Sergamumas piktybiniais navikais didėja. Kasmet Lietuvoje diagnozuojama po daugiau nei 17 800 naujų vėžio atvejų. Onkologinių ligonių gydyme dažnai taikoma chemoterapija, gydymas citotoksiniais preparatais. Šis gydymas sukelia eilę toksinių reiškinių, kurie pablogina paciento būklę, mitybos statusą, gydymo efektyvumą. Darbe tiriama, kaip pasikeičia pacientų, sergančių ginekologinės ir abdominalinės lokalizacijos piktybiniais navikais ir gaunančius gydymą chemoterapija, mityba, fizinė, emocinė, socialinė būsenos, kaip jos psichologiškai reaguoja į chemoterapinį gydymą. Darbo tikslas - įvertinti pacientų, sergančių vėžiu, gyvenimo kokybę ir mitybos būklę, taikant chemoterapinį gydymą. Tikslui pasiekti iškelti uždaviniai: 1. Nustatyti ligonių, sergančių onkologinėmis ligomis, gyvenimo kokybę chemoterapijos gydymo metu. 2. Išanalizuoti ligonių, sergančių onkologinėmis ligomis, laboratorinių tyrimų pokyčius chemoterapijos gydymo metu. 3. Įvertinti ligonių, sergančių onkologinėmis ligomis, mitybos būklę chemoterapijos gydymo metu. Tirti 39 pacientai, gydomi chemoterapija dėl II, III, IV stadijos abdominalinės ir ginekologinės lokalizacijos piktybinių navikų. Tiriamiesiems 2012 m. kovo mėn. – 2012 m. rugsėjo mėn. prieš ir po chemoterapijos kurso imami kraujo laboratoriniai tyrimai, matuojamas svoris, skaičiuojamas kūno masės indeksas, įvertinama gyvenimo kokybė QLQ-C30 klausimynu. Po chemoterapijos pacientams pablogėjo gyvenimo kokybės rodikliai: pablogėjo funkcinės skalės... [toliau žr. visą tekstą] / Morbidity of cancer diseases is increasing constantly. Every year over 17 800 new cancer cases are diagnosed in Lithuania. Chemotherapy is one of the mostly used treatment modality for the abdominal and gynecological cancer. This kind of treatment is highly toxic and significantly impedes the quality of life for patients receiving it. The aim of this research project was to evaluate the influence of chemotherapy on the nutritional status, physical health, emotional and social status of the patients with abdominal and gynecological cancer stage II, III, and IV. The main goal was to assess the influence of chemotherapy on the quality of life and nutritional status. The assessment was made before and after the chemotherapy. Thirty nine patients with abdominal and gynecological cancer stage II, III, and IV receiving chemotherapy were enrolled in to the study. All the patients before and after chemotherapy had blood tests, measured body weight, calculated body mass index. They were interrogated using the QLQ-C30 questionnaire. All patients were treated in the X Hospital of Lithuania. Analysis of the results of the whole study population (n=39) showed a significant decline of functional parameters, increased number of symptoms and worsening of the overall health status. The total score decreased by 19.5% in functional scale, increased by 16.3% in the symptom scale, while the global health status scale evaluation declined by 15.6%. After chemotherapy patients had lower hemoglobin... [to full text]

Electronic data capture technologies, such as interactive voice response (IVR) systems, are emerging as important alternatives for collecting self-reported data. The purpose of this research was to assess the measurement equivalence between the original paper-based versions and the adapted interactive voice response (IVR) versions of the EQ-5D and the QLQ-C30. Furthermore, we examined the test-retest reliability of two consecutive administrations of the IVR versions of the EQ-5D and the QLQ-C30. The comparison of the paper and IVR versions of the EQ-5D was conducted utilizing a crossover design with subjects randomly assigned to one of two assessment orders: 1) paper then IVR or 2) IVR then paper. A convenience sample of in-treatment outpatient cancer clinic patients (n=139) were asked to complete each assessment two days apart. For the test-retest component, outpatient cancer clinic patients (n=127) were asked to complete the IVR-based EQ-5D twice, two days apart. The analyses tested for mean differences (paired t-test) and test-retest reliability (ICC).In the crossover analysis, ten of the fifteen mean differences analyzed for the scales and items of the QLQ-C30 were within the equivalence interval set a priori. The ICCs for the scales and items of the QLQ-C30 ranged from 0.698 to 0.899. Two of the items, insomnia and appetite loss, did not meet our threshold of being statistically different from an ICC of 0.70. The EQ-5D index score means were equivalent between paper and IVR, however the EQ VAS score differences were not wholly contained in the equivalence interval. The ICCs were above 0.890 for the index and the EQ VAS. In the test-retest analysis, the ICCs for the nine multi-item scales for the QLQ-C30 were all above 0.69, ranging from 0.698 to 0.891. Ten of the fifteen mean differences analyzed were within the equivalence interval set a priori. For the EQ-5D, the mean differences were wholly contained within the equivalence intervals for both the index and the EQ VAS and the ICCs were significantly different from 0.70. Overall, the IVR version of the questionnaires provided psychometrically equivalent results to those obtained on the original paper version and showed good stability over time.

