Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [70]-73).

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 129-135).

Orientador: Maria Rita de Camargo Donalisio Cordeiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T00:14:50Z (GMT). No. of bitstreams: 1 Nasser_JeanetteTrigo_M.pdf: 6738554 bytes, checksum: 5c27e29a18055208148559337213b2c3 (MD5) Previous issue date: 2007 / Resumo: O presente trabalho tem como objetivo estudar o perfil epidemiológico e a distribuição geográfica dos casos de leishmaniose tegumentar americana (LTA) ocorridos em Campinas no período de 1992 a 2003. Para este fim foram utilizadas informações sobre os casos notificados de LTA em Campinas e os respectivos locais prováveis de infecção (LPI) obtidas na base de dados do Sistema de Informação sobre Agravos Notificáveis (SINAN), de fichas de investigação epidemiológicas disponibilizados pela Secretaria Municipal de Saúde de Campinas e Superintendência de Controle de Endemias regional - SUCEN-Campinas. Variáveis sociodemográficas e epidemiológicas foram estudadas. Estes dados foram georreferenciados mediante a coleta de coordenadas dos LPIs através de GPS (Global Position System). Datum: Córrego Alegre Projeção: UTM. Foram identificadas áreas com maior concentração de casos (clusters) no município, por meio do estimador de densidade kernel. Imagens do satélite Landsat 5 sensor TM 219/76 destas áreas foram processadas procurando identificar padrões de uso e ocupação do solo relacionados com o perfil epidemiológico da doença. O processamento das imagens constou de: registro, segmentação e classificação em classes temáticas (tipos de uso e ocupação do solo). Foi realizada a tabulação cruzada entre estas classes temáticas para se analisar mudanças no ¿tempo e espaço¿ das áreas de estudo. O software utilizado foi o Spring 4.01 Beta. A LTA em Campinas concentra-se em duas áreas do município (Leste e Sudoeste) diferentes entre si tanto no aspecto de uso e ocupação do solo como nas condições socioeconômicas. Na área Leste não se verificou desmatamento nos anos que precederam o surto. Na área Sudoeste essa doença é endêmica. Apresentando ciclos epidêmicos a cada 9-10 anos. O uso do sensoriamento remoto pode contribuir para compreender a dinâmica dessa enfermidade, bem como de outras de transmissão vetorial / Abstract: The aim of this work was to study the epidemiological profile and geographical distribution of American tegumentary leishmaniasis (ATL) cases occurring in Campinas between 1992 and 2003. Information on notified ATL cases in Campinas and the respective probable infection locations (PIL) were obtained from the Notifiable Diseases Information System (NDIS), epidemiological investigation forms available from Campinas Municipal Health Secretary, and the SUCEN-Campinas region Superintendent of Endemic Disease Control. Socio-demographic and epidemiological variables were studied. These data were georeferenced by recording PIL coordinates using GPS (Global Position System). Datum: Córrego Alegre Projection: UTM. Areas with high case concentrations (clusters) in the municipal area were identified using a kernel density estimator. Landsat 5 TM 219/76 sensor satellite images of these areas were processed to identify use, occupation and soil patterns related to the disease¿s epidemiological profile. This image processing consisted of: recording, segmenting, and classifying into theme classes (types of soil use and occupation). Cross tabulation was performed between these theme classes to analyze time and space changes in the study areas. The software used for this was Spring 4.01 Beta. The ATL in Campinas is concentrated in two areas of the city (East and Southwest) which differ from each other in aspects concerning occupation and use of the soil and socio-economic conditions. In the Eastern area, deforestation was not verified in the years that had preceded the outbreak. In the Southwestern area, this illness is endemic presenting epidemic cycles every 9-10 years. Remote Sensing can contribute to understanding the dynamics of this and other vector transmitted diseases / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Historicamente, o Sistema de Informações de Doenças de Notificação Compulsória tem sido o principal instrumento da Vigilância Epidemiológica. As doenças que vêm compondo este Sistema têm sido aquelas que podem colocar em risco a saúde das coletividades e, tradicionalmente, vem se restringindo às doenças transmissíveis, ainda que no Guia vigente estejam incorporados outros agravos e algumas doenças crônico-degenerativas, como câncer e diabetes. As subnotificações se constituem em uma das principais dificuldades para a Vigilância Epidemiológica, com causas variadas que apontam sobretudo para a forma de organização dos serviços de saúde. A discussão e implantação de novos modelos assistenciais podem contribuir para esta problemática, à medida que atenderem à proposta de transformação dos atuais sistemas de atenção a doenças, num sistema de vigilância da saúde, conseqüentemente de atenção a vida. A rede básica de saúde, como o local que se constitui na principal porta do sistema de saúde, onde se destaca de forma crescente, não só a prestação de assistência médica, mas sua organização em modalidade de pronto- atendimento, se constitui também no local de atendimento das doenças de notificação compulsória. Assim, para a realização deste estudo, elegemos o trabalho na Unidade Básica de Saúde, buscando analisar como se conforma a prática da Vigilância Epidemiológica na Unidade Básica de Saúde no contexto do SUS, segundo o entendimento dos trabalhadores do nível local. Foram escolhidas cinco Unidades Básicas de Saúde, segundo o critério de produção de atendimentos e foram utilizadas entrevistas semi-estruturadas para apreensão do objeto de estudo junto aos trabalhadores escolhidos por sorteio, sendo um médico, um enfermeiro, um trabalhador do nível médio e o gerente de cada local de estudo escolhido, totalizando 20 sujeitos. Não houve agrupamento por categoria profissional. Os resultados evidenciaram dois significados para a prática da vigilância epidemiológica: controlar e prevenir, das doenças e agravos infecciosos, e a compreensão como uma prática de assistir e vigiar, quando a identifica como uma prática necessária aos serviços de saúde, que possibilita um outro modo de agir em saúde, contribuindo para a integralidade da atenção preconizada pelo Sistema Único de Saúde (SUS) e implicando numa mudança na forma de organização da atenção à saúde. Apontamos para a implementação da descentralização das ações de vigilância epidemiológica para o nível local, como perspectiva desse novo modo de agir em saúde, pautado num permanente “vigiar”, para articular ações promocionais, preventivas e curativas, redefinindo o processo de trabalho em saúde. / Historically, the Information System of Compulsory Notification Diseases has been the main instrument of Epidemiological Surveillance. The diseases that are part of this system have been those that can cause risk to the collective health and, traditionally, are restricted to the transmissible diseases, even though that in the present Guide other circumstances and some chronic degenerative diseases such as cancer and diabetes are incorporated. The sub notifications are one of the main difficulties faced by Epidemiological Surveillance, with varied causes that especially indicate the organization of health services. The discussion and implementation of new care models can contribute to overcome this problem, while adopting the proposal of transforming the present health care system to a system of Health Surveillance, and consequently a system of life care. The Basic Health Network is the place that represents the main access to the health system and where is growing the emphasis not only on medical care but also on its organization as emergency care. Therefore, the Network is the place of care and compulsory notification of diseases as well. Thus, this study was developed in Basic Health Units. The purpose of this work is to analyze how the practice of Epidemiological Surveillance, in Basic Health Units, is performed according to the understanding of local workers. Five Basic Health Units were chosen in the Municipal Health System of the city of Ribeirão Preto, considering the criterion of care production. To achieve this goal, the author used semi-structured interviews conducted with the workers, such as a doctor, a nurse, a nursing assistant and a manager chosen at random in every place of the study, totalizing 20 subjects. They were not divided in professional categories. Results evidenced two meanings to the practice of Epidemiological Surveillance: to control and to prevent, when surveillance is understood as a restricted action to control infectious diseases; and the understanding of care and vigilance, when they are identified as necessary practices to health services, contributing to an integral care, as it is recommended by the Unified Health System in Brazil (SUS), implying a change in the organization of health care. The author recommended the decentralization of the epidemiological Surveillance actions in a local space, as a perspective for that new way of acting in health, guided by a permanent “vigilance” and the communication of promotion, prevention and curative actions, redefining the health work process.

