Este estudo epidemiológico do Câncer da Boca refere-se aos municípios da Grande São Paulo, excluído o município de São Paulo, no período de 1969-1971. Fundamenta-se em informações colhidas no Registro de Câncer da Faculdade de Saúde Pública da Universidade de São Paulo, onde dentre 44.140 fichas de notificação de câncer, 238 referem-se a câncer bucal em residentes nesses municípios. Sendo 194 casos no sexo masculino com 43 óbitos e 44 casos no sexo feminino com 9 óbitos. Os coeficientes de incidência de câncer bucal nos sexos masculino e feminino foram respectivamente, 5.71 por 100.000 homens e 2.19 por 100.000 mulheres. Os coeficientes de mortalidade foram de 1,27 para o sexo masculino e de 0.28 para o sexo feminino. A localização anatômica mais frequente no sexo masculino foi o lábio e no sexo feminino a lingua. O tipo histológico mais frequente foi o Carcinoma Espinocelular. / This epidemiological study of cancer of the mouth was conducted in the counties of the Greater São Paulo, excluded the Capital, from 1969 to 1971. It is based on information taken from the cancer files of the São Paulo University School of Public Health, where from 44,140 index cards reporting mouth cancer, 238 refer to mouth cancer in residents of those counties. Of these, 194 ocurred in the male population resulting in 43 deaths and 44 in the female population of which 9 ended in death. The incidence rates of cancer of the mouth in the male and the female populations were respectively 5.71 per 100,000 and 2.19 per 100,000. The death rates were also respectively 1.27 and 0.28. The region most frequently affected in the male population was the lip and in the female population the tongue. The most frequent histological type was the Spinocellu1ar Carcinoma.

by Kai-Hang Choi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 217-232). / Abstract also in Chinese. / ABSTRACT --- p.i / ACKNOWLEDGMENT --- p.iv / TABLE OF CONTENTS --- p.v / LIST OF FIGURES --- p.viii / LIST OF TABLES --- p.xiii / Chapter CHAPTER I --- INTRODUCTION --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.2 --- Role of GIS in Health Studies --- p.4 / Chapter 1.3 --- Research Objectives --- p.5 / Chapter 1.4 --- Organization of the Thesis --- p.6 / Chapter CHAPTER II --- LITERATURE REVIEW --- p.8 / Chapter 2.1 --- Introduction --- p.8 / Chapter 2.2 --- Human cancer --- p.8 / Chapter 2.3 --- Environment and Cancer --- p.10 / Chapter 2.4 --- Cancer Etiology and Epidemiology --- p.13 / Chapter 2.5 --- Observational Cancer Epidemiology --- p.15 / Chapter 2.6 --- Geography of Cancer --- p.17 / Chapter 2.7 --- Geographical Epidemiology of Cancer --- p.19 / Chapter 2.7.1 --- Geographical Variation in Cancer Occurrence --- p.21 / Chapter 2.7.1.1 --- Cancer Mapping --- p.24 / Chapter 2.7.1.2 --- Spatial Autocorrelation --- p.26 / Chapter 2.7.2 --- Identifying Causal Association --- p.29 / Chapter 2.7.3 --- Environmental Factors of Cancer --- p.31 / Chapter 2.8 --- Geographical Information Systems --- p.40 / Chapter 2.9 --- GIS and Health --- p.41 / Chapter 2.9.1 --- GIS Applications in Health Planning --- p.42 / Chapter 2.9.2 --- GIS Applications in Health Research --- p.43 / Chapter 2.10 --- Cancer Studies with GIS --- p.45 / Chapter 2.11 --- Conclusion --- p.47 / Chapter CHAPTER III --- THE STUDY AREA AND RESEARCH METHODOLOGY --- p.49 / Chapter 3.1 --- Introduction --- p.49 / Chapter 3.2 --- Disease Transition in Hong Kong --- p.49 / Chapter 3.3 --- Cancer in Contemporary Hong Kong --- p.52 / Chapter 3.3.1 --- Trends of Cancer Mortality and Incidence --- p.52 / Chapter 3.3.2 --- The Common Types of Cancer --- p.55 / Chapter 3.3.3 --- Geographical Variation of Cancer in Hong Kong --- p.58 / Chapter 3.4 --- The Research --- p.61 / Chapter 3.4.1 --- Cartographic Analysis --- p.62 / Chapter 3.4.2 --- Statistical Analyses --- p.63 / Chapter 3.4.3 --- Cancer Variables --- p.67 / Chapter 3.4.4 --- Environmental Variables --- p.70 / Chapter 3.5 --- Conclusion --- p.71 / Chapter CHAPTER IV --- DATABASE CONSTRUCTION --- p.73 / Chapter 4.1 --- Introduction --- p.73 / Chapter 4.2 --- Data Collection --- p.73 / Chapter 4.2.1 --- Base Maps --- p.73 / Chapter 4.2.2 --- Cancer Data --- p.74 / Chapter 4.2.3 --- Socio-demographic Data --- p.75 / Chapter 4.2.4 --- Air Pollution --- p.76 / Chapter 4.2.5 --- ELF EMFs --- p.77 / Chapter 4.3 --- Data Input --- p.77 / Chapter 4.3.1 --- Spatial Data --- p.77 / Chapter 4.3.1.1 --- Base Maps --- p.78 / Chapter 4.3.1.2 --- Point Data --- p.78 / Chapter 4.3.1.3 --- Line Data --- p.79 / Chapter 4.3.2 --- Attribute Data --- p.79 / Chapter 4.4 --- Data Editing and Conversions --- p.80 / Chapter 4.4.1 --- Spatial Data --- p.80 / Chapter 4.4.1.1 --- Standard Coverage Editing Procedures --- p.80 / Chapter 4.4.1.2 --- Specific Coverage Editing Procedures --- p.81 / Chapter 4.4.2 --- Attribute Data --- p.83 / Chapter 4.4.2.1 --- Cancer Rates --- p.83 / Chapter 4.4.2.2 --- Socio-economic Status --- p.85 / Chapter 4.5 --- Data Pre-processing and Manipulation --- p.86 / Chapter 4.5.1 --- Socio-economic Variables --- p.86 / Chapter 4.5.1.1 --- Interpretation of Factor Scores --- p.97 / Chapter 4.5.2 --- Compromised Traffic Index --- p.99 / Chapter 4.5.3 --- ELFEMFs --- p.104 / Chapter 4.6 --- Conclusion --- p.106 / Chapter CHAPTER V --- RESULTS AND DISCUSSIONS --- p.111 / Chapter 5.1 --- Introduction --- p.111 / Chapter 5.2 --- Geographical Analysis of Cancer Patterns --- p.111 / Chapter 5.2.1 --- Results --- p.112 / Chapter 5.2.1.1 --- Total Cancer --- p.113 / Chapter 5.2.1.2 --- Cancer of the Female Breast --- p.118 / Chapter 5.2.1.3 --- Cancer of the Cervix Uteri (Cervical Cancer) --- p.121 / Chapter 5.2.1.4 --- Cancer of the Colon and Rectum (Colorectal Cancer) --- p.124 / Chapter 5.2.1.5 --- Cancer of the Stomach (Gastric Cancer) --- p.129 / Chapter 5.2.1.6 --- Leukaemia --- p.129 / Chapter 5.2.1.7 --- Cancer of the Liver --- p.134 / Chapter 5.2.1.8 --- Cancer of the Lung --- p.143 / Chapter 5.2.1.9 --- Cancer of the Nasopharynx (NPC) --- p.149 / Chapter 5.2.1.10 --- Cancer of the Oesophagus --- p.154 / Chapter 5.3 --- Correlation among Cancer Variables --- p.160 / Chapter 5.3.1 --- Correlation among Cancer types --- p.160 / Chapter 5.3.2 --- Temporal Correlation among Cancers --- p.168 / Chapter 5.3.3 --- Correlation between Cancer Mortality and Incidence --- p.170 / Chapter 5.4 --- Correlation between Cancer and Environmental Variables --- p.172 / Chapter 5.4.1 --- Results --- p.174 / Chapter 5.5 --- Weighted Stepwise Regression Modeling --- p.182 / Chapter 5.5.1 --- Results --- p.183 / Chapter 5.5.1.1 --- Total Cancer --- p.184 / Chapter 5.5.1.2 --- Cancer of the Female Breast --- p.186 / Chapter 5.5.1.3 --- Cancer of the Cervix Uteri (Cervical Cancer) --- p.188 / Chapter 5.5.1.4 --- Cancer of the Colon and Rectum --- p.189 / Chapter 5.5.1.5 --- Cancer of the Stomach (Gastric Cancer) --- p.191 / Chapter 5.5.1.6 --- Leukaemia --- p.193 / Chapter 5.5.1.7 --- Cancer of the Liver --- p.195 / Chapter 5.5.1.8 --- Cancer of the Lung --- p.197 / Chapter 5.5.1.9 --- Cancer of the Nasopharynx (NPC) --- p.199 / Chapter 5.5.1.10 --- Cancer of the Oesophagus --- p.201 / Chapter 5.6 --- Interpretations of Results --- p.203 / Chapter CHAPTER VI --- CONCLUSION --- p.207 / Chapter 6.1 --- Summary of Findings --- p.207 / Chapter 6.1.1 --- Summary on Geographical Analysis of Cancer Patterns --- p.207 / Chapter 6.1.2 --- Summary on Statistical Analysis of Cancer Variables --- p.209 / Chapter 6.1.3 --- Summary on Associations between Cancers and Environment --- p.211 / Chapter 6.2 --- Research Limitations --- p.212 / Chapter 6.3 --- Implications for Future Studies --- p.215 / BIBLIOGRAPHY --- p.217 / APPENDICES --- p.233 / Appendix I Community Map of hong Kong --- p.234 / Appendix II List of Communities and their Components --- p.236 / Appendix III Tertiary Planning Units (TPUs) - Community Conversion Lists --- p.240 / Appendix IV BASIC Program for Calculating Moran and Geary Indices --- p.244

This thesis examines the impact of social policies on child mortality. It argues that structural factors explain most of the variation in child mortality across countries and time. But that in Vietnam the state implemented effective social policies; leading to this country having low child mortality for its structural factors (income, income equality and women’s power). This thesis uses panel data econometrics to investigate the structural determinants of child mortality. Our model shows that national income and women’s power reduce, and income inequality increases, child mortality. These independent variables are significant at the 1% level and explain over 90% of the variation in child mortality when our dependent variable is under-five mortality from the World Development Indicators dataset. These results are robust to changes in the functional form, lag structure, dataset and measure of child mortality used in our model. Vietnam is an outlier in our model; it has low child mortality for its structural factors. We consider that Vietnam’s effective social policies may explain why it is an outlier. This thesis also undertakes a detailed case study of Vietnam’s social policies. We argue and provide considerable evidence that in Vietnam the government implemented effective family planning, child immunization and female education policies and that these reduced child mortality. Developing countries are currently committed through MDG4 to reducing under-five mortality by two thirds between 1990 and 2015. Our results show that developing countries are unlikely to achieve this goal because social policies have a small impact on child mortality relative to structural factors.

