Program on Genomics (SenterNovem IGE05007), the Centre for Medical Systems Biology, and the Netherlands Consortium for Healthy Ageing (grant 050-060-810), all in the framework of the Netherlands Genomics Initiative, Netherlands Organization for Scientific Research (NWO), UnileverColworth, and by BBMRI-NL, a Research Infrastructure financed by the Dutch government (NWO 184.021.007). CHS: This CHS research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, N01HC15103, and HHSN268200960009C and grants U01HL080295, R01HL087652, R01HL105756, R01HL103612, R01HL120393, R01HL085251, and R01HL130114 from the NHLBI with additional contribution from NINDS. Additional support was provided through R01AG023629 from the NIA. A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. The provision of genotyping data was supported in part by the National Center for Advancing Translational Sciences, CTSI grant UL1TR001881, and the National Institute of Diabetes and Digestive and Kidney Disease Diabetes Research Center grant DK063491 to the Southern California Diabetes Endocrinology Research Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Rotterdam Study: The generation and management of GWAS genotype data for the Rotterdam Study is supported by the Netherlands Organisation of Scientific Research (NWO) Investments (no. 175.010.2005.011, 911-03-012). This study is funded by the Research Institute for Diseases in the Elderly (014-93-015; RIDE2), the Netherlands Genomics Initiative (NGI)/NWO project no. 050-060-810. The Rotterdam Study is funded by Erasmus MC Medical Center and Erasmus MC University, Rotterdam, Netherlands Organization for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. M.A.I. is supported by an NWO Veni grant (916.13.054). The 3-City Study: The 3-City Study is conducted under a partnership agreement among the Institut National de la Santé et de la Recherche Médicale (INSERM), the University of Bordeaux, and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, Mutuelle Générale de l'Education Nationale (MGEN), Institut de la Longévité, Conseils Régionaux of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research–INSERM Programme "Cohortes et collections de données biologiques." C.T. and S.D. have received investigator-initiated research funding from the French National Research Agency (ANR) and from the Fondation Leducq. S.D. is supported by a starting grant from the European Research Council (SEGWAY), a grant from the Joint Programme of Neurodegenerative Disease research (BRIDGET), from the European Union's Horizon 2020 research and innovation programme under grant agreements No 643417 & No 640643, and by the Initiative of Excellence of Bordeaux University. Part of the computations were performed at the Bordeaux Bioinformatics Center (CBiB), University of Bordeaux. This work was supported by the National Foundation for Alzheimer's Disease and Related Disorders, the Institut Pasteur de Lille, the Labex DISTALZ, and the Centre National de Génotypage. ADGC: The Alzheimer Disease Genetics Consortium is supported by NIH. NIH-NIA supported this work through the following grants: ADGC, U01 AG032984, RC2 AG036528; NACC, U01 AG016976; NCRAD, U24 AG021886; NIA LOAD, U24 AG026395, U24 AG026390; Banner Sun Health Research Institute, P30 AG019610; Boston University, P30 AG013846, U01 AG10483, R01 CA129769, R01 MH080295, R01 AG017173, R01 AG025259, R01AG33193; Columbia University, P50 AG008702, R37 AG015473; Duke University, P30 AG028377, AG05128; Emory University, AG025688; Group Health Research Institute, UO1 AG06781, UO1 HG004610; Indiana University, P30 AG10133; Johns Hopkins University, P50 AG005146, R01 AG020688; Massachusetts General Hospital, P50 AG005134; Mayo Clinic, P50 AG016574; Mount Sinai School of Medicine, P50 AG005138, P01 AG002219; New York University, P30 AG08051, MO1RR00096, UL1 RR029893, 5R01AG012101, 5R01AG022374, 5R01AG013616, 1RC2AG036502, 1R01AG035137; Northwestern University, P30 AG013854; Oregon Health & Science University, P30 AG008017, R01 AG026916; Rush University, P30 AG010161, R01 AG019085, R01 AG15819, R01 AG17917, R01 AG30146; TGen, R01 NS059873; University of Alabama at Birmingham, P50 AG016582, UL1RR02777; University of Arizona, R01 AG031581; University of California, Davis, P30 AG010129; University of California, Irvine, P50 AG016573, P50, P50 AG016575, P50 AG016576, P50 AG016577; University of California, Los Angeles, P50 AG016570; University of California, San Diego, P50 AG005131; University of California, San Francisco, P50 AG023501, P01 AG019724; University of Kentucky, P30 AG028383, AG05144; University of Michigan, P50 AG008671; University of Pennsylvania, P30 AG010124; University of Pittsburgh, P50 AG005133, AG030653; University of Southern California, P50 AG005142; University of Texas Southwestern, P30 AG012300; University of Miami, R01 AG027944, AG010491, AG027944, AG021547, AG019757; University of Washington, P50 AG005136; Vanderbilt University, R01 AG019085; and Washington University, P50 AG005681, P01 AG03991. The Kathleen Price Bryan Brain Bank at Duke University Medical Center is funded by NINDS grant NS39764, NIMH MH60451, and by GlaxoSmithKline. Genotyping of the TGEN2 cohort was supported by Kronos Science. The TGen series was also funded by NIA grant AG041232, the Banner Alzheimer's Foundation, The Johnnie B. Byrd Sr. Alzheimer's Institute, the Medical Research Council, and the state of Arizona and also includes samples from the following sites: Newcastle Brain Tissue Resource (funding via the Medical Research Council [MRC], local NHS trusts, and Newcastle University), MRC London Brain Bank for Neurodegenerative Diseases (funding via the Medical Research Council), South West Dementia Brain Bank (funding via numerous sources including the Higher Education Funding Council for England [HEFCE], Alzheimer's Research Trust [ART], BRACE, as well as North Bristol NHS Trust Research and Innovation Department and DeNDRoN), The Netherlands Brain Bank (funding via numerous sources including Stichting MS Research, Brain Net Europe, Hersenstichting Nederland Breinbrekend Werk, International Parkinson Fonds, Internationale Stiching Alzheimer Onderzoek), Institut de Neuropatologia, Servei Anatomia Patologica, and Universitat de Barcelona). ADNI: Funding for ADNI is through the Northern California Institute for Research and Education by grants from Abbott, AstraZeneca AB, Bayer Schering Pharma AG, Bristol-Myers Squibb, Eisai Global Clinical Development, Elan Corporation, Genentech, GE Healthcare, GlaxoSmithKline, Innogenetics, Johnson & Johnson, Eli Lilly and Co., Medpace, Inc., Merck and Co., Inc., Novartis AG, Pfizer Inc, F. Hoffman-La Roche, Schering-Plough, Synarc, Inc., Alzheimer's Association, Alzheimer's Drug Discovery Foundation, the Dana Foundation, and the National Institute of Biomedical Imaging and Bioengineering and NIA grants U01 AG024904, RC2 AG036535, and K01 AG030514. Support was also provided by the Alzheimer's Association (LAF, IIRG-08-89720; MAP-V, IIRG-05-14147) and the US Department of Veterans Affairs Administration, Office of Research and Development, Biomedical Laboratory Research Program. SiGN: Stroke Genetic Network (SiGN) was supported in part by award nos. U01NS069208 and R01NS100178 from NINDS. Genetics of Early-Onset Stroke (GEOS) Study was supported by the NIH Genes, Environment and Health Initiative (GEI) grant U01 HG004436, as part of the GENEVA consortium under GEI, with additional support provided by the Mid-Atlantic Nutrition and Obesity Research Center (P30 DK072488); and the Office of Research and Development, Medical Research Service, and the Baltimore Geriatrics Research, Education, and Clinical Center of the Department of Veterans Affairs. Genotyping services were provided by the Johns Hopkins University Center for Inherited Disease Research (CIDR), which is fully funded through a federal contract from the NIH to Johns Hopkins University (contract no. HHSN268200782096C). Assistance with data cleaning was provided by the GENEVA Coordinating Center (U01 HG 004446; PI Bruce S. Weir). Study recruitment and assembly of datasets were supported by a Cooperative Agreement with the Division of Adult and Community Health, Centers for Disease Control and Prevention, and by grants from NINDS and the NIH Office of Research on Women's Health (R01 NS45012, U01 NS069208-01). METASTROKE: ASGC: Australian population control data were derived from the Hunter Community Study. This research was funded by grants from the Australian National and Medical Health Research Council (NHMRC Project Grant ID: 569257), the Australian National Heart Foundation (NHF Project Grant ID: G 04S 1623), the University of Newcastle, the Gladys M Brawn Fellowship scheme, and the Vincent Fairfax Family Foundation in Australia. E.G.H. was supported by a Fellowship from the NHF and National Stroke Foundation of Australia (ID: 100071). J.M. was supported by an Australian Postgraduate Award. BRAINS: Bio-Repository of DNA in Stroke (BRAINS) is partly funded by a Senior Fellowship from the Department of Health (UK) to P.S., the Henry Smith Charity, and the UK-India Education Research Institutive (UKIERI) from the British Council. GEOS: Genetics of Early Onset Stroke (GEOS) Study, Baltimore, was supported by GEI Grant U01 HG004436, as part of the GENEVA consortium under GEI, with additional support provided by the Mid-Atlantic Nutrition and Obesity Research Center (P30 DK072488), and the Office of Research and Development, Medical Research Service, and the Baltimore Geriatrics Research, Education, and Clinical Center of the Department of Veterans Affairs. Genotyping services were provided by the Johns Hopkins University Center for Inherited Disease Research (CIDR), which is fully funded