Thesis (Ph. D.)--Case Western Reserve University, 2005. / [School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.

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This thesis focuses on tax incidence of selected products falling into the reduced VAT rate. This thesis analyzes the impact of changes of the reduced VAT rate on the consumer. It identifies the possible factors influencing the tax transfer and the tax impact and effects arising from it. The analysis focuses on reduced VAT rate in 2012, where there was an increase by four percentage points and on reduced VAT rate in 2013, where the rate was increased again by one percentage point. To determine the percentage impact of the change of reduced VAT rates, the average prices of food from the Czech Statistical Office are used in both cases. Finally the thesis gives recommendations on tax policy in the field of the reduced VAT rate.

Orientador: Helenice Bosco de Oliveira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T19:14:03Z (GMT). No. of bitstreams: 1 Saita_NanciMichele_M.pdf: 1460308 bytes, checksum: d19dc519e319a0f8f79a8ac7220393bd (MD5) Previous issue date: 2012 / Resumo: A tuberculose (TB) é uma doença infecto-contagiosa com características sociais, atingindo a classe economicamente ativa nos países desenvolvidos e em desenvolvimento. O Brasil está na lista dos 22 países em desenvolvimento que são responsáveis por 80% dos casos mundiais da doença. Após o surgimento da Aids, ocorreu aumento no número de casos notificados de TB entre as pessoas infectadas pelo vírus desta doença, gerando, dessa forma, novas estratégias para o controle da TB. Este trabalho teve como objetivo descrever a série histórica da tuberculose e da Aids na década atual, caracterizar e analisar o perfil dos pacientes com tuberculose que foram a óbito e comparar o período de 2001-2009 com o da década de 1990. Trata-se de um estudo descritivo sobre a dimensão epidemiológica da TB, da Aids e da coinfecção TB-Aids, dos indivíduos residentes na cidade de Campinas, Estado de São Paulo, Brasil, que morreram durante o tratamento da tuberculose e também dos óbitos notificados após a morte entre janeiro de 2001 a dezembro de 2009. A fonte utilizada foi o Banco de Dados para a Vigilância da Tuberculose da Universidade Estadual de Campinas (TB-WEB), o Banco de Óbitos da Secretaria Municipal de Campinas e o Centro de Referência e Treinamento DST-Aids do Estado de São Paulo. O número de casos de tuberculose, Aids, coinfecção TB-Aids e o número de óbitos encontrados nos sistemas de informação foram utilizados para visualizar a tendência epidemiológica. A letalidade por tuberculose foi utilizada para complementar o estudo do óbito por tuberculose. Para a análise dos dados foram utilizados recursos do Microsoft Excel versão 2007 e Epi-info versão 6.04, utilizando o teste qui-quadrado, considerando valor p < 0,05. Foi observado decréscimo dos casos de TB e tendência de estabilização para a Aids e coinfecção TB-Aids. A proporção de testes anti-HIV não realizados, entre pacientes com tuberculose, foi elevada (27,5%). A letalidade geral da tuberculose apresentou decréscimo nos três triênios (2001- 2003, 2004-2006, 2007-2009) estudados. Entre os pacientes que foram a óbito, foi verificada maior proporção entre os casos novos em todos os triênios. Houve predomínio da letalidade entre o sexo feminino com Aids e destaque para os casos sem a presença da Aids no sexo masculino. A letalidade aumentou entre os casos com Aids nos casos novos e de retratamento nas formas pulmonar e extrapulmonar. A vigilância epidemiológica do município, os serviços de saúde e os profissionais de saúde podem utilizar as informações sobre o óbito por TB para avaliação das ações desenvolvidas para esses pacientes, utilizando-as inclusive para rever e planejar novas estratégias. Esse cenário também revela a extensão epidemiológica da TB e da Aids e a necessidade de integração dos bancos de dados nas atividades de planejamento e controle / Abstract: Tuberculosis (TB) is an infectious contagious disease with social characteristics which reaches the economically active classes of both developed and developing countries. Brazil is on the list of 22 developing countries that are responsible for 80% of the World's TB cases. Since the emergence of AIDS, there has been an increase in the number of reported TB cases among people affected by the virus, thereby creating new strategies for the control of TB. The aim of the present study was to describe the historical series of tuberculosis and AIDS cases in the current decade while characterizing and analyzing the profiles of TB patients that died and comparing data from the period between 2001 and 2009 with data from the 1990's. This is a descriptive study on the epidemiological scale of TB, AIDS and the coinfection of TB-AIDS among residents of the city of Campinas, in the state of São Paulo, Brazil that died during TB treatment. Deaths that were reported at a later time between January 2001 and December 2009 were also studied. The following sources were employed in this study: the Tuberculosis Surveillance database of the state University of Campinas (TB-WEB); the data bank of deaths of the municipality of Campinas and the DST-Aids Reference and Training Center of the state of São Paulo. The numbers of tuberculosis, AIDS, and TB-AIDS coinfection cases, as well as the number of deaths found in the information systems were used to view the epidemiological trend. Mortality from TB was also used to complement the study of deaths from TB. Data analysis was carried out using Microsoft Excel