The current thesis is structured in four parts. Vector smoothing methods are used to study environmental data, in particular records of extreme precipitation, the models utilized belong to the vector generalized additive class. In the statistical analysis of observational studies the identification and adjustment for prognostic factors is an important component of the analysis; employing flexible statistical methods to identify and characterize the effect of potential prognostic factors in a clinical trial, namely "generalized additive models", presents an alternative to the traditional linear statistical model. The classes of models for which the methodology gives generalized additive extensions include grouped survival data from the Surveillance, Epidemiology, and End Results tumors of the brain and the central nervous system database; we are employing piecewise linear functions of the covariates to characterize the survival experienced by the population. Finally, both descriptive and analytical methods are utilized to study incidence rates and tumor sizes associated with the disease.

Streptococcus pneumoniae is a major bacterial pathogen which causes pneumoniae, meningitis, otitis media, and bacteremia. Currently there are two vaccines available, Pneumococcal Polysaccharide Vaccine (PPV) for adults and the Pneumococcal Conjugate Vaccine (PCV) for children. The PCV vaccine was developed in 2000 specifically for children and infants due to the ineffectiveness of the PPV vaccine in children. This is a cross sectional study of invasive S. pneumoniae in Florida during 2003. This study is designed to determine the population characteristics, clinically relevant antibiotic resistance patterns and specific risk factors for development of antibiotic resistance of invasive S. pneumoniae. Participants for the study of antimicrobial resistance will be selected if they are positive for invasive S. pneumoniae, and have been reported to the Florida Department of Health, Bureau of Epidemiology with a laboratory specimen collection date in 2003. A total of 1056 cases were reported. The incidence of invasive S. pneumoniae was calculated. Logistic regression was used to find an association between each risk factor and invasive S. pneumoniae. 95% Confidence Intervals were calculated to determine statistical significance. The incidence of invasive pneumococcal disease was calculated to be 6.61 per 100,000 persons (95% CI 6.21 -- 7.01). The incidence of drug resistant S. pneumoniae was calculated to be 3.3 per 100,000 persons (95% CI 3.03 -- 3.59).The incidence of penicillin resistant S. pneumoniae (PRSP) was estimated to be 2.6 per 100,000 persons (95% CI 2.37 -- 2.87). Fifty percent of the cases qualified as Drug Resistant S. pneumoniae (DRSP), being non-susceptible to one or more antibiotics as defined by the National Committee for Clinical Laboratory Standards (NCCLS). Age, race, gender, county and month of occurrence were evaluated as risk factors for DRSP. Only month of occurrence was determined to be a risk factor. Compared to current studies and previous results for Florida, it appears that Florida has a decreasing incidence of antibiotic resistant Streptococcus pneumoniae. I believe that this is due to the use of the PCV vaccine.

Central to the goals of public health are obtaining and interpreting timely and relevant information for the benefit of humanity. In this dissertation, we propose methods to monitor and assess the spread HIV in a more rapid manner, as well as to improve decisions regarding patient treatment options. In Chapter 1, we propose a method, extending the previously proposed dual-testing algorithm and augmented cross-sectional design, for estimating the HIV incidence rate in a particular community. Compared to existing methods, our proposed estimator allows for shorter follow-up time and does not require estimation of the mean window period, a crucial, but often unknown, parameter. The estimator performs well in a wide range of simulation settings. We discuss when this estimator would be expected to perform well and offer design considerations for the implementation of such a study. Chapters 2 and 3 are concerned with obtaining a more complete understanding of the impact of treatment in randomized clinical trials in which multiple patient outcomes are recorded. Chapter 2 provides an illustration of methods that may be used to address concerns of both risk-benefit analysis and personalized medicine simultaneously, with a goal of successfully identifying patients who will be ideal candidates for future treatment. Riskbenefit analysis is intended to address the multivariate nature of patient outcomes, while “personalized medicine” is concerned with patient heterogeneity, both of which complicate the determination of a treatment’s usefulness. A third complicating factor is the duration of treatment use. Chapter 3 features proposed methods for assessing the impact of treatment as a function of time, as well as methods for summarizing the impact of treatment across a range of follow-up times. Chapter 4 addresses the issue of meta-analysis, a commonly used tool for combining information for multiple independent studies, primarily for the purpose of answering a clinical question not suitably addressed by any one single study. This approach has proven highly useful and attractive in recent years, but often relies on parametric assumptions that cannot be verified. We propose a non-parametric approach to meta-analysis, valid in a wider range of scenarios, minimizing concerns over compromised validity.

No description available.