through a federal contract from the NIH to the Johns Hopkins University (contract no. HHSN268200782096C). Assistance with data cleaning was provided by the GENEVA Coordinating Center (U01 HG 004446; PI Bruce S. Weir). Study recruitment and assembly of datasets were supported by a Cooperative Agreement with the Division of Adult and Community Health, Centers for Disease Control and Prevention, and by grants from NINDS and the NIH Office of Research on Women's Health (R01 NS45012, U01 NS069208-01). HPS: Heart Protection Study (HPS) (ISRCTN48489393) was supported by the UK MRC, British Heart Foundation, Merck and Co. (manufacturers of simvastatin), and Roche Vitamins Ltd. (manufacturers of vitamins). Genotyping was supported by a grant to Oxford University and CNG from Merck and Co. J.C.H. acknowledges support from the British Heart Foundation (FS/14/55/30806). ISGS: Ischemic Stroke Genetics Study (ISGS)/Siblings With Ischemic Stroke Study (SWISS) was supported in part by the Intramural Research Program of the NIA, NIH project Z01 AG-000954-06. ISGS/SWISS used samples and clinical data from the NIH-NINDS Human Genetics Resource Center DNA and Cell Line Repository (ccr.coriell.org/ninds), human subjects protocol nos. 2003-081 and 2004-147. ISGS/SWISS used stroke-free participants from the Baltimore Longitudinal Study of Aging (BLSA) as controls. The inclusion of BLSA samples was supported in part by the Intramural Research Program of the NIA, NIH project Z01 AG-000015-50, human subjects protocol no. 2003-078. The ISGS study was funded by NIH-NINDS Grant R01 NS-42733 (J.F.M.). The SWISS study was funded by NIH-NINDS Grant R01 NS-39987 (J.F.M.). This study used the high-performance computational capabilities of the Biowulf Linux cluster at the NIH (biowulf.nih.gov). MGH-GASROS: MGH Genes Affecting Stroke Risk and Outcome Study (MGH-GASROS) was supported by NINDS (U01 NS069208), the American Heart Association/Bugher Foundation Centers for Stroke Prevention Research 0775010N, the NIH and NHLBI's STAMPEED genomics research program (R01 HL087676), and a grant from the National Center for Research Resources. The Broad Institute Center for Genotyping and Analysis is supported by grant U54 RR020278 from the National Center for Research resources. Milan: Milano–Besta Stroke Register Collection and genotyping of the Milan cases within CEDIR were supported by the Italian Ministry of Health (grant nos.: RC 2007/LR6, RC 2008/LR6; RC 2009/LR8; RC 2010/LR8; GR-2011-02347041), FP6 LSHM-CT-2007-037273 for the PROCARDIS control samples. WTCCC2: Wellcome Trust Case-Control Consortium 2 (WTCCC2) was principally funded by the Wellcome Trust, as part of the Wellcome Trust Case Control Consortium 2 project (085475/B/08/Z and 085475/Z/08/Z and WT084724MA). The Stroke Association provided additional support for collection of some of the St George's, London cases. The Oxford cases were collected as part of the Oxford Vascular Study, which is funded by the MRC, Stroke Association, Dunhill Medical Trust, National Institute of Health Research (NIHR), and the NIHR Biomedical Research Centre, Oxford. The Edinburgh Stroke Study was supported by the Wellcome Trust (clinician scientist award to C.L.M.S.) and the Binks Trust. Sample processing occurred in the Genetics Core Laboratory of the Wellcome Trust Clinical Research Facility, Western General Hospital, Edinburgh. Much of the neuroimaging occurred in the Scottish Funding Council Brain Imaging Research Centre (https://www.ed.ac.uk/clinical-sciences/edinburgh-imaging), Division of Clinical Neurosciences, University of Edinburgh, a core area of the Wellcome Trust Clinical Research Facility, and part of the SINAPSE (Scottish Imaging Network: A Platform for Scientific Excellence) collaboration (sinapse.ac.uk), funded by the Scottish Funding Council and the Chief Scientist Office. Collection of the Munich cases and data analysis was supported by the Vascular Dementia Research Foundation. This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreements no. 666881, SVDs@target (to M.D.) and no. 667375, CoSTREAM (to M.D.); the DFG as part of the Munich Cluster for Systems Neurology (EXC 1010 SyNergy) and the CRC 1123 (B3) (to M.D.); the Corona Foundation (to M.D.); the Fondation Leducq (Transatlantic Network of Excellence on the Pathogenesis of Small Vessel Disease of the Brain) (to M.D.); the e:Med program (e:AtheroSysMed) (to M.D.) and the FP7/2007-2103 European Union project CVgenes@target (grant agreement no. Health-F2-2013-601456) (to M.D.). M.F. and A.H. acknowledge support from the BHF Centre of Research Excellence in Oxford and the Wellcome Trust core award (090532/Z/09/Z). VISP: The GWAS component of the Vitamin Intervention for Stroke Prevention (VISP) study was supported by the US National Human Genome Research Institute (NHGRI), grant U01 HG005160 (PI Michèle Sale and Bradford Worrall), as part of the Genomics and Randomized Trials Network (GARNET). Genotyping services were provided by the Johns Hopkins University Center for Inherited Disease Research (CIDR), which is fully funded through a federal contract from the NIH to Johns Hopkins University. Assistance with data cleaning was provided by the GARNET Coordinating Center (U01 HG005157; PI Bruce S. Weir). Study recruitment and collection of datasets for the VISP clinical trial were supported by an investigator-initiated research grant (R01 NS34447; PI James Toole) from the US Public Health Service, NINDS, Bethesda, MD. Control data obtained through the database of genotypes and phenotypes (dbGAP) maintained and supported by the United States National Center for Biotechnology Information, US National Library of Medicine. WHI: Funding support for WHI-GARNET was provided through the NHGRI GARNET (grant no. U01 HG005152). Assistance with phenotype harmonization and genotype cleaning, as well as with general study coordination, was provided by the GARNET Coordinating Center (U01 HG005157). Funding support for genotyping, which was performed at the Broad Institute of MIT and Harvard, was provided by the GEI (U01 HG004424). R.L. is a senior clinical investigator of FWO Flanders. F.W.A. is supported by a Dekker scholarship-Junior Staff Member 2014T001–Netherlands Heart Foundation and UCL Hospitals NIHR Biomedical Research Centre. ; Peer Reviewed

Deutschland ist ein Einwanderungsland, das in den letzten Jahren große Wanderungsgewinne verzeichnet hat. Gleichzeitig lagen allerdings auch die Zahlen der Fortzüge in den Jahren 2019 mit 1,2 Millionen und 2020 mit 970.000 auf sehr hohem Niveau. Dies erklärt sich vorwiegend damit, dass viele Migrationsformen einen temporären Charakter haben, und ist daher auch nicht unbedingt kritisch zu sehen. Jedoch besteht in dieser Konstellation die Gefahr, dass für den deutschen Arbeitsmarkt ungünstige Abwanderungstendenzen in einzelnen Qualifikationsbereichen lange unentdeckt bleiben und entsprechend auch erst sehr spät nachgesteuert werden kann. Daher ist gerade vor dem Hintergrund der mit dem demografischen Wandel immer weiter zunehmenden Fachkräfteengpässe ein gezieltes Monitoring der Wegzüge aus Deutschland sehr wichtig. Dies ist mit den aktuell verfügbaren Daten allerdings nur in sehr beschränktem Umfang möglich. So erfasst die Wanderungsstatistik nur sehr wenige Charakteristika der fortziehenden Personen. Allerdings lässt sich mit ihr feststellen, dass die Nettoabwanderung von Inländern im Alter zwischen 23 und 31 Jahren am stärksten ausgeprägt ist, was mit Blick auf die Fachkräftesicherung relevant sein kann. Gehen Personen in dieser Lebensphase des Berufseinstiegs und der ersten Karriereschritte für den deutschen Arbeitsmarkt verloren, fehlen sie hier für einen längeren Zeitraum. Etwas differenzierter lassen sich die Abwanderungsbewegungen von Ausländern mit der Ausländerstatistik betrachten. So zeigt sich etwa, dass Personen aus den neuen EUMitgliedsländern Deutschland derzeit vergleichsweise häufig auch wieder verlassen. Zum für die Einordnung der Wanderungsbewegungen sehr wichtigen Bildungsstand der abwandernden Personen, lassen sich allerdings auch mit der Ausländerstatistik keine Aussagen treffen. Dass zumindest in der Vergangenheitsehr viele Personen mit tertiären Bildungsabschlüssen Deutschland verlassen haben, zeigt die auf den Bevölkerungsstatistiken der OECD-Länder basierende Database on Immigrants in OECD-Countries (DIOC). Ihr zufolge lag in den Jahren 2015/2016 der Anteil der Hochqualifizierten an den in Deutschland geborenen Personen im Alter zwischen 25 und 64 Jahren, die in den anderen OECD-Ländern lebten, bei 48,0 Prozent im Vergleich zu nur 29,2 Prozent bei den in Deutschland geborenen und lebenden Personen in diesem Alter. Vor diesem Hintergrund ist ein vergleichsweise hoher Akademikeranteil unter den Zuwanderern notwendig, um die Qualifikationsstruktur im Land konstant zu halten, was bei der Entwicklung migrationspolitischer Ziele und Maßnahmen zu beachten ist. Anders als zu den tatsächlich erfolgten Wegzügen sind auf Basis des Sozio-oekonomischen Panels (SOEP) sehr differenzierte Analysen zum Zusammenhang zwischen den sozioökonomischen Charakteristika und den Abwanderungsabsichten der in Deutschland lebenden Personen möglich. Allerdings ist dabei zu beachten, dass viele dieser Pläne letztlich nicht realisiert werden und der sozioökonomische Hintergrund auch bei ihrer Umsetzung eine Rolle spielt. Dennoch sind die Befunde für die Einordnung der Abwanderungsbewegungen sehr hilfreich. So planen junge Erwachsene und Personen mit einem akademischen Werdegang zwar, wie nicht anders zu erwarten, besonders häufig, das Land zu verlassen, streben dabei aber meist nur einen vergleichsweise kurzen Aufenthalt von einigen Monaten oder Jahren im Ausland an. Vor diesem Hintergrund dürften auch die