The incidence of differentiated thyroid cancer (DTC) is rising, but controversy exists in many aspects of its treatment. This study described the change in incidence of DTC in Ontario, variations in management including extent of thyroidectomy and the influence of provider volume, and the impact of these parameters on recurrence and thyroid cancer-specific death (TCSD). A population-based study identified all new cases of DTC between 1992-2007. The incidence of DTC increased dramatically (annual percentage change 7.6%). Linkage to administrative databases revealed that extent of thyroidectomy is influenced by various factors including patient gender, age, year of diagnosis, surgeon specialty, and hospital setting, but not provider volume. Total thyroidectomy is associated with a lower recurrence rate. There is a significant association between provider volume and recurrence, with lower volume surgeons having a higher recurrence risk. Extent of thyroidectomy and provider volume did not influence TCSD. Such variations in management may lead to disparities in health outcomes.

Background: Chronic pain is prevalent worldwide and is estimated to range from 2% to 55% in the general population. There is a limited understanding of the prevalence and incidence of chronic pain in Canada. Furthermore, our understanding of the sociodemographic predictors of chronic pain is limited; thus we are poorly positioned to identify potential populations at risk. Objectives: The primary objectives for this study included: 1) to determine the prevalence and incidence of chronic pain and pain-related interference in Canada over time and, 2) to determine the influence of sociodemographic predictors on the development of chronic pain by sex in the Canadian adult population over 12 years. Methods: Using data from the cross-sectional components of the National Population Health Survey (NPHS) (1994/95, 1996/97, 1998/99) and the Canadian Community Health Survey (2000/01, 2003, 2005, 2007/08), we examined the prevalence and interference of chronic pain. The longitudinal component of the NPHS was used to determine the incidence and sociodemographic predictors of chronic pain. Chronic pain was defined as the presence of “usual pain”. Results: The prevalence in the cross-sectional samples ranged from 15.1% to 18.9%. In the longitudinal sample, the incidence ranged from 5.4% to 7.8% and the prevalence ranged from 15.3% to 19.5%. Women, compared to men, had a higher prevalence, but not incidence of chronic pain each year. Of those individuals reporting chronic pain, the majority reported at least a few activities prevented. Women who were older, with lower education, and widowed, separated, or divorced were more likely to develop chronic pain. There were no sociodemographic risk factors for chronic pain in men. Conclusion/Implications: This population-based study supports previous research findings indicating that chronic pain affects daily activities of many Canadians. Furthermore, this is the first population-based prospective study examining the incidence and sociodemographic predictors of chronic pain in Canadians. Further study with more detailed definitions of pain and pain-related interference is warranted. Moreover, our findings suggest that older women are more likely to develop chronic pain and that men and women may have different risk factors for chronic pain, suggesting the need for gender-based preventative interventions. / Thesis (Master, Nursing) -- Queen's University, 2010-07-20 13:38:13.996

<p>Oral cancer is characterised by marked geographical differences in frequency and site preference as reported by various studies. In South Africa, a few studies have been reported on the patterns and aetiology of oral cancer, and age standardised incidence rates (ASIR). Studies in several countries have shown an increase in oral cancer incidence among younger people. Title:&nbsp / Epidemiology of oral cancer in South Africa 1996-2002.&nbsp / Aim and Objective: The aim of this study was to determine the age standardised incidence rates (ASIR) of oral cancer by age, gender, race&nbsp / and site in South Africa for a consecutive period of seven years. Method: Pathology case records of oral cancer diagnosed over a seven-year period from 1996 to 2002 and reported to the National&nbsp / Cancer Registry (NCR) were analysed for age, sex, race, and date of diagnosis, basis of diagnosis, topography and tumour type. The data was tabulated and categorised using Microsoft Excel. The South African population size for each year of the study was estimated by linear extrapolation using the 1996 and 2001 census results. Age standardisation incidence rates against the world&nbsp / population were calculated by the standard direct method. Results: The total number of oral squamous cell carcinoma cases over the 7-year period was 9702. The majority of cases (34%) were&nbsp / on the tongue. The male to female ratio was 1:3. The age standardized incidence rates in this study was lower among African women / (0.640 per 100000 per year) and the highest was 13.40 new cases per 100000 per year (coloured males). Lip cancer was highest among both males and females of the white population. The cumulative rate of developing oral cancer was 1:83 and 1:32 for males and females respectively.</p>

