A commonly used method for confounder selection is to determine the percent difference between the crude and adjusted odds ratio of the covariate of interest, and to include the adjusting variable if the difference is greater than 10-15%. However, in logistic regression the crude and adjusted odds ratio may be different even in the absence of confounding, a phenomenon called modification. This research shows through simulations that the change in odds ratio rule often leads to incorrect inclusion or exclusion of a covariate. Alternative ways for covariate selection are suggested that take confounding and modification as well as bias and variability of the estimated odds ratio into account. In addition, this research investigates the theoretical performance of the logistic regression model in terms of model fit by examining the discrepancy between misspecified logistic and true models using the Kullback-Leibler discrepancy (KLIC) and the Pearson $\chi\sp2.$ It is found that even though the discrepancy measures increase with the degree of model misspecification, large increases in misspecification often result in small changes in the discrepancy measures. The results suggest that statistics measuring lack of fit are large only if the misspecification is severe. The use of an empirical estimator of the Kullback-Leibler discrepancy based on non-parametric kernel estimation is examined. Its performance in approximating the KLIC is compared to the performance of the empirical Pearson $\chi\sp2$ statistic and the Hosmer-Lemeshow statistic as estimators of the true Pearson $\chi\sp2$ discrepancy. It is shown that the empirical estimator of the KLIC approximates the true discrepancy more closely than the other two statistics, but that it can only distinguish between highly different levels of model fit.

In this thesis we develop a method for efficient model building in nonlinear members of the GLM family, with emphasis on best subset selection and on utilization of existing linear regression software. The method is based on a "linearized" estimator of a subset of regression parameters, under the assumption that the remaining parameters are zero. It has been introduced by Lawless and Singhal (1978) in a form which requires special software. We define an estimator which has the same functional form as the maximum likelihood estimator of regression parameters obtained from the IRLS procedure, and show that it is identical with the estimator proposed by Lawless and Singhal. The same estimator has been discussed by Hosmer, Jovanovic and Lemeshow (1989) in the context of best subset logistic regression, by Nordberg (1982) in the context of stepwise selection and by Gilks (1986) in a broader context of model selection. Asymptotic results are developed for quadratic forms, F-statistics and Mallows' C used in weighted linear regression best subset selection on the vector of pseudo-data. Based on these, practical guidelines for the use of the method in nonlinear GLM members are provided. It is shown how the linearized estimator can be used to obtain diagnostic measures and to estimate the bias in regression parameter estimates, for nonlinear GLM members, from existing linear regression software. Simulation results are provided for the logistic and Poisson regression models with uniformly distributed independent regressors, for sample sizes 100, 200 and 400. Simulation results closely follow theoretical results developed for quadratic forms, F-statistics and Mallows' C, and the upper percentiles of F-statistics are well approximated by the percentiles of the corresponding F distributions. Correction factors for the moments of the Pearson Chi-square statistic as discussed by McCullagh and Nelder (1989) are examined. Evidence shows that the correction factors depend on the true value of the underlying parameter but not on the sample size. Simulation results for the Poisson regression model Pearson Chi-square statistic show closer adherence to theoretical moments than they do for the logistic regression model.

Introdução - O método de captura-recaptura vem sendo empregado em Epidemiologia desde meados do século XX, e se consolidou a partir dos anos 1990, quando se nota grande número de publicações sobre sua aplicação e desenvolvimento nesta área. O sub-registro de eventos vitais ainda se revela um entrave para o cálculo direto de indicadores como os de fecundidade e mortalidade infantil, forçando seu cálculo indireto através de métodos demográficos, cujos procedimentos não permitem estimação em níveis geográficos menores do que unidade da federação, em períodos intercensitários. Objetivo Estimar o sub-registro de nascidos vivos, aplicando o método de captura-recaptura para populações fechadas. Métodos - As bases de dados do Sistema Nacional de Informação sobre Nascidos Vivos (SINASC) e do Registro Civil do IBGE, nos segundo e terceiro trimestres de 2006 do estado de Sergipe, foram pareadas por relacionamento determinístico a partir do número da Declaração de Nascido Vivo. As desagregações geográficas adotadas foram as de microrregião e regional de saúde de residência da mãe. Os modelos de Huggins para populações fechadas foram aplicados para estimar as probabilidades de captura em cada uma das bases e o total de nascidos vivos ocorrido no período, dentro de cada