tatsächlichen Wanderungsbewegungen dieser Personengruppen vorwiegend einen temporären Charakter haben, was sie für die langfristige Entwicklung der Fachkräftebasis deutlich weniger problematisch macht. Hingegen liegen die Anteile der Personen, die dauerhaft im Ausland bleiben wollen, im mittleren Alter zwischen 45 und 49 Jahren und bei den Niedrigqualifizierten ohne berufsqualifizierenden Abschluss besonders hoch. ; Germany is an immigration country that has recorded large migration gains in recent years. However, the numbers of departures were also at a very high level in 2019 with 1.2 million and 2020 with 970,000. This is mainly explained by the fact that many forms of migration have a temporary character. Therefore, it is not necessarily to be regarded as critical. However, there is a danger in this constellation that migration trends in specific qualification groups that are unfavourable for the German labour market can remain undetected for a long time and that it will therefore only be possible to take corrective action at a very late stage. For this reason, a well-elaborated monitoring of emigration from Germany is very important, especially against the backdrop of the increasing shortage of skilled workers due to demographic change. However, this is only possible to a very limited extent with the data currently available. The official migration statistic records only very few characteristics of the people moving away. Nevertheless, it shows that the net outflow of nationals is most pronounced between the ages of 23 and 31, which can be relevant in terms of securing skilled labour. If people are lost to the German labour market in this phase of life, when they are entering the labour market and taking their first career steps, they will be lacking for a long period of time. The migration movements of foreigners can be analysed in a more differentiated way with the officialstatistic on foreigners. For instance, it can be found that people from the new EU member states leave Germany again relatively frequently. However, the statistic on foreigners does not give information on the educational level of the migrants, which is very important for the assessment of migration movements. The Database on Immigrants in OECD-Countries (DIOC), which is based on the population statistics of the OECD countries, shows that, at least in the past, many people with tertiary education qualifications left Germany. According to the DIOC, in 2015/2016 the proportion of highly educated people born in Germany and aged between 25 and 64 who lived in other OECD countries was 48.0 per cent, compared to only 29.2 per cent of people of this age born and living in Germany. Against this background, a comparatively high proportion of academics among immigrants is necessary to keep the qualification structure in the country constant. Developing migration policy goals and measures, this must be taken into account. In contrast to the actual number of departures, the Socio-Economic Panel (SOEP) allows very differentiated analyses of the connection between socio-economic characteristics and the intention of people living in Germany to emigrate. However, it should be noted that many of these plans are ultimately not realised, and the socio-economic background also plays a role in their realisation. Nevertheless, the findings are very helpful for classifying emigration movements. Young adults and people with an academic career indeed plan particularly often to leave the country, as is to be expected, but usually only aim for a comparatively short stay of a few months or years abroad. Against this background, the actual migration movements of these groups are also likely to be mainly temporary, which makes them much less problematic for the long-term development of the skilled labour base. On the other hand, the shares of people who want to stay abroad permanently are particularly high in the middle age group between 45 and 49 and among the low-skilled without a vocational qualification.

«Prosvita (Enlightment)» is the name for Ukrainian public societies aiming at mass spreading of education, culture and national consciousness among the people, which have functioned on Ukrainian lands and beyond Ukraine since the end of 1868 and up to now. The first «Prosvita» Society was founded in Lviv on December 8, 1868 and became the largest organization in Halychyna and the head organization for other societies which later became independent. The activity of «Prosvita» was regulated by the Statute, changes to which were introduced in case of necessity. The number of members in the first years was not large: 1869 – 100 members, 1870 – 204, 1872 – 145, 1874 – 289. According to the Statute of 1891 «Prosvita» got an opportunity not only to educate the workers and peasants but also to support them economically. The society was gradually becoming all-Ukrainian. By the example of «Prosvita» in Halychyna, «Ruska Besida» emerged in Bukovyna. And after the revolution in Russia in1905 new societies appeared in East Ukraine. They were headed by outstanding writers, scientists and public men – B. Hrinchenko, Lesya Ukrainka, S. Yefremov, M. Kotsubynskyi, M. Arkas. The Russian government prohibited their activities in some years after their foundation. Instead, in 1912 the reading rooms of «Prosvita» in Halychyna were affiliated with 540 shops, 339 small lending institutions and 121 public pantries. Under the supervision of the Society there were three economic and trade schools. Throughout 1869–1918 «Prosvita» published 477 titles of books in an edition of about 3.5 million copies. In 1939 the «Prosvita» Society numbered 360 thousand members, what made up to 15% of all the adult Ukrainian population, and the network of its reading rooms encompassed 85% of West Ukrainian lands. Throughout 1868–1939 the heads of Lviv «Prosvita» were A. Vakhnianyn, Yu. Lavrivskyi, V. Fedorovych, Yu. Ohonovskyi, Yu. Romanchuk, Ye. Olesnytskyi, P. Ohonovskyi, I. Kyveliuk, M. Halushchynskyi, I. Bryk, Yu. Dzerovych, and the heads of renewed «Prosvita» were R. Ivanychuk, R. Lubkivskyi, Ya. Pitko. The Bolshevik regime that settled in September 1939 in West Ukraine abolished «Prosvita», and thousands of its activists were subjected to repression. After the Bolshevik massacre in1922 in the East of Ukraine, and in 1939 in the West, the whole burden of «Prosvita» work and book publishing was overtaken by the Ukrainian Diaspora of Europe and America, the great contributions of which we take advantage of until today. The «Prosvita» Society in Ukraine was renewed on June 13, 1988. The Communist authority forbade to hold the foundation meeting of the Shevchenko Association of the Ukrainian Language and in this way provoked the first unsanctioned political meeting, at which the Statute of the Society was adopted. That day became the date of «Prosvita» renewal and the year of 2018 was proclaimed the year of «Prosvita» in Lviv region. ; «Просвіта» – назва українських громадських товариств для масового поширення освіти, культури і національної свідомости серед народу, що діяли з перервами на українських землях і поза межами України з кінця 1868 року і діють донині. Перша «Просвіта» була заснована народовцями у Львові 8 грудня 1868 року і стала згодом наймасовішою організацією Галичини і матірною для багатьох організацій і товариств, котрі пізніше усамостійнились. Діяльність «Просвіти» регламентувалась статутом, зміни до якого вносились у разі необхідності. Кількість членів у перші роки була невеликою: 1869 – 100, 1870 – 204, 1872 – 245, 1874 – 289. За статутом 1891 р. «Просвіта» отримала змогу займатися не тільки просвітництвом селянства і робітництва, але й економічним їх піднесенням. Гасло «Свій до свого по своє!» зробило корисну справу. Товариство щодалі набувало всеукраїнського характеру. За прикладом галицької «Просвіти» постала «Руська Бесіда» на Буковині, а після революції 1905 року почали виникати товариства й на Східній Україні. Їх очолювали видатні письменники, вчені й громадські діячі – Б.Грінченко, Леся Українка, С. Єфремов, М.Коцюбинський, М. Аркас. Російський уряд заборонив їхню діяльність через кілька років після створення. Головами Львівського товариства «Просвіти» у 1868–1939 рр. були Ю. Лаврівський, В. Федорович, О. Огоновський. Ю. Романчук, Є. Олесницький, П.Огоновський, І. Кивелюк, М. Галущинський, І. Брик, Ю. Дзерович, а головами відродженої «Просвіти» – Р. Іваничук, Р.Лубківський, Я. Пітко. У 1912 р. при читальнях «Просвіти» існувало 540 крамниць, 339 дрібних позичкових кас і 121 громадська комора. У віданні Товарситва було три господарсько-торгові школи. У 1869–1918 рр. «Просвіта» видала 477 назв книжок і метеликів накладом близько 3,5 млн. примірників. На 1939 рік товариство нараховувало у своїх лавах 360 тис. членів, що складало 15 відсотків усього дорослого українського населення, а мережею його філій та читалень було охоплено 85 відсотків західноукраїнських земель. Більшовицький режим, що запанував у Західній Україні у вересні 1939 року, ліквідував «Просвіту», а тисячі її активістів було репресовано. Після більшовицьких погромів у 1922 р. на Сході України, а в 1939 р. на західних землях весь тягар просвітницької праці та книгодрукування взяла на себе українська діаспора Європи та Америки, великими здобутками якої ми користуємось і сьогодні. В Україні Товариство «Просвіта» було відроджене 13 червня 1988 року. Заборона комуністичною владою проводити у Львові установчі збори Товариства української мови імені Т. Шевченка спровокували перший несанкціонований мітинг, на якому було прийнято Статут Товариства. Саме цей день і став датою відновлення Львівської «Просвіти», а 2018 рік оголошено на Львівщині обласною радою Роком «Просвіти», 150-ту річницю заснування якої відзначатиме Україна.

