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Importance: Infectious diseases present an ever-changing threat to public health. Analysis of pathogen-linked mortality trends is elucidatory to infectious disease burden. Objective: To describe major shifts in United States infectious disease mortality trends from 1900-2013 with emphasis on recent changes for1980-2013. Design: Ecological study of infectious disease mortality in the United States. Setting: Infectious disease deaths were summed from Vital Statistic Reports from 1900-1967. Infectious disease deaths from 1968-2013 were extracted from the Centers for Disease Control and Prevention Wonder database and tallied. Participants: Deaths among United States residents from 1900-2013. Main Outcome Measures: Crude and age-adjusted mortality rates for key infectious diseases including emerging infections, specifically human immunodeficiency virus and certain vector-borne diseases, re-emerging diseases, specifically, vaccine-preventable diseases and pathogens with drug-resistant strains, and newly defined infectious diseases such as cervical cancer due to human papilloma virus. Results: While human immunodeficiency virus mortality has been declining since 1995 (average annual percent change = 10.6%, 95% Confidence Interval (CI) [-13.1, -7.9]), recent years have seen an increase in infectious disease mortality related to vector-borne diseases. Specifically, with the emergence of West Nile virus in the United States, vector-borne disease mortality increased from 34.5 deaths per year (1980-2001) to 141.7 deaths per year (2002-2013). Vaccine preventable disease mortality continues to decrease with an average annual percent change of 2.4%, 95% CI [-2.8, -2.0] from 1980-2013. Mortality due to drug-resistant strains of infectious diseases is increasing at an average annual percent change of 0.8%, 95% CI [0.1, 1.6] from 1980-2013. Finally, mortality due to a disease previously not classified as infectious, cervical cancer, has been decreasing at an average annual percent change of 1.4%, 95% CI [-1.7, -1.1] since 1980. Conclusions: Despite the overall downward trends in infectious disease mortality, they still account for 43 per 100,000 deaths annually in the United States. Specific diseases and disease groups evaluated in this study show inconsistent, but concerning, trends across emerging, re-emerging, and newly defined infectious diseases, indicating that infectious diseases remain a public health concern.

Magister Philosophiae - MPhil / Infants and under 5 mortality have been universally researched and it reduction by twothird by 2015 has been announced as one of the millennium development goal of the United Nation. Continuous monitoring in form of studies on mothers related factors that determines infant, child and under 5 mortality appears to be a step towards achieving this goal. Therefore using the Eastern Cape Province as a case study, this study utilises the secondary data of the 1998 South Africa Demographic and Health Survey (SADHS) dataset for children to examine some specific mothers related socioeconomic and demographic determinants of infant and child mortality. As at the time this study is being conducted the SADHS 2003 survey datasets are not available. However, reports that summarize the survey and some preliminary results are available. In this study, infant and child mortality have been grouped into 0-12 months and 13-60 months age at death,which is taken as independent variable. Profiles of the distributions of the dependent and the independent variables are described with the aid of cross tabulation. Demographic factors examined include the age of the mother at the time of delivery, order of birth and birth interval, while the socioeconomic factors examined include working status of the mother, mother‟s work place (at home work at home or away) mothers‟ education level , and the place of residence. We found that demographic variables such as age of mothers at first birth, birth order, birth interval, and socioeconomic factors such as mothers‟ education level, and the place of birth, have a significant effect on the probability of child‟s survival. Therefore, the postponement of the female age at birth with an appropriate child spacing, nonetheless, the improvement mother‟s education will enhance the reduction of infant and child mortality. Steps that may be taken towards improving the health status of infant and child, including ways by which infant and child mortality may be reduced are recommended.

