Hip fracture has increased in the last decades and has been considered one of the major causes of mortality and morbidity in elderly people. In most cases is an event with catastrophic consequences to elderly life with impairment in your physical, psychical and social welfare. Is often responsible for the permanent institutionalization of the elderly. Epidemiologic studies contribute to specify certain orthopedic and traumatologic injuries and it helps in the treatment and prevention of these injuries. These actions are essential to health promotion. In Latin America, there are few epidemiological studies on mortality associated with hip fracture in elderly. Aims to assess mortality one year after hip fracture and in-hospital mortality in elderly subjects who were treated at the Orthopaedics and Traumatology division of University Hospital of Santa Maria. Identifying risk factors for one year mortality in-hospital mortality in these subjects and determinate one year subjects survival. This is a prospective cohort study that evaluates one year mortality by Cox s Regression and in-hospital mortality by Logistic Regression. The survival time was evaluate by Kaplan Meier analyze. The mean age was 80.6±7.5(SD) years, 76.4% were female gender, 57.8% were transtrochanteric fracture and 44.9% had ASA grade I or II. One year mortality was 25.2% and in-hospital mortality was 12.5%. One year mortality predictor s were ASA (HR 1.922, 95% CI 1.150 3.211) and time to surgery (HR 1.049, 95% CI 1.012 1.087). Only ASA grade were risk factor for in-hospital mortality (OR 6.373, 95% CI 2.954 13.747). The survival time was 297.7±11.3 days. The mean time to surgery was 7.8±5.4 days. In our study for every day that the surgery was delayed the one year survival was shortened by 9 days. Improvements in public health that would decrease time to surgery could have an impact at the survival of these subjects. The ASA grade is a useful tool to evaluate the patient clinical status. / A fratura do terço proximal do fêmur tem aumentado significativamente nas últimas décadas e tem sido uma das maiores causas de morbimortalidade em idosos. Constitui-se muitas vezes em um evento com consequências catastróficas para a vida do paciente, com grandes implicações no seu bem-estar físico, psíquico e social. É uma causa frequente de institucionalização permanente. Estudos epidemiológicos contribuem para especificar características de determinadas lesões traumato-ortopédicas, bem como, a partir daí, auxiliar na sua prevenção e tratamento. Estas ações são essenciais para a promoção da saúde. Na América Latina, existem poucos estudos epidemiológicos sobre a mortalidade associada a fraturas da extremidade proximal do fêmur em idosos. Este estudo tem como objetivos: avaliar a mortalidade um ano após fratura do fêmur proximal (FFP) e mortalidade intra-hospitalar nos pacientes com 65 anos ou mais, que foram atendidos no Serviço de Ortopedia e Traumatologia do Hospital Universitário de Santa Maria (SOT - HUSM); Identificar os fatores de risco para mortalidade um ano após FFP e mortalidade intra-hospitalar nestes pacientes; Determinar a sobrevida dos pacientes um ano após o evento trauma. Trata-se de um estudo de coorte prospectivo que avaliou através de Regressão de Cox os fatores de risco para mortalidade um ano após FFP e por meio de Regressão Logística, os preditores para mortalidade intra-hospitalar. A análise de sobrevida foi feita pelo método de Kaplan Meier. A idade média dos pacientes foi de 80,6±7,5(DP) anos, 76,4% eram do sexo feminino, 57,8% tiveram fratura transtrocantérica e 44,9% tinham escore ASA I ou ASA II. Ao final de um ano morreram 25,2% dos pacientes e 12,5% morreram durante a internação hospitalar. Foram fatores preditores de aumento de mortalidade em um ano o escore ASA (American Society of Anesthesiologists) (HR 1,922, 95% IC 1,150 3,211) e o tempo porta-cirurgia (HR 1,049, 95% IC 1,012 1,087). Apenas o escore ASA (OR 6,373, 95% IC 2,954 13,747) foi preditor de aumento da mortalidade intra-hospitalar. O tempo de sobrevida médio foi de 297,7±11,3 dias. O tempo médio entre a internação e a realização da cirurgia foi 7,8±5,4 dias. Em nosso estudo, para cada dia de espera, a sobrevida no primeiro ano foi encurtada em 9 dias. A tomada de medidas de saúde pública que venham a diminuir o tempo de espera para a cirurgia pode vir a apresentar um impacto positivo na diminuição dessa mortalidade. O escore ASA é uma importante ferramenta para avaliar o estado clínico do paciente.

No description available.