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation. ; We would like to thank the countless individuals who have contributed to the Global Burden of Disease Study 2015 in various capacities. Data for this research was provided by MEASURE Evaluation, funded by the United States Agency for International Development (USAID). Collection of these data was made possible by the US Agency for International Development (USAID) under the terms of cooperative agreement GPO-A-00-08-000_D3-00. Views expressed do not necessarily reflect those of USAID, the US Government, or MEASURE Evaluation. The following individuals would like to acknowledge various forms of institutional support: Panniyammakal Jeemon is supported by a clinical and public health intermediate fellowship from the Wellcome Trust-DBT India Alliance (2015-2020). Boris Bikbov, Monica Cortinovis, Giuseppe Remuzzi, and Norberto Perico would like to acknowledge that their contribution to this paper has been on behalf of the International Society of Nephrology (ISN) as a follow-up of the activities of the GBD 2010 Genitourinary Diseases Expert Group. Shifalika Goenka is partially supported through a Wellcome Trust Grant (No: 096735/A/11/Z) and The Bernard Lown Scholars in Cardiovascular Health Program, Harvard School of Public Health. Hjalte H Andersen would like to acknowledge funding received from the EliteForsk 2016 travel grant of the Danish Ministry of Higher Education and Science. Amador Goodridge would like to acknowledge funding for me from Sistema Nacional de Investigadores de Panamá-SNI. José das Neves was supported in his contribution to this work by a Fellowship from Fundação para a Ciência e a Tecnologia, Portugal (SFRH/BPD/92934/2013). Beatriz Paulina Ayala Quintanilla would like to acknowledge the Institutional support of PRONABEC (National Program of Scholarship and Educational Loan), provided by the Peruvian Government, while studying for her doctoral course at the Judith Lumley Centre of La Trobe University funded by PRONABEC. Ulrich O Mueller gratefully acknowledges funding by the German National Cohort Consortium (O1ER1511D). Andrea Werdecker gratefully acknowledges funding by the German National Cohort BMBF grant No OIER 1301/22. Charles D A Wolfe would like to acknowledge the following: National Institute for Health Research (NIHR) Program Grant (RP-PG-0407-10184), and the National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service (NHS) Foundation Trust and King's College London. No individuals acknowledged received additional compensation for their efforts. ; Peer-reviewed ; Publisher Version

The African population is ageing at an unprecedented rate. In sub-Saharan Africa (SSA), the number of people aged 60 years and above is projected to rise to over 67 million by 2030 (representing a 100% increase in the 25 years since 2005). Incidence and mortality data help us understand the epidemiology and disease burden of dementia, and thereby improve policy planning. Although dementia prevalence have been reported for many countries of SSA, incidence and mortality related to dementia remain poorly described to date as only Nigeria had reported dementia incidence among older African adults. This study aimed to assess the dementia related incidence and mortality, and associated risk factors in Congolese people aged over 65 years recruited in EPIDEMCA survey. The baseline population was followed up during two years. Older participants were traced and interviewed annually in rural and urban Congo between 2012 and 2014. DSM-IV and NINCDS-ADRDA criteria were required for dementia and Alzheimer's disease diagnoses. Data on vital status were collected throughout the follow-up. Cox proportional hazards model was used to assess the link between baseline dementia diagnosis and mortality risk. Risk factors for incident dementia were examined using a competing-risks regression model based on Fine and Gray methods. After two years of follow-up, 101 (9.8%) participants had died. Compared to participants with normal cognition at baseline, mortality risk was more than 2.5 times higher among those with dementia (HR= 2.53, 95% CI: 1.42-4.49, p=0.001). Among those with dementia, only clinical severity of dementia was associated with an additional increased mortality risk (HR=1.91; CI 95%, 1.23-2.96; p=0.004). Age (per 5-year increase), male sex and living in an urban area were independently associated with increased mortality risk across the full cohort. Among the dementia-free cohort, the crude incidence of dementia was estimated at 15.79 (95% CI 10.25 – 23.32) per 1000 Person Year. We estimated a standardised incidence (on the 2015 Sub-Saharan Africa population) of 13.53 (95% CI 9.98–15.66). Regarding baseline characteristics, old age (p=0.003) and poor social engagement (assessed by community activity) (p=0•028) at baseline were associated with increased dementia incidence among Congolese older adults.Our results, as previously described, support the ongoing demographic and epidemiologic transition in SSA. They highlight the need of longitudinal population-based studies dedicated to dementia incidence and mortality among African people. Given that Africa is a continent subject to unprecedented population ageing; our data highlight the need to address the burden of dementia in this region. Support should incorporate prevention plans based primarily on modifiable (cardiovascular) risk factors, education and social inclusion of the elderly, as well as support for patients and their relatives. ; L'Afrique est confrontée à un vieillissement démographique sans précédent. L'âge étant le facteur principal dans la survenue des démences, l'Afrique devra affronter l'un des plus grands risques socio-sanitaire et économique du 21e siècle. Cette situation accentue la pression sur des systèmes nationaux de santé sollicités au-delà de leurs capacités. L'épidémiologie des démences est encore très peu connue en Afrique et la plupart des données existantes portent sur la prévalence. La démence étant une pathologie chronique et actuellement incurable, la prévention et l'amélioration de la qualité de la prise en charge des malades restent les meilleures armes pour la gestion de cette pathologie. Pour mieux aider les pays africains à bâtir des politiques de santé adaptées, il est important de fournir des données portant sur l'évolution (incidence et mortalité) de cette pathologie. L'objectif de nos travaux était d'estimer l'incidence des démences et le pronostic de ces pathologies en terme de survie. Notre travail a été réalisé à partir d'une cohorte de sujets âgés, habitant les zones urbaine et rurale de la République du Congo, recrutés lors de l'enquête de prévalence EPIDEMCA et suivis pendant deux ans entre 2012 et 2014. Dans un premier temps nous avons estimé la mortalité associée à la démence. La comparaison des taux de mortalité en fonction du statut cognitif a montré que les sujets déments avaient un risque de décès plus important. Ce risque était 2,5 fois plus élevé par rapport aux sujets normaux (HR= 2,53, IC95%: 1,42-4,49, p=0,001) et augmentait avec l'âge et la sévérité de la maladie. Concernant l'incidence, nous avons observé 23 (2,38%) nouveaux cas de démence et estimé une incidence brute de 15,79 (IC95% :10,25 – 23,32) pour 1000 Personne Année (PA). L'incidence standardisée à la population âgée d'Afrique Subsaharienne S était de 13,53 (IC95% 9,98 – 15,66). En tenant compte des différents facteurs analysés, l'âge (p=0,003) et un faible engagement social (p=0,028) (défini par un manque ou une faible participation aux activités communautaires) étaient les principaux facteurs associés à l'incidence de la démence en population congolaise. Globalement, nos résultats soulignent le fardeau que représente la démence pour l'Afrique et sont en parfaite adéquation avec ceux issus d'autres pays à faibles et moyens revenus et des pays à revenus élevés. Toutefois, il est difficile de généraliser nos résultats à la population africaine, car il s'agit d'un continent vaste avec des spécificités pour chaque population. La mise en place de programmes d'études multicentriques dédiés aux démences adoptant des méthodologies similaires serait souhaitable. Les politiques de santé relatives aux personnes âgées devraient intégrer la prise en charge des démences.

Las sociedades contemporáneas cada vez más interconectadas globalmente confirman la diversidad humana en todas sus manifestaciones, siendo una de ellas la dinámica organización dentro de modalidades familiares que se constituyen en el marco de los derechos y los principios que defienden su reconocimiento y dignidad. El creciente número de uniones mixtas constituidas por las personas de diverso origen nacional, religioso y/o étnico, ha llamado la atención del ámbito científico a pesar de su existencia en el devenir de la humanidad. Con un objetivo relativamente sencillo de, conocer la percepción de las uniones mixtas acerca de sus diferencias culturales, la gestión y transformación de éstas en el transcurso de su convivencia, la presente tesis analiza diversos aspectos en su trayectoria vital individual y conjunta en los que se han hecho presentes. La tesis abarca las características del proceso migratorio emprendido por las parejas extranjeras, el encuentro y conformación de la unión, la convivencia en los planos interno y socio- familiar, la llegada de la descendencia, las expectativas futuras de la vida familiar y de pareja y, por último, su percepción de integración realizada. Con una metodología combinada y un enfoque exploratorio-interpretativo, la población participante estuvo conformada por personas pertenecientes a uniones mixtas, residentes en Andalucía, principalmente en las provincias de Huelva y Sevilla. Los resultados obtenidos coinciden con algunos de los principales estudios llevados a cabo en el territorio nacional. No obstante, se pone en cuestión algunas definiciones desde las cuales se han descrito la realidad familiar culturalmente mixta en términos de asimilación, heterogamia, entre otros, a partir de los análisis realizados sobre las trayectorias migratorias, formativas, laborales y de la unión. Entre las principales conclusiones, destaca, el dinamismo de las diferencias en el transcurso de la convivencia, sujetas a las interacciones dentro de contextos estructurados socioculturalmente. Las diferencias traspasan las formas identitarias estereotipadas pasando a formar parte de las biografías y del bagaje de la experiencia personal, sin ser ajenas a la influencia histórica, social, política y económica, en la producción y reproducción de los significados atribuidos a la alteridad. A su vez, no todas las diferencias son fuente potencial de conflictividad ni todos los conflictos tienen un componente cultural. Con un bajo nivel de conflictividad que, además presenta un carácter transitorio, las uniones manifiestan la importancia de las competencias, recursos y estrategias en su resolución, vehiculizadas mediante una comunicación eficaz, basada en el amor, la intimidad y compromiso. El estudio pretende contribuir con el desarrollo del conocimiento científico en las diferentes áreas, campos y disciplinas de las Ciencias Sociales implicadas con el estudio e intervención de la familia, las migraciones, la salud, la educación, el género, entre otras. ; Contemporary societies, which are increasingly interconnected at a global scale, confirm human diversity in all its manifestations, one of them being the dynamism of family organization within constituted in the framework of rights and principles that defend its recognition and dignity. The rising number of mixed unions formed by individuals of different national, religious or ethnic backgrounds, has attracted the attention of all scientific domains despite its existence in the evolution of humankind. With the relatively simple objective of knowing how mixed unions these perceive their cultural differences, how they manage them and how differences are transformed in the course of their living together, this dissertation analyses several aspects of couples' life considered individually and in partnership. The study tackles the characteristics of the migration process undertaken by foreign partners, the meeting and conformation of the union, co-existence at an internal and socio-familiar level, the arrival of descendants, future expectations about family life and partnership and, lastly, their views on attained integration. Using a combined methodology and an exploratory and interpretative approach, the partaking population was formed by adults' men and women in mixed unions living in Andalusia, chiefly in the provinces of Huelva and Seville. The results obtained are coincidental with some of the main studies conducted in the national territory. However, some of the definitions that have been used to describe the reality of families culturally mixed in terms of assimilation, heterogamy, among others, are questioned based on the analyses carried out about migratory, formative, professional and union trajectories. Among main conclusions, the dynamism of differences in coexistence process depending on interactions in sociocultural structured contexts is highlighted. Differences overstep stereotyped identity frames to take part into biographies and personal experiences, not being external to historic, social, political and economic influence in production and reproduction of meanings assigned to otherness. At the same time, not all differences are a potential source of conflict, nor do all conflicts have a cultural component; with a low level of conflict which, in addition, has a temporary nature, unions manifest the importance of competences, resources and strategies necessary for their resolution, achieved through efficient communication based on love, intimacy and compromise. This study aims to contribute to the development of scientific knowledge in different areas, fields and disciplines of Social Sciences involved in the study of, and interventions on family, migration, health, education, and gender issues, among others.