Magister Philosophiae - MPhil / Child mortality in Sierra Leone is the highest ranked in the world. Government officials and researchers have tried to understand how and why this has become such a big phenomenon in Sierra Leone. Researchers have come up with three main causes for child mortality in Sierra Leone: maternal factors, environmental factors and health factors. The majority of research has been carried out on maternal, as well as environmental factors. However, minimal research has been carried out on health factors in Sierra Leone. Therefore, the objective of this study is to see how maternal and environmental factors have an effect on health factors, which in turn causes child mortality. The data used was from the 2008 Sierra Leone Demographic and Household Survey (SLDHS). The child dataset was used as it contained the information required from both the mother and the child. Of the three categories that were used, the first was maternal factors, which included the mother’s age, the mother's occupation, the mother's education, the sex of the child, the birth number and religion. The second category was environmental factors, which included the source of water, type of toilet, place of residence, source of energy and the dwelling material used for the household. The final category was health factors, which included whether the child had a fever in the last 2 weeks, short rapid breaths, a cough or fever, a problem in the chest or runny nose and whether the child had Diarrhoea recently and still has Diarrhoea. The study showed that child mortality had four statistically significant factors associated with it: place of residence, birth number, religion and type of toilet facility. Furthermore, when it came to diseases affecting children, the SLDHS had not given much information, so we looked only at the effects it had on children. From our results, we concluded that ARI, Diarrhoea and Measles each had one variable that was statistically significant to it. As for Pneumonia, there were no variables associated with children contracting the disease.

Background: Routinely-collected data offer great potential for epidemiological research and could be used to make randomised controlled trials (RCTs) more efficient. The use of routine data for research has been limited by concerns surrounding data quality, particularly data completeness. To fully exploit these information-rich data sources it is necessary to identify approaches capable of overcoming high proportions of missing data. Using a 2008 extract of the Scottish Care Information – Diabetes Collaboration (SCIDC) database, a population-based register of people with a diagnosis of diabetes in Scotland, I compared the findings of several methods for handling missing data in a retrospective cohort study investigating the association between body mass index (BMI) and all-cause mortality in patients with type 2 diabetes. Methods: Discussions with clinicians and logistic regression analyses were used to determine the likely mechanisms of missingness and the relative appropriateness of a selection of missing data methods, such as multiple imputation. Sequentially more complicated imputation approaches were used to handle missing data. Cox proportional hazard model coefficients for the association between BMI and all-cause mortality were compared for each missing data method. Age-standardised mortality rates by categories of BMI at around the time of diagnosis were also presented. Results: There were 66,472 patients diagnosed with type 2 DM between 2004 and 2008. Of these patients, 21% of patients did not have a recording of BMI at time of diagnosis. Amongst patients with complete BMI data, there were 5,491 deaths during 296,584 person years of follow-up. Amongst patients with incomplete data, there were 2,090 deaths during 79,067 person-years of follow-up. Analyses indicated that the primary mechanism of missingness was missing at random, conditional on patient year of diagnosis and vital status. In particular, patients with missing data had considerably worse survival than patients without missing data. Regardless of the method for handling the missing data, a U-shaped relationship between BMI and mortality was observed. Compared to complete case analysis, the association between BMI and alliii cause mortality was weaker using multiple imputation approaches with estimates moving towards the null. Closest observation imputation had the smallest effect on estimates compared to complete case analysis. Risk of mortality was consistently highest in the less than 25kg/m² BMI group. For example, estimates obtained using multiple imputation using chained equations indicated that patients with a BMI below 25kg/m² had a 38% higher risk of mortality than patients in the 25 to less than 30kg/m² BMI category. Conclusions: Alternative methods to complete case analysis can be computationally intensive with many important practical considerations. However, it remains valuable to explore the robustness of estimates to departures from the assumptions made by complete case analysis. The use of these methods can preserve the sample size and therefore may be useful in developing risk prediction scores. Mortality was lowest amongst overweight or obese patients relative to normal weight. Further work is required to identify optimal approaches to weight management amongst patients with diabetes.

This research explores the concept of descendant insurance and its efficiency as a calculated estimate of a country's fertility rates based on the infant or child mortality rates of the same country. A database of 191 countries was used to evaluate the concept by nation. The results suggest that descendant insurance plays a significant roll in decreasing total fertility rates. Prediction strength for many countries can be increased greatly by incorporating time lags into the model. Adding a lag component produced strong results for predicting fertility rates in countries where many previous studies have failed to find significant fertility trends. The results of the analysis provide further evidence for the argument that preventing infant and child deaths is a driving factor for decreasing fertility rates.