version 2007, Epi-info version 6.04, and the chi-square test with the significance level set at p < 0.05. A decrease in TB cases and a trend of stabilization for AIDS and the TB-AIDS coinfection were found. The proportion of anti-HIV tests that were not performed among TB patients was high (27.5%). The overall mortality of TB decreased in the three studied triennia (2001-2003, 2004-2006, 2007-2009). A greater proportion of new cases were confirmed among patients that died in all triennia. Mortality was predominant among females with AIDS and males without AIDS. Mortality increased in new AIDS cases and cases of retreatment of pulmonary and extra-pulmonary forms. Epidemiological surveillance of the municipality, as well as health services and professionals may use this information about death from TB to assess the actions undertaken for these patients and to review and plan new strategies. The present study also highlights the epidemiological extent of TB and AIDS and the need to integrate databases into planning and control activities / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea in the United States. Although C. difficile is widely-recognized as a pathogen among hospitalized populations, CDI has emerged in the community setting but is under-diagnosed. This study sought to increase knowledge about the incidence of, risk factors for, and outcomes associated with community-associated CDI (CA-CDI). A retrospective nested case-control study was conducted using insurance claims data from the Wellmark Data Repository for the time period between January 1, 2003 and December 31, 2007. Persons with CDI were identified and were classified as community-associated CDI and hospital-acquired CDI. During this time, 304 cases of CA-CDI and 338 cases of HA-CDI were identified. Within this population, the incidence rate for CA-CDI was 11.16 cases per 100,000 person-years, whereas the incidence rate for HA-CDI was 12.41 cases per 100,000 person-years. Conditional logistic regression was utilized to determine the risk for CA-CDI related to pharmacologic exposures, comorbidity, demographic characteristics, and healthcare utilization. Prior to controlling for other risk factors and covariates; being over the age of 50 years, gender, history of hospitalization, number of outpatient physician visits, antimicrobial use, gastric acid suppressant use, underlying comorbidity, and diagnosis of gastrointestinal disease (including IBD, diverticular disease, GERD) were associated with the development of CA-CDI. However, after adjustment for all covariates, increased risk for CA-CDI within this population was consistently associated with antimicrobial use, being between the age of 19 and 74 years, and diagnosis of inflammatory bowel disease. Gastric acid suppressant use was a risk factor in a number of models, although this association was not consistent. Furthermore, persons who last received antimicrobials in the previous 150 days and persons who received a greater number of different antimicrobial agents were at increased risk for CA-CDI. Antimicrobial use was the primary risk factor for CA-CDI, although 27% of cases did not have prior exposure to antimicrobials. In fact, 17% of CA-CDI cases did not have any of the traditional risk factors for CDI (i.e., no antimicrobial or gastric acid suppressant exposure, no underlying illness, and no history of hospitalization). Furthermore, none of the CA-CDI cases underwent surgical procedures attributable to CA-CDI, although approximately 25% of CA-CDI cases were hospitalized with a diagnosis of CDI. This research demonstrates that CDI is occurring in the community setting and in populations that were previously not considered to be at risk. In this study, the risk factors for CA-CDI were similar to those identified in hospitalized populations, although it was not uncommon for persons to develop CA-CDI without any of these risk factors. Furthermore, the characteristics of persons with CA-CDI and the outcomes in this group were different than those previously reported among hospital-acquired CDI cases. Collectively, this study provides valuable knowledge about the epidemiology of CA-CDI and serves as a foundation for future research.

Background: In the United States, cases of human blastomycosis are largely described in defined geographic areas, with Mississippi reporting the highest prevalence of disease in the southeast region. The infection is uncommonly recognized in mountainous areas, and our previous report of blastomycosis in the southern Appalachian mountains of northeast Tennessee appeared to be an exception to the usual disease distribution. Methods: Our current retrospective study was undertaken to determine whether blastomycosis has persisted as an endemic fungal infection in our northeast Tennessee geographic area and whether epidemiologic features have changed over a 25-year time period. Results: Results show that clinical aspects of the disease have remained fairly constant with few exceptions; mass-type pulmonary lesions have become more common, and itraconazole has emerged as the therapy of choice. Most notably, however, are the observations that blastomycosis persists as a major endemic fungal infection in our mountain region, more than half of all cases occurring during the period from 1996 to 2005 were found in a core area centered on two counties, Washington and Unicoi; three of five counties surrounding the core counties experienced rate increases compared to our previous study. Conclusions: These findings suggest a further expansion of this endemic fungal disease beyond the core region.