Area-wide vaccination against pertussis, also known as whooping cough, has been going on since the 40th - 50th of the last century. In our country this vaccination started in 1958. The World Health Organization estimates that worldwide 20 to 30 million people per year contract pertussis. Patients from developing countries account for 90% of cases. Pertussis is the cause of the death of around 200 000 - 300 000 people per year, up to 85% of whom are children under 2 years of age. As the only source of the bacteria Bordetella pertussis are humans, they are also suitable candidate for the elimination. Therefore, the WHO established an ambitious plan to reduce the incidence of pertussis below 0.1 per 100 000 inhabitants by the year 2000. However, no country succeeded in meeting this plan´s objectives on a long-term basis and since the 80th of the 20th century there has been an increasing trend of the disease incidence across all age groups worldwide. As the proof of severity of this issue pertussis was categorized among the so-called "emerging infectious diseases", that is re-emerging diseases. Diseases whose incidence has increased in recent decades and which could become a major health problem in the near future are classified into this category. In the case of pertussis, the most effective prevention is high vaccination rates in the population, especially children. The theoretical part of the thesis summarizes the current knowledge about pertussis. In the practical part I focused on the incidence and development of the disease in the South Bohemian Region in the years 2005 - 2010, with regard to individual age groups. The results show that in the South Bohemian Region the incidence was rising. The highest incidence was in the age group of 10 to 14 years. Another purpose of the research was to compare the incidence of pertussis in the South Bohemian Region with other regions of the CR. The South Bohemian region in the surveyed 6-year-period ranked among the regions with the highest incidence.

The theoretical part of this work is focused on a tax harmonization and the position of tax on custom in tax systems of some countries which are members of the European Union. The practical part is focused on a measuring of the tax incidence in the Czech Republic. The tax incidence of excises in the Czech Republic in the time period from 2002 to 2007 is measured on the base of the statistical events which are published by the Czech Bureau of Statistics. The own calculation of the tax incidence is implemented by rate of progressivity by Norbert Kakwani.

En Europe, la France est située entre des zones à haut et bas risque de Sclérose en Plaques (SEP).Nous avons estimé la prévalence de la SEP en France au 31 octobre 2004 et l’incidence entre 2000 et 2007 à partir des données de la Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAMTS) qui assure 87 % de la population. La SEP, comme d’autres maladies chroniques, fait partie des affections de longue durée (ALD). Les variations géographiques de la prévalence et de l’incidence ont été analysées par un modèle Bayesien.La prévalence standardisée sur l’âge était de 94,7 pour 100 000 ; 130,5 pour les femmes ; 54,8 pour les hommes. Le taux de notification de SEP (2000-2007) standardisé sur la population Européenne était de 6,8 pour 100 000 ; 9,8 parmi les femmes et 3,7 parmi les hommes. Avec le modèle Bayesien, la prévalence était plus forte au nord-est et plus faible dans la région parisienne et sur la Côte d’Azur. L’incidence était également plus forte au nord-est mais plus faible sur la côte atlantique et de part et d’autre du Rhône.A partir des autres ALD, les comorbidités survenant avant l’ALD SEP ont été étudiées. Elles étaient rares et essentiellement représentées par les troubles psychiatriques (40,2%) et le diabète (20,3%). Cette étude a été réalisée parmi une population représentative avec une seule et même méthodologie. Le modèle Bayesien prenant en compte l’hétérogénéité et l’auto-corrélation spatiales ne confirme pas l’existence d’un gradient net mais des zones à sur ou sous risque. La meilleure connaissance de l’épidémiologie de la SEP permettra d’avancer sur ses facteurs étiologiques. / In Europe, France is located between high and low risk areas of Multiple Sclerosis (MS). We estimated the national prevalence of MS in France on 31st October 2004 and the incidence between 2000 and 2007 based on data from the ‘Caisse Nationale d’Assurance Maladie des Travailleurs Salariés’ which insures 87% of the population. MS like other chronic diseases is one of the 30 long-term illnesses (Affections de Longue Durée, ALD). We analysed geographic variations in the prevalence and incidence of MS in France using the Bayesian approach.Total MS prevalence in France standardised for age was 94.7 per 100,000; 130.5 in women; 54.8 in men. The notification rate for MS (2000-2007) after age-standardisation according to the European population was 6.8 per 100,000; 9.8 in women and 3.7 in men. With a Bayesian approach, the prevalence of MS was higher in northeast and lower in the Paris area and on the Mediterranean coast. The notification rate was higher in northeast and lower on the Atlantic coast and in the Alps as well as on both sides of the Rhône River.The study of other chronic diseases for which ALD status was registered before MS revealed that comorbidities were rare, essentially represented by psychiatric diseases (40.2%) and diabetes (20.3%).This study is performed among a representative population using the same method throughout. The Bayesian approach which takes into account spatial heterogeneity and spatial autocorrelation did not confirm the existence of a clear gradient but only higher or lower areas of MS. The better knowledge of MS epidemiology will allow to venture hypothesis its etiological factors.