Population density, growth and mortality rates, reproduction, feeding ecology and energy mobilization of dab (Limanda lmanda L) on the North Wales Coast have been investigated between 1998-2001. The total population number is estimated as 2.34 x 10 6. Average catch rates were lower in winterspring than in autumn-summer. 42 hr' in February 2000; 141 hr'in July 2000. Catch rates were generally higher at night than daylight: 1549 hr'at 02: 00 hr, 17 hr'at 10: 00 hr in November. The 2- year old fish form the dominant year class. There was seasonal variation in sex ratio (Females: Males). In the long-term data, in autumn, the females were more abundant (1.83: 1) in trawl catches but the contribution of the males increases in spring (1.15: 1). There were seasonal variations in length and weight relationships: the average relationship was nearly isometric (power bx3.0); in male W=0.01 x TL 91 and in female, W=0.01 x TL 3'04. April 1s' was established as the birthday of the fish and the greatest deposition of the opaque zone in the otolith occurred in summer. The male grows at a faster rate than female in autumn 2000: (Loo=25.7 cm; K= 0.30 y 1) and (loo=33.4 cm; K= 0.25 y-) respectively. The long-term average total mortality rate was significantly higher in males (Z= 1.95 y) than females (Z= 1.16 Y"). This difference was calculated to be largely due to the relatively higher fishing mortality rate on the males. There were cyclical cycles in the gonad, liver weight and condition factors. The peak spawning activity in males was in December-January whilst it occurred in February-March in females. In the 16-20 cm male, the maximum gonadocarcass ratio, GCR, (1.8 %) and hepatocarcass ratio, HCR, (2.9 %) were in January and August respectively. In female, the maximum GCR (17.1 %) and HCR (3.8 %) occurred in February. The GCR was at a minimum in spring-summer. The minimum HCR occurred in spring. The maximum condition factor (K) was in summer for male (K=0.97) and female (K=1.02) but, after spring spawning, declined to 0.67 and 0.72 respectively. The maximum average oocyte diameter (0.56-0.67 mm) was observed in fully ripe fish in the spawning season but, after spring spawning, reduced to between 0.10-0.22 mm. The total estimated egg production was 2.47 x 10 ' eggs but the average per mature female was 3.51 x 105 eggs. Relative fecundity declined from 3045 eggs g' in fish aged I to 1917 eggs g' in fish aged 8. The fecundity-total length (F= 41.6 TL IN) and fecunditysomatic weight (F= 4804SW 0.88) relationships are estimated to be good predictors of dab fecundity. In autumn 2000, the length (Lw%) and age (A w%) at 50 % maturity were lower in males (L = 13.3 cm; Ate, =1.3 yr. ) than females (L = 18.0 cm; A =2.4 yr. ). The long-term averages showed relative stability in the females but a decrease in males, Ate, from about 2 years to about 1.5 years. Five major taxonomic groups dominated the diet of dab: the ophiuroids, bivalves, crustaceans, polychaetes and hydroids. The ophiuroid, Amphiura brachiata, predominated. However, the study suggests size-selective preference for some prey groups. The composition of polychaetes in the diet declined with increasing size of the fish; 22.9 % by weight in the 11-15 cm length group to 5.7 % in the 26-30 cm group. On the contrary, the bivalves increase in the diet with increasing size of the fish, from 11.2 % (by weight) in the 11-15 cm group to 31.4 % in the 231cm group. There is however a significant diet overlap (C; >- 0.60) between the size groups. In general, daily food intake was higher in late spring-summer than in autumn-winter. In May, for example, daily food intake for the 21-25 cm and 26-30 cm female dab was estimated as 1.49 g and 4.61 g respectively. In February it was 0.52 g and 1.76 g respectively. There were distinct seasonal changes in lipid and energy composition in the liver. Lipid content was significantly higher in the summer-autumn period than spring season. In September, it was about 62 and 69 % in male and female livers respectively. After spring spawning, the composition declined to 28 and 24 % respectively. The energy content per dry weight of liver peaked in October (8.50 kcal g' and 8.61 kcal g') in male and female dab respectively. Also, after spring spawning, the energy levels declined to 6.18 and 5.86 kcal g'' respectively. The energy requirement for routine metabolism and gonad development in a 20 cm female is estimated as 111.3 kcal but energy gained from food intake and carcass and liver reserves is estimated as 117.9 kcal. In male, the total energy requirement was 83.4 kcal but energy gained from food intake and carcass and liver reserves is estimated as 113.3 kcal. Feeding (in late autumn and winter) and carcass tissues are the main suppliers of energy for activity and the spawning process.