desagregação geográfica O aplicativo utilizado para as estimações foi o Software MARK®. Resultados A aplicação do método de captura e recaptura para estimar sub-registro de nascidos vivos é factível, inclusive para desagregações geográficas menores do que unidade da federação. O relacionamento determinístico foi prejudicado em quatro microrregiões e em uma regional de saúde, devido à falta de preeenchimento do número da Declaração de Nascido Vivo na base do IBGE. O aplicativo MARK® apresenta interface amigável, o que facilitou a construção e seleção dos modelos estatísticos, permitindo identificar que a idade da mãe afeta a probabilidade de captura pelo Registro Civil, característica de heterogeneidade na população de nascidos vivos. Conclusões O relacionamento determinístico destas duas bases de dados oficiais viabiliza ações localizadas, porque acaba por identificar onde e quantas vidas mantêm-se no anonimato jurídico, devido ao sub-registro e registro tardio. O método de captura e recaptura mostrou-se uma alternativa acessível e barata para a estimação de sub-registro de nascidos vivos / Introduction Capture-recapture method has been used in Epidemiology since the middle of twentieth century and from the 1990s on, huge number of publications about applying and developing the method on this area have been noted. Underreporting of vital events is still a drawback for the direct calculation of health indicators like fertility and infant mortality, forcing indirect calculation with demographic methods, wich procedures do not allow estimation in geographic levels smaller than States, in intercensuses periods. Objective To estimate underreporting of live births, using the capture-recapture method for closed populations. Methods The National Live Birth Information System (SINASC) and the Civil Registry databases, in the second and third trimesters of 2006 of the State of Sergipe, Brazil, were linked through deterministic linkage using the Live Birth Declaration number as the connection key. Mothers micro-regions and health regions of residence were adopted as geographical subdivisions. Huggins closed capture models were used to estimate the capture probabilities for each database as well as the derived estimation of the total of live births in the selected time interval, at each of geographical subdivisions. MARK® Software was used to get all estimations. Results The capture-recapture method is feasible for estimation of live birth underreporting, even for geographical subdivisions smaller than States. Deterministic linkage was damaged due to lack of filling of the Live Declaration number in some of the Civil Registry databases registries, mainly at four mother residences micro-regions and at one health region. Program MARK® shows friendly interface, which favoured models building and selection, and allowed to point out mother ages influence in Civil Registry database capture probability, characterisc heterogeneity of live born population. Conclusions Deterministic linkage of these two official databases makes possible local actions, because it allows do identify where and how many lives are neglected legal registrations duty, due to underreporting and to late reporting. Capture-recapture method appears as an accessible and cheap alternative for live birth underreporting estimation

Introdução: No Brasil, verifica-se maior mortalidade masculina em, praticamente, todas as idades e para quase a totalidade das causas. Objetivo: Estimar e descrever a tendência da mortalidade masculina, entre 1979 e 2007, em três capitais de estados brasileiros, São Paulo (SP), Rio de Janeiro (RJ) e Porto Alegre (RS), segundo faixa etária, local de residência e causa básica de morte. Material e método: As populações de estudo referem-se aos contingentes de residentes em São Paulo, Rio de Janeiro e Porto Alegre, nos triênios, 1979/1981, 1990/1992, 1999/2001 e 2005/2007 e aos respectivos óbitos. As fontes de dados foram IBGE e Sistemas de Informações em Saúde do Ministério da Saúde. As localidades foram selecionadas por, reconhecidamente, apresentarem adequada qualidade das informações necessárias. Calcularam-se coeficientes de mortalidade gerais (brutos e padronizados) e específicos, médios para os triênios. Foram feitas comparações entre os indicadores, no tempo e no espaço. Resultados: Verificou-se, no período e nas três capitais, declínio da proporção de crianças e de jovens e tendência crescente da proporção de pessoas de 60 anos e mais de idade. Até os 24 anos, homens predominaram na população; a partir daí, já se observaram maiores participações femininas e razões de sexos cada vez mais baixas, evidenciando, entre idosos, alta presença de mulheres, fato associado à elevada mortalidade masculina (coeficientes padronizados, respectivamente, no início e fim da série temporal, de 11,9 e 9,4 óbitos por mil homens, em São Paulo; de 12,7 e 9,8 óbitos por mil homens, no Rio de Janeiro e de 12,1 e 9,5 mortes por mil homens, em Porto Alegre). Notou-se acometimento intenso de homens jovens pelas causas externas, cujos coeficientes específicos, para homens de 20 a 24 anos, foram, em 1979/1981 e 2005/2007, respectivamente, de 163,8 e 165,8 por cem mil homens paulistas; de 241 e 336,2 por cem mil, no Rio de Janeiro, e de 144,1 e 236,1 por cem mil, em Porto Alegre. Ao longo da série, as