The purpose of the study was to identify factors associated with the HIV transmission rate in 18 to 24 month-old children enrolled in the PMTCT programme at two selected City of Tshwane clinics. Mother-to-child transmission of HIV during labour and breastfeeding accounts for 40% of all HIV infection in children. The prevention of mother-to-child transmission of HIV programme is one effective strategy to reduce the rate of HIV infection in children. The HIV transmission rate was low at six weeks of age but increases at 18 to 24 months of age due to several factors. The researcher selected a descriptive retrospective correlational research design. A structured questionnaire was used to collect data from 60 mothers of children aged 18 to 24 months on the PMTCT programme and a data-collection form to collect data from 152 clinic records of children of the same age on the programme. The study found that the PMTCT guidelines were not properly adhered to by the nurses and the respondents. Prophylactic treatment was not provided as required and mixed feeding was prominent. The uptake of HIV test at 18 to 24 months was low compared to at 6 weeks. The transmission rate was high at 18 to 24 months compared to at 6 weeks. No factors were associated with the transmission rate / Health Studies / M.A. (Public Health)

This study, quantitative determinants of need and demand for primary health care in the District of Columbia (DCPC), analysed data over a twenty-year period from 1985 to 2004, on need and demand for primary care using standard and epidemiologically innovative statistical measures for physician distributions and socio-demographic characteristics in the District of Columbia (DC). The study attempted to answer the question: Using U.S census-based small area aggregations, Census Tract Groupings (CTGs), that are not zip-code areas or legislative/political boundaries, can a multivariate predictive model be developed using physician distributions, primary care service index (PCSI) and composite need scores (CNS) to explain variations in primary care visits shortages? Primary care visits shortages and priority scores (PCPS) were calculated, analysed and presented for CTGs in the District of Columbia from 1985 to 2004. Results indicated that the abundant supply of DC-based physicians – indicated by decreasing population per physician ratios of 239 (1985) to 146 (2004) – appear to be a long-term trend. As raw physician counts increased, the ratio of satisfied visits to demand decreased, from 2.62 (1985) to 1.80 (in 2004). This result appears to indicate that, due to inequities in distribution of primary care physicians in DC’s small areas, the increasing numbers of primary care physicians were by themselves, not sufficient to address the city’s overall primary care visits need. Epidemiological profiles and physician distribution analytical methods appear to be useful for small area analysis of urban primary care shortage areas and for setting priorities. Physician rates per 1,000 pop may be a necessary but not sufficient statistic for estimating urban primary health care needs / Health Studies / D. Litt. et Phil. (Health Studies)

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously. / Health Studies / D. Litt.. et Phil. (Health Studies)

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously. / Health Studies / D. Litt. et Phil. (Health Studies)