Made available in DSpace on 2014-06-11T19:29:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-29Bitstream added on 2014-06-13T20:39:41Z : No. of bitstreams: 1 buitragosanchez_f_me_botfm.pdf: 280716 bytes, checksum: a974f556f8eb7fd716a4968b04ed954a (MD5) / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / A super-expressão do HER-2 tem sido associada a maior agressividade biológica do tumor e a resistência a alguns tipos de tratamento. O objetivo deste trabalho é avaliar o valor prognóstico da super-expressão do HER-2, nas pacientes portadoras de câncer de mama. Estudo coorte que analisou 90 pacientes com diagnóstico de carcinoma ductal infi ltrante de mama atendidas no Hospital Regional de Sobradinho no período de 1 de Janeiro de 2005 até o 31 de dezembro de 2010. A investigação da super-expressão do HER-2 foi realizada por técnica de Imunohistoquimica. As pacientes foram divididas em dois grupos: Grupo A presença de super-expressão do HER-2 (HER-2 positivo) e grupo B ausência de super-expressão (HER-2 negativo). Ambos os grupos foram comparados às características clinicas, patológicas, eventos adversos, sobrevida global e sobrevida livre de doença. A prevalência da presença do HER-2 na amostra foi de 15,55%. A meia de idade no momento do diagnóstico, o tamanho do tumor, o estado menstrual, o estádio clinico e estado linfonodal não foram fatores signifi cativos de prevalência para a presença do HER-2 positivo. O receptor de estrogênio (p=0,0356), receptor de progesterona (p=0,0059) e mostraram associação signifi cativa com o HER-2. A análise multivariada mostrou que a prevalência do HER-2, em pacientes com câncer é 2,92 vezes maior naqueles com receptor de estrogênio negativo (p= 0,0007) e 8,84 vezes maior naqueles com receptor de progesterona positivo (p< 0,0001). A sobrevida livre de doença e sobrevida global é igual em pacientes com HER-2 positivo. A sobrevida livre de doença para pacientes com axila com mais de 4 linfonodos comprometidos é menor (p=0,0009) assim como a sobrevida global (p<0,0001). O tamanho tumoral também é fator adverso mostrando que tumores maiores de... / The overexpression of HER-2 has been associated with increased aggressiveness of the tumor and resistance to some types of treatment. The objective of this study is to evaluate the prognostic value of overexpression of HER-2 in patients with breast cancer. A cohort study that analyzed 90 patients diagnosed with infi ltrating ductal carcinoma breast treated at the Regional Hospital Sobradinho the period 1 January 2005 until December 31, 2010. The investigation of the presence of overexpression of HER-2 was performed by immunohistochemical techniques. The patients were divided into two groups: Group A who had the overexpression of HER-2 and the B group who had no overexpression and compared the clinical, pathological, adverse events, overall survival and disease-free survival. The prevalence of the presence of HER-2 in the sample was 15.55%. The age at diagnosis, tumor size, menopausal status, clinical stage and lymph node status were not signifi cant factors prevalence for the presence of HER-2. The estrogen receptor (p = 0.0356), progesterone receptor (p = 0.0059) and showed signifi cant association with HER-2. Multivariate analysis showed that the prevalence of HER-2 in cancer patients is 2.92 times higher in those with estrogen receptor negative (p = 0.0007) and 8.84 times higher in those with progesterone receptor positive (p < 0.0001). The disease-free survival and overall survival is equal in patients with HER-2 positive. The disease-free survival for patients with more than 4 axillary lymph nodes is lower (p = 0.0009) and overall survival (p <0.0001). The tumor size is also an adverse factor showing that tumors larger than 2 cm have a lower disease-free survival (p = 0.0103) and shorter overall survival (p = 0.0103). The presence of over-expression of... (Complete abstract click electronic access below)

