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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Celiac disease (CD) is an autoimmune gastrointestinal disorder that has been well studied amongst non‐Hispanic white populations. Data specifically describing the disease in the U.S. Hispanic population is limited and available studies that do report prevalence and incidence within this population reveal discrepancies. The aim of this study is to estimate the incidence of CD and to define common presenting symptoms in Hispanics in Phoenix, AZ. Data was collected via a retrospective chart review from Maricopa Integrated Health System (MIHS), an organization caring for a patient population that is >50% Hispanic, between 2004‐2013. The study population is both adult and pediatric patients that had received the ICD‐9 code 579.0. The total number of non‐repeat patients seen at MIHS each year between 2004‐2013 was also determined and broken down by race for incidence calculations. During this 10‐year period, 29 total patients were diagnosed with CD at MIHS. The overall yearly incidence increased from 1 in 44,011 patients in 2004 to 1 in 27,948 in 2013. Of the 29 diagnosed, 52% were Caucasian, 34% Hispanic, 7% Asian and 7% African American. The yearly incidence in Hispanic patients also increased from 0 in 2004 to 1 in 58,302 in 2007 to 1 in 25,826 in 2013. Although diagnosis was greater in females of both races, Hispanic patients were diagnosed at a younger age than Caucasians (22 vs. 31 y/o, respectively). The most common diagnostic approach was serological testing combined with duodenal biopsy. The 3 most common gastrointestinal presenting symptoms in Caucasians were diarrhea, abdominal pain and nausea/vomiting, while those in Hispanics were constipation, bloating/abdominal distention and diarrhea. At the time of diagnosis, at least 1/3rd of both Caucasian and Hispanic patients had presented with another autoimmune disorder. Other associated conditions were neurological symptoms and iron‐deficiency anemia. Data from this study suggests that CD in the Hispanic population may be more common in Phoenix than the overall population in the U.S. as described in the literature. It also suggests that Hispanic patients may have different presenting symptoms than do Caucasians. The reason behind the increase in CD incidence in Hispanics is unclear, although increased physician awareness and diagnosis may play a role. Further research and awareness of CD in the Hispanic population may be necessary to optimize diagnosis & treatment of the condition.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Research has shown an association between childhood maltreatment and risk factors for cardiovascular disease and depression. The purpose of this study is to examine the total and unique effects of various forms of childhood maltreatment on the development of risk factors for cardiovascular disease and depression in both women and men. Data for this study will be obtained from retrospective chart review and from an already established research database at a private healthcare facility specializing in the treatment of trauma and addiction. All information will pertain to participants’ admission to the healthcare facility and will include self‐report data on childhood maltreatment and symptoms of depression, as well as retrospective chart review data regarding physiological metrics of risk for cardiovascular disease (blood pressure, cholesterol, diabetes). Results from 290 patients indicated that emotional abuse and emotional neglect were the leading predictors of negative outcomes with emotional neglect being a significant predictor of adult depression even after controlling for age, gender, and marital status. Younger participants and women reported higher levels of depression. However, the gender‐specific regressions showed that younger age and emotional neglect remained significant predictors of depression, with the percent variance explained by the model being greater among men compared to women. This greater effect size among men was driven by a stronger association between younger age and depression in men than in women. Childhood emotional abuse was associated with greater risk for coronary heart disease, even after controlling for gender and marital status. Gender‐specific analyses showed that, for men, childhood physical neglect emerged as a significant predictor of coronary heart disease risk after controlling for marital status. Contrary to predictions, among women, none of the five types of childhood maltreatment emerged as a significant predictor of coronary heart disease risk. Moreover, depression was inversely associated with risk for coronary heart disease. In other words, higher levels of depression were consistently associated with lower levels of coronary heart disease risk. This was attributed to the fact that younger people reported higher levels of depression, but younger age was also associated with lower levels of coronary heart disease risk. Furthermore, the results of this study can be used to develop screening tools, based on childhood maltreatment severity and type, for depression and cardiovascular disease. To what degree are specific types of childhood abuse and neglect (i.e., emotional, physical, or sexual) risk factors for depression and cardiovascular disease and how are these risks moderated by gender? Hypotheses: 1) It is expected that higher levels of childhood neglect and abuse (all forms taken together) will be related to higher levels of depressive symptoms and greater risk for cardiovascular disease. 2) Comparing five basic forms of neglect and abuse, it is anticipated that emotional abuse will have the strongest association with elevations in depression and cardiovascular risk. 3) It is hypothesized that the relation between childhood maltreatment and cardiovascular risk will be stronger in women compared to men.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management Johannesburg, 2011 / Introduction: South Africa is currently facing a quadruple burden of diseases: poverty related conditions, emerging chronic diseases, injuries and HIV/AIDS. Increasing burden of these diseases is having a detrimental impact on service delivery particularly in rural areas, where the majority of the population are dependent on public health system. Although numerous epidemiological studies had been done in the past to determine the prevalence of these conditions, only a few studies have attempted to quantify the effect of these diseases on health facilities such as admission rate, bed occupancy rate and resource utilisation. More data is required to develop a better understanding of their impact and to guide development of appropriate response strategies. Aim of the study: To `analyse trends of admissions and resource utilisation in adult medical wards of a rural district hospital in South Africa. Methodology: This was a descriptive cross-sectional, retrospective study involving an analysis of data from adult medical wards in the George Masebe Hospital (a district hospital in Limpopo Province) for six months in 2009. Results: The study found average number of admissions per month was 148, their length of stay varied from one day to more than a year. Their median age was 44 years. They were black, had no medical aid and unemployed and the majority of them were dependent on social welfare grant. The most common health problems diagnosed amongst the medical admissions were HIV related conditions such as gastro-enteritis, pneumonia, AIDS and tuberculosis as well as other chronic diseases such as diabetes mellitus. A striking discovery was the high incidence of mental illness amongst the admissions. The majority of them were discharged home. The crude death rate was 190 per 1000 admissions and the main cause of death was HIV related conditions. The average direct expenditure per month was R 1,040,579. The expenditure for salaries was the main expenditure (54%) followed by Allied health services (29%). The average expenditure per patient was R 7,039 (R 7,548 for female patients and R 6454 for male patients). v Conclusion: This was the first study on admission trends resource utilisation in this Hospital and in the Limpopo Province. The evidence from this study would hopefully steer the re-organisation of some of the Hospital services, more especially the establishment of a step-down ward facility within the Hospital. This study has recognised that the increased number of admissions in rural district hospitals often result from double burden of infectious and chronic diseases. More studies on the subject are needed to identify their impact on resource utilisation at these hospitals.