Service oriented computing is crucial to a large and growing number of computational undertakings. Central to its approach are the open and network-accessible services provided by many different organisations, and which in turn enable the easy creation of composite workflows. This leads to an environment containing many thousands of services, in which a programmer or automated composition system must discover and select services appropriate for the task at hand. This discovery and selection process is known as matchmaking. Prior work in the field has conceived the problem as one of sufficiently describing individual services using formal, symbolic knowledge representation languages. We review the prior work, and present arguments for why it is optimistic to assume that this approach will be adequate by itself. With these issues in mind, we examine how, by reformulating the task and giving the matchmaker a record of prior service performance, we can alleviate some of the problems. Using two formalisms—the incidence calculus and the lightweight coordination calculus—along with algorithms inspired by information retrieval techniques, we evolve a series of simple matchmaking agents that learn from experience how to select those services which performed well in the past, while making minimal demands on the service users. We extend this mechanism to the overlooked case of matchmaking in workflows using multiple services, selecting groups of services known to inter-operate well. We examine the performance of such matchmakers in possible future services environments, and discuss issues in applying such techniques in large-scale deployments.

BACKGROUND: Organ transplantation is one of the best modalities for treating fatal organ failure. Despite the success of this procedure, an increasing incidence of cancer in this population has drawn the attention of public health officials in recent years. OBJECTIVES: The overall objective of this study is to conduct a detailed examination of adverse health outcomes among Canadian organ transplant recipients, with an emphasis on cancer incidence and mortality. METHODS: This project employed a retrospective cohort follow-up study design, whereby Canadian Organ Replacement Registry records were linked to the Canadian Mortality Database and the Canadian Cancer Registry Database. The study population consisted of more than 16,000 solid organ transplant recipients registered between January 1, 1981 and December 31, 1998. This study was designed to assess the risks of developing cancer, overall and site-specific, in transplant recipients in comparison to the general Canadian population using Standardized Incidence Ratios (SIR), Standardized Mortality Ratios (SMR), and Proportionate Mortality Ratios (PMR). In addition, Cox and logistic models were used to assess the effects of various risk factors on cancer incidence and mortality in transplant sub-populations, while cumulative incidence was used to study the patient survival pattern. Lastly, Population Attributable Risk (PAR) was used to quantify the impact of organ transplantation on cancer incidence and mortality. RESULTS: Among major causes of death, the highest PMRs are due to genitourinary diseases, followed by endocrine, nutritional and metabolic diseases, and infectious diseases. SIRs indicate that cancer incidence and mortality were relatively lower than that observed for other major causes of death, and slightly higher than that observed in the general Canadian population. Lastly, logistic regression results indicate that age, year of surgery, and smoking status were significant risk factors in mortality due to all causes, while the Cox regression model shows that age, sex and year of surgery were significant risk factors for cancer incidence. Overall, the PAR in this cohort was very minimal, indicating that the risk in mortality and cancer incidence due to organ transplantation is negligible. CONCLUSION: Life threatening diseases such as those of the genitourinary system, as well as endocrine, nutritional and metabolic diseases and infectious diseases are leading causes of death. Future research should be directed at ways of reducing incidence and subsequent mortality due to these causes.

