Diss. (sammanfattning) Örebro : Örebro universitet, 2009. / Härtill 4 uppsatser.

Background: Life expectancy (LE) estimation is an important part of both screening and treatment decision-making for potentially curable prostate cancer. Clinicians’ estimation of patient life expectancy is typically made using population-based life tables and intuition and it is often inaccurate. This study explores methods to improve LE prediction by formally considering patient co-morbid illness status, in addition to age, in the development of a LE prediction tool. Methods: We conducted a population-based retrospective cohort study of patients from the Ontario Cancer Registry who were curative treatment candidates, identified between 1990-1998. We analyzed data on three sub-populations of this cohort, and we used LE estimates from the Ontario Life Tables. Each model utilized Cox proportional hazards analysis, and/or the declining exponential approximation of LE, to estimate the survival experience of potential curative treatment candidates, including the impact due to both age and co-morbid illness status. We developed five separate models, tested them using a random subset of the cohort study sample, and compared their predictive accuracy by measuring both discriminative ability and calibration to determine the ‘best’ model. We also conducted a supplementary analysis using logistic regression to develop a model to predict the probability of 10-year survival. Results: The ‘best’ of our models demonstrated a c-index of 0.65 and very good calibration. Further analysis revealed that our ‘best’ model violated the Cox PH assumption for age and it’s predictions consistently over-estimated observed LE. Supplementary analysis of the logistic regression prediction model demonstrated a c-index of 0.70. Conclusions: Our exploration of methods to predict LE resulted in modest predictive accuracy. However, based on the results of the logistic regression model, we conclude that the results of our LE prediction models are reasonable, and obtaining a high level of predictive accuracy may not be possible given just age and co-morbidities as predictors. Further studies should continue to explore these and other methods for LE prediction. External validation of the ‘best’ model from the current study is required before the model and its accompanying LE reference tables can be recommended for use in a clinical setting for screening or treatment decision-making. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-04-07 19:11:34.216

No description available.

No description available.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.S.)--University of Michigan, 1985.

Abstract The aim of this cross-sectional controlled study was to determine frequent attenders' chronic diseases and their reasons for encounter in primary health care. Furthermore, the study aimed to determine the associations of social, psychological and family factors with frequent attendance in a Finnish health centre. Patients who made eight or more annual visits to physicians in the health centre during one year were defined as frequent attenders (FA). All the FAs during 1994 (N=304) and 304 randomly selected age- and sex-matched controls constituted the study population. The data were collected from annual statistics, medical records and postal questionnaires. Over one third of the study population was interviewed. International Classification of Primary Care (ICPC) was used to determine the reasons for encounter and Symptom Checklist - 36 (SCL-36) to assess the psychological distress. Toronto Alexithymia Scale -20 (TAS-20) was used as a measure of alexithymia and Whiteley Index (WI) to determine hypochondriacal beliefs. The results showed that 4.7% of the whole population aged 15 years or older in Oulainen were FAs. They accounted for 23.5% of all visits made within the respective age group. The mean age of the FAs was 49.8 years. Over two thirds of them were female. The FAs had lower basic education and occupational status than the controls. The FAs visited physicians in the health centre mostly for reasons related to the musculoskeletal, respiratory and digestive systems. There appeared to be more chronic diseases among the FAs than among the controls. The FAs had over three times more mental disorders than the controls. The interviewed FAs had significantly more psychological distress, somatization and hypochondriacal beliefs than the controls. The risk of frequent attendance was higher in the older family life cycle phases than in the younger family life cycle phases. Multivariate analyses showed chronic somatic disease and hypochondriacal beliefs to be risk factors for frequent attendance. Concurrence of somatization and hypochondriacal beliefs increased the risk to be a FA. As a conclusion, the results emphasize the need to consider the FAs' own bodily concerns expressed as hypochondriacal beliefs when managing them. Furthermore, the study implicates a need to integrate the biomedical, psychological and social dimensions in the care of FAs in primary health care.