Como herederos de la civilización occidental, de la cultura grecorromana y colonizados por un país resultado de múltiples mezclas etnoculturales, la llamada madre patria, España, fuimos obligados a romper un proceso de conocimiento y formas de aprendizaje de nuestros aborígenes para adoptar otra forma de captar el mundo externo aristotélico tomista. De Aristóteles, mediante la lógica formal y de Tomás de Aquino el mismo proceso para llegar a la verdad absoluta que es Dios. En los intensos y prologados estudios e investigaciones que hemos realizado en las comunidades andinas de la provincia de Chimborazo y Ecuador, con el apoyo y aceptación de los líderes comunitarios y los estudiantes indígenas de la facultad de Ciencias de la Educación de la Universidad Nacional de Chimborazo, hemos llegado a constatar y comprender no existe sensibilidad interna y externa, espacio y tiempo como elementos separados, sensaciones y "formas a priori" como plantea y Kant y fue motivo de varios años que necesitó para tratar de solucionar el problema del conocimiento y buscar caminos entre el dogmatismo y el escepticismo, el racionalismo y el empirismo. En los procesos del conocimiento que todavía se mantienen al interior de la vida de las comunidades andinas el ser humano (niño, joven, adulto, anciano, hombre o mujer) es un todo concreto ubicado y fechado que vive en un texto y en un contexto sociocultural, económico y político comunitario, por lo tanto la sensibilidad es integral y colectiva. Cuando separamos en el proceso de conocimiento del niño sensibilidad, entendimiento y razón estamos desdoblando su normal proceso de aprendizaje, trastocando en partes y separando el conocimiento en islas de aprendizaje, primero la sensación, luego el entendimiento y por último la razón. Por esto los estudiantes indígenas tienen múltiples dificultades en el aprendizaje universitario y algunos docentes por desconocimiento de su cultura e idioma les califican de incapaces y sin conocimientos elementales. El conocimiento en el ser humano es uno solo en el que se integra simultáneamente la percepción de los sentidos y la razón en el proceso cotidiano de ver (observar) juzgar (reflexionar) y actuar (aplicación). Este proceso sirve tanto en el aprendizaje familiar escolar, universitario y del científico, doctorado y postdoctorado. Por lo tanto el fenómeno y el noumeno de Kant se convierten en tema de discusión porque la única realidad existente es la realidad concreta que se vive todos los días en la naturaleza del sujeto, del hombre normal y común, del científico, el filósofo o el político. Las acciones humanas no solo están determinadas por la razón sino por toda la realidad humana: emociones, pasiones, razón y sensibilidad. Se trata de una investigación que pretende iniciar la elaboración de una teoría del aprendizaje desde el conocimiento andino. ; As heirs of Western civilization, Greco-Roman culture and colonized by a country result of multiple ethnocultural mixtures, called mother country, Spain, we were forced to break a process of knowledge and learning styles of our Aboriginal people to adopt another way of capturing Aristotelian Thomist external world. Aristoteles, formal logic by Thomas Aquino and the same process to get to the absolute truth which is God. In the intense and prefaced studies and research we have done in Andean communities in the province of Chimborazo and Ecuador, with the support and acceptance of the community leaders and indigenous students of the Faculty of Education Sciences, National University of Chimborazo we have come to observe and understand there isinternal and external sensibility, space and time as separate elements, feelings and "a priori forms" as stated and Kant and was the subject of several years it took to try to solve the problem of knowledge and search paths between dogmatism and skepticism, rationalism and empiricism. In the processes of knowledge which are still within the life of the Andean communities man (child, youth, adult, elder, male or female) is a concrete located and dated all living in a text and in a context sociocultural, economic and political community, therefore the sensitivity is comprehensive and collective. When we separate the knowledge of the child process sensitivity, understanding and reason we are unfolding their normal learning process, upsetting parts and separating the islands of knowledge learning, the feeling first, then understanding and finally the right. Therefore Indian students have many difficulties learning in the university and some teachers' ignorance of their culture and language qualify them unable and basic skills. Knowledge in humans is one in which the perception of the senses and reason in everyday process see (observe) judging (thinking) and acting (implementation) are simultaneously integrated. This process serves schools, universities and scientific family learning, doctoral and postdoctoral. Hence the phenomenon and the noumenon of Kant become the subject of discussion because the only existing reality is the concrete reality of life every day in the nature of the subject, the normal and ordinary man, the scientist, the philosopher or politician. Human actions are determined not only by reason but for the whole human reality: emotions, passions, reason and sensibility. This is a research that aims to initiate the development of a theory of learning from the Andean knowledge. ; Facultad de Humanidades y Ciencias de la Educación

Como herederos de la civilización occidental, de la cultura grecorromana y colonizados por un país resultado de múltiples mezclas etnoculturales, la llamada madre patria, España, fuimos obligados a romper un proceso de conocimiento y formas de aprendizaje de nuestros aborígenes para adoptar otra forma de captar el mundo externo aristotélico tomista. De Aristóteles, mediante la lógica formal y de Tomás de Aquino el mismo proceso para llegar a la verdad absoluta que es Dios. En los intensos y prologados estudios e investigaciones que hemos realizado en las comunidades andinas de la provincia de Chimborazo y Ecuador, con el apoyo y aceptación de los líderes comunitarios y los estudiantes indígenas de la facultad de Ciencias de la Educación de la Universidad Nacional de Chimborazo, hemos llegado a constatar y comprender no existe sensibilidad interna y externa, espacio y tiempo como elementos separados, sensaciones y "formas a priori" como plantea y Kant y fue motivo de varios años que necesitó para tratar de solucionar el problema del conocimiento y buscar caminos entre el dogmatismo y el escepticismo, el racionalismo y el empirismo. En los procesos del conocimiento que todavía se mantienen al interior de la vida de las comunidades andinas el ser humano (niño, joven, adulto, anciano, hombre o mujer) es un todo concreto ubicado y fechado que vive en un texto y en un contexto sociocultural, económico y político comunitario, por lo tanto la sensibilidad es integral y colectiva.Cuando separamos en el proceso de conocimiento del niño sensibilidad, entendimiento y razón estamos desdoblando su normal proceso de aprendizaje, trastocando en partes y separando el conocimiento en islas de aprendizaje, primero la sensación, luego el entendimiento y por último la razón. Por esto los estudiantes indígenas tienen múltiples dificultades en el aprendizaje universitario y algunos docentes por desconocimiento de su cultura e idioma les califican de incapaces y sin conocimientos elementales. El conocimiento en el ser humano es uno solo en el que se integra simultáneamente la percepción de los sentidos y la razón en el proceso cotidiano de ver (observar) juzgar (reflexionar) y actuar (aplicación). Este proceso sirve tanto en el aprendizaje familiar escolar, universitario y del científico, doctorado y postdoctorado. Por lo tanto el fenómeno y el noumeno de Kant se convierten en tema de discusión porque la única realidad existente es la realidad concreta que se vive todos los días en la naturaleza del sujeto, del hombre normal y común, del científico, el filósofo o el político. Las acciones humanas no solo están determinadas por la razón sino por toda la realidad humana: emociones, pasiones, razón y sensibilidad.Se trata de una investigación que pretende iniciar la elaboración de una teoría del aprendizaje desde el conocimiento andino ; As heirs of Western civilization, Greco-Roman culture and colonized by a country result of multiple ethnocultural mixtures, called mother country, Spain, we were forced to break a process of knowledge and learning styles of our Aboriginal people to adopt another way of capturing Aristotelian Thomist external world. Aristoteles, formal logic by Thomas Aquino and the same process to get to the absolute truth which is God. In the intense and prefaced studies and research we have done in Andean communities in the province of Chimborazo and Ecuador, with the support and acceptance of the community leaders and indigenous students of the Faculty of Education Sciences, National University of Chimborazo we have come to observe and understand there isinternal and external sensibility, space and time as separate elements, feelings and "a priori forms" as stated and Kant and was the subject of several years it took to try to solve the problem of knowledge and search paths between dogmatism and skepticism, rationalism and empiricism. In the processes of knowledge which are still within the life of the Andean communities man (child, youth, adult, elder, male or female) is a concrete located and dated all living in a text and in a context sociocultural, economic and political community, therefore the sensitivity is comprehensive and collective. When we separate the knowledge of the child process sensitivity, understanding and reason we are unfolding their normal learning process, upsetting parts and separating the islands of knowledge learning, the feeling first, then understanding and finally the right. Therefore Indian students have many difficulties learning in the university and some teachers' ignorance of their culture and language qualify them unable and basic skills. Knowledge in humans is one in which the perception of the senses and reason in everyday process see (observe) judging (thinking) and acting (implementation) are simultaneously integrated. This process serves schools, universities and scientific family learning, doctoral and postdoctoral. Hence the phenomenon and the noumenon of Kant become the subject of discussion because the only existing reality is the concrete reality of life every day in the nature of the subject, the normal and ordinary man, the scientist, the philosopher or politician. Human actions are determined not only by reason but for the whole human reality: emotions, passions, reason and sensibility. This is a research that aims to initiate the development of a theory of learning from the Andean knowledge

