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Academic literature on the topic 'Epidemiology Case studies'

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Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Epidemiology Case studies"

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Shapiro, Eugene D. "Analytic Strategies in Hospital Epidemiology: Case-Control Studies." Infection Control & Hospital Epidemiology 10, no. 4 (April 1989): 167–69. http://dx.doi.org/10.1086/645993.

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Case-control studies (sometimes referred to as case-referent studies) have long been important in epidemiologic research. This technique has been instrumental in allowing researchers to discover the associations between cigarettes and lung cancer, thromboembolism and oral contraceptives, and stilbesterol and vaginal cancer, just to cite a few examples. The case-control method is also a very useful technique for studies in hospital epidemiology. This article will briefly review this technique, its advantages, and some of its potential pitfalls.
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Wecht, Cyril H., and Steven A. Koehler. "Case Studies in Forensic Epidemiology." Journal of Legal Medicine 24, no. 4 (December 2003): 587–94. http://dx.doi.org/10.1080/714044492.

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Stang, Andreas, and Karl-Heinz Jöckel. "Appending Epidemiological Studies to Conventional Case–Control Studies (Hybride Case–Control Studies)." European Journal of Epidemiology 19, no. 6 (June 2003): 527–32. http://dx.doi.org/10.1023/b:ejep.0000032380.03554.9f.

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K??nzli, Nino, and Christian Schindler. "Case???Crossover Studies." Epidemiology 16, no. 4 (July 2005): 592–93. http://dx.doi.org/10.1097/01.ede.0000165792.14924.f1.

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Sullivan, Jeffrey, Lianne Sheppard, Astrid Schreuder, and Joel Kaufman. "Case???Crossover Studies." Epidemiology 16, no. 4 (July 2005): 593. http://dx.doi.org/10.1097/01.ede.0000165815.89253.25.

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Sanders, Joseph. "Review of: Case Studies in Forensic Epidemiology." Journal of Forensic Sciences 49, no. 4 (2004): 1. http://dx.doi.org/10.1520/jfs2004086.

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Langholz, Bryan. "Case-Control Studies = Odds Ratios." Epidemiology 21, no. 1 (January 2010): 10–12. http://dx.doi.org/10.1097/ede.0b013e3181c308f5.

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Wang, Shirley V., Joshua J. Gagne, Robert J. Glynn, and Sebastian Schneeweiss. "Case-crossover Studies of Therapeutics." Epidemiology 24, no. 3 (May 2013): 375–78. http://dx.doi.org/10.1097/ede.0b013e31828ac9cb.

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Frombier, D. J. "Case-control studies of screening." Journal of Clinical Epidemiology 41, no. 1 (January 1988): 101. http://dx.doi.org/10.1016/0895-4356(88)90015-7.

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CUMMING, ROBERT L., and JENNIFER L. KELSEY. "Case-control studies." International Journal of Epidemiology 18, no. 3 (1989): 725–26. http://dx.doi.org/10.1093/ije/18.3.725.

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Dissertations / Theses on the topic "Epidemiology Case studies"

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Haneuse, Sebastian J. P. A. "Ecological studies using supplemental case-control data /." Thesis, Connect to this title online; UW restricted, 2004. http://hdl.handle.net/1773/9595.

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Hein, Misty. "Occupational Cohort Studies and the Nested Case-Control Study Design." University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1250795434.

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Andric, Nikola. "Exploring Objective Causal Inference in Case-Noncase Studies under the Rubin Causal Model." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17467481.

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Case-noncase studies, also known as case-control studies, are ubiquitous in epidemiology, where a common goal is to estimate the effect of an exposure on an outcome of interest. In many areas of application, such as policy-informing drug utilization research, this effect is inherently causal. Although logistic regression, the predominant method for analysis of case-noncase data, and other traditional methodologies, may provide associative insights, they are generally inappropriate for causal conclusions. As such, they fail to address the very essence of many epidemiological investigations that employ them. In addition, these methodologies do not allow for outcome-free design (Rubin, 2007) of case-noncase data, which compromises the objectivity of resulting inferences. This thesis is directed at exploring what can be done to preserve objectivity in the causal analysis of case-noncase study data. It is structured as follows. In Chapter 1 we introduce a formal framework for studying causal effects from case-noncase data, which builds upon the well-established Rubin Causal Model for prospective studies. In Chapter 2 we propose a two-party, three-step methodology — PrepDA — for objective causal inference with case-noncase data. We illustrate the application of our methodology in a simple non-trivial setting. Its operating characteristics are investigated via simulation, and compared to those of logistic and probit regression. Chapter 3 focuses on the re-analysis of a subset of data from a published article, Karkouti et al. (2006). We investigate whether PrepDA and logistic regression, when applied to case-noncase data, can generate estimates that are concordant with those from the causal analysis of prospectively collected data. We introduce tools for covariate balance assessment across multiple imputed datasets. We explore the potential for analyst bias with logistic regression, when said method is used to analyze case-noncase data. In Chapter 4 we discuss our technology’s advantages over, and drawbacks as compared to, traditional approaches.
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Hansson, Lisbeth. "Statistical Considerations in the Analysis of Matched Case-Control Studies. With Applications in Nutritional Epidemiology." Doctoral thesis, Uppsala University, Department of Information Science, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-1092.

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The case-control study is one of the most frequently used study designs in analytical epidemiology. This thesis focuses on some methodological aspects in the analysis of the results from this kind of study.