Introdução: A infecção pelo vírus da Hepatite B (HBV) é um grande problema de saúde pública, uma vez que cerca de 257 milhões de pessoas em todo o mundo são acometidas pelo vírus. Mundialmente, devido ao grande movimento migratório, descrevem-se mudanças no perfil dos pacientes portadores de HBV. Desta forma, objetivamos caracterizar a população de pacientes portadores HBV atendidos no ambulatório A2MG404 de Hepatites Virais do HC-FMUSP. Métodos: Este foi um estudo retrospectivo descritivo de 617 novos pacientes com exames sorológicos positivos para HBV, em seguimento no ambulatório A2MG404 entre janeiro de 2005 e dezembro de 2015. Dados demográficos, epidemiológicos e clínicos foram obtidos de prontuários eletrônicos institucionais (SIGH-PRODESP, HCMED e ProntMed). A coleta e gerenciamento de dados foi realizada utilizando o software on-line REDCap (V6.16.4). A análise estatística foi realizada utilizando o software R (V3.3.0). O teste de Shapiro-Wilk foi utilizado para testar a normalidade dos dados; dados não paramétricos foram comparados utilizando-se o teste de Wilcoxon-Mann-Whitney; as proporções entre populações foram comparadas utilizando-se o Teste Z. Foram considerados estatisticamente significativos valores de p < 0,05. Resultados: Foi observada predominância do sexo masculino (60,9%); mediana de idade de 48 anos; raça branca (70,8%) e nível de escolaridade baixo [ensino fundamental completo (37,4%)] entre os pacientes. A maioria deles eram brasileiros (93,5%), residentes no estado de São Paulo (98,4%), principalmente na cidade de São Paulo (63,6%). Pacientes residentes em outros estados do Brasil também foram atendidos no serviço (1,6%), bem como estrangeiros (6,5%). Coinfecção por HCV foi identificada em 7,8% dos pacientes; e por HIV em 1,3% destes. De base, 109/617 (17,66%) pacientes eram AgHBe positivo [infecção crônica: 42/617 (6,8%); hepatite crônica: 67/617 (10,8%)]; 350/617 (56,72%) pacientes eram AgHBe negativo [infecção crônica: 290/617 (47,0%); hepatite crônica: 60/617 (9,7%)]; 104/617 (16,9%) pacientes eram Anti-HBc Total e Anti-HBs positivos; 49/617 (8,0%) pacientes eram Anti-HBc Total isolado; e 5/617 (0,8%) pacientes eram portadores de perfil sorológico anômalo da hepatite B. Entre o início e término de seguimento foram observados diminuição significativa dos valores de ALT, AST, APRI, carga viral (p < 0,001), hemoglobina (p=0,007) e bilirrubina total (p=0,011), bem como aumento significativo de bilirrubina direta e INR (p < 0,001). O FIB-4 não apresentou diferença estatisticamente significativa no mesmo intervalo. A análise mostra que 30,3% dos pacientes receberam tratamento com antivirais, sendo Tenofovir (28,3%) o mais prescrito, seguido de Lamivudina (19,8%), Tenofovir+Lamivudina (19,8%) e Entecavir (19,2%). Entecavir apresentou a maior taxa de soroconversão de AgHBe (6/9; 66,66%), enquanto que Lamivudina apresentou a maior taxa para AgHBs (5/30; 16,66%). Tenofovir possui maior potencial para redução de carga viral, aumento de plaquetas e melhora de enzimas hepáticas do que Lamivudina e Entecavir (p < 0,05). No total, foram realizadas 5412 consultas médicas, sendo a maioria delas do tipo \"seguimento\" (85,8%). Faltas foram registradas em 11,9% das consultas médicas agendadas no período. Conclusões: A população atendida no serviço é heterogênea, com representação de diferentes sexos, etnias, faixas etárias e nacionalidades; ao menos 14 nacionalidades representadas, refletindo o fenômeno da migração observado globalmente. São necessárias ações educacionais para promoção da adesão aos cuidados médicos adequados / Background: Hepatitis B virus (HBV) is a major public health problem with significant burden across all global regions, once they affect about 250 million people around the world. Worldwide, due to the great migratory movement, changes were described in the profile of patients with hepatitis B. In this way, we aimed to characterize the population of patients with chronic hepatitis B seen in the ambulatory A2MG404 of Viral Hepatitis of HC-FMUSP. Methods: This was a retrospective descriptive study of 617 new patients with positive serological tests results for HBV, followed up in the A2MG404 ambulatory between January 2005 and December 2015. Demographic, epidemiological and clinical data were obtained from institutional electronic medical records (SIGH-PRODESP, HCMED and ProntMed). Data collection and management was performed using REDCap online software (V6.16.4). Statistical analysis was performed using R software (V3.3.0). Shapiro-Wilk Test was used to test the normality of the data; non-parametric data were compared using Wilcoxon-Mann-Whitney Test; proportions among populations were compared using the Z-Test. Values of p < 0.05 were considered statistically significant. Results: Male predominance (60.9%); median age of 48 years; white race (70.8%) and low educational level (37.4%) was observed among the patients. Most of them were Brazilian (93.5%), living in the State of São Paulo (98.4%), mainly in the city of São Paulo (63.6%). Patients living in other Brazilian states were also assisted in the service (1.6%), as well as foreigners (6.5%). HCV coinfection were identified in 7.8% of patients; and HIV in 1.3% of these. At baseline, 109/617 (17.66%) patients were HBeAg positive [chronic infection: 42/617 (6.8%); chronic hepatitis: 67/617 (10.8%)]; 350/617 (56.72%) patients were HBeAg negative [chronic infection: 290/617 (47.0%); chronic hepatitis: 60/617 (9.7%)]; 104/617 (16.9%) patients were Total Anti-HBc and Anti-HBs positive; 49/617 (8.0%) patients were Anti-HBc Total isolated; and 5/617 (0.8%) patients had anomalous serological profile of hepatitis B. Significant decrease in ALT, AST, APRI, viral load (p < 0.001), hemoglobin (p = 0.007) and total bilirubin (p = 0.011); as well as significant increase of direct bilirubin and INR (p < 0.001) of patients were observed during the follow-up. FIB-4 score didn\'t present a statistically significant difference in the same interval. The analysis shows that 30.3% of the patients received antiviral treatment, being Tenofovir (28.3%) the most prescribed, followed by Lamivudine (19.8%), Tenofovir+Lamivudine (19.8%) and Entecavir (19.2%). Entecavir presented the highest HBeAg seroconversion rate (6/9; 66.66%), whereas Lamivudine presented the highest rate for HBsAg (5/30, 16.66%). Tenofovir has greater potential for viral load reduction, platelet increase, and hepatic enzymes normalization than Lamivudine and Entecavir (p < 0.05). In total, 5412 medical appointment were performed, most of them was classified as \"follow up\" type (85.8%). Absences were recorded in 11.9% of the medical appointments scheduled in the period. Conclusions: The population served in the service is heterogeneous, with representation of different genders, ethnicities, age groups and nationalities. In it, at least 14 nationalities are represented, reflecting the phenomenon of immigration observed worldwide. Educational actions are required to promote adherence to the necessary medical care for these patients