Introduction: Frailty is characterized by vulnerability to declining health and increased risk for adverse health outcomes. Measuring frailty would be beneficial for developing interventions and assessing healthcare resource needs. No standardized measurement tool for frailty has been established. The objective of this thesis was to evaluate the frailty of participants in the Canadian Longitudinal Study on Aging (CLSA). Methods: A Frailty Index (FI) was constructed for CLSA participants based on the cumulative deficit theory of frailty. Exploratory factor analysis was conducted to study the underlying constructs of frailty and identify key factors. A hypothesized measurement model for frailty was specified. The model was modified and tested using structural equation modelling (SEM) to improve goodness-of-fit. A new frailty measurement tool was created and the construct validity of the new tool and the Frailty Index were evaluated. Results: A FI was calculated for 20,874 CLSA participants (Mean 0.14 SD 0.07). The maximum FI value was 0.68. A model containing all hypothesized variables had good fit of the data, and all variables contributed significantly. A simplified model also showed good fit and included four domains: upper-body strength, lower-body strength, dexterity, and depressive symptoms. These results persisted in an independent dataset. A Simplified Frailty (SF) score was created based on this simplified model. The FI and SF scores showed significant agreement and associations with sociodemographic variables were as predicted. Conclusions: A FI was simple to construct in the CLSA, having good fit of the data and construct validity. These results are consistent with previous research on the cumulative deficit theory of frailty. A simplified frailty model revealed key domains of frailty and resulted in a potentially useful short screening tool. The FI is recommended as a valid and reproducible approach for measuring frailty in the CLSA and similar population datasets. / Thesis / Master of Science (MSc)