A population based case-control study was conducted in northern Norway and central Sweden in order to study the associations of several potential risk factors with thyroid cancer. Cases and controls were individually matched and the information on the factors under study was provided by means of a self-completed questionnaire. The analysis was conducted with logistic regression. No association was found with pregnancies, oral contraceptives and hormone replacement after menopause. Early pregnancy and artificial menopause were associated with an increased risk, and cigarette smoking with a decreased risk, of thyroid cancer (paper I). The relation with diet was also examined. High consumption with fat- and starch-rich diet was associated with an increased risk (paper II).

Conditional and unconditional maximum likelihood estimations of the parameters in a logistic regression were compared through a simulation study. Conditional estimation had higher root mean square error but better model fit than unconditional, especially for 1:1 matching, with relatively little effect of the proportion of missing values (paper III). Two common approaches to handle partial non-response in a questionnaire when calculating nutrient intake from diet variables were compared. In many situations it is reasonable to interpret the omitted self-reports of food consumption as indication of "zero-consumption" (paper IV).

The reproducibility of dietary reports was presented and problems for its measurements and analysis discussed. The most advisable approach to measure repeatability is to look at different correlation methods. Among factors affecting reproducibility frequency and homogeneity of consumption are presumably the most important ones (paper V). Nutrient variables can often have a mixed distribution form and therefore transformation to normality will be troublesome. When analysing nutrients we therefore recommend comparing the result from a parametric test with an analogous distribution-free test. Different methods to transform nutrient variables to achieve normality were discussed (paper VI).

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R, Machado-Rivera, Rolando Machado-Rivera, and E. Mezones-Holguín. "Are directed acyclic graphs (DAGS) an important tool to perform observational studies? reflections from a case in burned patients." Mediterranean Club for Burns and Fire Disasters, 2018. http://hdl.handle.net/10757/624669.

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Pisani, Elizabeth. "Back to basics : putting the epidemiology back into planning and monitoring HIV prevention programmes : case studies in Indonesia." Thesis, London School of Economics and Political Science (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430790.

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Pina, Juliana Coelho. "Abordagem hierarquizada para a identificação de fatores associados à hospitalização por pneumonia, em menores de cinco anos de idade: estudo caso-controle." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-21052014-191538/.