Objectif : L’objectif principal de ce travail était d’évaluer les facteurs de risque d’incidence et de rémission de l’incontinence urinaire (IU) au sein d’une cohorte de femmes de la cinquantaine en prenant en compte le type d’IU (Incontinence urinaire d’effort - IUE -, Incontinence par argenture - IUU- et Incontinence urinaire mixte – IUM) et la gravité des symptômes.Matériel et Méthodes : Les données sont issues des questionnaires de l’enquête « les femmes et leur santé », des questionnaires annuels de la cohorte GAZEL et du questionnaire spécifique « les troubles urinaires » posé en 2000 et 2008. Un modèle de Cox a été utilisé entre 1990 et 2008 à partir des données de la question « Avez-vous des difficultés à retenir vos urines ? ». Des modèles de régression logistiques ont été utilisés entre 2000 et 2008 à partir de la question validée de l’IU « Au cours des 12 derniers mois, vous est-il arrivé d’avoir des fuites involontaires d’urine ? ».Résultats : Au sein de notre population, le taux annuel d’incidence de l’IU est de 5,5 % et le taux annuel de rémission est de 6,2 %, confirmant que l’IU est un phénomène dynamique avec des périodes possibles d’aggravation et d’amélioration partielle ou totale. Ces taux sont variables avec le type d’IU : entre 2000 et 2008, les taux d’incidence étaient respectivement de 14,9 % pour l’IUE, de 3,2 % pour l’IUU et de 3.1% pour l’IUM. L’IUE est le type le plus enclin à connaître une rémission de l’IU en comparaison à l’IUU et l’IUM. Les facteurs associés à l’apparition d’une IU sont des facteurs sociaux (le niveau d’études élevé), obstétricaux (la parité), hormonaux (la ménopause), et en rapport avec l’état de santé, physique ou mentale (la prise de poids, l’apparition de symptômes dépressifs, la dégradation de la qualité de vie - dans les dimensions tonus et isolement social du score NHP). La rémission complète est d’autant moins fréquente que les femmes vieillissent et qu’elles prennent du poids. Pour chaque type d’IU, l’influence des facteurs de risque semble différente. Ainsi, le niveau d’étude (être titulaire du baccalauréat), l’IMC (à l’inclusion, et au cours du suivi) et un syndrome dépressif à l’inclusion sont associés à l’apparition d’une IUE. Un antécédent de prise en charge chirurgicale de l’IU est associé à l’apparition d’une IUU et d’une IUM. La correction chirurgicale de l’IU pendant le suivi est, comme attendu, associée à une rémission des symptômes d’IUE, mais en revanche la rééducation périnéale et un antécédent d’accouchement par voie vaginale, sont associés à une persistance des symptômes d’IUE. L’accouchement par voie vaginale était également associé à la persistance de l’IUM. L’IUU et l’IUM sont les types d’IU les plus graves à l’inclusion. De plus, l’aggravation est plus marquée en cas d’IUU ou d’IUM que d’IUE. Hormis le type, les facteurs associés à une aggravation des symptômes sont une operation pour une IU (à l’inclusion) et l’apparition d’un syndrome dépressif. L’aggravation des symptômes est négativement associée à la consommation d’alcool à l’inclusion et une chirurgie de l’incontinence pendant la période d’étude. Le rôle des facteurs sociaux, comme l’obtention du baccalauréat par exemple, est associé à l’apparition d’un IU légère, alors que des facteurs obstétricaux comme un antécédent d’accouchement par voie basse est associé à une apparition de l’IU grave.Conclusion : L’IU est un phénomène dynamique avec des périodes possibles d’aggravation et d’amélioration partielle ou totale. L’analyse des facteurs de risque associés à l’IU doit intégrer une différentiation du type et de la gravité. Les données concernant l’épidémiologie de l’IU chez