Philosophiae Doctor - PhD / This study extends the existing literature on how social networks enhance the performance and sustainability of small enterprises. More specifically, the study isolates and investigates the mechanisms through which social capital helps with the growth and survival of MSMEs. The evidence presented in this study strongly suggests that an indigenous social network widely practiced in Ethiopia, the "iqqub", contributes significantly to the start-up, survival and development of urban MSMEs. / South Africa

In the presented thesis the aim is to apply methods of survival analysis to the data from the Labour Force Survey, which are interval-censored. With regard to this type of data, I use specific methods designed to handle them, especially Turnbull estimate, weighted log-rank test and the AFT model. Other objective of the work is the design and application of a methodology for creating a model of unemployment duration, depending on the available factors and its interpretation. Other aim is to evaluate evolution of the probability distribution of unemployment duration and last but not least aim is to create more accurate estimate of the tail using extreme value theory. The main benefits of the thesis can include the creation of a methodology for examining the data from the Labour Force Survey based on standard techniques of survival analysis. Since the data are internationally comparable, the methodology is applicable at the level of European Union countries and several others. Another benefit of this work is estimation of the parameters of the generalized Pareto distribution on interval-censored data and creation and comparison of the models of piecewise connected distribution functions with solution of the connection problem. Work brought empirical results, most important of which is the comparison of results from three different data approaches and specific relationship between selected factors and time to find a job or spell of unemployment.

This thesis introduces methods used in time-to-date analysis. It is written generally and so usable in dealing with any example. The thesis deals with problem of censoring, which means, that some observations occurred after the following, which is typical for the lifetime analysis. Methods mentioned in the thesis are nonparametric and parametric estimates of the survival function and their characteristics, and regression models, concretely Cox model and accelerated failure time model, which examine effect of the covariates on survival function. In the thesis is beside survival function presented hazard function, which express intensity of the analyzed event and cumulative hazard function, which is created as the name suggests by cumulative summation of the hazard function. Estimates of these functions are obtainable from survival function and for parametric estimate often exists formula resulting from parameters of used distribution. Empirical part of the thesis introduces influence of several different types and degrees of censoring on parametric and nonparametric estimates of the survival function, mean and median. The other empirical example is the usage of regression analysis on the data from the lungs cancer research made by Mayo Clinic.

In response to the drastic decline of the European eel (Anguilla anguilla (L.)) fisheries have been reduced and elvers are stocked in areas where natural abundances are low. Are these measures adequate? To answer different aspects of this question, we have analysed more than a century of eel tagging, using both traditional and more novel capture – recapture analyses. Based on these long-term data, we have evaluated the impact of the Swedish eel coastal fisheries using Survival analysis. Our analysis indicates that the fishing mortality just prior the 2009 fishing restrictions were in the order of 10%. More recent tagging programs have focused on issues related to the fate of stocked fish. If and how they migrate out of the Baltic Sea and further on towards the Atlantic Ocean. Both earlier and our new studies reveal that all eels recaptured on the Swedish East Coast, no matter of their origin, migrate at a reasonable speed and direction towards the outlets of the Baltic Sea. Even though it is sometimes difficult to determine their origin, our analyses indicate that stocked fish were scarce among the recaptures. In an experiment on the Swedish West Coast, we knew the individuals’ origin (stocked or wild) and they had similar migration patterns. In contrast, silver eel in Lake Mälaren – assumed to have been stocked as elvers or bootlace eels – seemed to have difficulties in finding the outlets. Instead they overwintered and lost weight. However, weight losses are also significant among non-stocked individuals in the Baltic Sea, both if they overwinter and if they appear to be on their way out from the area. It remains an open question whether eels from the Baltic region in general, and whether the overwintered fish in particular, manage to reach the spawning area in the Atlantic Ocean. Based on current knowledge, I advocate invoking the precautionary approach and to concentrate Swedish eel stockings to the West Coast and allow the young fish to spread out on their own. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 2: Manuscript.</p><p> </p>