Bakgrund: Dysfagi innebär avvikelser i den normala sväljningsfunktionen och är en vanlig funktionsnedsättning till följd av stroke. Tidigare studier har påvisat att incidensen av dysfagi i det akuta skedet efter stroke är 41-68 %. Kliniskt sett upplevs incidensen ha minskat de senaste tio åren.  Syfte: Syftet med denna studie var därför att (1) undersöka den nuvarande incidensen av orofaryngeal dysfagi hos nyinsjuknade strokepatienter, (2) undersöka hur många av deltagarna som upplever svårigheter att äta och svälja samt bedöms lida av dysfagi enligt vårdpersonal.  Metod: Sextiotre patienter inkluderades i studien, av dessa fick 42,9 % diagnosen stroke. Samtliga deltagare genomgick en dysfagibedömning inom tre dygn efter inskrivning på vårdavdelning. Denna bestod av testerna the Standardized Swallowing Assessment – Svensk översättning (SSA-S) och sväljkapacitetstest (SCT). Deltagare som inte klarade kriterierna i dessa bedömdes lida av orofaryngeal dysfagi.  Resultat: Totalt bedömdes 24 deltagare lida av orofaryngeal dysfagi. I diagnosgruppen stroke var incidensen 48,1 %. Det fanns noteringar om dysfagi i patientjournal hos 20,8 % av deltagarna som enligt testledare bedömdes lida av orofaryngeal dysfagi. Vidare upplevde 29,2 % av samtliga deltagare med orofaryngeal dysfagi samt 30,8 % i diagnosgruppen stroke svårigheter att äta eller svälja.  Slutsatser: Studien indikerar på att incidensen av orofaryngeal dysfagi hos nyinsjuknade strokepatienter inte har minskat i jämförelse med tidigare studier. Däremot tycks det finnas en låg medvetenhet om befintliga ät- och sväljningssvårigheter hos såväl patienter som vårdpersonal. / Background: Dysphagia involves abnormalities in the normal swallowing function, and is a common impairment following stroke. Previous studies have shown that the incidence of dysphagia in the acute phase after stroke is 41-68 %. Clinically interprets that the incidence has declined over the past decade.  Aim: The purpose of this study was to (1) examine the current incidence of oropharyngeal dysphagia in recent-onset stroke patients, (2) investigate how many of the participants who experience difficulty eating and swallowing, and how many is believed to suffer from dysphagia according to healthcare professionals.  Method: Sixty-three patients were enrolled in the study, of whom 42,9 % were diagnosed with stroke. All participants underwent a bedside assessment of swallowing function within three days after enrollment in the nursing ward. The assessment consisted of the Standardized Swallowing Assessment - Swedish translation (SSA-S) and swallowing capacity test (SCT). Participants who did not pass the criteria of these two tests suffered from oropharyngeal dysphagia.  Results: Totally, 24 participants suffered from oropharyngeal dysphagia. The incidence in the stroke group was 48,1 %. There were notes about dysphagia in medical records in 20,8 % of the participants who were judged to suffer from oropharyngeal dysphagia by the test managers. Furthermore 29,2 % of all participants with oropharyngeal dysphagia and 30,8 % in the stroke group experienced difficulty eating or swallowing.  Conclusions: This study indicates that the incidence of oropharyngeal dysphagia in recent-onset stroke patients has not decreased in comparison with previous studies. In contrast, it appears to be a low awareness of existing eating and swallowing difficulties for both patients and healthcare professionals.

Bakgrunn: Blodbaneinfeksjon er en av de alvorligste sykehusinfeksjonene pasienter kan utsettes for, og i intensivavdelingen rammes de mest sårbare pasientene. Målet med studien:Å finne insidensen av blodbaneinfeksjoner (BSI) i en intensivavdeling i et lokalsykehus i Norge, samt undersøke ulike risikofaktorer knyttet til Centrale Venekatetre (CVK) og generell infeksjon ved innleggelse i intensivavdelingen. Metode: Insidensregistrering av BSI i løpet av 12 mnd. der definisjoner av BSI bygger på 2001 International Sepsis Definition Conference. Data er samlet inn prospektivt etter hvert som pasientene ble lagt. Studiepopulasjonen er antallet pasienter som hadde vært innlagt i mer enn 48 timer i intensivavdelingen, og deles opp i tre åpne kohorter:Pasienter med diagnostisert BSI i løpet av oppholdet, pasienter som fikk lagt inn CVK og pasienter med infeksjon ved innleggelse. Resultater: 615 pasienter ble lagt inn i intensivavdelingen i løpet av 12 mnd, av disse ble 116 av de pasientene som hadde vært innlagt i intensivavdelingen i mer enn 48 timer inkludert i studien. Gjennomsnittlig liggetid i intensivavdelingen varierte fra 2 til 40 (median 4 dager). 