This dissertation examines the relation between occupational exposure to the solvent methylene chloride and mortality in a cohort of cellulose fiber production workers. The first paper, entitled The Mortality of Cellulose Fiber Production Workers, presents the main results of the mortality follow-up of the cellulose fiber workers cohort through September 1, 1986. Mortality from neoplastic and non-neoplastic disease among cellulose fiber production workers is compared to that of the U.S. and local (county level) populations, while controlling for the effects of gender, race, calendar period, and age. Mortality from cancers of the lung, breast, and pancreas, and ischemic heart disease was less than expected. Excess mortality was observed for melanoma of the skin, cancer of the buccal cavity and pharynx, tumors of the liver and biliary tract, and accidental deaths. Three deaths from cancer of the bile ducts were observed (3 observed, 0.15 expected, SMR=20). This is the first known report of an association between exposure to methylene chloride and cancer of the bile ducts. [TRUNCATED]

Giant Cell arteritis (GCA) is a systemic inflammatory disease that affects arteries of medium- and large size. Symptoms of GCA such as headache and fever usually promptly improve with treatment of glucocorticoids. Apart from advanced age, female sex and Northern-European descent, risk factors for GCA are unknown. Most studies have found that life expectancy for patients with GCA is not reduced compared with the general population and studies on cardiovascular disease in GCA have provided conflicting results. Data for the studies of this thesis are drawn from the Reykjavik Study (RS) that is a general population-based cohort study with continuous surveillance for coronary heart disease and vital status. Subjects born in 1907–1934 and living in Reykjavik, Iceland or adjacent communities in 1966 were invited for study visit from 1967-1994. Information on cardiovascular risk factors were collected at study visit. Diagnosis of GCA for this study was based on re-examination of all temporal arteries biopsies (TAB) from members of the RS cohort; however, information was also obtained from the original pathology report. Of 19,360 subjects included in the RS, 194 developed GCA during the follow-up period. Body mass index was inversely associated with the occurrence of GCA. Among men, but not women, hypertension was associated and smoking inversely associated with the occurrence of GCA. Among women, but not men, GCA was associated with coronary heart disease. Subjects with GCA had approximately 50% increase in mortality risk compared with the general population. Increase mortality was mainly observed among GCA patients based on the diagnosis of re-examination of TAB; however, no such an association was found if diagnosis of GCA was made based on the original pathology report. Those subjects were likely not clinically diagnosed with GCA, signaling that treatment for GCA might be beneficial with respect to mortality risk.

The objective of this study was to explore a possible association between infant mortality rate (IMR) and Medicaid dental benefit payouts per state, as well as propose an expansion of the dental benefits provided through Medicaid. Data was obtained from the Vital Statistics report 2012 and the Center for Medicare & Medicaid Services (CMS) Medicaid coverage database for fiscal year 2011. Population and demographic data was also collected for further comparison. The states observed were Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee. The IMR data was ranked in ascending order and then the dental payments were compared between the seven southern states. There did not appear to be an association between the two variables. It was hypothesized that the state with the highest IMR would have the least amount of Medicaid dental payments; possibly indicating limited benefits and a need for expansion. The data did not support the hypothesis. Although Mississippi had the highest IMR at 9.9 per 1,000 live births, the amount dental benefits paid through Medicaid was not the lowest. Kentucky had the lowest IMR at 6.9 per 1,000 live births, and North Carolina had the highest amount of dental payments with $352,602 being paid by the state. However, the comparing variable in each state did not reflect an association. Limitations of the study were addressed and suggested improvements were made for future studies that would possibly yield significant findings. In conclusion, the data collected and observed did not provide evidence that the expansion of Medicaid dental benefits would combat infant mortality rates across the country.