causas externas apresentaram grande estimativa de risco de morte masculina, sendo que, em 2005/2007, foram a primeira causa de morte em homens até a idade de 40 a 44 anos, em São Paulo e Rio de Janeiro; em Porto Alegre, manteve a primeira posição até a faixa de 30 a 34 anos. Após, em quase todos os grupos etários seguintes, as doenças do aparelho circulatório aparecem como a principal causa de morte e, as neoplasias passam à segunda posição entre as mais importantes causas de morte masculina. Considerações finais: As localidades evidenciam características de cidades em vias de desenvolvimento, com redução da fecundidade, aumento da longevidade e conseqüente envelhecimento populacional. As estimativas do elevado risco de morrer de homens tornam clara sua vulnerabilidade em adultos jovens, acometimento intenso das mortes violentas; a partir dos 35 anos, as doenças crônicas e degenerativas se destacam. A intensidade com que estes eventos ocorrem, entre homens, demanda ações que possibilitem redução dos índices de mortalidade por causas preveníveis e evitáveis, eliminando comportamentos de risco e adoção de hábitos de vida saudáveis. Diante disso, haverá aumento da sua esperança de vida e redução das diferenças entre mortalidade feminina e masculina / Introduction: In Brazil, there is a higher male mortality in almost all ages and causes. Objective: To estimate and describe the trend in male mortality, between 1979 and 2007, in three State Capitals, São Paulo (SP), Rio de Janeiro (RJ) and Porto Alegre (RS), according to age, place of residence and underlying cause of death. Methods: The study populations refer to the residents in Sao Paulo, Rio de Janeiro and Porto Alegre, in the periods, 1979/1981, 1990/1992, 1999/2001 and 2005/2007, and their deaths. The data sources were Brazilian Institute of Geography and Statistics and Information System in Health of the Brazilian Ministry of Health. These cities were selected because, admittedly, they have an appropriate quality of death information. Overall (crude and standardized) and specific mortality coefficients were calculated (average for the triennium). Comparisons were done in time and space. Results: There was, in the period, reduction in the proportion of children and youth, and growing trend in the proportion of older people (60 years and above). Up to 24 years, men predominate in the population; it has been observed higher female participation and gender ratios ever lower, showing among the elderly, high presence of women. This fact is associated with high male mortality (standardized coefficients, respectively, at the beginning and end of the series, from 11.9 to 9.4 deaths per thousand men in São Paulo, from 12.7 to 9.8 deaths per thousand men in Rio de Janeiro and 12.1 to 9, 5 deaths per thousand men in Porto Alegre). It was noted, specifically, intense involvement of young men and external causes, whose specific rates for ages 20 to 24, were in 1979/191 and 2005/2007, respectively, 163.8 and 165.8 deaths per hundred thousand men from São Paulo, 241 and 336.2 per hundred thousand in Rio de Janeiro, and 144.1 and 236.1 per hundred thousand men in Porto Alegre. Throughout the series, these causes were responsible for large risk estimates of male death, and in 2005/2007, this group was the leading cause of death in men until the age group 40 to 44 years in Sao Paulo and Rio Janeiro. In Porto Alegre, it maintained the first position until ages 30 to 34 years. After that, almost in all age groups, deaths by circulatory system diseases appear as the main cause; cancer came in the second position among the most important causes of male deaths. Conclusion: These capitals show features of a developing city, with reduced fertility, increased longevity and consequent trending to an aging population. Estimates of the men high risk of dying make clear their vulnerability as young adults, in intense involvement in violent deaths; after 35 years, chronic and degenerative diseases stand out. The intensity with which these events occur demand actions that should reduces the mortality rates of preventable diseases, reduce the mens risky behaviors. It is necessary that men try to adopt healthier lifestyles habits, thus increasing life expectancy and reducing the differences between female and male mortalities

Introdução: No Brasil, verifica-se maior mortalidade masculina em, praticamente, todas as idades e para quase a totalidade das causas. Objetivo: Estimar e descrever a tendência da mortalidade masculina, entre 1979 e 2007, em três capitais de estados brasileiros, São Paulo (SP), Rio de Janeiro (RJ) e Porto Alegre (RS), segundo faixa etária, local de residência e causa básica de morte. Material e método: As populações de estudo referem-se aos contingentes de residentes em São Paulo, Rio de Janeiro e Porto Alegre, nos triênios, 1979/1981, 1990/1992, 1999/2001 e 2005/2007 e aos respectivos óbitos. As fontes de dados foram IBGE e Sistemas de Informações em Saúde do Ministério da Saúde. As localidades foram selecionadas por, reconhecidamente, apresentarem adequada qualidade das informações necessárias. Calcularam-se coeficientes de mortalidade gerais (brutos e padronizados) e específicos, médios para os triênios. Foram feitas comparações entre os indicadores, no tempo e no espaço. Resultados: Verificou-se, no