73 av de 116 pasientene fikk lagt inn CVK, og av disse fikk 11 en bekreftet BSI. Tre pasienter uten CVK fikk bekreftet BSI, totalt 14. Av disse 14 var 6 nosokomiale, altså 5,2 % (6 av 116) eller 7,8 BSI/1000 pasientdøgn. Enpasient fikk diagnosen kateter-relatert BSI(CR-BSI), noe som tilsvarer 1,7 CR-BSI/1000 kateterdøgn. Det ble tatt totalt 69 blodkulturer, herav 54 fra pasienter med CVK. Pasienter med CVK har signifikant større risiko for å utvikle klinisk BSI, enn de utenCVK (OR=5,31; 95 % CI 2,32 –12,0; p&lt; 0,0001). Konklusjon: Denne studien viser en relativt lav forekomsten av BSI, NBSI og CR-BSI, men for å kunne sammenligne tall nasjonalt og internasjonalt er det behov for en consensus i fagmiljøet rundt definisjoner BSI og særlig CR-BSI. Det er signifikant sammenheng mellom CVK og utvikling av klinisk BSI, men studien viser ingen signifikant sammenheng mellom CVK og bekreftet BSI. Studien bør bidra til fokus på risikofaktorene knyttet til bruk av CVK, samt arbeid for consensus angående definisjoner og økt fokus på CR-BSI og klinisk BSI, siden dette har vist seg å ha like høy letalitet som bekreftet BSI / Background: BSIs is areof the most serious hospital infections patients are exposed to, and in the intensive care unit (ICU) it affects the most vulnerable patients. Aim: To find the incidence of BSI in an ICU in a local hospital in Norway, as well as examine the various risk factors related to Central venous catheters (CVK), as well as patients with general infection at point of admission. Method: Incidence registration of BSIs within 12 months, where the definitions of BSI is based upon the 2001 Sepsis Definition Conference. Data is collected prospectively as patients were admitted to the ICU. The study population is the number of patients who had been hospitalized for more than 48 hours in the ICU, and the study population is divided into three open cohorts.Patients with diagnosed BSI during their stay, patients with CVK during stay and patients with infection at admission. Results: 615 patients were in the ICU within 12 months, and 116 of those patients had been hospitalized for more than 48 hours in the ICU and were included in the study. Average length of stay ranged from 2 to 40 days (median 4 days). 73 of the 116 patients had CVK in place during their stay, andof these 11 had a laboratory confirmed BSI. Three patients without any central CVK in place during their stay in the ICU had a laboratory confirmed BSI, 14 in total. Of these 14, 6 weredefined nosocomial, i.e.5.2% (6 of 116) or 7.8 BSI/1,000 patient days. One patient was diagnosed with catheter-related BSI (CR-BSI), which corresponds to 1.7 CR-BSI/1, 000 catheter days. A total of 69 blood cultures were performed, of which 54 patients with CVK. Patients with CVK has a significantly higher risk of developing clinical BSI than those without CVK (OR = 5.3, 95% CI 2.32 to 12.0, p &lt; 0.0001). Conclusion: This study shows a relatively low incidence of BSI, NBSI and CR-BSI. CVK is significantly related to the development of clinical BSI, but the study shows no link between CVK and laboratory confirmed BSI. This study may encourage health care  workers to focus more on the risk factors associated with the use of CVK to critically ill patients. It should also encourage researchers to focus more on the importance of consensus regarding definitions of BSI and clinical BSI, since this have been proven to have as high lethality rates as laboratory confirmed BSI / <p>ISBN 978-91-86739-86-7</p>

Background: The causes of trends in asthma incidence are not fully understood. Objectives: This study examined trends in age and severity at asthma diagnosis for Ontario children. Methods: Multiple birth cohorts of Ontario children between 1992-2000 were created using health administrative data. Descriptive statistics and multivariable logistic regression examined changes in age and severity of asthma at diagnosis over time. Results: Age at asthma diagnosis decreased (p<0.0001) with a higher relative risk of asthma in children under age three (RR=1.5, 95% CI:1.47, 1.54). Predictors of asthma diagnosis before three included male sex, lower income quintile, and maternal asthma. ‘Severe onset asthma’ increased over time (p<0.0001), its predictors being male sex, lower income quintile, rural residence, comorbidity, low birth weight and age less than three. Conclusions: Observed trends in asthma incidence are not confined to mild disease and are secondary to variations in asthma rates in children under age three.

