A Claim incidence study for Individual Disability Insurance was conducted for study period from 2004 through 2007. Incidence was measured by count and amount and was compared with its 2007 EVM assumption and with standard industry tables 1985 CIDA. Generally, incidence rates are higher by amount than by count. This analysis and discussion focus on the experience by amount since this measure more closely reflects the financial impact. This report is to determine which assumption will be used going forward. Results have been provided for each calendar year within the study period. Further, results by significant blocks of business, elimination period, benefit period, CIDA occupation class and geographic location have been summarized in the body of the report. Additional details are included in the Appendices. In the report, the name of the insurance company and any other revealing information are suppressed due to confidentiality and sensitivity of the nature of these data. / text

Η οξεία αιμορραγία ανώτερου πεπτικού (ΟΑΑΠ) παραμένει ένα από τα πιο συχνά και επείγοντα περιστατικά που συνοδεύεται με αυξημένη νοσηρότητα και θνητότητα. Σκοπός της μελέτης είναι να δειχθούν αλλαγές στα κλινικο-επιδημιολογικά χαρακτηριστικά των ασθενών με ΟΑΑΠ την τελευταία δεκαετία. Συλλέχθηκαν δεδομένα από όλους τους ασθενείς που εισήχθησαν στα νοσοκομεία του Νομού Αχαΐας με ΟΑΑΠ από 1η Ιανουαρίου ως την 31η Δεκεμβρίου 2005 και έγινε αναδρομική σύγκριση με δεδομένα από ασθενείς που εισήχθησαν πριν 10 έτη στην ίδια περιοχή την περίοδο από 1η Ιανουαρίου ως τη 31η Δεκεμβρίου 1995. Η επίπτωση των ασθενών με ΟΑΑΠ και των πεπτικών ελκών και στις δυο περιόδους υπολογίσθηκε με βάση δεδομένων στοιχείων από την Εθνική Στατιστική Υπηρεσία. Παρατηρήθηκε μείωση στην επίπτωση των ασθενών με ΟΑΑΠ από 162,9/100.000 πληθυσμού το 1995, σε 108,2 /100.000 πληθυσμού (RR=0,49, CI 95%=0,37-0,63) το 2005 και στην επίπτωση των ασθενών με αιμορραγία από πεπτικό έλκος (ΑΠΕ) από 104,8 /100.000 πληθυσμού σε 72,5 /100000 (RR=0,49, CI 95%=0,35-0,68). Η μείωση αυτή οφειλόταν κυρίως στη μείωση της επίπτωσης των ασθενών με αιμορραγία από δωδεκαδακτυλικό έλκος (ΑΔΕ)(από 66,7ασθενείς/100.000 σε 35,5/100.000 πληθυσμού), ενώ η επίπτωση της αιμορραγίας από γαστρικά έλκη παρέμεινε στα ίδια επίπεδα (από 33,1 /100.000 σε 34,4 /100.000). Η μέση ηλικία των ασθενών αυξήθηκε από 59,4±17,1 έτη σε 66,1±16,1, p<0.0001, όπως και η συν-νοσηρότητα των ασθενών. Το ποσοστό χρήσης μη στεροειδών αντιφλεγμονωδών φαρμάκων (ΜΣΑΦ) σε αυτούς τους ασθενείς παρέμεινε σταθερό (49,3% vs 48,2%), ενώ η χρήση από του στόματος αντιπηκτικών και αντιαιμοπεταλιακών φαρμάκων αυξήθηκε σημαντικά (από 2,2% σε 6,8%, p=0,001 και από 1,2% σε 10,8%, p<0,0001 αντίστοιχα). Η συχνότητα υποτροπής αιμορραγίας σε ασθενείς με ΑΠΕ ,καθώς και η συχνότητα της επείγουσας χειρουργικής αιμόστασής τους μειώθηκαν σημαντικά (από 12% σε 5,9%, p=0,02 και από 8,9% σε 3,4%, p=0,009, αντίστοιχα). Δεν ανεβρέθηκε στατιστικά σημαντική διαφορά στην συνολική θνητότητα (3,9% το 1995 vs 6,5 % το 2005). Η επίπτωση της ΟΑΑΠ κατά την τελευταία δεκαετία μειώθηκε σημαντικά κυρίως λόγω της μείωσης της επίπτωσης των ασθενών με ΑΔΕ. Οι ασθενείς αυτοί είναι πιο ηλικιωμένοι με αυξημένα συνοδά νοσήματα, αλλά χωρίς να έχει μεταβληθεί στατιστικά η θνητότητά τους τα τελευταία δέκα έτη. / Acute upper gastrointestinal bleeding (AUGIB) remains a common medical emergency and an important cause of morbidity and mortality. The aim of this study was to evaluate changes in clinico-epidemiologic characteristics of patients who presented with AUGIB during the last 10 years. Data from all patients admitted with AUGIB in a defined geographical area in Greece from January 1 to December 31, 2005 (period B) were compared with retrospectively collected data from all patients admitted with AUGIB in the same area 10 years ago, from January 1 to December 31, 1995 (period A). The estimated incidence of AUGIB and peptic ulcer bleeding (PUB) in both periods was calculated using data from the population of this area according to the National Statistical Service. A reduction in the incidence of AUGIB from 162.9/100,000 population in 1995, to 108.2/100,000 population (rate ratio=0.49, confidence interval 95%=0.37-0.63) in 2005 and in the incidence of PUB from 104.8/100,000 population to 72.5/100,000 (rate ratio=0.49, confidence interval 95%=0.35-0.68) were, respectively, observed. This reduction was mainly due to the reduction in the incidence of duodenal ulcer bleeding (from 66.7 cases/100,000 to 35.5/100,000 population), whereas gastric ulcer bleeding incidence remained unchanged (33.1/100,000 vs. 34.4/100,000 cases). Mean age of patients increased from 59.4+/-17.1 years to 66.1+/-16.1, P<0.0001, and the patients' comorbidity. The percentage of NSAIDs' use remained stable (49.3% vs. 48.2%), whereas the use of oral anticoagulants and antiplatelets drugs increased significantly (from 2.2% to 6.8%, P=0.001 and from 1.2% to 10.8%, P<0.0001, respectively). Blood transfusion requirements per patient significantly decreased (from 2.5+/-2 to 2+/-2.4, P=0.009). The rate of rebleeding in PUB patients and emergency surgical hemostasis statistically decreased (from 12% to 5.9%, P=0.02 and from 8.9% to 3.4%, P=0.009, respectively). No significant difference in the overall mortality was observed (3.9% in 1995 vs. 6.5% in 2005). The incidence of AUGIB during the past 10 years significantly decreased, mainly due to the decline in the incidence of bleeding duodenal ulcers. Nowadays, patients are older with more comorbidities, but mortality remains unchanged.