período e nas três capitais, declínio da proporção de crianças e de jovens e tendência crescente da proporção de pessoas de 60 anos e mais de idade. Até os 24 anos, homens predominaram na população; a partir daí, já se observaram maiores participações femininas e razões de sexos cada vez mais baixas, evidenciando, entre idosos, alta presença de mulheres, fato associado à elevada mortalidade masculina (coeficientes padronizados, respectivamente, no início e fim da série temporal, de 11,9 e 9,4 óbitos por mil homens, em São Paulo; de 12,7 e 9,8 óbitos por mil homens, no Rio de Janeiro e de 12,1 e 9,5 mortes por mil homens, em Porto Alegre). Notou-se acometimento intenso de homens jovens pelas causas externas, cujos coeficientes específicos, para homens de 20 a 24 anos, foram, em 1979/1981 e 2005/2007, respectivamente, de 163,8 e 165,8 por cem mil homens paulistas; de 241 e 336,2 por cem mil, no Rio de Janeiro, e de 144,1 e 236,1 por cem mil, em Porto Alegre. Ao longo da série, as causas externas apresentaram grande estimativa de risco de morte masculina, sendo que, em 2005/2007, foram a primeira causa de morte em homens até a idade de 40 a 44 anos, em São Paulo e Rio de Janeiro; em Porto Alegre, manteve a primeira posição até a faixa de 30 a 34 anos. Após, em quase todos os grupos etários seguintes, as doenças do aparelho circulatório aparecem como a principal causa de morte e, as neoplasias passam à segunda posição entre as mais importantes causas de morte masculina. Considerações finais: As localidades evidenciam características de cidades em vias de desenvolvimento, com redução da fecundidade, aumento da longevidade e conseqüente envelhecimento populacional. As estimativas do elevado risco de morrer de homens tornam clara sua vulnerabilidade em adultos jovens, acometimento intenso das mortes violentas; a partir dos 35 anos, as doenças crônicas e degenerativas se destacam. A intensidade com que estes eventos ocorrem, entre homens, demanda ações que possibilitem redução dos índices de mortalidade por causas preveníveis e evitáveis, eliminando comportamentos de risco e adoção de hábitos de vida saudáveis. Diante disso, haverá aumento da sua esperança de vida e redução das diferenças entre mortalidade feminina e masculina / Introduction: In Brazil, there is a higher male mortality in almost all ages and causes. Objective: To estimate and describe the trend in male mortality, between 1979 and 2007, in three State Capitals, São Paulo (SP), Rio de Janeiro (RJ) and Porto Alegre (RS), according to age, place of residence and underlying cause of death. Methods: The study populations refer to the residents in Sao Paulo, Rio de Janeiro and Porto Alegre, in the periods, 1979/1981, 1990/1992, 1999/2001 and 2005/2007, and their deaths. The data sources were Brazilian Institute of Geography and Statistics and Information System in Health of the Brazilian Ministry of Health. These cities were selected because, admittedly, they have an appropriate quality of death information. Overall (crude and standardized) and specific mortality coefficients were calculated (average for the triennium). Comparisons were done in time and space. Results: There was, in the period, reduction in the proportion of children and youth, and growing trend in the proportion of older people (60 years and above). Up to 24 years, men predominate in the population; it has been observed higher female participation and gender ratios ever lower, showing among the elderly, high presence of women. This fact is associated with high male mortality (standardized coefficients, respectively, at the beginning and end of the series, from 11.9 to 9.4 deaths per thousand men in São Paulo, from 12.7 to 9.8 deaths per thousand men in Rio de Janeiro and 12.1 to 9, 5 deaths per thousand men in Porto Alegre). It was noted, specifically, intense involvement of young men and external causes, whose specific rates for ages 20 to 24, were in 1979/191 and 2005/2007, respectively, 163.8 and 165.8 deaths per hundred thousand men from São Paulo, 241 and 336.2 per hundred thousand in Rio de Janeiro, and 144.1 and 236.1 per hundred thousand men in Porto Alegre. Throughout the series, these causes were responsible for large risk estimates of male death, and in 2005/2007, this group was the leading cause of death in men until the age group 40 to 44 years in Sao Paulo and Rio Janeiro. In Porto Alegre, it maintained the first position until ages 30 to 34 years. After that, almost in all age groups, deaths by circulatory system diseases appear as the main cause; cancer came in the second position among the most important causes of male deaths. Conclusion: These capitals show features of a developing city, with reduced fertility, increased longevity and consequent trending to an aging population. Estimates of the men high risk of dying make clear their vulnerability as young adults, in intense involvement in violent deaths; after 35 years, chronic and degenerative diseases stand out. The intensity with which these events occur demand actions that should reduces the mortality rates of preventable diseases, reduce the mens risky behaviors. It is necessary that men try to adopt healthier lifestyles habits, thus increasing life expectancy and reducing the differences between female and male mortalities