So Hung-kwan. / "August 2000." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (p. 251-23). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Esta é a primeira descrição específica de casos de afogamento, em uma área nãolitorânea no Brasil, realizada na região de Ribeirão Preto, Estado de São Paulo. É uma região cujos padrões sociais são comparáveis aos de países desenvolvidos. Um total de 89 casos foi analisado. Esses casos ocorreram entre 2001 e 2004, com coeficiente de mortalidade de 2,44 casos por 100.000 habitantes por ano. Foi delineado o padrão de afogamentos fatais avaliando-se os parâmetros de idade, sexo e sazonalidade. O perfil predominantemente observado foi o de homens brancos, em idade economicamente produtiva (15 a 59 anos), acidentalmente afogados em rios e represas de áreas rurais, de ocorrência durante o verão e o outono. O estudo dessas fatalidades pode permitir o desenvolvimento de programas de prevenção de afogamento em áreas não-litorâneas e não-turísticas no Brasil e em outros lugares do mundo. / This is the first specific description of drowning cases in a non-coastal area of Brazil, in the locality of Ribeirão Preto, State of São Paulo—a region with standards of living comparable to those in developed countries. A total of 89 cases were analyzed. These cases occurred between 2001 and 2004, at a rate of 2.44 cases per 100,000 habitants per year. The pattern of drowning fatalities in relation to parameters of age, sex, seazonality is discussed. The predominant profile observed was that of the Caucasian male of economically productive age (15 to 59 years), accidentally drowned in rivers and dams in rural areas during the summer and autumn. Observation of the pattern of fatalities may permit the development of a program of prevention of drowning in non-coastal, non-tourist areas in Brazil and elsewhere.

Esta é a primeira descrição específica de casos de afogamento, em uma área nãolitorânea no Brasil, realizada na região de Ribeirão Preto, Estado de São Paulo. É uma região cujos padrões sociais são comparáveis aos de países desenvolvidos. Um total de 89 casos foi analisado. Esses casos ocorreram entre 2001 e 2004, com coeficiente de mortalidade de 2,44 casos por 100.000 habitantes por ano. Foi delineado o padrão de afogamentos fatais avaliando-se os parâmetros de idade, sexo e sazonalidade. O perfil predominantemente observado foi o de homens brancos, em idade economicamente produtiva (15 a 59 anos), acidentalmente afogados em rios e represas de áreas rurais, de ocorrência durante o verão e o outono. O estudo dessas fatalidades pode permitir o desenvolvimento de programas de prevenção de afogamento em áreas não-litorâneas e não-turísticas no Brasil e em outros lugares do mundo. / This is the first specific description of drowning cases in a non-coastal area of Brazil, in the locality of Ribeirão Preto, State of São Paulo—a region with standards of living comparable to those in developed countries. A total of 89 cases were analyzed. These cases occurred between 2001 and 2004, at a rate of 2.44 cases per 100,000 habitants per year. The pattern of drowning fatalities in relation to parameters of age, sex, seazonality is discussed. The predominant profile observed was that of the Caucasian male of economically productive age (15 to 59 years), accidentally drowned in rivers and dams in rural areas during the summer and autumn. Observation of the pattern of fatalities may permit the development of a program of prevention of drowning in non-coastal, non-tourist areas in Brazil and elsewhere.