During the past decade, there has been a dramatic increase by postsecondary institutions in providing academic programs and course offerings in a multitude of formats and venues (Biemiller, 2009; Kucsera & Zimmaro, 2010; Lang, 2009; Mangan, 2008). Strategies pertaining to reapportionment of course-delivery seat time have been a major facet of these institutional initiatives; most notably, within many open-door 2-year colleges. Often, these enrollment-management decisions are driven by the desire to increase market-share, optimize the usage of finite facility capacity, and contain costs, especially during these economically turbulent times. So, while enrollments have surged to the point where nearly one in three 18-to-24 year-old U.S. undergraduates are community college students (Pew Research Center, 2009), graduation rates, on average, still remain distressingly low (Complete College America, 2011). Among the learning-theory constructs related to seat-time reapportionment efforts is the cognitive phenomenon commonly referred to as the spacing effect, the degree to which learning is enhanced by a series of shorter, separated sessions as opposed to fewer, more massed episodes. This ex post facto study explored whether seat time in a postsecondary developmental-level algebra course is significantly related to: course success; course-enrollment persistence; and, longitudinally, the time to successfully complete a general-education-level mathematics course. Hierarchical logistic regression and discrete-time survival analysis were used to perform a multi-level, multivariable analysis of a student cohort (N = 3,284) enrolled at a large, multi-campus, urban community college. The subjects were retrospectively tracked over a 2-year longitudinal period. The study found that students in long seat-time classes tended to withdraw earlier and more often than did their peers in short seat-time classes (p < .05). Additionally, a model comprised of nine statistically significant covariates (all with p-values less than .01) was constructed. However, no longitudinal seat-time group differences were detected nor was there sufficient statistical evidence to conclude that seat time was predictive of developmental-level course success. A principal aim of this study was to demonstrate—to educational leaders, researchers, and institutional-research/business-intelligence professionals—the advantages and computational practicability of survival analysis, an underused but more powerful way to investigate changes in students over time.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-11T12:24:30Z No. of bitstreams: 1 patriciaoliveiracarmo.pdf: 901114 bytes, checksum: 4238f828115db8965f8df71f43a82da1 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T17:05:15Z (GMT) No. of bitstreams: 1 patriciaoliveiracarmo.pdf: 901114 bytes, checksum: 4238f828115db8965f8df71f43a82da1 (MD5) / Made available in DSpace on 2016-01-25T17:05:15Z (GMT). No. of bitstreams: 1 patriciaoliveiracarmo.pdf: 901114 bytes, checksum: 4238f828115db8965f8df71f43a82da1 (MD5) Previous issue date: 2015-06-19 / Em geral, o câncer de mama subtipo luminal exibe melhor prognóstico em relação aos outros subtipos tumorais. No entanto, a doença nesta condição pode assumir uma evolução desfavorável em algumas circunstâncias, o que sinaliza para a necessidade de melhor entendimento sobre o comportamento deste subtipo tumoral. O presente estudo teve por objetivo estimar a sobrevida livre de doença de mulheres em cinco anos com câncer de mama subtipo luminal e avaliar as variáveis prognósticas, clínicas, sociodemográficas, histopatológicas, relacionadas à utilização dos serviços de saúde e ao tratamento visando conhecer o impacto destas e sua implicação na recorrência e sobrevida da população estudada. Os dados foram obtidos a partir de uma coorte de base hospitalar, composta por 331 mulheres diagnosticadas com a doença no período entre 2003 e 2005, com perfil imunohistoquímico compatível com tumor luminal, não metastático (estadios I, II e III), atendidas em hospital referência em Oncologia no Município de Juiz de Fora – MG. A sobrevida livre de doença em cinco anos foi de 79,5% (IC95%: 74,6-83,6). Na análise univariada, observou-se associação da recorrência do tumor com o tipo de serviço de saúde, estadiamento, tamanho tumoral, comprometimento linfonodal e número de linfonodos comprometidos, quimioterapia e hormonioterapia (p<0,05), sendo verificada menor recorrência para as mulheres que frequentaram o serviço privado, que apresentaram doença inicial, menor tamanho tumoral e ausência de comprometimento linfonodal axilar e que foram submetidas a hormonioterapia. No modelo multivariado, permaneceram gravidade da doença e hormonioterapia como os fatores prognósticos mais importantes. As técnicas de biologia molecular representam o futuro do tratamento do câncer e também para os tumores luminais. Deve-se garantir o acesso ao tratamento hormonal quando indicado