„Comorbidity“ among mental disorders is commonly observed in both clinical and epidemiological samples. The robustness of this observation is rarely questioned; however, what is at issue is its meaning. Is comorbidity „noise“ – nuisance covariance that researchers should eliminate by seeking „pure“ cases for their studies – or a „signal“ – an indication that current diagnostic systems are lacking in parsimony and are not „carving nature at its joints?“ (Krueger, p. 921). With these words, Krueger started a discussion on the structure of mental disorders, which suggested that a 3-factor model of common mental disorders existed in the community. These common factors were labeled „anxious-misery,“ „fear“ (constituting facets of a higher-order internalizing factor), and „externalizing.“ Along with similar evidence from personality research and psychometric explorations and selective evidence from genetic and psychopharmacologic studies, Krueger suggested that this model might not only be phenotypically relevant, but might actually improve our understanding of core processes underlying psychopathology. Since then, this suggestion has become an influential, yet also controversial topic in the scientific community, and has received attention particularly in the context of the current revision process of the Manual of Mental Disorders (Fifth Edition) (DSM-V) and the International Classification of Diseases, 11th Revision (ICD-11). Focusing on anxiety disorders, this article critically discusses the methods and findings of this work, calls into question the model’s developmental stability and utility for clinical use and clinical research, and challenges the wide-ranging implications that have been linked to the findings of this type of exploration. This critical appraisal is intended to flag several significant concerns about the method. In particular, the concerns center around the tendency to attach wide-ranging implications (eg, in terms of clinical research, clinical practice, public health, diagnostic nomenclature) to the undoubtedly interesting statistical explorations.

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The field of medicine is regularly faced with the challenge of utilizing information that is complicated or difficult to characterize. Physicians often must use their best judgment in reaching decisions or recommendations for treatment in the clinical setting. The goal of this thesis is to use innovative statistical tools in tackling three specific challenges of this nature from current healthcare applications. The first aim focuses on developing a novel approach to meta-analysis when combining binary data from multiple studies of paired design, particularly in cases of high heterogeneity between studies. The challenge is in properly accounting for heterogeneity when dealing with a low or moderate number of studies, and with a rarely occurring outcome. The proposed approach uses a Rasch model for translating data from multiple paired studies into a unified structure that allows for properly handling variability associated with both pair effects and study effects. Analysis is then performed using a Bayesian hierarchical structure, which accounts for heterogeneity in a direct way within the variances of the separate generating distributions for each model parameter. This approach is applied to the debated topic within the dental community of the comparative effectiveness of materials used for pit-and-fissure sealants. The second and third aims of this research both have applications in early detection of breast cancer. The interpretation of a mammogram is often difficult since signs of early disease are often minuscule, and the appearance of even normal tissue can be highly variable and complex. Physicians often have to consider many important pieces of the whole picture when trying to assess next steps. The final two aims focus on improving the interpretation of findings in mammograms to aid in early cancer detection. When dealing with high frequency and irregular data, as is seen in most medical images, the behaviors of these complex structures are often difficult or impossible to quantify by standard modeling techniques. But a commonly occurring phenomenon in high-frequency data is that of regular scaling. The second aim in this thesis is to develop and evaluate a wavelet-based scaling estimator that reduces the information in a mammogram down to an informative and low-dimensional quantification of the innate scaling behavior, optimized for use in classifying the tissue as cancerous or non-cancerous. The specific demands for this estimator are that it be robust with respect to distributional assumptions on the data, and with respect to outlier levels in the frequency domain representation of the data. The final aim in this research focuses on enhancing the visualization of microcalcifications that are too small to capture well on screening mammograms. Using scale-mixing discrete wavelet transform methods, the existing detail information contained in a very small and course image will be used to impute scaled details at finer levels. These "informed" finer details will then be used to produce an image of much higher resolution than the original, improving the visualization of the object. The goal is to also produce a confidence area for the true location of the shape's borders, allowing for more accurate feature assessment. Through the more accurate assessment of these very small shapes, physicians may be more confident in deciding next steps.

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.