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Objetivos: Investigar os fatores associados à hospitalização por pneumonia, em crianças menores de cinco anos de idade, no município de Ribeirão Preto - SP. Métodos: Estudo epidemiológico com delineamento do tipo caso-controle de base hospitalar, com alocação de 345 casos e 345 controles. Fatores socioeconômicos, reprodutivos, ambientais, perinatais, nutricionais, relativos ao cuidado à criança e à morbidade prévia foram considerados variáveis explanatórias. Os dados foram coletados por meio da aplicação de um questionário pré-codificado que contemplou o elenco de variáveis do estudo, incluindo-se o Instrumento de Avaliação da APS - PCATool. Odds ratios (OR) brutos e ajustados, com respectivos intervalos de confiança (95%) foram calculados, aplicando-se a regressão logística multivariada e seguindo-se os pressupostos da abordagem hierarquizada, buscando-se um modelo explicativo que contemplasse as relações hierárquicas existentes entre as exposições e o desfecho, sendo as análises desenvolvidas no software STATA, versão 12.0. Resultados: Renda familiar superior a R$700,00 foi responsável por uma redução de 32% na chance de hospitalização das crianças por pneumonia (OR=0,68; IC95%=0,47-0,98). Paridade >=2 representou um expressivo aumento na chance de hospitalização (categoria 2 partos: OR=4,60, IC95%=2,18-9,72; categoria >=3 partos: OR=3,25, IC95%=1,55-6,81), enquanto o intervalo interpartal >=48 meses e o ganho de peso na gestação de 10 Kg ou mais apresentaram efeito protetor para o desfecho (OR=0,28, IC95%=0,14-0,56 e OR=0,68, IC95%=0,47-0,97, respectivamente). Frequência à creche foi responsável por um aumento de 67% na chance de hospitalização por pneumonia (OR=1,67, IC95%=1,16-2,41). As crianças desnutridas apresentam uma chance duas vezes maior de serem hospitalizadas pela doença (OR=2,53; IC=1,06-6,05) enquanto aquelas com excesso de peso apresentam uma redução de 63% nessa chance (OR=0,37; IC=0,14-0,99); no entanto, questiona-se a plausibilidade biológica desse efeito protetor. A situação vacinal não atualizada foi responsável por um aumento de quase 3 vezes na chance de hospitalização por pneumonia (OR=2,81; IC=1,76-4,49). As crianças que fizeram uso pregresso de medicamentos apresentaram uma chance 67% maior de serem hospitalizadas por pneumonia (OR=1,67; IC=1,00-2,78; p=0,049). Crianças com sibilância prévia apresentaram o dobro de chance de serem hospitalizadas pela doença (OR categoria 1 episódio = 2,13; IC95%=1,31-3,47; OR categoria >=3 episódios = 2,37; IC95%=1,35-4,15). A exclusão de pneumonias aspirativas dentre os casos pode ter contribuído para uma maior proporção de crianças com refluxo referido entre os controles, levando a uma associação inversa à esperada (efeito de proteção) entre refluxo gastroesofágico e hospitalização por pneumonia (OR=0,55; IC=0,31-0,99). Escores Essenciais da APS acima de 3,17 foram responsáveis por um efeito protetor em relação à hospitalização por pneumonia, reduzindo as chances de hospitalização em 43% (OR para a categoria >3,41 = 0,57; IC=0,32-0,99) a 50% (OR para a categoria >3,17 e <=3,41 = 0,50; IC=0,28-0,88). Conclusões: O modelo explicativo obtido pelo presente estudo é composto, em grande parte, por variáveis relacionadas ao cuidado à criança ou às características da mãe e da família. Considerando-se os procedimentos referentes ao planejamento do estudo, à execução da coleta de dados e às análises estatísticas empregadas, reitera-se a consecução de validade interna para o estudo, sendo possível afirmar que o modelo obtido é explicativo do fenômeno da hospitalização por pneumonia, na população estudada.
Objectives: To investigate the factors associated with hospitalization due to pneumonia in children under five years of age in the city of Ribeirão Preto - SP, Brazil. Methods: Epidemiological study with a hospital-based case-control design, including 345 cases and 345 controls. Socioeconomic, reproductive, environmental, perinatal, nutritional, childcare and previous morbidity factors were considered as explanatory variables. The data were collected through the application of a pre-coded questionnaire that addressed the study variables and included the Primary Care Assessment Tool - PCATool. Gross and adjusted odds ratios (OR) were calculated with their respective confidence intervals (95%), applying multivariate logistic regression in accordance with the premises of the hierarchized approach, looking for an explanatory model that considered the existing hierarchical relations between the exposures and the outcome. The analyses were developed in STATA software, version 12.0. Results: A family income superior to R$700 was responsible for a 32% reduction in children\'s chance of hospitalization due to pneumonia (OR=0.68; 95%CI=0.47-0.98). Parity>=2 represented a considerable increase in the chance of hospitalization (category 2 births: OR=4.60, 95%CI=2.18-9.72; category >=3 births: OR=3.25, 95%CI=1.55-6.81), while the inter-birth interval >=48 months and the weight gain of 10 Kg or more during pregnancy represented a protective effect against the outcome (OR=0.28, 95%CI=0.14-0.56 and OR=0.68, 95%CI=0.47-0.97, respectively). Attending kindergarten was responsible for a 67% increase in the chance of hospitalization due to pneumonia (OR=1.67, 95%CI=1.16-2.41). Malnourished children present twice as many chances of being hospitalized due to the disease (OR=2.53; CI=1.06-6.05), while children with overweight present a 63% reduction in that chance (OR=0.37; CI=0.14-0.99); the biological plausibility of this protective effect is questioned though. An outdated vaccine situation was responsible for almost three times as many chances of hospitalization due to pneumonia (OR=2.81; CI=1.76-4.49). Children with earlier medication use revealed a 67% higher chance of being hospitalized due to pneumonia (OR=1.67; CI=1.00-2.78; p=0.049). Children with earlier wheezing presented twice as many chances of being hospitalized due to the disease (OR category 1 episode = 2.13; 95%CI=1.31-3.47; OR category >=3 episodes = 2.37; 95%CI=1.35-4.15). The exclusion of aspiration pneumonias from the cases may have contributed to a greater proportion of children with reflux among the control, leading to an inverse association (protective effect) between gastroesophageal reflux and hospitalization due to pneumonia (OR=0.55; CI=0.31-0.99). Essencial Scores of PHC superior to 3.17 were responsible for a protective effect with regard to hospitalization due to pneumonia, reducing the chances of hospitalization by 43% (OR for the category >3.41 = 0.57; CI=0.32-0.99) to 50% (OR for the category >3.17 and <=3.41 = 0.50; CI=0.28-0.88). Conclusions: The explanatory model obtained in this study largely includes variables related to childcare or the mother\'s and family\'s characteristics. In view of the study planning and data collection procedures and the statistical analyses applied, the internal validity of the study is highlighted, based on which it can be affirmed that the obtained model explains the phenomenon of hospitalization due to pneumonia in the study population.
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Paiva, Júnior Francisco Pessoa de 1986. "Modelagens alternativas para a meningite no Maranhão." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/306456.