Bakgrund: Cancer är en sjukdom som omfattar tumörsjukdomar med onaturlig och okontrollerad cellväxt. Sjukdomen drabbar tiotusentals personer i Sverige varje år. Hälsorelaterad livskvalitet är ett begrepp som använts för att beskriva individers uppfattning av sitt välmående i relation till sin hälsa. Livskvaliteten kan användas som ett verktyg för att förstå patientgruppen och de förändringar de genomgår i samband med sjukdomsprogression och behandling. Onkologisk rehabilitering erbjuds vissa patientgrupper. Syftet med rehabiliteringen är främst att genom patientundervisning och träning återge patienten kontroll över sitt liv. Syfte: Att undersöka hälsorelaterad livskvalitet över tid hos patienter som genomgått onkologisk rehabilitering. Metod: Studien har en prospektiv design. Samtliga patienter som remitterades till en onkologisk rehabiliteringsverksamhet i Sverige under ett år tillfrågades. För att utvärdera livskvaliteten användes enkäten EORTC QLQ-C30. Enkäten lämnades ut till patienterna vid baseline, efter tre och sex månader. Deskriptiv statistik. Resultat: Studiens resultat visar att livskvaliteten var låg och oförändrad vid de tre mätningarna. Deltagarnas uppvisar goda funktioner i samtliga mätningar, högst vid tre månader. Symtomen minskar överlag vid varje mätning. Kraftigast minskar sömnsvårigheterna. Slutsats: Sammanfattningsvis visar studien att livskvaliteten var opåverkad de sex första månaderna efter rehabiliteringen. Dock förbättrades deltagarnas sömn, vilket kan ses som en positiv effekt av rehabiliteringen. Viss skillnad mellan kön, cancerdiagnoser samt svenskfödda och utlandsfödda finns; men dessa kan även bero på skillnader inom normalpopulationen. Funktionsskalornas maxvärde efter tre månader kan visa på behov av uppföljande rehabilitering. Klinisk betydelse: Studiens resultat ska användas i ett kvalitetsgranskningsarbete. / Background: Cancer is a diagnosis which encompasses diseases with abnormal and uncontrolled cellular growth. Tens of thousands of people are affected by cancer every year in Sweden. Health-related quality of life (HRQoL) is a concept used to describe people’s perception of well-being in relation to their health. HRQoL can also be used as a tool to understand the patients and the changes they go through during progression of disease and treatment. Oncological rehabilitation is offered to some patient groups. The goal with the rehabilitation is to give the patients control back over their lives through education and training. Aim: To study the oncological rehabilitations effect on HRQoL over time. Method: All patients remitted to a certain rehabilitation facility in Sweden during one year were asked to participate. To evaluate the HRQoL the EORTC QLQ-C30 questionnaire was used. The questionnaire was sent out to the respondents at baseline and after three and six months. Descriptive statistics. Result: The results of the study showed that quality of life was low and unaffected at the three measurements. The functions reached their highest value after three months. The symptoms overall decreased at each measurement. The most positive change was seen with insomnia. Conclusion: In conclusion, the quality of life was unaffected during the first six months after the rehabilitation. The improvement of the participants’ insomnia might be a positive outcome of the rehabilitation. The results points to some differences between gender, cancerdiagnose and people born in Sweden or abroad; but these might as well depend on differences in the population. The functions higher value after three months might show a need for follow-up rehabilitation. Clinical implication: The result of the study is to be used in a quality audit.