Introdução: As bronquiectasias não-fibrocísticas são uma doença supurativa crônica caracterizada pela dilatação anormal e irreversível de um ou mais brônquios e são a via final de uma grande variedade de doenças, embora possam não ter uma causa identificável. Elas levam ao comprometimento da função pulmonar, colonização bacteriana crônica das vias aéreas, infecções respiratórias de repetição, redução da tolerância ao exercício e piora na qualidade de vida, entre outras coisas. Existem poucos estudos na literatura que abordam os fatores relacionados ao prognóstico desses pacientes. Objetivos: O objetivo deste estudo é avaliar a taxa de mortalidade e os fatores relacionados à morbidade e à mortalidade de uma coorte de pacientes com bronquiectasias não-fibrocísticas durante um seguimento de 6 a 8 anos e testar a habilidade dos escores Bronchiectasis Severity Index (BSI) e FACED de predizer a mortalidade dos pacientes na nossa coorte. Materiais e métodos: Trata-se de um estudo prospectivo de uma coorte de 70 pacientes com bronquiectasias não-fibrocísticas que foram originalmente recrutados de Maio de 2008 a Agosto de 2010. O estudo original forneceu os dados necessários para a classificação de gravidade da doença segundo os escores BSI e FACED e todos os dados usados para esse propósito foram coletados na avaliação inicial. Após o cálculo dos escores, os pacientes foram separados em diferentes grupos de acordo com a gravidade da doença. Nós também avaliamos os prontuários de todos os pacientes para determinar o número de hospitalizações por exacerbações após a avaliação inicial, o desfecho a longo prazo para cada paciente e a causa do desfecho quando apropriado. Os desfechos foram definidos como favoráveis e desfavoráveis (sobreviventes submetidos a transplante pulmonar e óbito por todas as causas) e foram determinados até 1° de março de 2016. Resultados: Dos 70 pacientes, 27 (38,57%) haviam morrido e 1 (1,43%) sido submetido ao transplante pulmonar. Análise de sobrevivência demonstrou que o tempo médio para a ocorrência dos desfechos desfavoráveis foi de 74,67 ± 4,00 meses (IC 66,82 – 82,52). A principal causa de óbito foi a exacerbação infecciosa aguda das bronquiectasias (60,7% dos óbitos). Na nossa coorte, o modelo de risco proporcional de Cox identificou a idade (p=0,035; HR 1,04; IC 1,01 – 1,08), o VEF1 % do previsto (p=0,045; HR 0,97; IC 0,93 – 0,99) e a Pemax (p=0,016; HR 0,97; IC 0,94 – 0,99) como preditores independentes de desfechos desfavoráveis. A maior parte dos pacientes (44,3%) foi classificada como tendo doença grave pelo escore BSI e 97,2% como tendo doença leve ou moderada (48,6% cada) pelo escore FACED. De maneira geral, o escore FACED foi um melhor preditor de desfechos desfavoráveis na nossa população de pacientes (log-rank test, FACED p = 0,001 e BSI p = 0,286). A análise da curva ROC demonstrou que ambos os escores foram similares na predição de desfechos desfavoráveis (área sob a curva BSI 0,65; FACED 0,66), mas nenhum deles foi um bom preditor para essa população específica de pacientes. Conclusão: Os pacientes da nossa coorte apresentaram maior comprometimento da função pulmonar e uma taxa de mortalidade mais alta do que o previamente reportado na literatura. A principal causa de óbito foi a exacerbação infecciosa aguda da doença. A idade mais avançada, o VEF1 % do previsto e uma Pemax mais baixa foram os fatores independentemente associados aos desfechos desfavoráveis. Os escores FACED e BSI não foram bons preditores de mortalidade para este grupo de pacientes, contrastando com os dados disponíveis na literatura até o momento, portanto outros estudos incluindo um maior número de pacientes são necessários para validar o uso deles na nossa população. / Background: Non-cystic fibrosis bronchiectasis is a chronic suppurative disease characterized by an abnormal and irreversible dilation of one or more bronchi. It is the final pathway of a large number of diseases, although it can be present without an identifiable cause. It leads to impaired lung function, chronic bacterial colonization, recurrent respiratory tract infections, reduced exercise tolerance and poor quality of life, among other things. There are few studies about prognostic factors in these patients. Objectives: The goal of this study is to assess the mortality rates and the factors related to the morbidity and mortality on a cohort of patients with non cystic fibrosis bronchiectasis during a 6 to 8-year follow-up and to test the ability of the Bronchiectasis Severity Index (BSI) and FACED scores in predicting mortality in our cohort. Materials and methods: This was a prospective cohort analysis of 70 patients with non-cystic fibrosis bronchiectasis