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Orientador: Rodney Carlos Bassanezi
Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Instituto de Matemática Estatística e Computação Científica
Made available in DSpace on 2018-08-27T10:26:23Z (GMT). No. of bitstreams: 1 PaivaJunior_FranciscoPessoade_M.pdf: 1984605 bytes, checksum: cff9b391d2d2e4dc68ca2d19ce4e20a8 (MD5) Previous issue date: 2015
Resumo: A modelagem matemática epidemiológica constitui uma ferramenta importante para o estudo do comportamento de doenças, entre outras coisas, ela é capaz de analisar a forma de propagação e apontar meios eficazes para a prevenção e erradicação dessas doenças. Tal modelagem é feita através do estudo de sistemas de equações diferenciais que descrevem a interação entre a população e a doença. Com base nisso este trabalho tem como objetivo determinar modelos matemáticos alternativos para o estudo do número de casos de Meningite ocorridos no Estado do Maranhão nos anos de 2001 a 2012. Este trabalho se divide em duas partes, na primeira delas será feito uma análise qualitativa dos modelos epidemiológicos matemáticos SI (Suscetível-Infectado), SIS (Suscetível-Infectado-Suscetível) e SIR (Suscetível-Infectado-Recuperado). Os modelos estudados foram analisados conforme a presença ou não de dinâmica vital, e ainda conforme os pontos de equilíbrio e o seu número de reprodutividade basal R0. Na segunda parte, os dados foram utilizados para formulação de 5 modelos alternativos para a doença, estes modelos diferenciam-se entre si, principalmente, por não haver uma constância no número de casos confirmados ano a ano; por isso, em alguns deles foram necessários utilizar equações que determinem uma certa periodicidade.Tais modelos propostos tem por objetivo fazer uma análise sobre a real situação da doença no estado e predizer o seu comportamento futuro, afim de que os resultados aqui encontrados sirvam de base para estudos posteriores
Abstract: The mathematical epidemiological modeling is an important tool for the study of behavior of behavior. Among other things, through this modeling we can analyze the form of disease spread and point effective means for its prevention and eradication. Such modeling is done through the study of systems of differential equations that describe the interaction between population and diseases. Based on that, this research aims to determine alternative mathematical models to study the number of cases of meningitis occurred in the state of Maranhão ¿ Brazil from 2001 to 2012. This work is divided into two parts. The first one will be a qualitative analysis of mathematical epidemiological models SI (Susceptible-Infected), SIS (Susceptible-Infected-Susceptible) and SIR (Susceptible-Infected-Recovered). The models were analyzed according to the presence or absence of vital dynamics, and as the points of balance and the number of basal reproducibility R0. In the second part, the data contained in were used for 05 (five) alternative models formulation. They differ from each other mainly because there is no consistency in the number of confirmed cases from year to year, so in some of them it was necessary to use equations to determine a certain periodicity. These proposed models aims to perform an analysis of the actual situation of the disease in the state and predict their future behavior, so that the present results can provide basis for further studies
Mestrado
Matematica Aplicada e Computacional
Mestre em Matemática Aplicada e Computacional
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Pinheiro, Luis Correia. "Vigilância activa de eventos após vacinação." Master's thesis, Faculdade de Ciências Médicas. Universidade Nova de Lisboa, 2008. http://hdl.handle.net/10362/4843.

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A vigilância de efeitos indesejáveis após a vacinação é complexa. Existem vários actores de confundimento que podem dar origem a associações espúrias, meramente temporais mas que podem provocar uma percepção do risco alterada e uma consequente desconfiança generalizada acerca do uso das vacinas. Com efeito as vacinas são medicamentos complexos com características únicas cuja vigilância necessita de abordagens metodológicas desenvolvidas para esse propósito. Do exposto se entende que, desde o desenvolvimento da farmacovigilância se tem procurado desenvolver novas metodologias que sejam concomitantes aos Sistemas de Notificação Espontânea que já existem. Neste trabalho propusemo-nos a desenvolver e testar um modelo de vigilância de reacções adversas a vacinas, baseado na auto-declaração pelo utente de eventos ocorridos após a vacinação e testar a capacidade de gerar sinais aplicando cálculos de desproporção a datamining. Para esse efeito foi constituída uma coorte não controlada de utentes vacinados em Centros de Saúde que foram seguidos durante quinze dias. A recolha de eventos adversos a vacinas foi efectuada pelos próprios utentes através de um diário de registo. Os dados recolhidos foram objecto de análise descritiva e análise de data-mining utilizando os cálculos Proportional Reporting Ratio e o Information Component. A metodologia utilizada permitiu gerar um corpo de evidência suficiente para a geração de sinais. Tendo sido gerados quatro sinais. No âmbito do data-mining a utilização do Information Component como método de geração de sinais parece aumentar a eficiência científica ao permitir reduzir o número de ocorrências até detecção de sinal. A informação reportada pelos utentes parece válida como indicador de sinais de reacções adversas não graves, o que permitiu o registo de eventos sem incluir o viés da avaliação da relação causal pelo notificador. Os principais eventos reportados foram eventos adversos locais (62,7%) e febre (31,4%).------------------------------------------ABSTRACT: The monitoring of undesirable effects following vaccination is complex. There are several confounding factors that can lead to merely temporal but spurious associations that can cause a change in the risk perception and a consequent generalized distrust about the safe use of vaccines. Indeed, vaccines are complex drugs with unique characteristics so that its monitoring requires specifically designed methodological approaches. From the above-cited it is understandable that since the development of Pharmacovigilance there has been a drive for the development of new methodologies that are concomitant with Spontaneous Reporting Systems already in place. We proposed to develop and test a new model for vaccine adverse reaction monitoring, based on self-report by users of events following vaccination and to test its capability to generate disproportionality signals applying quantitative methods of signal generation to data-mining. For that effect we set up an uncontrolled cohort of users vaccinated in Healthcare Centers,with a follow-up period of fifteen days. Adverse vaccine events we registered by the users themselves in a paper diary The data was analyzed using descriptive statistics and two quantitative methods of signal generation: Proportional Reporting Ratio and Information Component. themselves in a paper diary The data was analyzed using descriptive statistics and two quantitative methods of signal generation: Proportional Reporting Ratio and Information Component. The methodology we used allowed for the generation of a sufficient body of evidence for signal generation. Four signals were generated. Regarding the data-mining, the use of Information Component as a method for generating disproportionality signals seems to increase scientific efficiency by reducing the number of events needed to signal detection. The information reported by users seems valid as an indicator of non serious adverse vaccine reactions, allowing for the registry of events without the bias of the evaluation of the casual relation by the reporter. The main adverse events reported were injection site reactions (62,7%) and fever (31,4%).
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Xavier, Maria José Pinto Barreira Rego de Sousa. "Rastreio combinado do 1º trimestre e doenças autoimunes : Impacto das variaveis pré-analíticas na avaliação do risco." Doctoral thesis, Faculdade de Ciências Médicas, 2014. http://hdl.handle.net/10362/12156.