e os estágios avançados devem ser objeto de abordagem terapêutica mais ampliada. / Luminal breast cancer usually has a better prognosis in relation to other tumoral subtypes. Nonetheless, the illness in this point can evolve unfavorably in some circumstances what signals the need for a better understanding about this tumoral subtype behavior. The present study aimed at estimating the diseasefree survival of women with luminal breast cancer in five years. In this study, many variables have been evaluated, including prognostic, clinic, sociodemographic, histopathological and related to the use of public health services and treatment, aiming to get to know their impact and implications on recurrence and survival among the population of the study. The database was a hospital based cohort study, composed of 331 women diagnosed with the disease between 2003 and 2005, with immunohistochemical profile compatible with luminal breast cancer, non-metastatic (stages I, II or III), treated in a hospital seen as a reference for cancer care in Juiz de Fora, MG. The study showed a disease-free survival of 79.5% (IC95%: 74.6-83.6) in five years. The univariate analysis has shown an association of tumor recurrence with the type of health care, staging, tumor size, lymph node involvement and their number, chemotherapy and hormonal therapy (p<0.05) and it has indicated better survival rates among women who used private health care, who are in an initial stage, with smaller tumors, no axillary involvement and who used hormonal therapy. In the multivariate model, there remained gravity of the illness and the use of hormonal therapy as the most important prognostic factors. Molecular biology techniques represent the future for cancer treatment and also for luminal tumors. Access to hormonal therapy should be granted whenever prescribed and advanced stages must receive an amplified range of therapeutic approach.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-26T12:33:12Z No. of bitstreams: 1 vivianassisfayer.pdf: 1716966 bytes, checksum: 6112a4fa69673c197984cf60d4f75fa6 (MD5) / Rejected by Adriana Oliveira (adriana.oliveira@ufjf.edu.br), reason: Renata, verifique se a palavra do título "coorte" está correta on 2016-01-27T10:54:17Z (GMT) / Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-27T11:10:08Z No. of bitstreams: 1 vivianassisfayer.pdf: 1716966 bytes, checksum: 6112a4fa69673c197984cf60d4f75fa6 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-27T13:56:30Z (GMT) No. of bitstreams: 1 vivianassisfayer.pdf: 1716966 bytes, checksum: 6112a4fa69673c197984cf60d4f75fa6 (MD5) / Made available in DSpace on 2016-01-27T13:56:30Z (GMT). No. of bitstreams: 1 vivianassisfayer.pdf: 1716966 bytes, checksum: 6112a4fa69673c197984cf60d4f75fa6 (MD5) Previous issue date: 2014-02-20 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O câncer de mama é um dos principais problemas de saúde pública em diversas partes do mundo, uma vez que apresenta alta incidência sendo considerado uma das principais causas de morte por câncer entre mulheres em diversos países. Este estudo teve como objetivo avaliar a sobrevida de 10 anos e fatores prognósticos em mulheres com diagnóstico de câncer de mama entre 2000 e 2001, assistidas em centro de referência em assistência oncológica da região Sudeste do país. A coorte foi identificada a partir de busca no Registro Hospitalar de Câncer do serviço de saúde incluído no estudo. O seguimento dos casos foi realizado mediante retorno aos prontuários, complementado por busca no banco do Sistema de Informação sobre Mortalidade (SIM) e contato telefônico. As principais variáveis analisadas foram: natureza do serviço, idade ao diagnóstico, cor da pele, tamanho do tumor, comprometimento de linfonodos, estadiamento, marcadores tumorais, hormonioterapia e radioterapia, entre outras. As funções de sobrevida foram calculadas por meio do método de Kaplan-Meier. O modelo de riscos proporcionais de Cox foi utilizado para avaliação dos fatores prognósticos. Os resultados deste estudo indicam que a sobrevida de dez anos foi de 61,2% (IC95%: 55,0-66,8). Os fatores prognósticos mais importantes que estiveram associados a pior sobrevida, de forma independente, foram: presença de metástase ganglionar (HR=2,64; IC95%: 1,73-4,02), tumores maiores que dois centímetros (HR=1,88; IC95%: 1,15-3,09) e não uso de hormonioterapia (HR=1,53; IC95%: 1,01-2,30). Na análise multivariada estratificada por natureza do serviço de saúde, a presença de metástase ganglionar (HR=2,36; IC95%: 1,42-3,90), tumores com mais de dois centímetros (HR=1,76; IC95%: 0,95-3,25) e utilização de radioterapia (HR=0,67; IC95%: 0,42-1,09) foram os principais fatores prognósticos para pior sobrevida entre as pacientes assistidas pelo serviço público. Já para o serviço privado, estadiamentos mais avançados e ausência de marcadores tumorais associaram-se aos melhores prognósticos (HR=2,82; IC95%: 1,24-6,42). No Brasil, ainda existem poucas publicações a respeito de análise de sobrevida em pacientes com câncer de mama com seguimento de dez anos. Este trabalho foi importante para fornecer informações sobre o seguimento de longo