Background: The causes of trends in asthma incidence are not fully understood. Objectives: This study examined trends in age and severity at asthma diagnosis for Ontario children. Methods: Multiple birth cohorts of Ontario children between 1992-2000 were created using health administrative data. Descriptive statistics and multivariable logistic regression examined changes in age and severity of asthma at diagnosis over time. Results: Age at asthma diagnosis decreased (p<0.0001) with a higher relative risk of asthma in children under age three (RR=1.5, 95% CI:1.47, 1.54). Predictors of asthma diagnosis before three included male sex, lower income quintile, and maternal asthma. ‘Severe onset asthma’ increased over time (p<0.0001), its predictors being male sex, lower income quintile, rural residence, comorbidity, low birth weight and age less than three. Conclusions: Observed trends in asthma incidence are not confined to mild disease and are secondary to variations in asthma rates in children under age three.

Hintergrund: Weltweit berichteten zahlreiche Studien von einer steigenden Inzidenz von Patienten mit angeborenen Bauchwanddefekten. Besonders die Zahl der Gastroschisis-Kinder hat deutlich zugenommen. Auch die Neonatologen der Universitätsklinik Leipzig beschrieben ein gehäuftes Auftreten von Patienten mit Gastroschisis und Omphalocele. Aufgabe der vorliegenden Arbeit war es, die Inzidenz dieser beiden Fehlbildungen am Universitätsklinikum Leipzig zu ermitteln und zu untersuchen, wie sich die Fallzahlen während des Untersuchungszeitraumes (1998-2008) entwickelt hatten. Zudem sollten Parameter identifiziert werden, die die Prognose der betroffenen Kinder bis zur Entlassung beeinflussten. Ein weiteres Anliegen dieser Studie war es, mithilfe einer ausführlichen Literaturrecherche, einen Überblick über die aktuelle Behandlung und Prognose der beiden Fehlbildungen zu geben. Methoden: Im Rahmen einer retrospektiven Untersuchung erfolgte die Erhebung und Auswertung der Daten von 27 Kindern mit Gastroschisis sowie 19 Kindern mit Omphalocele, die zwischen 1998 und 2008 in der Universitätsklinik Leipzig behandelt wurden. Mithilfe des Mann-U-Whitney-Tests sowie des exakten Tests nach Fisher wurden zahlreiche Merkmale hinsichtlich ihrer Auswirkungen auf das Outcome überprüft. Als Parameter, die das Outcome widerspiegelten, galten der Beginn des enteralen Kostaufbaus mit Tee-Glucose-Lösung und Milch, die Dauer der parenteralen Nährstoffzufuhr und des Krankenhausaufenthaltes, sowie Nachoperationen, Komplikationen und die Letalität während des stationären Aufenthaltes. Ergebnisse: An der Universitätsklinik Leipzig betrug die Inzidenz von Gastroschisis 14 pro 10 000 Lebendgeburten und von Omphalocele 9 pro 10 000 Lebendgeburten. Die Inzidenz blieb während des elfjährigen Beobachtungszeitraumes konstant. Der Vergleich früh- und reifgeborener Gastroschisis-Patienten zeigte, dass eine Frühgeburt weder mit einem früheren Beginn der oralen Ernährung mit Tee-Glucose-Lösung (11 d vs. 14 d; p nicht signifikant) und Milch (17 d vs. 17 d; p nicht signifikant), noch mit einer Verkürzung der parenteralen Ernährung (36 d vs. 37 d; p nicht signifikant) und stationären Behandlung (48 d vs. 50 d; p nicht signifikant) einherging. Häufig verkomplizierten Infektionen (12/27) und sekundäre Darmverschlüsse (9/27) mit der Notwendigkeit