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RESUMO: Contexto: As anomalias congénitas, com particular destaque para as neuploidias , afectam aproximadamente 2% dos recém-nascidos, constituindo causas frequentes de morbilidade e mortalidade. Actualmente, a avaliação do grau de risco para as aneuploidias mais prevalentes (T21, T13, T18) é efectuada através do “Rastreio Combinado do 1º Trimestre”, devendo as grávidas com risco acrescido ser sujeitas a exames invasivos (ex.biópsia das vilosidades coriónicas,amniocentese). Quanto mais qualidade existir num rastreio, menos falsos positivos existirão e menor o número de exames diagnósticos invasivos desnecessários. As doenças autoimunes são doenças inflamatórias crónicas em cuja fisiopatologia se encontram distúrbios da imunidade humoral e celular, dependentes de factores genéticos, hormonais,psicológicos e ambientais. Atingem mais o sexo feminino e durante a idade fértil,podendo influenciar o outcome da gravidez e a saúde neonatal causando significativa morbilidade e mortalidade. O lúpus eritematoso sistémico para além de potencialmente afectado pelas alterações imunoendócrinas fisiológicas da gravidez, associa-se frequentemente a problemas de fertilidade. Recentemente, foi sugerido que as anormalidades ocorridas durante a invasão precoce do sinciciotrofoblasto, resultando em deficiente diferenciação, deficiente maturação e diminuição na produção de hCG, poderão ser o mecanismo fisiopatológico primário para as perdas fetais no primeiro trimestre, nos doentes com SLE. A ocorrência de níveis elevados de hCG total e ß-hCG livre no rastreio para despiste de síndrome de Down do segundo e do primeiro trimestre foi assinalada em grávidas portadoras de lúpus, mas a escassez de estudos comprovativos e a pequena dimensão das amostras estudadas constituiu uma limitação significativa na fidedignidade dos resultados obtidos. Objectivos: O estudo teve como objectivos i. estabelecer valores normativos Portugueses e de distribuição para as MoM’s dos parâmetros séricos do primeiro trimestre, por semana de gestação:(PAPP-A e ß-hCG livre), ii. avaliar a influência que as doenças autoimunes têm sobre as MoM’s individuais dos parâmetros bioquímicos PAPP-A e/ou ß-hCG livre, utilizados no rastreio pré-natal combinado do 1º trimestre, e iii. saber se as doenças autoimunes podem condicionar um aumento da taxa de resultados falsos positivos, com consequente aumento do número de amniocenteses. Metodologia: Estudo longitudinal prospectivo, consistindo num rastreio pré-natal combinado de 1º trimestre para pesquisa de aneuploidias, em duas amostras provenientes do Reino Unido (n= 45,854) e de Portugal (n=3122). Foram avaliados parâmetros socio-demográficos, ecográficos, laboratoriais, e calculados os indicadores de desempenho do rastreio combinado. A execução analítica dos testes bioquímicos séricos (PAPP-A e ß-hCG livre) foi realizada no autoanalisador Brahms Kryptor e no autoanalizador 6000 Delfia Xpress. Compararam-se os grupos autoimune e não autoimune das amostras. Resultados: Relativamente às características populacionais, o grupo auto imune tinha valores significativamente superiores nas variáveis idade materna e idade gestacional. Comparando os grupos com e sem doença autoimune, constatou-se a existência de uma elevação das MoM’s da ß-hCG livre nas grávidas com doença autoimune, nomeadamente nos casos de lúpus eritematoso sistémico. Conclusões: os resultado obtidos reforçam a indicação do rastreio combinado do 1º trimestre certificado pela FMF nas grávidas com doenças autoimunes, nomeadamente para as doentes com LES; no entanto, devem ser calculados e introduzidos factores de correcção no algoritmo de risco, de modo a evitar a subida no número de resultados falso-positivos, e consequentemente a sobre- utilização de métodos invasivos.------------ ABSTRACT: Context: Congenital anomalies, with particular reference to aneuploidias, affect approximately 2% of newborns, and are frequent causes of morbidity and mortality. Currently, the risk evaluation for the most prevalent aneuploidias (T21, T13, T18) is carried out through the “combined first trimester screening”, and pregnant women with increased risk are subjected to invasive tests (e.g. villus biopsy done, amniocentesis). The more quality exists in a screening, less false positives exists and fewer unnecessary invasive diagnostic exams. Autoimmune diseases are chronic inflammatory diseases in whose pathophysiology are immune humoral and cellular disorders, dependent on genetic factors, hormonal, psychological and environmental factors. The disease is more prevalent among females, during the child-bearing age, and may influence the outcome of pregnancy and neonatal health causing significant morbidity and mortality. Lupus Erythematosus in addition to potentially affected by immunoendocrine physiological changes of pregnancy, is often associated with fertility problems. Recently, it has been suggested that the abnormalities that occurred during the early invasion of the syncytiotrophoblast, resulting in insufficient differentiation, deficient maturation and decrease in production of hCG may be the primary pathophysiological mechanism for fetal losses in the first quarter, in patients with SLE. The occurrence of elevated levels of total hCG and free ß-hCG in screening for Down’s syndrome of the second and first trimester was reported in pregnant women with lupus, but the paucity of supporting studies and the small size of the samples studied constituted a significant limitation on the trustworthiness of the results obtained. Objectives: this study aims to i. establish normative values for the serum parameters MoM’s (PAPP-A and free β-hCG) and it’s distribution, in the first trimester, by week of pregnancy; ii. assess the influence that the autoimmune diseases have on the MoM’s of individual biochemical PAPP-A and/or β-hCG, used in antenatal screening combined for the first trimester, and iii. whether the autoimmune diseases may make an increased rate of false positives, with consequent increase in the number of amniocenteses.Methodology: Prospective longitudinal study, consisting of a combined first trimester antenatal screening for aneuploidies lookup in two samples from the United Kingdom (n=45.854) and Portugal (n= 3.122). Socio-demographic, echographic and laboratory parameters were evaluated, and combined screening performance indicators were calculated. The analytical run of serum biochemical tests (PAPP-A and ß-hCG) was held at the Brahms Kryptor and in Delfia Xpress 6000. Comparisons between autoimmune group and non-autoimmune group were made. Results: Relating to population characteristics, the autoimmune group had significantly diferente values in the variables maternal age and gestational age. Comparing the groups with and without autoimmune disease, it was noted that there is an elevation of the MoM’s of free ß-hCG levels in pregnant women with autoimmune disease, particularly in cases of systemic lupus erythematosus. Conclusions: The results obtained reinforce the indication of FMF certified combined screening in pregnant women with autoimmune diseases, notably to the patients with SLE; However, correction factors should be calculated and entered in the risk algorithm, in order to avoid the rise in the number of false positive results, and consequently the over-use of invasive methods.
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Books on the topic "Epidemiology Case studies"