La present tesi vol explicar la implantació de la Reforma Catòlica en una sèrie de parròquies rurals dels bisbats de Girona (valls de Ridaura, Bas, Hostoles i Amer) i Vic (El Collsacabra i les valls de Susqueda i Sau), entre 1587 i 1800, des dels bisbes posttrentins Jaume Caçador i Pedro Jaime als il·lustrats Tomàs de Lorenzana i Francisco de Veyan. La documentació principal són les sèries de les visites pastorals conservades a l'Arxiu Diocesà de Girona i l'Arxiu Episcopal de Vic; paral·lelament, s'ha reforçat amb documentació parroquial (llibres sagramentals, consuetes, llibres d'obra i confraries), protocols notarials (notaries de Rupit, Sant Feliu de Pallerols, El Mallol i Amer) i impresos episcopals. Els manaments de les visites pastorals s'han contrastat, amb semblances i diferències, amb els decrets del concili de Trento, de les constitucions provincials tarraconenses i les sinodals gironines i vigatanes, i amb les evidències artístiques, arquitectòniques i arqueològiques. Tots ells han servit per demostrar la lentitud en la implantació del programa tridentí, que s'assoleix, de fet, amb força retard (ben entrat el segle XVIII). / The present thesis tries to explain the implantation of the Catholic Reform in a few rural parish churches in the bishoprics of Girona (Valleys of Ridaura, Bas, Hostoles and Amer) and Vic (El Collsacabra and Valleys of Susqueda and Sau), from 1587 to 1800, from the post-Trent bishops Jaume Caçador and Pedro Jaime to Illustrated Tomàs de Lorenzana and Francisco de Veyan. The main sources of information are the pastoral bishop visits. These series are well preserved in the Arxiu Diocesà de Girona and the Arxiu Episcopal de Vic. We also have added some other documents: parish registers, notary books (from Rupit, Sant Feliu de Pallerols, El Mallol i Amer) and bishop printed material. We have contrasted the orders from the bishops visits with the decrees from the Council of Trent, the Constitutions of the Tarraconense Province and the Synodal Constitutions of Girona and Vic, and the artistic, architectural and archaeological evidences. All of them have shown the slow pace and the delay of the enterprise.