einer zusätzlichen Operation den postoperativen Verlauf der Gastroschisis-Patienten. Letztgenannte Komplikation führte zu einer erheblich protrahierten parenteralen Ernährung (79 d vs. 31 d; p < 0,05) und stationären Behandlung (101 d vs. 38 d; p < 0,05), während Infektionen kaum Auswirkungen auf das Outcome hatten. Es zeigte sich, dass vorrangig Kinder mit kleinem Defekt (<= 4 cm) sowie mit prolabiertem Magen einen Ileus entwickelten. Neben Darmverschlüssen führten intestinale Begleitfehlbildungen tendenziell zu einer Verlängerung der Hospitalisierungszeit (73 d vs. 48,5 d; p nicht signifikant). Gelang die orale Zufuhr von Milch innerhalb der ersten 14 Lebenstage, so verringerte sich die Dauer der parenteralen Ernährung (30 d vs. 37 d; p < 0,05) und der stationären Behandlung (41 d vs. 67 d; p nicht signifikant). Bei Patienten mit Omphalocele bestimmten vor allem die Größe der Omphalocele, der Inhalt des Bruchsackes sowie der Zeitpunkt des oralen Ernährungsbeginns die Prognose. Ein großer (> 4 cm) Bauchwanddefekt ging mit einer erhöhten Infektionsrate (4/7 vs. 1/11; p < 0,05), prolongierten parenteralen Nahrungszufuhr (26 d vs. 17 d; p < 0,05) sowie stationären Behandlung (46 d vs. 24 d; p nicht signifikant) einher. Extraintestinale Begleitanomalien zeigten sich jedoch häufiger bei Patienten mit kleinem Defekt (5/11 vs. 1/7; p nicht signifikant). Befand sich die Leber außerhalb der Abdominalhöhle, waren zusätzliche Fehlbildungen seltener (3/11 vs. 5/7; p < 0,05). Eine prolabierte Leber verzögerte tendenziell die parenterale Ernährung (24 d vs. 18 d; p nicht signifikant) und die Krankenhausverweildauer (46 d vs. 21 d; p nicht signifikant). Ein frühzeitiger Beginn des enteralen Kostaufbaus mit Milch innerhalb der ersten zehn Lebenstage führte hingegen zu einer Verkürzung der parenteralen Ernährung (17 d vs. 27 d; p < 0,05) und stationären Behandlung (22,5 d vs. 49 d; p nicht signifikant). Schlussfolgerung: Die Inzidenz von Gastroschisis und Omphalocele blieb während des Beobachtungszeitraumes konstant. Die Prognose der Gastroschisis-Patienten wurde durch eine Frühgeburt nicht verbessert, so dass eine Termingeburt angestrebt werden sollte. Die Daten der vorliegenden Arbeit legen nahe, dass ein frühzeitiger Nahrungsaufbau mit der oralen Zufuhr von Tee ab dem achten Lebenstag sowie Milch ab dem zehnten Lebenstag günstig für das Outcome hinsichtlich der Dauer der parenteralen Ernährung und des stationären Aufenthaltes ist. Darmverschlüsse stellten schwerwiegende Komplikationen dar und verschlechterten das Outcome maßgeblich. Eine große Omphalocele sowie eine ausgetretene Leber erhöhten die Morbidität. Ebenso wie bei Gastroschisis-Kindern scheint ein frühzeitiger Beginn der enteralen Ernährung das Outcome der Omphalocele-Patienten hinsichtlich der Dauer der parenteralen Ernährung und Krankenhausbehandlung zu verbessern. Deshalb empfehlen wir ab dem fünften sowie siebten Lebenstag die enterale Ernährung mit Tee sowie Milch zu beginnen. Ein großes Manko der vorliegenden Studie ist die kleine Fallzahl dieser retrospektiven, monozentrischen Erhebung. Zur besseren Erfassung der Patienten mit angeborenen Bauchwanddefekten und um aussagekräftige epidemiologische und prognostische Ergebnisse zu erhalten, bedarf es eines Fehlbildungsregisters in Sachsen, so wie es bereits in anderen Bundesländern angewandt wird.