who were originally recruited from May 2008 to August 2010. The original study records provided the necessary data for the determination of the disease severity scores (BSI and FACED) and all the data used for that purpose were collected at baseline. After the calculation of the scores, patients were separated into different groups according to disease severity. We also reviewed the records of all patients to determine the number of hospitalizations for exacerbations after baseline, the long-term outcome for each patient and the cause of the outcome when appropriate. Outcomes were defined as favorable and unfavorable (survivors who underwent lung transplantation and death from all causes) and were determined as of March 1st, 2016. Results: Out of 70 patients, 27 (38.57%) had died and 1 (1.43%) had undergone lung transplantation by the end of the study. Survival analysis demonstrated that the mean time for the occurrence of an unfavorable outcome was 74.67 ± 4.00 months (CI 66.82 – 82.52). The main cause of death among non-survivors was an acute infectious exacerbation of bronchiectasis (60.7% of the deceased). In our cohort, the multivariate Cox proportional hazard model analysis identified age (p=0.035; HR 1.04; CI 1.01 – 1.08), FEV1 % of predicted (p=0.045; HR 0.97; CI 0.93 – 0.99) and MEP (p=0.016; HR 0.97; CI 0.94 – 0.99) as independent predictors of unfavorable outcomes. Most patients (44.3%) were classified as having severe disease when BSI was used and 97.2% as having a mild or moderate disease (48.6% each) when FACED was used. Overall the FACED score was better at predicting unfavorable outcomes in our population of patients (log-rank test, FACED p = 0.001 and BSI p = 0.286). AUC from the ROC analysis shows us that both scores are similar in predicting poor outcomes in our cohort (BSI 0.65; FACED 0.66), but they weren't good predictors for this specific population. Conclusion: Patients in our cohort had worst lung function and a higher mortality rate than previously reported and the main cause of death among them was an acute infectious exacerbation of bronchiectasis. Older age, lower FEV1 % of predicted and lower MEP were independently linked to the occurrence of poor outcomes. FACED and BSI scores were not accurate in predicting mortality in our cohort, contradicting the available data at the moment, so other studies including a greater number of subjects are needed to validate their use in our population.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective The objective of this study was to investigate the effect of preoperative diastolic dysfunction on postoperative mortality and morbidity after cardiovascular surgery. Methods We systematically searched for articles that assessed the prognostic role of diastolic dysfunction on cardiovascular surgery in PubMed, Cochrane Library, Web of Science, Embase and Scopus until February 2016. Twelve studies (n=8224) met our inclusion criteria. Due to scarcity of outcome events, fixed-effects meta-analysis was performed using the Mantel-Haenszel method. Results Preoperative diagnosis of diastolic dysfunction was associated with higher postoperative mortality (OR 2.41, 95% CI 1.54-3.71; p<0.0001), major adverse cardiac events (MACE) (OR 2.07, 95% CI 1.55-2.78; p <=0.0001) and prolonged mechanical ventilation (OR 2.08, 95% CI 1.04-4.16; p=0.04) in comparison to patients without diastolic dysfunction among patients who underwent cardiovascular surgery. The odds of postoperative myocardial infarction (OR: 1.29, 95% CI 0.82, 2.05; p=0.28) and atrial fibrillation (OR: 2.67; 95% CI 0.49-14.43; p=0.25) did not significantly differ between the two groups. Severity of preoperative diastolic dysfunction was associated with increased postoperative mortality (OR 21.22, 95% CI 3.74 -120.33; p=0.0006) for Grade 3 diastolic dysfunction compared with patients with normal diastolic function. Inclusion of left ventricular ejection fraction (LVEF) <40% accompanying diastolic dysfunction, did not further impact postoperative mortality (p=0.27; I2 =18%) when compared with patients with normal LVEF and diastolic dysfunction. Conclusions Presence of preoperative diastolic dysfunction was associated with higher postoperative mortality and MACE, regardless of LVEF. Mortality was significantly higher in grade III diastolic dysfunction. Keywords Diastolic dysfunction; cardiovascular surgical procedures; mortality; meta-analysis / Revisión por pares