It is of interest that researchers study competing risks in which subjects may fail from any one of K causes. Comparing any two competing risks with covariate effects is very important in medical studies. This thesis develops omnibus tests for comparing cause-specific hazard rates and cumulative incidence functions at specified covariate levels. In the thesis, the omnibus tests are derived under the additive risk model, that is an alternative to the proportional hazard model, with by a weighted difference of estimates of cumulative cause-specific hazard rates. Simultaneous confidence bands for the difference of two conditional cumulative incidence functions are also constructed. A simulation procedure is used to sample from the null distribution of the test process in which the graphical and numerical techniques are used to detect the significant difference in the risks. A melanoma data set is used for the purpose of illustration.

Darbo tikslas- įvertinti hospitalinės infekcijos paplitimą bei valdymo galimybes rajonų ir apskričių ligoninėse. Uždaviniai: 1) įvertinti hospitalinių infekcijų struktūrą ir paplitimą Lietuvos rajonų ir apskričių ligoninėse, 2) nustatyti ir palyginti rizikos veiksnius ir objektus rajoninėse ir apskričių ligoninėse, 3) teikti pasiūlymus hospitalinių infekcijų valdymo tobulinimui. Tyrimo metodika. Tyrimo objektai –bendrosios chirurgijos, ortopedijos- traumatologijos, reanimacijos- intensyvios terapijos, akušerijos – ginekologijos skyriai. Hospitalinių infekcijų paplitimas įvertintas 4 rajonų ligoninėse ir 2 apskričių ligoninėse. Tyrimas buvo atliekamas naudojantis hospitalinių infekcijų registravimo protokolais, kurie buvo ligos istorijose. Už 2005 m. ištirta 2002 hospitalinių infekcijų atvejai. Duomenys apie hospitalinės infekcijos atvejus buvo gretinami su įrašais hospitalinių infekcijų žurnaluose ir pranešimais Visuomenės sveikatos centruose. Tyrimo duomenų matematinė ir statistinė analizė atlikta, naudojantis skaičiuoklės Microsoft EXCEL statistinėmis funkcijomis bei uždavinių analizės posistemės “Data Analysis”funkcijomis. Rezultatai: Tyrime dalyvavusių rajonų ligoninėse hospitalinių infekcijų paplitimas 3,1%; 3,2%; 2,8%; 3,3%, o apskričių – 4,0%; 4,6%. Rizikos veiksnių paplitimas : operacija 24%; intraveninė priemonė 22,9% ; pneumonija 16,8 %, kitos kvėpavimo takų infekcijos 13,9 %. Hospitalinių infekcijų atvejai registracijos žurnaluose ir VSC tirtose rajonų... [toliau žr. visą tekstą] / Aim: to assess the incidence of nosocomial infections and possibilities of their management in district and county hospitals. Objectives: 1) to assess the incidence and structure of nosocomial infections in district and county hospitals in Lithuania, 2) to determine and compare the risk factors of nosocomial infections in district and county hospitals, 3) to develop proposals for the improvement of nosocomial infection management. Methodology. The analysis was carried out in 4 district and 2 county hospitals, at the departments of general surgery, orthopedics and traumatology, reanimation and intensive therapy, obstetrics and gynaecology.. Nosocomial infection registration records presented in case histories served as a primary source of information. 2002 cases of nosocomial infections that occurred in 2005 were investigated. The data of the cases of nosocomial infections were compared with the records in nosocomial infection registers and reports in Public Health Centres. Statistical analysis of the research data was performed applying statistical functions of the Microsoft EXCEL spreadsheet and the functions of the task analysis subsystem Data Analysis. Results: The incidence of nosocomial infections was 3.1%, 3.2%, 2.8%, and 3.3% in the district hospitals, and 4.0%, 4.6% in the county hospitals. The major risk factors were surgery (24%), intravenous implement (22.9%), pneumonia (16.8%), and other respiratory infections (13.9%). The cases of nosocomial infections... [to full text]