Introdução - O método de captura-recaptura vem sendo empregado em Epidemiologia desde meados do século XX, e se consolidou a partir dos anos 1990, quando se nota grande número de publicações sobre sua aplicação e desenvolvimento nesta área. O sub-registro de eventos vitais ainda se revela um entrave para o cálculo direto de indicadores como os de fecundidade e mortalidade infantil, forçando seu cálculo indireto através de métodos demográficos, cujos procedimentos não permitem estimação em níveis geográficos menores do que unidade da federação, em períodos intercensitários. Objetivo Estimar o sub-registro de nascidos vivos, aplicando o método de captura-recaptura para populações fechadas. Métodos - As bases de dados do Sistema Nacional de Informação sobre Nascidos Vivos (SINASC) e do Registro Civil do IBGE, nos segundo e terceiro trimestres de 2006 do estado de Sergipe, foram pareadas por relacionamento determinístico a partir do número da Declaração de Nascido Vivo. As desagregações geográficas adotadas foram as de microrregião e regional de saúde de residência da mãe. Os modelos de Huggins para populações fechadas foram aplicados para estimar as probabilidades de captura em cada uma das bases e o total de nascidos vivos ocorrido no período, dentro de cada desagregação geográfica O aplicativo utilizado para as estimações foi o Software MARK®. Resultados A aplicação do método de captura e recaptura para estimar sub-registro de nascidos vivos é factível, inclusive para desagregações geográficas menores do que unidade da federação. O relacionamento determinístico foi prejudicado em quatro microrregiões e em uma regional de saúde, devido à falta de preeenchimento do número da Declaração de Nascido Vivo na base do IBGE. O aplicativo MARK® apresenta interface amigável, o que facilitou a construção e seleção dos modelos estatísticos, permitindo identificar que a idade da mãe afeta a probabilidade de captura pelo Registro Civil, característica de heterogeneidade na população de nascidos vivos. Conclusões O relacionamento determinístico destas duas bases de dados oficiais viabiliza ações localizadas, porque acaba por identificar onde e quantas vidas mantêm-se no anonimato jurídico, devido ao sub-registro e registro tardio. O método de captura e recaptura mostrou-se uma alternativa acessível e barata para a estimação de sub-registro de nascidos vivos / Introduction Capture-recapture method has been used in Epidemiology since the middle of twentieth century and from the 1990s on, huge number of publications about applying and developing the method on this area have been noted. Underreporting of vital events is still a drawback for the direct calculation of health indicators like fertility and infant mortality, forcing indirect calculation with demographic methods, wich procedures do not allow estimation in geographic levels smaller than States, in intercensuses periods. Objective To estimate underreporting of live births, using the capture-recapture method for closed populations. Methods The National Live Birth Information System (SINASC) and the Civil Registry databases, in the second and third trimesters of 2006 of the State of Sergipe, Brazil, were linked through deterministic linkage using the Live Birth Declaration number as the connection key. Mothers micro-regions and health regions of residence were adopted as geographical subdivisions. Huggins closed capture models were used to estimate the capture probabilities for each database as well as the derived estimation of the total of live births in the selected time interval, at each of geographical subdivisions. MARK® Software was used to get all estimations. Results The capture-recapture method is feasible for estimation of live birth underreporting, even for geographical subdivisions smaller than States. Deterministic linkage was damaged due to lack of filling of the Live Declaration number in some of the Civil Registry databases registries, mainly at four mother residences micro-regions and at one health region. Program MARK® shows friendly interface, which favoured models building and selection, and allowed to point out mother ages influence in Civil Registry database capture probability, characterisc heterogeneity of live born population. Conclusions Deterministic linkage of these two official databases makes possible local actions, because it allows do identify where and how many lives are neglected legal registrations duty, due to underreporting and to late reporting. Capture-recapture method appears as an accessible and cheap alternative for live birth underreporting estimation

This thesis deals with the problems of cardiovascular diseases in Czech Republic and selected EU countries. Over the long term mortality in the Czech Republic there are changes in mortality rates. Largest fluctuations in the intensity of mortality were caused just cardiovascular diseases. These changes can be explained by the greater part of the changing economic and social factors, eating habits and decrease levels of some risk factors. On overall cardiovascular mortality in the long term the most involved two groups of diseases, ischemic heart diseases and cerebrovascular diseases. In international comparisons, the differences in the development of cardiovascular mortality between developed countries and the former socialist countries considerable.