While all racial/ethnic groups in the U.S. exhibited an increase in longevity during the twentieth century, inequalities in survival remain. Hispanics have the highest life expectancy at birth in the United States, non-Hispanic blacks have the lowest, and non-Hispanic whites exhibit life expectancy between the two minority groups. An overarching objective of Healthy People 2020 is to "achieve health equity, eliminate disparities, and improve the health of all groups." Yet, a similar objective based on the Healthy People 2010 campaign regarding reduction of health inequalities was clearly not met. As the population of the United States becomes increasingly diverse as a result of immigration, intermarriage, and evolving notions regarding race and ethnicity, health demographers must monitor adult survival outcomes and inequalities across racial and ethnic subpopulations. This dissertation examines current inequalities in survival among Hispanic, non-Hispanic black, and non-Hispanic white adults in the United States. Using the 1989-2006 National Health Interview Survey Linked Mortality Files and 2010 U.S. National Vital Statistics System, I contribute to the understanding of racial/ethnic survival disparities through three empirical studies: The first chapter affirms that Hispanic mortality rate and life expectancy estimates are favorable relative to blacks and whites, particularly for foreign-born Hispanics and from smoking-related causes. The second chapter shows that, in addition to their higher mean age at death, Hispanics exhibit less variability around that mean relative to non-Hispanic whites. Non-Hispanic blacks, on the other hand, have greater variability and lower life expectancy than the other two racial/ethnic groups. The lower variability among Hispanics relative to whites is largely attributable to lower incidence in cancer, suicide, and other external cause mortality, whereas the greater variability among blacks relative to whites is mainly due to greater dispersion in age at death from heart disease and the residual cause grouping. The third chapter finds that smoking initiation in childhood or adolescence contributes additional mortality risk for current heavy and light smokers relative to never smokers. Lower smoking prevalence and later initiation among foreign-born and U.S-born Hispanics account for much of their lower mortality risk relative to whites. / text

Many countries, including Nepal, have been affected with highly pathogenic avian influenza (HPAI) outbreaks. There have been human mortalities in some countries and large numbers of poultry either died or were culled due to HPAI. The overall objective of this thesis was to improve our understanding of the epidemiology and economics of avian influenza (AI), and particularly HPAI, in Nepal. We determined the seroprevalence of and risk factors for AI virus antibodies presence in ducks in Kathmandu, Nepal. The estimated true prevalence of AI viruses (AIV) antibodies was 27.2% [95% Confidence Interval (CI): 24.6- 29.5]. Age of the ducks was identified as the only risk factor for AIV seropositivity. Ducks older than one year were more likely to be seropositive compared to ducks less than six months of age [Odds Ratio= 2.17 (95% CI: 1.07- 4.39)]. This study provided baseline information about seroprevalence of AIVs in Kathmandu that will benefit further research to differentiate the subtypes of AIVs circulating in Kathmandu. We also evaluated alternatives to the current control program (CCP) for HPAI in Nepal. The considered alternatives were: (i) absence of control measures (ACM) and (ii) vaccinating 60% of the domestic poultry flock twice per year. Cost-benefit analysis approach was used to evaluate the economic feasibility of the programs. In terms of the benefit-cost ratio, our findings indicated that there is a return of 1.96 dollars for every dollar spent in the CCP compared to ACM. The net present value of the CCP versus ACM was US$ 989,918. The vaccination program yielded a return of 2.41 dollars for every dollar spent when compared to the CCP. The net present value of vaccination versus implementing the CCP was US$ 13,745,454. These results support a continued investment into the CCP rather than ceasing to implement government regulated control measures and suggest that vaccination may be an even better control alternative. In summary, our studies have highlighted the value of epidemiologic and economic analysis in research of AI. Our results are expected to lead to an improved understanding and awareness of AI in Nepal and to formulation of better control strategies.