les femmes entre 45 et 60 ans sont encore trop peu nombreuses. D'autres enquêtes longitudinales incluant un nombre plus important de femmes sont essentielles afin de confirmer nos résultats et mieux conseiller les femmes en présentant les symptômes. / Objective: The main objective of this work was to evaluate the risk factors of incidence and remission of urinary incontinence (UI) in a cohort of women at midlife, taking into account the type of UI (Stress urinary incontinence - SUI – Urge urinary incontinence – IUU - and mixed urinary incontinence - IUM) and the severity of symptoms.Material and Methods: Data were obtained from the survey questionnaires "women and their health," the annual questionnaires cohort GAZEL and specific questionnaire "urinary problems" posed in 2000 and 2008. A Cox model was used between 1990 and 2008 from the data of the question "Have you trouble holding your urine? ". Logistic regression models were used between 2000 and 2008 from the issue validated UI "Over the last 12 months, did you have any involuntary loss of urine ? ".Results: In our population, the annual rate of incidence of UI was 5.5% and the annual rate of remission was 6.2%, confirming that the UI is a dynamic condition with possible periods of worsening and of improvement. These rates vary with the type of UI: between 2000 and 2008, incidence rates were 14.9% for SUI, 3.2% for UUI and 3.1% for the MUI. SUI is the most likely type to experience a possible remission of the UI compared to UUI and MUI. Factors associated with the occurrence of UI are social factors (high educational level), obstetrical (parity), hormonal (menopause), and factors in relation with physical or mental health status (weight gain, onset of depressive symptoms, impairment in health-related quality of life - energy dimension and social isolation dimension of NHP score). Complete remission is even less common as women gain in age and in weight. For each type of UI, the influence of risk factors seems different. Thus, educational level (baccalaureate), BMI (at baseline and during follow-up) and a depressive syndrome at baseline are associated with the onset of SUI. An antecedent of surgical procedure for UI is associated with the occurrence of UUI and MUI. Surgical correction of the UI during follow-up is, as expected, associated with remission of symptoms of SUI. By contrast, pelvic floor muscle training exercises and vaginal childbirth, are associated with persistence of symptoms of SUI. The vaginal delivery was also associated with the persistence of MUI. MUI and UUI are the more severe types of UI at baseline. Furthermore, the aggravation is more pronounced in case of UUI or MUI that for SUI. Aside from the type, the factors associated with worsening symptoms are a prior surgery for a UI (at baseline) and the onset of a depressive syndrome. A worsening of UI is negatively associated with alcohol consumption at baseline and incontinence surgery during the study period. The role of social factors, such as the baccalaureate for example, is associated with the appearance of a slight UI, while obstetric factors such as a vaginal childbirth is associated with the appearance of a severe UI.Conclusion: The UI is a dynamic condition with possible periods of worsening and of partial or total improvement. The analysis of risk factors associated with the UI must incorporate a differentiation of the type and severity. Data on the epidemiology of UI in women between 45 and 60 years are still too few. Other longitudinal studies including a larger number of women are essential to confirm our results and to better counselling women with UI symptoms.