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Case studies in forensic epidemiology. New York: Kluwer Academic/Plenum Publishers, 2002.

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Biosurveillance: Methods and case studies. Boca Raton: Chapman & Hall/CRC, 2011.

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Norell, Staffan E. A short course in epidemiology. New York: Raven Press, 1992.

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A short course in epidemiology. New York: Raven Press, 1992.

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Coughlin, Steven S. Case studies in public health ethics. 2nd ed. Washington, DC: American Public Health Association, 2009.

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Association, American Public Health, ed. Case studies in public health ethics. 2nd ed. Washington, DC: American Public Health Association, 2009.

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L, Soskolne Colin, and Goodman Kenneth W. 1954-, eds. Case studies in public health ethics. Washington, D.C: American Public Health Assoc., 1997.

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Yuejuan, Liao, and Lai Jun, eds. Yi xue shen tan. Taibei Shi: Tian xia yuan jian chu ban gu fen you xian gong si, 2006.

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The medical detectives. New York, N.Y., U.S.A: Truman Talley Books/Plume, 1988.

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Tu fa gong gong wei sheng shi jian ying dui: Xian dai qi shi lu. Beijing Shi: Ren min wei sheng chu ban she, 2009.

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Book chapters on the topic "Epidemiology Case studies"

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Kestenbaum, Bryan. "Case-Control Studies." In Epidemiology and Biostatistics, 17–19. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-97433-0_6.

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Kestenbaum, Bryan. "Case-Control Studies." In Epidemiology and Biostatistics, 45–57. New York, NY: Springer New York, 2009. http://dx.doi.org/10.1007/978-0-387-88433-2_6.

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Breslow, Norman E. "Case-Control Studies." In Handbook of Epidemiology, 293–323. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-0-387-09834-0_7.

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Kestenbaum, Bryan. "Case-Control Studies." In Epidemiology and Biostatistics, 63–78. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-96644-1_7.

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Stewart, Antony. "Case-control studies." In Basic Statistics and Epidemiology, 121–23. 5th ed. London: CRC Press, 2022. http://dx.doi.org/10.1201/9781003148111-30.

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Kramer, Michael S. "Case-Control Studies." In Clinical Epidemiology and Biostatistics, 93–112. Berlin, Heidelberg: Springer Berlin Heidelberg, 1988. http://dx.doi.org/10.1007/978-3-642-61372-2_8.

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Olsen, Jørn, Kaare Christensen, Jeff Murray, and Anders Ekbom. "Case–Control Studies." In An Introduction to Epidemiology for Health Professionals, 67–78. New York, NY: Springer New York, 2010. http://dx.doi.org/10.1007/978-1-4419-1497-2_10.

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Garhöfer, Gerhard, and Leopold Schmetterer. "Epidemiology and Biostatistics." In Clinical Pharmacology: Current Topics and Case Studies, 219–32. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-27347-1_14.

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Garhöfer, Gerhard, and Leopold Schmetterer. "Epidemiology and bio statistics." In Clinical Pharmacology: Current Topics and Case Studies, 167–80. Vienna: Springer Vienna, 2010. http://dx.doi.org/10.1007/978-3-7091-0144-5_12.

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Wallace, Robert B. "Conducting Case-Control and Cohort Studies in Older Adults." In The Epidemiology of Aging, 15–26. Dordrecht: Springer Netherlands, 2012. http://dx.doi.org/10.1007/978-94-007-5061-6_2.

