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Background: Cervarix is a prophylactic vaccine used in preventing cervical cancer associated with human papillomavirus types 16/18. A previous study that investigated the risk of miscarriage associated with this bivalent vaccine by pooled analysis of data from two clinical trials, showed a numerically higher but statistically insignificant miscarriage rate in the HPV arm for pregnancies that began within three months following the vaccination. We explored this issue using an alternative statistical approach. Objectives: To develop a hierarchical Bayes model to identify the potential time-dependent risk window of miscarriage rate associated with the bivalent HPV vaccine. Methods: This study comprised the development of a hierarchical Bayes Model with its model inference and the application of this model to a real-world question. A multivariate logistic model was proposed that involved an indicator variable to accommodate a risk window with lower and higher cut-off points. Gibbs Sampling algorithms were used for the inference on the parameters of interest. Over ninety sets of simulation studies were conducted to evaluate the performance of the proposed method and estimate the power in detecting the risk effect. The Bayesian approach was then compared to the existing traditional approaches (e.g. the permutation test). The proposed model was applied to the subpopulation of pregnant women from the Costa Rica Vaccine Trial. Results: In simulation studies, the Bayesian model demonstrated a better performance over the traditional approaches. It showed higher power than the traditional hypothesis testing in detecting the risk effect; it was more informative than the permutation test because it provided both the point estimates and the corresponding credible intervals for the cut-points and the ratio of odds ratios. In the analysis of the CVT data, we observed an effect of 1.13 (95% credible interval: 0.49 to 2.75), implying no significant evidence to support the hypothesis that HPV is associated with a higher miscarriage rate. Conclusions: The hierarchical Bayes model can be applied to investigate the time-dependent risk of adverse events in clinical trials. Using the new Bayesian method, no significant risk of miscarriage in the Costa Rica Vaccine Trial was established, which is consistent with previous report. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-01-30 23:20:39.859

<p> Radiation is a ubiquitous health risk. Contemporary populations are exposed to several hundred milliSieverts per person over their lifetimes from both natural and human made sources such as radon, cosmic rays, CT-scans, etc. Risk estimates based on studies of atomic bomb survivors suggest that these exposures induce excess cancer mortality at a rate of several percent per Sievert. </p><p> To develop accurate risk estimates, it is important to recognize that contemporary exposures are different than atomic bomb survivor exposures. Instead of a single acute high dose rate exposure from an atomic explosion, populations today experience many small, protracted exposures accumulating to moderate total doses over their lifetimes. Therefore, in order to estimate the risk of contemporary exposures using atomic bomb survivor data, it is important to determine the differences in radiation dose response following acute vs. protracted exposures. </p><p> The committee to estimate the biological effects of ionizing radiation exposure in humans (BEIR) is one of the central authorities in the United States tasked with estimating radiation risk. Their seventh and most recent report (BEIR VII) written in 2006 estimated that contemporary protracted exposures induce 1.5 fold less risk than atomic bomb survivor exposures. </p><p> The work presented in this dissertation leverages a large body of historical animal mortality data to argue that BEIR VII overestimates the risk of protracted exposures. Concretely, evidence is presented from animal exposures that support the concept that contemporary protracted exposures induce about 2 fold less risk than atomic bomb survivor exposures.</p>

<p> <i><u>Introduction:</u></i></p><p> Medication related osteonecrosis of the jaw (MRONJ) is exposed bone in the maxillofacial region that does not heal within eight weeks after identification by a health professional. Cancer patients taking or who have a history of taking anti-resorptive or anti-angiogenic agents have an increased risk for MRONJ. MRONJ adversely affects quality of life and results in significant morbidity. It has been shown that patients with risk factors for MRONJ are not aware of the condition or preventive strategies. Understanding patient awareness is the first step in communicating strategies for the prevention of and management of MRONJ.</p><p> <i><u>Aim of the study:</u></i></p><p> To describe the awareness level and characteristics, such as education level, of MRONJ among Roswell Park Cancer Institute (RPCI) patients who receive dental services in the RPCI dental clinic.</p><p> <i><u>Material and Methods:</u></i></p><p> This is a prospective interviewer administered research electronic data capture (REDCap) survey project. The sample include RPCI dental patients who are at least 18 years old with a history of taking, currently taking or will be taking Bisphosphonate, Denosumab, and/or Anti-angiogenic agent as part of their treatment at RPCI and volunteered to participate in the study. Patients were screened for eligibility by an RPCI dentist. Selected patients have been asked 21 questions.</p><p> <i><u>Results:</u></i></p><p> Twenty patients, 10 males and 10 females, participated in this study. The age of our subjects were ranging from 23 to 82 years. Eleven patients have completed a college degree or above, five have completed a high school diploma, and four have some college. Out of 20, nine patients only were aware of osteonecrosis of the jaw (ONJ). No relation has been found between ONJ awareness and gender, education level, or age.</p><p> <i><u>Conclusion:</u></i></p><p> This study shows that awareness of medication-related osteonecrosis of the jaw is poor amongst oncology patients who are at risk of MRONJ. There was no relation between age, gender, or education level and ONJ awareness in oncology patients. An effort to educate users of bisphosphonate, denosumab, bevacizumab, and sunitinib about their medications and their potential side effects as well as including preventative measures must be pursued. Health care providers, especially dentists, must be aware of MRONJ and its risk factors. In addition, they should know the significance of their role in educating and preventing the condition by following their health practice guidelines as well as applying the necessary preventive measures on their patients.</p>

A dissertation submitted to the faculty of Medicine of the University of the Witwatersrand in partial fulfillment of the requirements for the Master of Medicine (Community Health) Johannesburg, October 1991. / This dissertation reviews the international literature and South African literature and data on the epidemiology of Measles. The main purpose is to contribute to an understanding of the local epidemiology of the disease that will further the development of more targeted efforts for its control. [Abbreviated Abstract. Open document to view full version] / MT2018