Vector autoregressive (VAR) models are frequently used for forecasting and impulse response analysis. For both applications, shrinkage priors can help improving inference. In this paper we derive the shrinkage prior of Griffin et al. (2010) for the VAR case and its relevant conditional posterior distributions. This framework imposes a set of normally distributed priors on the autoregressive coefficients and the covariances of the VAR along with Gamma priors on a set of local and global prior scaling parameters. This prior setup is then generalized by introducing another layer of shrinkage with scaling parameters that push certain regions of the parameter space to zero. A simulation exercise shows that the proposed framework yields more precise estimates of the model parameters and impulse response functions. In addition, a forecasting exercise applied to US data shows that the proposed prior outperforms other specifications in terms of point and density predictions. (authors' abstract) / Series: Department of Economics Working Paper Series

We propose a large-scale Bayesian VAR model with factor stochastic volatility to investigate the macroeconomic consequences of international uncertainty shocks on the G7 countries. The factor structure enables us to identify an international uncertainty shock by assuming that it is the factor most correlated with forecast errors related to equity markets and permits fast sampling of the model. Our findings suggest that the estimated uncertainty factor is strongly related to global equity price volatility, closely tracking other prominent measures commonly adopted to assess global uncertainty. The dynamic responses of a set of macroeconomic and financial variables show that an international uncertainty shock exerts a powerful effect on all economies and variables under consideration. / Series: Department of Economics Working Paper Series

The paper estimates a dynamic macroeconometric model for the US economy that captures two important features commonly observed in the study of the US business cycle, namely the strong co-movement of key macroeconomic quantities, and the distinction between expansionary and recessionary phases. The model extends the factor-augmented vector autoregressive model of Bernanke et al. (2005) by combining Markov switching with factor augmentation, modeling the Markov switching probabilities endogenously, and adopting a full Bayesian estimation approach which uses shrinkage priors for several parts of the parameter space. Exploiting a large data set for the US economy ranging from 1971:Q1 to 2014:Q2, the model is applied to measure not only the dynamic effects of unconventional monetary policy within distinct stages of the business cycle, but also the dynamic response of the recession probabilities, based on conducting counterfactual simulations. The results obtained provide new insights on the effect of monetary policy under changing business cycle phases, and highlight the importance of discriminating between expansionary and recessionary phases of the business cycle when analyzing the impact of monetary policy on the macroeconomy. (authors' abstract) / Series: Working Papers in Regional Science

We analyze the interaction between monetary policy in the US and the global economy proposing a new class of Bayesian global vector autoregressive models that accounts for time-varying parameters and stochastic volatility (TVP-SV-GVAR). Our results suggest that US monetary policy responds to shocks to the global economy, in particular to global aggregate demand and monetary policy shocks. On the other hand, US-based contractionary monetary policy shocks lead to persistent international output contractions and a drop in global inflation rates, coupled with rising interest rates in advanced economies and a real depreciation of currencies with respect to the US dollar. We find considerable evidence for heterogeneity in the spillovers across countries, as well for changes in the transmission of monetary policy shocks over time. (authors' abstract) / Series: Department of Economics Working Paper Series

In this paper we aim to improve existing empirical exchange rate models by accounting for uncertainty with respect to the underlying structural representation. Within a flexible Bayesian non-linear time series framework, our modeling approach assumes that different regimes are characterized by commonly used structural exchange rate models, with their evolution being driven by a Markov process. We assume a time-varying transition probability matrix with transition probabilities depending on a measure of the monetary policy stance of the central bank at the home and foreign country. We apply this model to a set of eight exchange rates against the US dollar. In a forecasting exercise, we show that model evidence varies over time and a model approach that takes this empirical evidence seriously yields improvements in accuracy of density forecasts for most currency pairs considered. / Series: Department of Economics Working Paper Series

This paper explores the relationship between household income inequality and macroeconomic uncertainty in the United States. Using a novel large-scale macroeconometric model, we shed light on regional disparities of inequality responses to a national uncertainty shock. The results suggest that income inequality decreases in most states, with a pronounced degree of heterogeneity in terms of the dynamic responses. By contrast, some few states, mostly located in the Midwest, display increasing levels of income inequality over time. Forecast error variance and historical decompositions highlight the importance of uncertainty shocks in explaining income inequality in most regions considered. Finally, we explain differences in the responses of income inequality by means of a simple regression analysis. These regressions reveal that the income composition as well as labor market fundamentals determine the directional pattern of the dynamic responses. / Series: Working Papers in Regional Science

In this paper, we estimate a Bayesian vector autoregressive (VAR) model with factor stochastic volatility in the error term to assess the effects of an uncertainty shock in the Euro area (EA). This allows us to incorporate uncertainty directly into the econometric framework and treat it as a latent quantity. Only a limited number of papers estimates impacts of uncertainty and macroeconomic consequences jointly, and most literature in this sphere is based on single countries. We analyze the special case of a shock restricted to the Euro area, whose countries are highly related by definition. Among other variables, we find significant results of a decrease in real activity measured by GDP in most Euro area countries over a period of roughly a year following an uncertainty shock. / Series: Department of Economics Working Paper Series