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Background Obesity, insulin resistance and type 2 diabetes mellitus (T2DM) have been associated with endometrial cancer (EC). In this systematic review and meta-analysis we evaluated the effect of metformin on clinical outcomes in patients with EC and insulin resistance or T2DM. Methods Four research databases were searched for original articles published in all languages up to 30 October 2016. Outcomes of interest were overall mortality (OM), cancer-specific mortality, disease progression, and metastases. We performed a random effect meta-analysis of adjusted effects expressed as hazard ratios (HR); heterogeneity among studies was described with the I2 statistic. Results Of the 290 retrieved citations, 6 retrospective cohort studies in women with EC (n = 4723) met the inclusion criteria, and 8.9% to 23.8% were treated with metformin; OM data was available from 5 studies. In 4 studies of EC patients (n = 4132), metformin use was associated with a significant reduction in OM in comparison with not using metformin (adjusted HR [aHR] 0.64, 95% CI 0.45–0.89, p = 0.009). In three studies evaluating patients with EC and T2DM (n = 2637), metformin use was associated with a significant reduction in OM (aHR 0.50, 95%CI 0.34–0.74, p = 0.0006). There was low to moderate heterogeneity of adjusted effects across studies. There was no information about the effect of metformin on cancer-specific mortality, disease progression, or metastases. Conclusions Metformin treatment is associated with a significant reduction in OM irrespective of diabetes status in patients with EC. The survival benefit suggests that diabetes screening and maintenance of good glycemic control may improve outcomes in EC. / Revisión por pares

This dissertation describes the background, setting, set-up and analysis of several 11-year prospective longitudinal studies with exposures of Proteinuria or Dyspnea and the primary outcome of all-cause mortality. Cause-specific mortality was also obtained for each exposed/unexposed group to determine whether exposures are at all related to mortality outcome. These studies came out of the Health Effects of Arsenic Longitudinal Study (HEALS). The objectives of this dissertation are to: 1) assess the reproducibility of dyspnea as determined by questionnaire in evaluating for the presence or absence of dyspnea; 2) examine the association between arsenic exposure and dyspnea cross-sectionally since one of the longitudinal studies proposed, evaluating the symptom of dyspnea as a predictor of mortality, is embedded in an ongoing study evaluating the effects of chronic exposure to arsenic in well water; 3) review the worlds relevant literature on the potential for dyspnea, a symptom, to be a predictor of all-cause mortality; 4) try to determine whether dyspnea, a symptom, is a predictor of all-cause and cause-specific mortality in the developing country of Bangladesh; 5) try to determine whether simple dipstick proteinuria, is a predictor of all-cause and cause-specific mortality in rural Bangladesh. A methodologic study was done on a small subgroup of subjects to determine whether dyspnea determined by simple questionnaire was reproducible. If the presence or absence of dyspnea on questionnaire occurred by chance, then using dyspnea as the exposure variable would not be valid. The results of this study revealed that: 1) dyspnea as determined by questionnaire was reproducible ie the same response occurs when the same question on dyspnea was asked at a later time and disguised by being buried in a list of questions; 2) the reproducibility of the response was greater than 90%, independent of whether dyspnea was present or absent on the initial response. A second preliminary cross-sectional evaluation was done to determine whether the exposure variables of proteinuria or dyspnea were associated with arsenic exposure at baseline since the primary overall focus of HEALS is related to arsenic exposure. No definitive association for proteinuria and arsenic was found. However, an analysis and study found a strong dose-response relationship between arsenic well water concentration (exposure) and the presence of dyspnea, independent of smoking. A weak dose-response relationship was also found between smoking and dyspnea. Clearly, both arsenic exposure and smoking are two of a number of important variables that need to be controlled for in these prospective studies. In addition, dyspnea was found in a longitudinal study to be associated with all-cause and cause-specific mortality, diseases most related to the heart and lungs. Finally, dipstick proteinuria at the 1+ level (not trace) was found to be a predictor of all-cause and cardiovascular disease mortality in rural Bangladesh. Further discussion is on the implications of the study findings including the concepts of dipstick proteinuria in screening and dyspnea in screening and directions of future research.