Como herederos de la civilización occidental, de la cultura grecorromana y colonizados por un país resultado de múltiples mezclas etnoculturales, la llamada madre patria, España, fuimos obligados a romper un proceso de conocimiento y formas de aprendizaje de nuestros aborígenes para adoptar otra forma de captar el mundo externo aristotélico tomista. De Aristóteles, mediante la lógica formal y de Tomás de Aquino el mismo proceso para llegar a la verdad absoluta que es Dios. En los intensos y prologados estudios e investigaciones que hemos realizado en las comunidades andinas de la provincia de Chimborazo y Ecuador, con el apoyo y aceptación de los líderes comunitarios y los estudiantes indígenas de la facultad de Ciencias de la Educación de la Universidad Nacional de Chimborazo, hemos llegado a constatar y comprender no existe sensibilidad interna y externa, espacio y tiempo como elementos separados, sensaciones y "formas a priori" como plantea y Kant y fue motivo de varios años que necesitó para tratar de solucionar el problema del conocimiento y buscar caminos entre el dogmatismo y el escepticismo, el racionalismo y el empirismo. En los procesos del conocimiento que todavía se mantienen al interior de la vida de las comunidades andinas el ser humano (niño, joven, adulto, anciano, hombre o mujer) es un todo concreto ubicado y fechado que vive en un texto y en un contexto sociocultural, económico y político comunitario, por lo tanto la sensibilidad es integral y colectiva.Cuando separamos en el proceso de conocimiento del niño sensibilidad, entendimiento y razón estamos desdoblando su normal proceso de aprendizaje, trastocando en partes y separando el conocimiento en islas de aprendizaje, primero la sensación, luego el entendimiento y por último la razón. Por esto los estudiantes indígenas tienen múltiples dificultades en el aprendizaje universitario y algunos docentes por desconocimiento de su cultura e idioma les califican de incapaces y sin conocimientos elementales. El conocimiento en el ser humano es uno solo en el que se integra simultáneamente la percepción de los sentidos y la razón en el proceso cotidiano de ver (observar) juzgar (reflexionar) y actuar (aplicación). Este proceso sirve tanto en el aprendizaje familiar escolar, universitario y del científico, doctorado y postdoctorado. Por lo tanto el fenómeno y el noumeno de Kant se convierten en tema de discusión porque la única realidad existente es la realidad concreta que se vive todos los días en la naturaleza del sujeto, del hombre normal y común, del científico, el filósofo o el político. Las acciones humanas no solo están determinadas por la razón sino por toda la realidad humana: emociones, pasiones, razón y sensibilidad.Se trata de una investigación que pretende iniciar la elaboración de una teoría del aprendizaje desde el conocimiento andino ; As heirs of Western civilization, Greco-Roman culture and colonized by a country result of multiple ethnocultural mixtures, called mother country, Spain, we were forced to break a process of knowledge and learning styles of our Aboriginal people to adopt another way of capturing Aristotelian Thomist external world. Aristoteles, formal logic by Thomas Aquino and the same process to get to the absolute truth which is God. In the intense and prefaced studies and research we have done in Andean communities in the province of Chimborazo and Ecuador, with the support and acceptance of the community leaders and indigenous students of the Faculty of Education Sciences, National University of Chimborazo we have come to observe and understand there isinternal and external sensibility, space and time as separate elements, feelings and "a priori forms" as stated and Kant and was the subject of several years it took to try to solve the problem of knowledge and search paths between dogmatism and skepticism, rationalism and empiricism. In the processes of knowledge which are still within the life of the Andean communities man (child, youth, adult, elder, male or female) is a concrete located and dated all living in a text and in a context sociocultural, economic and political community, therefore the sensitivity is comprehensive and collective. When we separate the knowledge of the child process sensitivity, understanding and reason we are unfolding their normal learning process, upsetting parts and separating the islands of knowledge learning, the feeling first, then understanding and finally the right. Therefore Indian students have many difficulties learning in the university and some teachers' ignorance of their culture and language qualify them unable and basic skills. Knowledge in humans is one in which the perception of the senses and reason in everyday process see (observe) judging (thinking) and acting (implementation) are simultaneously integrated. This process serves schools, universities and scientific family learning, doctoral and postdoctoral. Hence the phenomenon and the noumenon of Kant become the subject of discussion because the only existing reality is the concrete reality of life every day in the nature of the subject, the normal and ordinary man, the scientist, the philosopher or politician. Human actions are determined not only by reason but for the whole human reality: emotions, passions, reason and sensibility. This is a research that aims to initiate the development of a theory of learning from the Andean knowledge

Como herederos de la civilización occidental, de la cultura grecorromana y colonizados por un país resultado de múltiples mezclas etnoculturales, la llamada madre patria, España, fuimos obligados a romper un proceso de conocimiento y formas de aprendizaje de nuestros aborígenes para adoptar otra forma de captar el mundo externo aristotélico tomista. De Aristóteles, mediante la lógica formal y de Tomás de Aquino el mismo proceso para llegar a la verdad absoluta que es Dios. En los intensos y prologados estudios e investigaciones que hemos realizado en las comunidades andinas de la provincia de Chimborazo y Ecuador, con el apoyo y aceptación de los líderes comunitarios y los estudiantes indígenas de la facultad de Ciencias de la Educación de la Universidad Nacional de Chimborazo, hemos llegado a constatar y comprender no existe sensibilidad interna y externa, espacio y tiempo como elementos separados, sensaciones y "formas a priori" como plantea y Kant y fue motivo de varios años que necesitó para tratar de solucionar el problema del conocimiento y buscar caminos entre el dogmatismo y el escepticismo, el racionalismo y el empirismo. En los procesos del conocimiento que todavía se mantienen al interior de la vida de las comunidades andinas el ser humano (niño, joven, adulto, anciano, hombre o mujer) es un todo concreto ubicado y fechado que vive en un texto y en un contexto sociocultural, económico y político comunitario, por lo tanto la sensibilidad es integral y colectiva.Cuando separamos en el proceso de conocimiento del niño sensibilidad, entendimiento y razón estamos desdoblando su normal proceso de aprendizaje, trastocando en partes y separando el conocimiento en islas de aprendizaje, primero la sensación, luego el entendimiento y por último la razón. Por esto los estudiantes indígenas tienen múltiples dificultades en el aprendizaje universitario y algunos docentes por desconocimiento de su cultura e idioma les califican de incapaces y sin conocimientos elementales. El conocimiento en el ser humano es uno solo en el que se integra simultáneamente la percepción de los sentidos y la razón en el proceso cotidiano de ver (observar) juzgar (reflexionar) y actuar (aplicación). Este proceso sirve tanto en el aprendizaje familiar escolar, universitario y del científico, doctorado y postdoctorado. Por lo tanto el fenómeno y el noumeno de Kant se convierten en tema de discusión porque la única realidad existente es la realidad concreta que se vive todos los días en la naturaleza del sujeto, del hombre normal y común, del científico, el filósofo o el político. Las acciones humanas no solo están determinadas por la razón sino por toda la realidad humana: emociones, pasiones, razón y sensibilidad.Se trata de una investigación que pretende iniciar la elaboración de una teoría del aprendizaje desde el conocimiento andino ; As heirs of Western civilization, Greco-Roman culture and colonized by a country result of multiple ethnocultural mixtures, called mother country, Spain, we were forced to break a process of knowledge and learning styles of our Aboriginal people to adopt another way of capturing Aristotelian Thomist external world. Aristoteles, formal logic by Thomas Aquino and the same process to get to the absolute truth which is God. In the intense and prefaced studies and research we have done in Andean communities in the province of Chimborazo and Ecuador, with the support and acceptance of the community leaders and indigenous students of the Faculty of Education Sciences, National University of Chimborazo we have come to observe and understand there isinternal and external sensibility, space and time as separate elements, feelings and "a priori forms" as stated and Kant and was the subject of several years it took to try to solve the problem of knowledge and search paths between dogmatism and skepticism, rationalism and empiricism. In the processes of knowledge which are still within the life of the Andean communities man (child, youth, adult, elder, male or female) is a concrete located and dated all living in a text and in a context sociocultural, economic and political community, therefore the sensitivity is comprehensive and collective. When we separate the knowledge of the child process sensitivity, understanding and reason we are unfolding their normal learning process, upsetting parts and separating the islands of knowledge learning, the feeling first, then understanding and finally the right. Therefore Indian students have many difficulties learning in the university and some teachers' ignorance of their culture and language qualify them unable and basic skills. Knowledge in humans is one in which the perception of the senses and reason in everyday process see (observe) judging (thinking) and acting (implementation) are simultaneously integrated. This process serves schools, universities and scientific family learning, doctoral and postdoctoral. Hence the phenomenon and the noumenon of Kant become the subject of discussion because the only existing reality is the concrete reality of life every day in the nature of the subject, the normal and ordinary man, the scientist, the philosopher or politician. Human actions are determined not only by reason but for the whole human reality: emotions, passions, reason and sensibility. This is a research that aims to initiate the development of a theory of learning from the Andean knowledge