prazo do centro de referência oncológica avaliado e para caracterizar o perfil das pacientes diagnosticadas com câncer de mama no município e regiões adjacentes. Os resultados deste estudo fortalecem a importância do diagnóstico precoce através do rastreamento por meio do exame clínico das mamas e de mamografia, e da disponibilidade do exame imuno-histoquímico para todas as pacientes, independente da natureza do serviço, para orientar a abordagem terapêutica. Estas informações são extremamente úteis para os gestores de saúde adotarem medidas voltadas para a prevenção e controle da doença, assim como para avaliações da qualidade do cuidado prestado e acessibilidade ao sistema de saúde; além de viabilizar avaliações dos avanços diagnósticos e terapêuticos empregados pelo centro de atenção oncológica. / Breast cancer is a major public health problem in many parts of the world, since it has high incidence is considered one of the leading causes of cancer death among women in many countries. This study aimed to evaluate the survival of 10 years and prognostic factors in women diagnosed with breast cancer between 2000 and 2001, assisted at a referral center for cancer care in the Southeast region of the country. Recruitment of cases was made from the search in the Hospital Cancer Registry of the health service included in the study. The follow-up of cases was achieved by returning to the medical records, supplemented by searching the database of the Mortality Information System (MIS) and telephone contact. The main variables analyzed were: type of service, age at diagnosis, race, tumor size, lymph node involvement, staging, tumor markers, hormone therapy and radiotherapy, among others. Survival functions were calculated using the Kaplan-Meier method. The model of Cox proportional hazards regression was used to evaluate prognostic factors.The results of this study indicate that the ten-year survival was 61.2% (95% CI= 55.0 to 66.8). The most important prognostic factors that were associated with worse survival, independently, were: presence of lymph node metastasis (HR = 2.64, 95% CI= 1.73 to 4.02), larger than two centimeters (HR = 1 tumors , 88, 95% CI= 1.15 to 3.09) and no use of hormone therapy (HR = 1.53, 95% CI= 1.01 to 2.30). In multivariate analysis stratified by type of health service, the presence of lymph node metastasis (HR = 2.36, 95% CI= 1.42 to 3.90), tumors larger than two centimeters (HR = 1.76, 95% CI= 0.95 to 3.25) and use of radiotherapy (HR = 0.67, 95% CI= 0.42 to 1.09) were the main prognostic factors for poor survival among patients attended by the public service. As for the private service, more advanced staging and absence of tumor markers were associated with the best prognosis (HR = 2.82, 95% CI= 1.24 to 6.42). In Brazil, there are few publications about survival analysis in patients with breast cancer followed up for ten years. This work was important to provide information on the outcome of long-term oncology referral center assessed and to characterize the profile of patients diagnosed with breast cancer in the city and surrounding regions. The results of this study reinforce the importance of early diagnosis through screening by clinical breast examination and mammography, and availability of immunohistochemical examination for all patients, regardless of the nature of the service, to guide the therapeutic approach. This information is extremely useful for health managers adopt measures aimed at the prevention and control of disease, as well as evaluations of the quality of care delivery and accessibility to health care, as well as providing reviews of diagnostic and therapeutic advances employed by the center cancer care.

O principal objetivo deste trabalho é desenvolver procedimentos inferências em uma perspectiva bayesiana para modelos de sobrevivência com (ou sem) fração de cura baseada na distribuição exponencial por partes. A metodologia bayesiana é baseada em métodos de Monte Carlo via Cadeias de Markov (MCMC). Para detectar observações influentes nos modelos considerados foi usado o método bayesiano de análise de influência caso a caso (Cho et al., 2009), baseados na divergência de Kullback-Leibler. Além disso, propomos o modelo destrutivo binomial negativo com fração de cura. O modelo proposto é mais geral que os modelos de sobrevivência com fração de cura, já que permitem estimar a probabilidade do número de causas que não foram eliminadas por um tratamento inicial / The main objective is to develop procedures inferences in a bayesian perspective for survival models with (or without) the cure rate based on piecewise exponential distribution. The methodology is based on bayesian methods for Markov Chain Monte Carlo (MCMC). To detect influential observations in the models considering bayesian case deletion influence diagnostics based on the Kullback-Leibler divergence (Cho et al., 2009). Furthermore, we propose the negative binomial model destructive cure rate. The proposed model is more general than the survival models with cure rate, since the probability to estimate the number of cases which were not eliminated by an initial treatment