Le purpura rhumatoïde, récemment renommé vascularite à IgA (IgAV) est, en Occident, la vascularite systémique la plus fréquente de l’enfant. Cette vascularite leucocytoclasique IgA-médiée des petits vaisseaux touche principalement la peau, les articulations, le tube digestif et les reins. L’évolution est le plus souvent favorable mais certains patients peuvent développer une pathologie rénale chronique. L’étiologie de l’IgAV étant inconnue, les études épidémiologiques sont importantes afin de générer des hypothèses étiologiques. La première partie de cette thèse consacrée à l’épidémiologie de l’IgAV, consiste en une revue de la littérature résumant l’ensemble des connaissances actuelles d’épidémiologie descriptive de l’IgAV ainsi que les facteurs de risque génétiques ou environnementaux rapportés. La seconde partie est une étude prospective sur 3 ans décrivant les caractéristiques épidémiologiques des cas incidents d’IgAV survenus chez les enfants habitant le département du Val de Marne, localisé au sud-est de Paris. Grâce à une analyse capture–recapture à 4 sources, nous avons estimé l’incidence annuelle de l’IgAV à 30/100 000 enfants < 15 ans. La faible variation de l’incidence de l’IgAV dans le temps et dans l’espace et l’existence d’une saisonnalité de la maladie suggèrent un facteur déclenchant infectieux ubiquitaire et non émergent. La troisième partie de cette thèse, s’intéresse à la question du rôle de la vaccination dans le déclenchement de l’IgAV. En l’absence d’études pharmaco-épidémiologiques robustes, nous avons réalisé une étude en case-crossover, qui est une variante d’une étude cas–témoin traditionnelle afin d’étudier l’effet de la vaccination sur le risque à court terme d’IgAV. Nos résultats indiquent que les vaccins communément réalisés chez l’enfant n’augmentent pas significativement le risque d’IgAV dans les 3 mois suivant la vaccination. Les résultats de cette thèse améliorent nos connaissances de l’épidémiologie de l’IgAV et suggèrent que les infections, mais pas les vaccins, jouent un rôle dans l’étiologie de la maladie. D’autres études épidémiologiques sont toutefois nécessaires, en particulier dans les populations non étudiées et multi-ethniques, afin de mieux cerner le rôle des facteurs génétiques dans la survenue de la maladie. / Henoch-Schönlein purpura, recently renamed immunoglobulin A vasculitis (IgAV), is the most common systemic vasculitis in childhood in Western countries. The sites predominantly affected by this IgA-mediated, leukocytoclastic, small-vessel vasculitis are the skin, joints, gastrointestinal tract and kidneys. IgAV is often self-limiting, although chronic kidney disease can develop in some patients. Because the cause of IgAV is unknown, epidemiological studies are important to provide clues to understanding its etiology. The first part of this thesis, devoted to the epidemiology of IgAV, is a literature review summarizing the currently available knowledge on descriptive epidemiological aspects of IgAV and environmental and genetic risk determinants. The second part is a prospective survey describing the epidemiological characteristics of IgAV in Val de Marne, located in the southeast suburbs of Paris, France. With a 3-year study and 4-source capture–recapture analysis, we estimated the annual incidence of IgAV at 30/100,000 children (age ≤ 15 years). The few secular and geospatial variations in IgAV incidence and the observation of a seasonal pattern in IgAV incidence lend support to a role for a ubiquitous and communicable infectious trigger. The third part of the thesis addresses the concern suggested mainly by case reports of vaccination as a potential trigger of IgAV. In light of the lack of robust pharmacoepidemiological studies, we performed a case–crossover study, a variant of a traditional case–control study, to investigate the effect of vaccination on short-term risk of IgAV. The results indicated that vaccines commonly administered to children do not significantly increase the risk of IgAV in the 3 months after vaccine exposure. The results of this thesis enhance our knowledge of IgAV epidemiology and suggest that infections but not vaccines may play a role in the etiology of the disease. More epidemiological investigation is required, particularly in understudied areas and multiethnic populations, to gain insight in the burden of genetics in IgAV etiology.