University of Macau / Faculty of Science and Technology. / Department of Computer and Information Science

Cancer affects a wide range of organs and tissues within the body and epidemiologically is forecasted to affect almost half of the world's population. As an industry, cancer therapeutics represent a booming field. Standard treatment options, however, still heavily rely upon chemotherapeutics developed over fifty years ago. The past decade has seen a huge proliferation of different types of cancer drugs. Recently, an entirely new class of drugs has been unveiled and holds promising results of preventing further relapse incidents. Immunotherapeutics come in many varieties and currently several strategies are under intense investigation. Because these drugs harness the body's own immune system to specifically attack tumor cells, these drugs hold an advantage to current therapeutic options in that they induce notably less severe side effects, facilitating patients' abilities to maintain quality of life. In addition, these drugs potentially hold the promise to cure certain types of cancer, as the body's memory T cells will prevent relapse of the same tumor type. This review will focus on dendritic cell-based therapies, which attempt to program these antigen-presenting cell types to prime T cell responses, checkpoint blockade drugs that inhibit immunosuppression, and neoadjuvants that aim to render the surrounding tumor microenvironment more susceptible for immune attack. In addition, some documented and projected downsides to immunotherapeutics will be discussed, as well as the need to combine multiple modalities in order to create an effective and personalized treatment regimen for cancer patients.

Thesis (M.A.)--Northern Michigan University, 2009. / "14-62713." Bibliography: leaves 58-61.

Thesis (M.Sc.)--York University, 2008. Graduate Programme in Biology. / Typescript. Includes bibliographical references. Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR45925