The study sample was comprised of 18,953 subjects aged 18 years and older who participated in the Third National Health and Nutrition Examination Survey. Preference for diet soda over regular soda was higher in females as compared to males and in Caucasians as compared to other races. Mean alcohol consumption was almost three times higher in males than in females. Undiagnosed hypertension was more common in males than in females, in 65-90 than in 50-64 year olds, and in people with less than high school education compared to those with higher education. Diastolic pressure was correlated with the level of consumption of diet soda, coffee, tea, and alcohol. Diet soda and alcohol consumption had a statistically significant positive relationship with hypertension even after adjusting for demographic variables and body mass index. The study provides useful information of the patterns of beverage uses and the prevalence of hypertension in the United States.

Gender, minority, and regional-related disparities have been documented in diabetes management. Self-efficacy, the belief in one's ability to carry out the actions mandated by a task, has been identified as a key predictor in glycemic control; however, it has not been investigated in rural, female populations. This cross-sectional, correlation investigation examined the relationships among self-efficacy, depression, and diabetes self-care management in women living in Appalachia with type 2 diabetes. Using Bandura's Social Cognitive Theory, 85 women ages ≥ 21 with type 2 diabetes for a minimum of 6 months who were residents in Appalachia completed the 1) Diabetes Self-Efficacy Scale, 2) Beck Depression Inventory-II, 3)Summary of Diabetes Self-Care Activities, and a 4) Diabetes Health-Related Demographics tool. Descriptive statistics detailed the sample characteristics. ANOVA, chi-square, and independent t-tests were computed for between group differences as they related to depression, various physiologic states, presence of self-efficacy sources, and glycosylated hemoglobin. Pearson correlation coefficients were used to describe the relationships between self-efficacy, depression, and self-care management. Multiple linear regression analyses examined prediction models for glucose control while controlling for potential confounders. Eighty-four Caucasian and one African-American enrolled in the study with a mean age of 61. The mean time since diabetes diagnosis was 7 years with a mean glycosylated hemoglobin value of 6.9% (SD=1.3). Higher self-efficacy scores were associated with a lower glycosylated hemoglobin (r-.30, p=.005) and ability to choose foods best to maintain a healthy eating plan(r-.415, p=.001). The sources of self-efficacy associated with enhanced self-care management were mastery experience and vicarious experience. There were no significant relationships between self-efficacy and depression or depression and glycosylated hemoglobin. The diabetes self-care management regression model resulted in self-efficacy and education accounting for 7.5% of the variance in glycosylated hemoglobin. Study findings support the social cognitive theory and the utility of self-efficacy as a predictor of glycemic control. Depression was not found to be a significant obstacle in this Appalachian population. Comprehending the significant relationship between self-efficacy and diabetes self-care management allows providers to modify their interventions when caring for women type 2 diabetes in the region.

Lung cancer remains the leading cause of cancer deaths in the United States despite public health campaigns aimed at reducing its rate of mortality. Kentucky is the state with the highest lung cancer incidence and mortality. This study aims to assess the impact of misclassification of cause of death from Lung Cancer in Kentucky for the period 1979 to 2002. We will examine the potential competing classification of death for two other smoking-related diseases, Chronic Obstructive Pulmonary Disease (COPD) and Emphysema. Age-adjusted mortality rates for these diseases for white males were obtained from the National Center for Health Statistics. There was little evidence that any misclassification between COPD or Emphysema mortality rates was in agreement with the rising lung cancer rates in Kentucky. The long-term increase in lung cancer mortality in Kentucky is likely because of a combination of risk effects between smoking and other risk-factors for this disease.