Medicinos darbuotojai dėl kasdieninio kontakto su žmogaus organizmo skysčiais priskiriami didžiausios biologinių veiksnių rizikos grupei. Incidentų – mikrotraumų ir ekspozicijos krauju, rizika yra susijusi su kraujo keliu plintančiomis infekcijomis (HBV, HCV, ŽIV). Darbo tikslas: Nustatyti medicinos darbuotojų profesinių biologinių veiksnių riziką ir paplitimą Kauno medicinos universiteto klinikų chirurgijos profilio skyriuose. Tyrimo metodika. Vykdytas retrospektyvinis tyrimas 2006 m. 1-6 mėnesių, duomenys rinkti Kauno medicinos universiteto klinikų chirurgijos profilio skyriuose. Atlikta anketinė apklausa. Išdalintos 347 anoniminės anketos, atsako dažnis 89,6 % (311). Statistiniam duomenų apdorojimui naudotas SPSS 11.0 programinis paketas. Rezultatai. 64,5% respondentų patyrė mikrotraumą, 71,1 % – ekspoziciją biologiniais skysčiais, mikrotraumą, ir ekspoziciją patyrė 39,6% darbuotojų. Visais mikrotraumų atvejais buvo sužeistos rankos, ekspozicijų metu 63% respondentų apsitaškė sveiką odą, 20% – akis. Dažniausiai darbuotojai apsitaškė krauju (60%). Gydytojai mikrotraum��� dažniausiai patyrė operacijų metu (79,3%), slaugytojos – apruošdamos instrumentus (35,1%), pagalbiniai darbuotojai – tvarkydami atliekas (75,8%). Gydytojai dažniausiai susižeidė chirurgine adata (72,4%), slaugytojos – injekcine adata (72,4%), pagalbiniai darbuotojai – stiklu (60,6%). 86% respondentų nebuvo pasiskiepiję HB vakcina. Mikrotraumų metu 14,5%, ekspozicijų metu 5% respondentų asmeninių apsaugos... [toliau žr. visą tekstą] / The health care workers are attributed to the highest biological factors risk group, as they daily come into contact with fluids of human body. Risk of incidents – sharps injuries and blood exposure – is related to the infections, spread by blood (HBV, HCV, HIV). Aim of the study. Determine the professional biological risk factors for health care workers and their incidence in the surgical departments of Kaunas Medical University Hospital. Methods. Retrospective study of 1-6 months of year 2006 was performed; data was collected in the surgical departments of Kaunas Medical University Hospital. Anonymous questionnaire survey was performed. 347 questionnaires were distributed; rate of response was 89.6% (311). SPSS 11.0 software was used for statistical data processing. Results. 64.5% of respondents had experienced sharps injury, 71.1% were exposed to the biological fluids, and 39.6% of workers had experienced the injury and the exposure. The hands were injured during all the sharps injury cases; 63% of respondents were drabbled by blood on the healthy skin and 20 % were drabbled into the eyes during the blood exposure. In most cases worker were drabbled by blood (60%). Physicians mostly experience the sharps injury during the surgery (79.3%), nurses – during the preparation of instruments (35.1%), supporting staff – disposing the waste (75.8%). Commonly physicians were injured by the surgical needle (72.4%), nurses – by needlestick (72.4%), and the supporting staff – by glass... [to full text]

Darbo tikslas – atlikti sergamumo hospitalinėmis infekcijomis, jų rizikos veiksnių, hospitalinių infekcijų sąlygoto mirštamumo bei ekonominį įvertinimą Lietuvos vaikų intensyviosios terapijos skyriuose. Tikslui pasiekti iškelti šie uždaviniai: 1) ištirti sergamumą hospitalinėmis infekcijomis, nustatyti dažniausią jų lokalizaciją bei sukėlėjus; 2) įvertinti hospitalinių infekcijų rizikos veiksnius; 3) nustatyti sergamumo bei rizikos įgyti hospitalines infekcijas pokyčius, įdiegus intervencijos programą; 4) įvertinti hospitalinių infekcijų ir ligos baigties sąsajas; 5) įvertinti hospitalinę infekciją įgijusių ir neįgijusių tiriamųjų gulėjimo trukmę bei gydymo išlaidas ir apskaičiuoti gulėjimo trukmės pailgėjimo dėl įgytos hospitalinės infekcijos sąlygotas išlaidas; 6) įvertinti intervencijos metodo ekonominę naudą, išvengus hospitalinės infekcijos. Perspektyvusis analitinis stebėjimo tyrimas vyko Lietuvos vaikų intensyviosios terapijos skyriuose 2003 - 2007 m. Į tyrimą įtraukti visi nuo 1 mėn. iki 18 m. amžiaus ligoniai, kurie gydėsi VITS > 48 val. Iš viso dalyvavo 1831 tiriamasis. Tyrimo duomenimis, sergamumas hospitalinėmis infekcijomis sudarė 15,0 atvejų 100-ui ligonių arba 24,5 atvejo 1000-čiui lovadienių. Sukurtas ir išbandytas unikalus ventiliacinės pneumonijos profilaktikos priemonių paketas. Išnagrinėtos hospitalinės infekcijos ir ligos baigties sąsajos bei ekonominiai šios problemos aspektai, remiantis šalyje patvirtintais vaikų reanimacijos paslaugų įkainiais... [toliau žr. visą tekstą] / The objectives of the study were as follows: 1) to investigate and to assess the incidence rates of nosocomial infections, their distribution by site and causative microorganisms; 2) to assess the risk factors of nosocomial infections; 3) to evaluate the changes of the risk of acquisition of nosocomial infections and the changes of the incidence of nosocomial infections after the implementation of the intervention programme; 5) to assess the association between nosocomial infection and outcomes; 6) to evaluate the increase of length of stay and the costs of patients with and without nosocomial infections, and to calculate the cost of single case of nosocomial infection and single patient with noscomial infection; 7) to make cost-benefit analysis of the intervention programme. The prospective surveillance study was carried out between March 2003 and December 2007. The paediatric intensive care unit patients aged between 1 month and 18 years and stayed in the units for more than 48 hours were eligible for inclusion in this study. The incidence of 15.0 cases per 100 patients and incidence density of 24.5 cases per 1000 patient-days was observed. Also the unique intervention programme was designed and implemented, which resulted in significant decrease of the incidence rates. No mortality attributable to nosocomial infections was found in the study. The minimal direct costs due to increase in length-of-stay was calculated in the study, as well as benefit of the intervention... [to full text]