Este trabalho foi realizado com o objetivo de se estudar: - a concordância de um mesmo pesquisador, ao classificar, em ocasiões diferentes, as curvas de mortalidade proporcional, - a concordância entre diferentes pesquisadores na interpretação das curvas de mortalidade proporcional e ou - a concordância entre a curva de mortalidade proporcional e cada um dos indicadores, coeficiente de mortalidade infantil e razão de mortalidade proporcional, na indicação de alteração do nível de saúde de coletividades. Empreqou-se a estatística do tipo Kappa e encontrou-se: (GRÁFICO) / This study was realized with the purpose of examining: - the agreement of the same researcher, in classifying, on different occasions, the proportional mortality curves, - the agreement among different researchers in the interpretation of the proportional mortality curves, - the agreement among the proportional mortality curve and each one of the health indicators, infant mortality rate and proportional mortality ratio, in the indication of alteration of the level of health for communities. The statistics, type Kapna, was utilized and these were the findings: (GRAFICO)

INTRODUÇÃO: A tuberculose (TB) é uma doença grave, porém curável em praticamente 100 por cento dos casos novos, desde que os princípios da quimioterapia sejam seguidos. Porém, ainda determina elevadas taxas de morbimortalidade no município de São Paulo. OBJETIVOS: Descrever os casos de óbito por tuberculose no município de São Paulo, segundo causas básicas nos anos censitários de 1980, 1991, 2000 e 2010. MÉTODOS: Estudo descritivo que analisou a mortalidade por TB como causa básica, utilizando os dados do PRO-AIM, e da Fundação SEADE. RESULTADOS: Houve redução inconstante do número e da taxa de mortalidade por TB ao longo do período estudado, de 5,9 em 1980 para 2,8 por 100 mil habitantes, em 2010. Foi observada redução acentuada da mortalidade de 1980 até 1985, quando houve reversão desta tendência tornando-se crescente até 1996, quando declina novamente. Houve predomínio três vezes superior dos óbitos masculinos. A faixa etária mais atingida pelos óbitos por tuberculose no MSP foi a dos 60 anos e + de idade. Quanto à forma clínica, predominaram os óbitos por TB pulmonar (83,9 por cento ) seguidos pela TB miliar (10,4 por cento ). Foi observada importante influência da ampla cobertura da vacina BCG no MSP na redução dos óbitos por TB meníngea nos menores de 4 anos de idade. A melhor evolução quanto à mortalidade por TB foi na Zona Norte do município, sendo a Zona Leste, a região que apresentou nos quatro anos estudados, aumento proporcional dos óbitos por tuberculose no MSP, apesar da redução dos coeficientes de mortalidade encontrados em todas as regiões do município. CONCLUSÃO: A terceira idade deve ser privilegiada quanto às ações do PCT no MSP. Identificar áreas com diferentes coeficientes de mortalidade por tuberculose no MSP permite ao PCT priorizar estas diferentes regiões, dando especial atenção à região Leste. Dada a conhecida associação entre TB/HIV, a influência da epidemia de Aids reflete indiretamente nas tendências de mortalidade de tuberculose / INTRODUCTION: Tuberculosis (TB) is a serious disease, is curable in virtually 100 per cent of new cases, provided that the principles of chemotherapy are followed. However, still determines high rates of morbidity and mortality in São Paulo city (SPC). METHODS: Descriptive study of tuberculosis as underlying cause of death based on secondary data from the São Paulo City Information Mortality System (PRO-AIM), and the Foundation System State Information from São Paulo Brazil (SEADE). RESULTS: An fluctuating reduction of tuberculosis death numbers and mortality rates during the study period, from 5,9 in 1980 to 2,8 per 100,000 inhabitants in 2010, was observed. An accelerated reduction in mortality trend was seen from 1980 until 1985, when there was a reversal of the trend that became increasingly growing and so staying until 1996, when it declines again. Three fold male deaths predominated during the period. The 60 years old and above age group was the most affected by TB deaths in the MSP. Regarding the clinical form, the deaths by pulmonary TB (83.9 per cent ) followed by miliary TB (10.4 per cent ) predominated. A significant influence of coverage of BCG vaccine in São Paulo city in reducing deaths due to TB meningitis in children under 4 years old was observed. The best evolution in terms of TB mortality was seen in northern SPC. The eastern presented a proportional increase in tuberculosis deaths in SPC in the four years studied, despite the reduction of mortality rates found in all regions of the city. CONCLUSIONS: The elderly group should be favored by the actions of the SPC Tuberculosis Control Program. The identification of areas with different TB mortality rates in the city of São Paulo allows the TBCT to prioritize these different regions. Given the well-known association between TB/HIV co-infection, the impact of Aids epidemic indirectly affects TB mortality trends