Schistosomiasis is a major parasitic disease caused by parasitic helminths of the genus Schistosoma which affects children in Africa, with negative impacts on general health, growth and cognitive development. Infection and morbidity are controlled by treatment with the antihelminthic drug praziquantel. Preschool children (aged ≤5 years old) have been neglected both in terms of research and control, and it is only recently that the World Health Organization (WHO) recommended praziquantel treatment and the inclusion of preschool children in control programmes. However, the burden of disease in this age group still remains poorly understood, and the performance of the currently available tools for detecting infection and morbidity is still yet to be systematically evaluated. The aim of this thesis was to compare the utility of currently available tools for diagnosing S. haematobium infection and related morbidity. The initial study cohort consisted of 438 Zimbabwean children (age range: 1-10 years) who were endemically exposed. Point-of-care schistosome-related morbidity markers applicable in the field, as well as serological biomarkers (CHI3L1, CRP, ferritin, resistin and SLPI) and inflammatory cytokines (IL-4, IL-5, IL-10, IL-13 and IFN-γ) that could predict early stages of immune-mediated pathology due to schistosomiasis were measured. Using a combination of applied statistical methods, the effect of treatment on factors associated with S. haematobium exposure, infection and morbidity in children aged 1-5 years was determined and the findings compared with those observed in children aged between 6-10 years old, who are the current targets of the schistosome control programmes. In this thesis, I able to demonstrate that preschool children carried significant infection, further reiterating the need for their inclusion in control programmes. Furthermore, this study demonstrated the importance of using additional sensitive diagnostic methods as this has implications on the required intervention strategies for the targeted populations. This study further revealed that preschool children can be effectively screened for schistosome-related morbidity using the same currently available diagnostic tools applicable to older children. Urinalysis markers microhaematuria, proteinuria and albuminuria are recommended in this thesis as the best choice for rapid assessment of morbidity attributed to S. haematobium infection in the field. Additionally, it was shown that the praziquantel treatment regimens aimed at controlling schistosome infection and morbidity currently designated for primary school-aged children and older populations are applicable to preschool-aged children. The involvement of serum biomarkers and immune correlates in the biological processes of inflammation suggests that these markers can be potential early predictors of schistosome-related pathology. Further research efforts are required to establish the relationship between these biomarkers and presence of schistosome-related morbidity as measured using point-of-care indicators in larger cohorts of populations chronically exposed to schistosome infections. In summary, the findings of this thesis highlight the need for the refinement of existing diagnostic methods for accurate detection of infection and morbidity in children. This will enable appropriate and timely intervention strategies, aimed at improving the current and future health of preschool aged-children to be implemented. The findings presented here will aid researchers and other stakeholders in making informed choices about intervention tools for control programmes targeting young children.

Introduction.: The evaluation and improvement of the quality of health care services begins with the knowledge about the trends and causes of diseases. Purpose: To describe the morbidity and mortality patterns for the under-5 year old children who were admitted in 11 district hospitals in Eastern Cape Province from 2000 to 2004. Methods: Descriptive study where a multi-stage sampling technique was used to select 11 district hospitals. There were 25,122 causes of paediatric ward admissions (2000 to 2004) among under-5 children from ward register were reviewed and ICD-10 coded. Findings: Pre-transitional causes were the leading causes of morbidity (68.4%) and mortality (74.2%) especially diarrhoeal lower respiratory tract infections and protein-energy malnutrition. There was particularly among male high infant morbidity and mortality rates observed from 2000 to 2004. Non-communicable diseases (8% morbidity and 4.2% mortality) and injuries (10% morbidity and 4.4% mortality) appeared to be of less public health concern among the under-5 children. Majority of under-5 mortality (43.4%) occurred within 24 hours of admissions (23.7% died on arrival). Influential variables for morbidity and mortality were region (Eastern), age (infants), year admitted and broad classification of the diseases (group I causes). There was a constant increase in morbidity and mortality which was observed during studied period. Conclusion: Pre-transitional causes (especially diarrhoeal, lower respiratory tract infections and protein energy malnutrition) were of public health concern among the under-5 children and their magnitude has increased over the years studied. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / Clinical Epidemiology / unrestricted

Background: Arm morbidity continues to impact the lives of many breast cancer survivors long after acute treatments are completed. The most debilitating symptoms of arm morbidity are pain, lymphedema and limitation with range of motion (ROM). As a chronic condition, management of arm morbidity symptoms requires survivors to engage in self-management practices that alleviate symptoms. Objective: To explore self-management practices performed by breast cancer survivors, and the treatments women receive from healthcare practitioners in managing symptoms of arm morbidity. Methods: A secondary analysis of quantitative and qualitative data was undertaken. A descriptive correlational design was used to analyze data from breast cancer survivors (N = 740). Logistic regression identified variables related to self-management that were associated with pain, lymphedema and ROM limitations. A descriptive qualitative design was used to analyze data from a subset of participants (n = 40). Inductive content analysis approach was applied to develop codes, categories and themes related to how women self-manage arm morbidity symptoms and the treatments they received from healthcare providers to manage their arm morbidity. Results: Participants reported ongoing symptoms of pain (24%), lymphedema (21%), and range of motion limitation (34%) 30 to 36 months post-surgery. Pain was associated with experiencing swelling, taking pain medications, and discussing treatments for pain. Lymphedema was associated with swelling and receiving treatment for pain. ROM limitations were associated with swelling, receiving treatment for pain and taking pain medication. Two overarching qualitative themes emerged: 1) physical symptoms self-management, and 2) psychosocial self-management of uncertainty. Themes for treatments options included: rehabilitation and taking medications. Conclusion: Findings highlight that women living with symptoms of arm morbidity require ongoing monitoring and support for self-management, and there is a need for multidisciplinary approaches. Self-management practices reported are in line with the current lymphedema guidelines, however, the complexities associated with self-management practices can be burdensome to women. Chronic pain and ROM limitation necessitates further investigation to understand their cause and develop management strategies. Oncology nurses are well positioned to implement survivorship care plans that address survivorship needs with multidisciplinary teams and primary healthcare practitioners when women with breast cancer transition from acute cancer care to home. Future research is needed to provide an in depth understanding of self-management of arm morbidity in breast cancer survivors.