Previous healthcare-based studies have reported increasing herpes zoster (HZ) incidence over time; however, this could be an artifact of increased healthcare utilization. This study is a cross-sectional analysis of 15,103 respondents in the 2008 wave of the Health and Retirement Study (HRS) to evaluate changes in HZ incidence from 1940 to 2008. Negative binomial regression is used to model the effect of calendar year, age of onset of HZ, gender and race/ethnicity on HZ incidence. A nonparametric method based on B-spline basis expansion is used to model the effect of calendar year to avoid imposing a predetermined functional form and produce flexible and accurate estimates. This study demonstrates increasing HZ incidence from 1940 to 2008 using self-reported HZ. Although the reason for this increase remains unknown, this study supports the assertion that this trend is real and not an artifact of increasing healthcare utilization for HZ over time.

Introduction: High-stress situations, such as military deployments, may be a risk factor for hypertension. The relationship between the stress triggered by combat deployment and hypertension is unknown. Acute stress from combat conditions can cause a temporary rise in blood pressure, which decreases within hours or days. Cross-sectional studies have shown no association between hypertension and deployment to the 1991 Gulf War or to Vietnam. Self-reported hypertension often is used as an outcome in large population studies. Fair to substantial agreement has been observed between self-reported hypertension and various sources of administrative data, medical records, and blood pressure measurements. The goal of this dissertation was to determine whether recent deployment to Iraq and Afghanistan was associated with new-onset hypertension.Methods: Baseline Millennium Cohort Study questionnaires (July 2001 to June 2003) were completed by 77,047 individuals. Follow-up questionnaires (June 2004 to February 2006) were completed by 55,021 responders. The relationship between new-onset hypertension and history of a recent military deployment was assessed through multivariable logistic regression (N=37,075). Baseline data were analyzed cross-sectionally to assess factors associated with prevalent hypertension (N=70,100). Kappa statistics were used to compare self-reported hypertension with provider diagnosed hypertension and prescription antihypertensive medication dispensed (N=41,129).Results: The 3-year incidence of hypertension was 6.9%. After adjusting for demographic and lifestyle characteristics, deployers without combat exposure were less likely to develop new-onset hypertension compared to nondeployers (odds ratio [OR]=0.74; 95% confidence interval [CI]: 0.64, 0.85). There was no association between deployment with combat exposure and hypertension compared to nondeployers (OR=0.94; 95% CI: 0.82, 1.07). Among deployers reporting combat exposures, the risk for incident hypertension was 1.31 (95% CI: 1.07, 1.61) compared to deployers not reporting combat exposures. The prevalence of self-reported hypertension at baseline among Cohort members was 10.4%. There was moderate agreement between self-reported hypertension and provider-diagnosed hypertension, as well as antihypertensive medications dispensed.Conclusion: Military service members are adversely affected by hypertension. Although deployers had lower incidence of hypertension compared to nondeployers, individuals reporting combat exposures were more likely to report new-onset hypertension. Self-reported hypertension had moderate reliability compared with provider-diagnosed hypertension and dispensed antihypertensive medication.

In this project, the correction factor of different solar panels of the laboratory of the University of Gävle, located in Sweden, is going to evaluated. The solar modules’working conditions are different from the ones used to test them in the laboratory. In the laboratory. the output energy of the modules is less than in working conditions,and therefore a correction factor is going to be calculated from the data collected, inorder to describe the factors that affect the performance of the solar modules.Also, the obtained correction factor validity for different PV systems it is going to be examined, determining which system has a better correction factor and the energy losses due to temperature, angle of incidence and micro invertor.

The thesis deals with current legal regulation of incidence contentions, which can occur in the enforcement proceedings. The thesis consists of 3 chapters. The introductory chapter of the thesis deals with the introduction of the basic terminology, historic background, attributes of civil procedure and differences betweenen forcement proceedings and exekutory proceedings. It is essential to bear in mind that for a very purpose of this thesis a term "enforcement proceedings" refers to the civil execution on the one hand, and the enforcement procedure on the other. Among others, folowing disputes have been tackled: disputes about enforcement, exclusive contentions and last, but not least Third-Party Debtor disputes. Disputes which emerge from both types of civil enforcement proceedings are currently not regulated in the Execution Law and must therefore be governed by the rule of Civil Procedure. Principal diferences among certain types of disputes consist in particular in the phase of proceedings in which each dispute shall be addressed. While disputes about enforcement shall be settled in the phase of enforcement proceedings, the others shall then be transfered back in to the phase of adversarial proceedings. Second chapter deals with disputes about enforcement and its characteristics. Third chapter...

The general opinion is that an increase in fuel taxation would affect the countryside of Sweden to a greater extent, than the inner-city areas of the country. The topic of fuel taxation has become widely discussed on a political level throughout Europe. This paper examines the distributional effects on taxation of fuel in Sweden, by comparing different municipalities from different regions. By using aggregated data from different sources and estimate an increase in fuel prices by 10 percent, this paper estimates the direct effects of an increase in fuel taxation. The results show that by increasing the price on fuel with 10 percent, the municipalities located in the countryside of Sweden have a higher distributional impact and a greater tax burden compared to municipalities located near larger cities. But the differences are modest, and this paper concludes that the fuel tax should be considered proportional throughout all regions of the country.