Background: Coinfections with multiple types of human papillomavirus (HPV) are a common occurrence among HPV-infected individuals, but the clinical significance and etiology of these infections remain unclear. Though current evidence suggests that women with coinfections have increased HPV exposure (i.e. more sexual partners), it is also hypothesized that these women may represent a subgroup with increased HPV susceptibility, though this has been rarely studied to date. Purpose: The purpose of this project was to examine the occurrence, determinants and dynamics of HPV coinfections in a cohort of university students in order to explore the relationship(s) between coinfections, lifestyle factors and immunological susceptibility. Methods: This project is based on a secondary analysis of data from the McGill-Concordia Cohort, a longitudinal study of the natural history of HPV infection in 621 female university students in Montreal, Quebec. Participants were followed for 2 years at 6-month intervals. At each visit, cervical specimens were collected for cytology and HPV testing, and women completed a questionnaire about lifestyle and risk behaviours. Two definitions of coinfections were used: cumulative coinfection over follow-up and concurrent coinfection at each visit. Kaplan-Meier techniques were used to estimate incidence and duration of coinfections and multiple logistic regression was used to identify determinants of coinfections and associations between coinfections and squamous intraepithelial lesions (SIL). Results: More than half of the cohort became infected with HPV and of those, over 60% acquired multiple HPV types over follow-up. Incidence of coinfections was significantly increased among HPV-infected women at enrollment. The most important determinant of coinfection occurrence was number of sexual partners (both lifetime and new), though some genes of the immune response (HLA-DQB1*06:02, HLA-G*01:01:03 and HLA-G*01:01:05) were also significant predictors. Women with coinfections, particularly those with 4+ HPV types, also had longer infection durations and greatly increased odds of SIL. Conclusions: Women with coinfections acquire new HPV types at an increased rate and have greater HPV persistence and occurrence of SIL, which may indicate immunological susceptibility. HPV coinfections mainly occur due to increased sexual activity but a decreased immune response to the virus may also be involved in a subset of women. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-04-21 01:04:26.265

<p> <p>&nbsp / </p> <p align="left">&nbsp / </p> </p> <p align="left">In addition to football and basketball, volleyball has become a very popular sport globally over the last 30 years. The International Federation of Volleyball represents about 150 million players in approximately 170 countries. While a large body of research has been conducted regarding the nature and prevalence of volleyball injuries internationally, very little has been done locally or on the African continent to assess the status of injuries incurred at professional or amateur levels. The aim of this study is to determine the prevalence of injuries sustained by professional volleyball players of a club in the WPVU in one season. An exploratory, descriptive, nonexperimental approach was used for this study on 42 volleyball players at the University of the Western Cape Volleyball Club. A self&ndash / administered questionnaire that was based on a questionnaire used in a Dutch national volleyball study was used in the present study. A response rate of 89.4% was obtained. The collected data were captured and analysed by means of the Statistical Package for Social Science version 14.0 (SPSS). The associations between variables were evaluated by means of the chi-square test and a 5% level of significance was used. The results were displayed using tables, bar chart, and pie chart. Most of the volleyball players sustained one or more injuries in the season, giving a prevalence rate of 88.1%. The incidence rate was 1.2 injuries per player. Injuries prevalence was higher among male players 54.1% than female players 45.9%. Among the injured players, ankle and knee injuries showed the highest injury prevalence with 25.5% for each followed by 19.6% for shoulder injuries. The study revealed 69.2% injury prevalence with a higher significance (p=0.04) that players who are injured in the ankle were in contact. Half of the injuries (50%), which occurred gradually, were prevalent in the shoulder, followed by the knee (28.6%), then the ankle and fingers (14.3%). Players in the left and right front row were significantly (p=0.008) more prone to be injured during spiking. Awareness programmes highlighting prevention strategies and physiotherapy intervention are required for coaches and players at the University of the Western Cape Volleyball Club to assist in the prevention of volleyball injuries.</p>