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Conference papers on the topic "Epidemiology Case studies"

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Pasquet, Romain, Emmanuelle Batisse, France Labrèche, Mark Goldberg, and Vikki Ho. "P-334 Occupational exposures experienced by Montréal women participating in two case-control studies." In 28th International Symposium on Epidemiology in Occupational Health (EPICOH 2021). BMJ Publishing Group Ltd, 2021. http://dx.doi.org/10.1136/oem-2021-epi.274.

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Oorburg, D., H. J. Wisselink, C. B. van Solt-Smits, A. Hiller, Lourens Heres, and B. A. P. Urlings. "Case studies: Tuberculination in pig herds suspected of infection with Mycobacterium avium." In Ninth International Conference on the Epidemiology and Control of Biological, Chemical and Physical Hazards in Pigs and Pork. Iowa State University, Digital Press, 2011. http://dx.doi.org/10.31274/safepork-180809-617.

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Lowe, G. D. O. "EPIDEMIOLOGY AND RISK PREDICTION OF VENOUS THROMBOEMBOLISM." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642965.

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Uses of epidemiology. Venous thromboembolism continues to be an important cause of death and disability in Western Countries. Its epidemiology may provide clues to etiology, e.g. the increased incidence in oral contraceptive users, and the low prevalence at autopsy in Central Africa or Japan compared to the U.S.A. A second use is the monitoring of time-trends: the diagnosis of pulmonary embolism increased during the 1970s, although the case fatality decreased. A third use is the identification and quantification of risk factors: these could be modified in the hope of prevention, or else used to select high risk groups for selective prophylaxis, e.g. during acute illness. Prevention is the only feasible approach to reducing the burden of venous thromboembolism, since most cases are not diagnosed, and since the value of current treatment is debatable.Case definition. Presents problems: clinical diagnosis is unreliable, and should if possible be supported by objective methods. Autopsy studies are performed on selected populations, at a decreasing rate; the frequency of thromboembolism depends on technique; and pathologists cannot be blinded and are open to bias. It can also be difficult to judge whether a patient dying with pulmonary embolism died from pulmonary embolism. 125I-fibrinogen scans indicate minimal disease, and now present ethical problems in screening due to risks of viral transmission. Venography is invasive and is not readily repeatable, which limits its use as a screening method. Plethysmography merits wider evaluation, since it is non-invasive, and sensitive to major thrombosis.Community epidemiology. Data on the community epidemiology are limited. The risk increases with age. When age is taken into account, there is little sex difference. Overweight in women, use of oral contraceptives and blood group A increase the risk: smoking, varicose veins, blood pressure, cholesterol and glucose do not, on current evidence. Long-term follow-up of patients with proven thromboembolism shows an increased risk of malignancy, hence occult cancer may also be a risk factor. Polycythaemia and certain congenital deficiencies (e.g. antithrombin III) are also well-recognised risk factors, although uncommon.Hospital epidemiology. Data on hospital epidemiology are derived largely from autopsy prevalence, and from short-term incidence of minimal thrombosis detected by 125I—fibrinogen scanning. Old, immobile and traumatised patients are most at risk. Previous thromboembolism, polycythaemia, antithrombin III deficiency, hip and leg fractures, elective hip and leg surgery, hemiplegia, paraplegia, and heart failure carry high risks, and merit consideration for routine prophylaxis. The risk in elective surgery precedes the operation, and increases with age, overweight, malignancy, varicose veins, non-smoking, and operative factors (duration, approach, general anaesthesia, intravenous fluids). Diabetics appear to have no extra risk. Combinations of clinical variables can be used to predict high risk groups for selective prophylaxis, but combination indices require further study. Laboratory variables may increase the predictability of deep vein thrombosis, but the results of published studies are conflicting, and the cost-effectiveness of laboratory prediction should be evaluated.
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Souza, Leandro Cândido de, Ricardo Santos de Oliveira, Francisco de Assis Carvalho do Vale, and Matheus Fernando Manzolli Ballestero. "Epidemiology of Pediatric Traumatic Brain Injury in Brazil." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.630.

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Background: Pediatric traumatic brain injury (TBI) is a serious social and economic problem. Emerging countries have 89% of the cases worldwide and lack relevant epidemiological studies on the subject. Objectives: Characterize the demographic, social and economic profiles of the pediatric population suffering TBI in Brazil. Methods: Data on the cases of pediatric TBI in Brazil between 2008 and 2020 were collected through the computer department of the Unified Health System (DATASUS) maintained by the Brazilian Ministry of Health. Results: There are about 28,836 hospital admissions due to pediatric TBI per year and an incidence of 45.11 admissions /100,000/year. The in-hospital mortality rate was 1.47/100,000/year, and the case fatality rate was 3.26%. The average annual cost of hospital expenses was US$ 12.311.759, with the average admission cost having a value of US $417. The 15–19 age group was the most frequently admitted to hospital for pediatric TBI and had the highest number of in- hospital deaths; in addition, more males were affected by this trauma compared to females at a rate of 2.31:1. Ethnic populations that are social minorities are more susceptible to a poor prognosis of TBI. Conclusion: Pediatric TBI should be recognized as an important public health problem in Brazil, as it is responsible for considerable social and economic costs. Public policies that reduce the causes of this type of trauma in the pediatric population are urgently needed in Brazil and other emerging countries.
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Grace, D., F. Unger, K. Roesel, G. Tinega, D. Ndoboli, D. X. Sinh, H. Nguyen-Viet, and T. Robinsion. "Present and future use of antimicrobials in pigs in developing countries and case studies from Uganda and Vietnam." In Fourth International Symposium on the Epidemiology and Control of Salmonella and Other Food Borne Pathogens in Pork. Iowa State University, Digital Press, 2015. http://dx.doi.org/10.31274/safepork-180809-261.