Population-based administrative data (2009-2012) from several sources were used to compare the health status and access to health services between a cohort of children in care with developmental disabilities (DD) (n=1,212) and a matched comparison group of children in care without DD (n=2,424). The two study groups were compared on a number of measures, including total respiratory morbidity, prevalence of diabetes, mood and anxiety disorders, continuity of care, injury-related hospitalizations, hospital-based dental care, and total number of ambulatory physician visits. Children in care with DD were significantly more likely to have a history of mood and anxiety disorders, respiratory illnesses, diabetes, hospital-based dental care, and injury-related hospitalizations compared to the matched comparison group. Children in care with DD also had significantly higher number of physician visits than children in the matched comparison group. No significant difference between the two study groups was found for continuity of care. / October 2015

This work focuses on statistical methods to understand how frequently rare events occur and what the magnitude of extreme values such as large losses is. It lies in a field called extreme value analysis whose scope is to provide support for scientific decision making when extreme observations are of particular importance such as in environmental applications, insurance and finance. In the univariate case, I propose new techniques to model tails of discrete distributions and illustrate them in an application on word frequency and multiple birth data. Suitably rescaled, the limiting tails of some discrete distributions are shown to converge to a discrete generalized Pareto distribution and generalized Zipf distribution respectively. In the multivariate high-dimensional case, I suggest modeling tail dependence between random variables by a graph such that its nodes correspond to the variables and shocks propagate through the edges. Relying on the ideas of graphical models, I prove that if the variables satisfy a new notion called asymptotic conditional independence, then the density of the joint distribution can be simplified and expressed in terms of lower dimensional functions. This generalizes the Hammersley- Clifford theorem and enables us to infer tail distributions from observations in reduced dimension. As an illustration, extreme river flows are modeled by a tree graphical model whose structure appears to recover almost exactly the actual river network. A fundamental concept when studying limiting tail distributions is regular variation. I propose a new notion in the multivariate case called one-component regular variation, of which Karamata's and the representation theorem, two important results in the univariate case, are generalizations. Eventually, I turn my attention to website visit data and fit a censored copula Gaussian graphical model allowing the visualization of users' behavior by a graph.

Text in English / Social media has taken the world by storm and keeps on evolving. This evolution poses a threat as well as an opportunity to mankind, to the livelihoods of hordes of people employed in the media industry. It also presents a unique opportunity to chart new waters. This study explores the convergence and divergence of new media and traditional media. This divergence and convergence, if properly understood, will help in understanding the future of traditional media, and thus mitigate the threats posed by the ever evolving social media and communication technologies. This study provided a test case on the legitimacy of traditional media in as much as the ‘public interest and purveyor of public opinion’ clause of the media is concerned. The media cannot afford to live by Marx doctrine of “he who owns the means of production also controls the production of ideas in that epoch’. If it is going to be a driver and custodian of democracy in a new emerging Africa, the media has a responsibility to be the voice of the voiceless. Social media plugs the gap that traditional media leaves. Thus, the two can thus complement each other, rather than compete with each other within the same space. The population in Africa is becoming younger and younger and by extension they are moving away from traditional media towards digital and social media. There is an opportunity to be seized there. This study established that the traditional media has entrenched ways of looking at news, which are normally divergent from the way that the general populace, as captured in social media does. / Communication Science / M.A. (Communication Science)

This study, quantitative determinants of need and demand for primary health care in the District of Columbia (DCPC), analysed data over a twenty-year period from 1985 to 2004, on need and demand for primary care using standard and epidemiologically innovative statistical measures for physician distributions and socio-demographic characteristics in the District of Columbia (DC). The study attempted to answer the question: Using U.S census-based small area aggregations, Census Tract Groupings (CTGs), that are not zip-code areas or legislative/political boundaries, can a multivariate predictive model be developed using physician distributions, primary care service index (PCSI) and composite need scores (CNS) to explain variations in primary care visits shortages? Primary care visits shortages and priority scores (PCPS) were calculated, analysed and presented for CTGs in the District of Columbia from 1985 to 2004. Results indicated that the abundant supply of DC-based physicians – indicated by decreasing population per physician ratios of 239 (1985) to 146 (2004) – appear to be a long-term trend. As raw physician counts increased, the ratio of satisfied visits to demand decreased, from 2.62 (1985) to 1.80 (in 2004). This result appears to indicate that, due to inequities in distribution of primary care physicians in DC’s small areas, the increasing numbers of primary care physicians were by themselves, not sufficient to address the city’s overall primary care visits need. Epidemiological profiles and physician distribution analytical methods appear to be useful for small area analysis of urban primary care shortage areas and for setting priorities. Physician rates per 1,000 pop may be a necessary but not sufficient statistic for estimating urban primary health care needs / Health Studies / D. Litt. et Phil. (Health Studies)