La tesis explora el modelo explicativo de la Diabetes Mellitus tipo 2 (DM2) desde la metodología cualitativa, basándonos en entrevistas en profundidad y grupos focales realizadas entre agosto 2009 y abril 2011 a treinta y nueve adultos diabéticos en Tarapoto; el análisis de los conceptos y significados vertidos muestran su modelo etiológico y explicativo para la DM2. La interacción de las dimensiones cognitiva, actitudinal, conductual y social, muestra un modelo con adecuado nivel cognitivo, en el cual destaca el concepto causal cuyo significado semántico tiene valor pronóstico e influye en las actitudes y conductas. Algunas creencias y prejuicios instalados en el paciente y en su entorno, favorecerían el abandono del tratamiento. La actitud de los participantes evaluada mediante la percepción de la estabilidad y del daño global o específico, mostró que la negación es el principal método de afrontamiento. Pese al conocimiento teórico, las acciones no son siempre congruentes, respondiendo a factores emocionales, resultando insuficiente el autocuidado. La autovigilancia se basa en la auto observación, sin autoanálisis glicémico. El entorno social participa permanente y activamente. La familia, los allegados y los pares, conforman una red de apoyo, percibida como positiva por los pacientes, pero sin ayudar efectivamente al control glicémico. La atención en los servicios de salud y el rol de lo económico complementan el modelo. El itinerario terapéutico del paciente muestra la falta de límites precisos entre el estado de salud y enfermedad, acudiéndose a los sistemas formal e informal de salud. Las historias individuales nos muestran cómo la DM2 se inserta en sus vidas y las modifica, en todos sus aspectos. El actual modelo biomédico de abordaje de la DM2 no satisface las necesidades de los afectados, ni concuerda con el modelo explicativo hallado, requiriéndose un modelo médico multidimensional e integral, que incorpore lo psicológico y lo social, centrándose en el paciente y no en la enfermedad, y que incluya el diálogo transcultural y la presencia del entorno familiar en la relación médico –paciente. Priorizar las determinantes de la salud, enfatizando lo educativo, el empoderamiento familiar, el fomento de estilos de vida saludables, la adecuación de los servicios de salud son actividades que participarían, además de la necesaria voluntad política, para la adopción de un modelo preventivo promocional dentro del programa de Atención Primaria para la DM2, hacia el logro de la salud y el bienestar. ; This thesis addresses the explanatory model of Diabetes Mellitus type 2 (DM2), using qualitative methodology. Through in-depth interviews and focus groups carried out between August 2009 and April 2011, in thirty-nine adult diabetics in the city of Tarapoto. We studied concepts and meanings that make up the etiological and explanatory model of DM2 held by the patients. The interaction of cognitive, attitudinal, behavioral and social dimensions in the patients, displays a model with appropriate knowledge level. In this model the semantic meaning of the causes attributed to the disease has a prognostic value and influences the attitude and behavior of the patient. Some beliefs and prejudices held by the patients and their social and familial environment, promote the abandonment of the treatment. The attitude of the patients who participated in the study that was evaluated through the perception of stability and of global or specific damage showed that denial is the main method of coping. Despite theoretical knowledge, the actions were not always consistent, responding to emotional factors, and resulting in insufficient self-care. Self-monitoring is based on self observation without glycemic self-analysis. The social and familial environment is an active and permanent factor in this dynamic. Family, relatives and peers make up a network of support, perceived as positive by patients, but which does not actually help to control glycemic levels. The model discovered is rounded out with a description of health care services as well as the role of the patient's economic situation. The patient´s therapeutic history shows periods of wellbeing alternating with periods of illness, the patient having recourse to both formal and informal systems of health. The individual stories show us how DM2 is inserted into their life and modifies it in every aspect. The actual biomedical approach to the DM2 model does not satisfy the needs of the patient and differs from the explanatory model we developed. What is required is a holistic medical model able to incorporate psychological as well as social aspects; a multi-dimensional model focused on the patient that includes both cross-cultural dialogue and the presence of their familial environment in the relationship between doctor and patient. It is necessary to prioritize the social determinants of health, emphasizing education, family empowerment, the promotion of healthy lifestyles and the competence of the health services, activities that would additionally require the existence of the necessary political will in order to adopt a preventive promotional model within the Primary Health Care planning for DM2, towards the achievement of health and well-being. ; Tesis

The purpose of this study is to provide with basic information on application of hand acupuncture as a complementary and alternative therapy by giving some recognition of efficiency and effectiveness of hand acupuncture. And so, answers for questionnaires of 290 respondents were used for this research and collected from June 5 through 13, 1999 from adults twenty and over who were participating in the hand acupuncture training program in Seoul and had some direct experiences with hand acupuncture therapy, whatever they had been treated and/or had treated. To secure reliability of measurement tool, Cronbach'a has been calculated and Factor Analysis was done as Validity Analysis of question classification. Demographical characteristics of hand acupuncture experienced people and factors related to hand acupuncture experiences are calculated based on the real number and percentage. The degree of recognition of efficiency and effectiveness of hand acupuncture is made as average and standard deviation, while the degree of recognition of efficiency and effectiveness based on general characteristics come from one-way ANOVA. 1. According to socio-demographical analysis, the questioned could be classified firstly as age (40-49 : 32.5%, 30-39 : 24.9%, 50-59 : 21.9%, 60-69 : 14.7%, 20-29 : 6.0%), secondly gender (male : 36.6%, female : 63.4%), thirdly occupation (housewife : 43.8%, self-employed : 15.5%, company-employee : 14.8%), fourthly education (high school graduate : 41.9%, college graduate : 37.9%), and lastly monthly-income (1 to 2 million : 51.4%, 2 to 3 million : 20.3%) 2. As for the general aspects related to hand acupuncture, 80.0% of the respondents answered almost zero for the monthly average number of visit to hospital and 15.5% responded 1 to 2 visits. 6.2% of the respondents is complaining of a disorder of digestive system, 19.0% circulatory disease, 10.7% bad nervous system. By utilizing hand acupuncture, 84% of the questioned have following experiences in curing diseases: digestive system 47.3%, circulatory system 9.3%, nervous system 8.3%. 54.1% are curing 1 to 2 and 10.3% 3 to 4 patients on a daily basis with hand acupuncture. Research on the demerits of giving medical treatment with hand acupuncture shows 23.8% are feeling economic burden, 16.6% difficulty of learning and 16.2% weak theoretical backgrounds. 3. Among the efficiency recognition, possibility of general application is average 4.29 and simple treatment is 4.19, economic merits 4.36, possibility of establishment with supplementary and alternative medicine 4.17, medical effectiveness 4.09. 4. As a result of demographical analysis on the efficiency and effectiveness of hand acupuncture therapy, it appears that the recognition of efficiency based on occupation and the recognition of effectiveness based on monthly income are most significant to be noticed. In an orderly fashion, governmentemployee, self-employed, company-employee, and then housewife have perceived hand acupuncture very efficiently. And those who recognize hand acupuncture to be most effective are people earn 1 million to 2 million won a month. 5. The efficiency(p=.003) and effectiveness (p=.049) of hand acupuncture therapy by number of visit to hospital were statiscally significant, and effectiveness of hand acupuncture therapy by disease exist was statiscally significant (p=.033). ; 본 연구의 목적은 직접적으로 수지침 경험(시술과 직 접 시술받은 경험)이 있는 사람들의 수지침에 대한 효율성과 효과성에 대한 인식을 통해 보완대체의료 중 수지 침 적용에 관한 기초자료를 제공하고자 1999년 6월 5일 부터 13일까지 서울에 소재 한 수치침요법 교육시설에서 교육 받고 있는 20세 이상 성인 290명의 설문을 이용하 였다. 측정도구의 신뢰성으로 Cronbach,s a 계수를 구하였 으며, 문항분류의 타당성 분석(Validity Analysis)으로 요인분석(Factor Analysis)을 실시하였다. 수지침 경험자의 인구학적 특성과 수지침경험 관련 요 인은 실수와 백분율을 산출하였다. 수지침의 효율성과 효과성 인식정도는 평균과 표준편차를 구하였으며, 일반 적 특성에 따른 효율성과 효과성 인식정도는 ANOVA (Oneway ANOVA)을 실시하였다. 1. 대상자의 사회인구학적 특성에서, 40대 32.5%, 30대 24.9%, 50대 21.9%, 60대 이상 14.7%, 20대 6.0%이었다. 남자가 36.6%, 여자가 63.4%이었으며, 직업별 분포에서 주부가 43.8%, 자영업 15.5%, 회사 원 14.8%순이었다. 학력은 고졸 41.9%, 대졸 37.9% 이었다. 월평균 가계소득은 100-200만원이 51.4%, 200-300만원이 20.3% 이었다. 2. 수지침관련 일반적 사항에서, 대상자의 월평균 병 원 방문횟수는 80.03%가 거의 가지 않는다 이며 한 달 에 1-2회 방문은 15.5%이었다. 현재질병은 소화기계통 36.2%, 순환기계통 19.0% 신경계통 10.7%, 순으로 나타났다. 수지침을 통해서 치료한 경험이 있는 병으로 는 소화기 47.6%, 순환기 9.3%, 신경계 8.3%로 조사 대상의 84%가 수지침을 통하여 병을 치료한 경험을 가 지고 있었다. 대상자중 54.1%가 하루 1-2명, 10.3%는 3-4명 사람에게 수지침요법을 적용해 주는 것으로 나타 났다. 수지침 시술의 단점에 관한 조사에서 경제적 부 담 23.8%, 배우기 어렵다 16.6%, 미약한 이론적 배경 16.2% 이었다. 3. 수지침의 효율성 인식정도 중 일반적 적용가능성의 평균이 4.29점, 간단한 병의 치료 4.19점 순으로 나타 났으며, 효율성 인식정도 중 다른 치료방법에 비교한 경 제성이 4.36점, 보완대체의학으로서의 성립 가능성 4.17, 의학적 효과 4.09순으로 나타났다. 4. 인구학적 특성에 따른 수지침요법의 효율성과 효과 성 분석결과, 직업에 따른 효율성 인식과 월 소득에 따 른 효과성 인식이 유의하게 나타났다. 공무원, 자영업, 회사원, 주부의 순으로 수지침요법을 효율적으로 인식하 였고, 월 소득 100-200백만원에 속하는 사람들이 수지침요법을 가장 효과적이라고 인식하고 있는 것으로 나타 났다. 5. 병원 방문 횟수에 따른 효율성(p=.003)과 효과성 (p=.049) 및 질병 유무에 따른 효과성(p=.033)에 대 한 인식의 차이는 통계적으로 유의하게 나타났다. ; open