Background: Knowledge regarding the associations of (i) hemoglobin level (Hb) prior to cancer diagnosis and cancer mortality (ii) the full range of Hb and cancer incidence and (iii) baseline inflammatory/other biomarkers and Hb in older populations is limited. The present study examined the associations of anemia status/Hb with cancer incidence and mortality, as well as the association with inflammatory biomarker levels in post-menopausal women. Methods: Anemia was defined as Hb <1 2 g/dl, while high Hb was defined as Hb >= 15 g/dl, or >= 16 g/dl. Associations were determined in three Women's Health Initiative Study sub-populations. The association between anemia/Hb with cancer mortality was determined in women without (N=21,021) or with (N=2,976) cancer history who had cancers on follow-up. The cross-sectional association of biomarkers and anemia/Hb was determined on 1,001 women with these available data. Finally, the association between anemia/Hb with cancer incidence was determined in women enrolled in the Observational Study/Clinical Trial who did not have a history of cancer/extreme energy intakes/missing follow-up time (N=140,269). Results: Anemia was associated with a 21% higher hazard of total cancer death in participants with, and a 55% greater hazard in participants without cancer history. Anemic women with a history of cancer had twice the hazard of colorectal cancer death. C-reactive protein, TNF-alpha, TNF-beta and TNFR2 were significantly associated with anemia. IL-1 alpha and IL-10 were significantly associated with continuous Hb. Anemia was not associated with cancer incidence in the total population, but anemic African-American women had a reduced risk of any cancer incidence which was not observed in white women (p-interaction=0.03). Women with high Hb had an increased hazard of any (HR: 1.37; 95% CI: 1.17, 1.60) or breast cancer (HR: 1.42; 95% CI: 1.10, 1.84) incidence. Conclusions: Anemia determined prior to cancer diagnosis was associated with total and colorectal cancer death. High Hb was associated with increased risk of total cancer and breast cancer incidence. Anemia was associated with elevated levels of C-reactive protein, TNF-alpha, TNF-beta and TNFR2, while continuous Hb was associated with IL-1 alpha and IL-10. Further research is required to confirm associations and clarify causal mechanisms.