Background: Low lung function has been associated with increased body mass index (BMI). The aim of this study was to investigate whether the effect of BMI on lung function is mediated by DNA methylation. Methods: We used individual data from 285,495 participants in four population-based cohorts: the European Community Respiratory Health Survey, the Northern Finland Birth Cohort 1966, the Swiss Study on Air Pollution and Lung Disease in Adults, and the UK Biobank. We carried out Mendelian randomisation (MR) analyses in two steps using a two-sample approach with SNPs as instrumental variables (IVs) in each step. In step 1 MR, we estimated the causal effect of BMI on peripheral blood DNA methylation (measured at genome-wide level) using 95 BMI-associated SNPs as IVs. In step 2 MR, we estimated the causal effect of DNA methylation on FEV1, FVC, and FEV1/FVC using two SNPs acting as methQTLs occurring close (in cis) to CpGs identified in the first step. These analyses were conducted after exclusion of weak IVs (F statistic < 10) and MR estimates were derived using the Wald ratio, with standard error from the delta method. Individuals whose data were used in step 1 were not included in step 2. Results: In step 1, we found that BMI might have a small causal effect on DNA methylation levels (less than 1% change in methylation per 1 kg/m2 increase in BMI) at two CpGs (cg09046979 and cg12580248). In step 2, we found no evidence of a causal effect of DNA methylation at cg09046979 on lung function. We could not estimate the causal effect of DNA methylation at cg12580248 on lung function as we could not find publicly available data on the association of this CpG with SNPs. Conclusions: To our knowledge, this is the first paper to report the use of a two-step MR approach to assess the role of DNA methylation in mediating the effect of a non-genetic factor on lung function. Our findings do not support a mediating effect of DNA methylation in the association of lung function with BMI. ; This work was conducted within the Ageing Lungs in European Cohorts (ALEC) project and received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 633212. The funders of this study had no role in study design, data analysis and interpretation of results, or writing of the manuscript. The ECRHS was supported by a contract from the European Commission (018996), Fondo de Investigación Sanitaria (91/0016–060-05/E, 92/0319, 93/0393, 97/0035–01, 99/0034–01 and 99/0034–02), Hospital General de Albacete, Hospital General Ramón Jiménez, Consejería de Sanidad del Principado de Asturias, CIRIT (1997SGR 00079, 1999SGR 00241), and Servicio Andaluz de Salud, SEPAR, Public Health Service (R01 HL62633–01), RCESP (C03/09), Red RESPIRA (C03/011), Basque Health Department, Swiss National Science Foundation, Swiss Federal Office for Education and Science, Swiss National Accident Insurance Fund (SUVA), GSF-National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (DFG) (FR 1526/1–1, MA 711/4–1), Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, Ministere de l'Emploi et de la Solidarite, Direction Generale de la Sante, CHU de Grenoble, Comite des Maladies Respiratoires de l'Isere. UCB-Pharma (France), Aventis (France), Glaxo France. Estonian Science Foundation, and Asthma UK (formerly known as National Asthma Campaign UK). The NFBC resource has been supported by grants from the Academy of Finland (project grants 104781, 120315, 129269, 1114194, 24300796, Center of Excellence in Complex Disease Genetics and SALVE), University Hospital Oulu, Biocenter, University of Oulu, Finland (75617), NHLBI grant 5R01HL087679–02 (1RL1MH083268–01), NIH/NIMH (5R01MH63706:02), ENGAGE project and grant agreement HEALTH-F4–2007-201413, EU FP7 EurHEALTHAgeing − 277849, the Medical Research Council, UK (G0500539, G0600705, G1002319, PrevMetSyn/SALVE) and the MRC, Centenary Early Career Award. H2020 DynaHEALTH (European Union's Horizon 2020 research and innovation programme under grant agreement No 633595); Exposomic, Genomic and Epigenomic Approach to Prediction of Metabolic and Cardiorespiratory function and Ill-Health (EGEA), Academy of Finland, Grant No 285547; ALEC Study (funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No. 633212); H2020 / Marie Skłodowska-Curie Actions, CAPICE (Marie Curie Grant agreement Number 721567); National Public Health Institute, Biomedicum Helsinki, Finland. The SAPALDIA study was funded by the Swiss National Science Foundation (grants no 33CS30–148470/1&2, 33CSCO-134276/1, 33CSCO-108796, 324730_135673, 3247BO-104283, 3247BO-104288, 3247BO-104284, 3247–065896, 3100–059302, 3200–052720, 3200–042532, 4026–028099, PMPDP3_129021/1, PMPDP3_141671/1), the Federal Office for the Environment, the Federal Office of Public Health, the Federal Office of Roads and Transport, the canton's government of Aargau, Basel-Stadt, Basel-Land, Geneva, Luzern, Ticino, Valais, and Zürich, the Swiss Lung League, the canton's Lung League of Basel Stadt/ Basel Landschaft, Geneva, Ticino, Valais, Graubünden and Zurich, Stiftung ehemals Bündner Heilstätten, SUVA, Freiwillige Akademische Gesellschaft, UBS Wealth Foundation, Talecris Biotherapeutics GmbH, Abbott Diagnostics, European Commission 018996 (GABRIEL), Wellcome Trust WT 084703MA, Exposomics EC FP7 grant (Grant agreement No: 308610).

PROBLEM/CONDITION: Cigarette smoking is the leading preventable cause of death in the United States, accounting for approximately 440,000 deaths each year. The prevalence of cigarette smoking nationwide among high school students (grades 9-12) increased during the 1990s, peaking during 1996-1997, and then declined. Approximately 80% of tobacco users initiate use before age 18 years. An estimated 6.4 million children aged <18 years who are living today will die prematurely as adults because they began to smoke cigarettes during adolescence. The annual health-related economic cost associated with tobacco use exceeds 167 billion dollars. Because of these health and economic consequences, CDC has recommended that states establish and maintain comprehensive tobacco-control programs to reduce tobacco use among youth. REPORTING PERIOD: This report covers data collected during January 2001-December 2002. DESCRIPTION OF THE SYSTEM: The National Youth Tobacco Survey (NYTS) and state youth tobacco surveys (YTS) were developed to provide states with data to support the design, implementation, and evaluation of comprehensive tobacco-control programs. NYTS is representative of middle and high school students in the 50 states and the District of Columbia. During spring 2002, a total of 26,149 students in 246 schools completed NYTS questionnaires. Weighted data for the YTS were achieved by 13 states in 2001 and by 20 states in 2002; state sample sizes varied (range: 982-38,934). This report summarizes data from the 2002 NYTS and the 2001 and 2002 YTS. RESULTS AND INTERPRETATION: Findings from the 2002 NYTS indicate that current use of any tobacco product ranged from 13.3% among middle school students to 28.2% among high school students. Cigarette smoking was the most prevalent form of tobacco use, with 9.8% of middle school students and 22.5% of high school students reporting that they currently smoke cigarettes. Cigar smoking was the second most prevalent form of tobacco use, with 6.0% of middle school students and 11.6% of high school students reporting that they currently smoke cigars. Among current cigarette smokers, 41.8% of middle school students and 52.0% of high school students reported that they usually smoke Marlboro cigarettes. Black middle school and high school students who smoke were more likely to smoke Newport cigarettes than any other brand (58.3% and 66.8%, respectively). Among middle school students aged <18 years, 75.9% were not asked to show proof of age when they bought or tried to buy cigarettes, and 63.4% were not refused purchase because of their age. Among high school students aged <18 years, 58.5% were not asked to show proof of age when they bought or tried to buy cigarettes, and 60.6% were not refused purchase because of their age. Nearly half (49.6%) of middle school students and 62.1% of high school students who smoke reported a desire to stop smoking cigarettes, with 55.4% of middle school students and 53.1% of high school students reported having made at least one cessation attempt during the 12 months preceding the survey. Among students who have never smoked cigarettes, 21.3% of middle school students and 22.9% of high school students were susceptible to initiating cigarette smoking in the next year. Exposure to secondhand smoke (i.e., environmental tobacco smoke) was high. During the week before the survey, 1) 88.3% of middle school students and 91.4% of high school students who currently smoke cigarettes and 47.1% of middle school students and 53.3% of high school students who have never smoked cigarettes were in the same room with someone who was smoking cigarettes; 2) 81.7% of middle school students and 83.7% of high school students who currently smoke cigarettes and 31.5% of middle school students and 29.1% of high school students who have never smoked cigarettes rode in a car with someone who was smoking cigarettes; and 3) 71.5% of middle school students and 57.5% of high school students who currently smoke cigarettes and 33.3% of middle school students and 29.9% of high school students who have never smoked cigarettes lived in a home in which someone else smoked cigarettes. Media and advertising influence was also noted, with 58.1% of middle school students and 54.9% of high school students who currently use tobacco and 11.0% of middle school students and 13.7% of high school students who have never used tobacco reporting that they would wear or use an item with a tobacco company name or logo on it. Although 84.6% of middle school students and 91.2% of high school students had seen or heard antismoking commercials on television or radio, 89.9% of middle school students and 91.3% of high school students also had seen actors using tobacco on television or in the movies. PUBLIC HEALTH ACTIONS: Health and education officials use YTS and NYTS data to plan, evaluate, and improve national and state programs to prevent and control youth tobacco use. States can use these data in presentations to their state legislators to demonstrate the need for funding comprehensive tobacco-control programs, including tobacco cessation and prevention programs for youth. ; LaTisha Marshall, Michael Schooley, Heather Ryan, Patrick Cox, Alyssa Easton, Cheryl Healton, Kat Jackson, Kevin C. Davis, Ghada Homsi ; Caption title. ; Also available via the World Wide Web. ; Includes bibliographical references (p. 24).