The geographic disparity of multiple sclerosis has been noted in the literature for well over a century. The frequency of the disease varies significantly both within countries and in different parts of the world. The goal of this project is to give new insight regarding the etiology of multiple sclerosis. Several theories regarding the etiology of the disease have been reviewed, including a geographic theory, a nutritional theory, and a genetic theory. Although the geographic and nutritional theories have been thoroughly investigated by researchers, neither of them provides a conclusive explanation for the etiology of the disease, and there are discrepancies with respect to both theories. The purpose of this study is to reveal the discrepancies in the epigenetic theories regarding the etiology of multiple sclerosis and to demonstrate the correlation of multiple sclerosis prevalence and the migration and settlement history of Northern Europeans, thus conferring the passage of a genetic susceptibility to the disease.

Background: Inflammatory breast cancer (IBC) is a rare form of breast cancer associated with a poor prognosis. This study describes the incidence, survival, and management of IBC in the province of Ontario. Methods: We conducted a retrospective, population-based, cohort study using data systems held at the Division of Cancer Care and Epidemiology at Queen’s University in Kingston, Ontario. Using the Ontario Cancer Registry (OCR), we identified all primary, pathologically confirmed cases of breast cancer. IBC cases were identified using the unique histology code ‘85303’. OCR records were linked to Statistics Canada data, Canadian Institutes of Health Information (CIHI) records of surgical procedures, and cancer centre records detailing radiotherapy and chemotherapy administration. We calculated age-adjusted incidence rates of IBC for cases diagnosed between 1984 and 2005. Using the Kaplan Meier product-limit method and log-rank statistics we compared overall survival for IBC and non-IBC, and assessed temporal and regional variations in IBC survival. We described the management of IBC for patients diagnosed between 1984 and 2004, and assessed variations over time and across cancer centres. Results: Age-adjusted incidence rates of IBC increased from 0.57/105 women-years in 1984-1987 to 1.15/105 women-years in 2003-2005 (p<0.0001). 10-year survival was 21.5% for IBC compared to 61.7% for non-IBC (p<0.0001). For IBC, 10-year survival increased from 12.0% (95% CI: 8.3–16.3) for those diagnosed between 1984-1994 to 24.0% (95% CI: 20.1–28.2) for those diagnosed between 1995-2005. The utilization of combined mastectomy and postoperative radiotherapy increased from 28.9% in 1984-1994 to 46.1% in 1995-2004 (p<0.0001). We observed no statistically significant difference in the utilization of chemotherapy over time. Differences in the utilization of combined mastectomy and postoperative radiotherapy were observed across cancer centres (29.8% at centre C vs. 54.7% at centre A, p<0.0001). We also observed wide variations in the estimates of survival across cancer centres. Discussion: Rates of IBC have increased over time in Ontario and we observed an improvement in the long-term survival. Management has shifted over time towards increased use of mastectomy and postoperative radiotherapy. Additional prognostic information is needed to determine how variations in practice may be related to variations in outcome. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-09-24 16:15:10.068

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Au Québec, en 2007, plus de 1 384 000 voyages internationaux ont été effectués. Ce nombre est 50 % plus élevé qu'il ne l'était en 2000. Conséquemment, le comité consultatif québécois sur la santé des voyageurs (CCQSV) a émis, comme priorité en 2008, de dresser un portrait actuel de l'épidémiologie et du fardeau lié aux maladies acquises en voyage. OBJECTIFS Décrire l'épidémiologie des 4 maladies à l'étude au Québec, entre 2004 et 2007. Secondairement, comparer certains résultats avec une étude antérieure pour 3 de ces maladies et valider une variable nommée "ÉPISODE ACQUIS HORS QUÉBEC" ajoutée au fichier provincial des maladies à déclaration obligatoire (MADO) en 2003. DEVIS : Étude descriptive transversale des cas de fièvre typhoïde, d'hépatite A, de malaria et de shigellose. DONNÉES ET MÉTHODOLOGIE: Les cas des quatre maladies à l'étude, inscrits dans le fichier MADO, entre les années 2004 et 2007, ont été analysés avec l'information disponible dans les enquêtes épidémiologiques. Pour les cas de shigellose, un échantillonnage a eu lieu. Les variables ont été colligées par un seul évaluateur à l'aide d'une grille pré-testée. La qualité des données a été validée par une double collecte et une double saisie. Lorsque possible, les données concernant l'ensemble des voyageurs, et non seulement les cas, ont été tirées des données sur les voyages internationaux de STATISTIQUE CANADA. La sensibilité et la spécificité de la variable "épisode acquis hors Québec" ont été calculées en comparant l'information inscrite au fichier MADO avec celle des questionnaires d'enquête épidémiologique des directions de santé publique, considérés comme l'étalon or. L'étude de Provost et al. (2006) a été utilisée aux fins de comparaisons. RÉSULTATS: La proportion de cas liés aux voyages a été calculée : malaria (78,3 %), fièvre typhoïde (73,4 %), shigellose (50 %) et hépatite A (35,8 %). Le nombre de cas déclarés durant la période varie de 55 cas pour la fièvre typhoïde à 760 cas pour la shigellose. L'incidence annuelle moyenne (par 100 000 personnes) liée aux voyages pour la période 2004-2007 est de 0,59 pour la malaria, 0,13 pour la fièvre typhoïde, 0,49 pour la shigellose et 0,44 pour l'hépatite A. Les immigrants qui retournent visiter la famille et les amis (VFA). sont importants en proportion chez les cas de malaria (52,9 %). Les cas d'hépatite A surviennent davantage durant les voyages de plus de deux semaines (75,6 %). Une proportion importante des cas d'hépatite A provient de l'Afrique (28,3 %). Le sous-continent indien obtient le rapport du nombre de cas sur le nombre de voyages le plus élevé pour la fièvre typhoïde, l'hépatite A et la shigellose. La shigellose se démarque des autres maladies avec une majorité de cas chez les touristes (76,1 %) et les cas surviennent principalement lors de courts séjours d'une semaine ou moins (39,6 %). La variable "ÉPISODE ACQUIS HORS QUÉBEC" du fichier MADO présente encore une proportion importante de dossiers ou l'information est inconnue (28,6 %) pour les maladies à l'étude. En excluant les données inconnues, la variable présente une sensibilité de 97,5 % et une spécificité de 98,5 %. Comparativement à la période 2000-2002, la proportion de cas chez les VFA a augmentée pour la malaria et la fièvre typhoïde. La proportion de cas de malaria contractés en Afrique sub-saharienne a aussi augmentée (87,2 % vs 72 % en 2000-2002). CONCLUSIONS Les 4 maladies à l'étude sont encore des maladies fréquentes chez les voyageurs internationaux québécois. Les voyageurs à destination de l'Afrique et du sous-continent indien méritent une attention spéciale, tout particulièrement les voyageurs du type VFA. Les touristes devraient être avisés du risque de shigellose malgré la vaccination contre d'autres maladies. Il est recommandé d'uniformiser le format des questionnaires d'enquête au niveau provincial et de sensibiliser les professionnels à l'importance de saisir le pays d'acquisition au fichier MADO. Malgré l'excellente sensibilité et spécificité de la variable, il est conseillé de l'utiliser avec prudence.

No description available.

We demonstrate new results in additive combinatorics, including a proof of a conjecture by J. Solymosi: for every epsilon > 0, there exists delta > 0 such that, given n² points in a grid formation in R², if L is a set of lines in general position such that each line intersects at least n^{1-delta} points of the grid, then |L| < n^epsilon. This result implies a conjecture of Gy. Elekes regarding a uniform statistical version of Freiman's theorem for linear functions with small image sets.

Thesis (M.A.) in Economics--University of Maine, 2007. / Includes vita. Includes bibliographical references (leaves 68-70).