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Lückstädt, C., and P. Theobald. "Control of E. coli and Salmonella in growing-finishing pigs through the use of potassium diformate (KDF) – European case studies." In Ninth International Conference on the Epidemiology and Control of Biological, Chemical and Physical Hazards in Pigs and Pork. Iowa State University, Digital Press, 2011. http://dx.doi.org/10.31274/safepork-180809-693.

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Hosseini, Bayan, Joachim Schüz, and Ann Olsson. "AN INVENTORY OF OCCUPATIONAL CANCER STUDIES AND THEIR EXPOSURE ASSESSMENT METHODS IN IRAN." In The 16th «OCCUPATION and HEALTH» Russian National Congress with International Participation (OHRNC-2021). FSBSI “IRIOH”, 2021. http://dx.doi.org/10.31089/978-5-6042929-2-1-2021-1-612-616.

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Abstract: Introduction: The presence of occupational carcinogens in workplaces in Iran is not well characterized, and little is known about the burden of occupational cancer in Iran and other Middle East countries. Objectives: This study aimed to provide an overview of exposure assessments used in or informative for epidemiological studies on occupational cancer in Iran. Methods: Studies estimating occupational exposures applied to or informative for occupational cancer risk up to January 2021 in Iran were identified through different databases. Results: Forty-nine publications from 2009 to 2020 were included. The exposure monitoring studies were conducted mainly in gasoline refueling stations, foundries, construction industry, and manufacturing, and some of the case-control studies also reported increased risk of cancers in relation to work in those industries. Conclusion: Occupational cancer epidemiology in Iran is at an early stage. Both epidemiological and exposure monitoring studies are generally limited in size to provide robust evidence. A coherent strategy to estimate the occupational cancer burden in Iran should start with systematic monitoring of occupational carcinogens for use in hazard control and research.
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Souza, Felipe dos Santos, and Alvaro Moreira Rivelli. "Bobble Head Doll Syndrome: what have we described in the scientific literature?" In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.016.

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Introduction: The bobble head syndrome (BHDS) is described in the literature as a complex and rare syndrome with repetitive movements of the anteroposterior head. Furthermore, it is known that this movement disorder is due to the effect of pressure from the third dilated ventricle, which distorts the red dorsomedial nucleus and the dentatorubrotalamic pathways. Objective: to evaluate the number of studies on the syndrome and, added to the findings, describe the manifestations about the Bobble Head Doll Syndrome, elucidating the main neurological exams, treatments used and reported prognoses, in order to make it a potential diagnosis in children who present a compatible clinic. Methodology: a systematic review based on databases (SCIELO <LILACS and PUBMED), using the PRISMA method with the following descriptor: Bobble Head Doll Syndrome. The selection criteria included: studies made available in full, case reports, reviews and clinical trials. Exclusion criteria: articles not available in full, duplicates and works that only touched on the theme. Results: it was found in the scientific literature, PUBMED: 52 studies and SCIELO: 0. SCIELO: 2. Conclusions: the articles selected based on the established criteria showed a significant scientific scarcity around the Bobble Head Doll Syndrome. The dissemination of new studies and documentation of case reports is essential in understanding both the general syndrome and the specific knowledge of the procedures in which neurologists must take it. In this sense, the epidemiology is approximately between 2 and less than 5 years of age in children.
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Utterback, D., K. Fraeman, J. Quarantillo, and J. Rayner. "323. PC Database for Industrial Hygiene Measurement Data: A General Application for Occupational Epidemiologic Studies." In AIHce 1996 - Health Care Industries Papers. AIHA, 1999. http://dx.doi.org/10.3320/1.2764999.

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Meade, T. W. "THE EPIDEMIOLOGY OF HAEMOSTATIC AND OTHER VARIABLES IN CORONARY ARTERY DISEASE." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643833.

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The increase in the clinical manifestations of coronary artery disease (CAD) since the 1920s cannot be explained solely in terms of atheroma. Another major process such as thrombogenesis must also be involved. Pathological studies show that thrombosis contributes not only to myocardial infarction but to nearly all cases of sudden coronary death as well. Epidemiologically, it is the coagulation system rather than platelet function that has so far been more rewarding in attempting to identify characteristics of the haemostatic system that are associated with the subsequent risk of CAD. In particular, two clotting factors - factor VII coagulant activity, VIIc, and fibrinogen - may be involved. Factor VII has several characteristics that are required for a system to secure rapid haemostasis after injury. The question is whether an exaggeration of the physiological state of readiness implied by these features may predispose to thrombosis. There are at least four pathways through which high fibrinogen levels, however they are determined, may operate to increase the risk of CAD - involvement in atherogenesis, determination of blood and plasma viscosity, effects on platelet aggregability and an influence on the amount of fibrin formed. The prospective Northwick Park Heart Study (NPHS) has shown an association between high VIIc levels and an increased risk of CAD. NPHS and three other prospective studies have also demonstrated a clear association between high levels of plasma fibrinogen and an increased risk of CAD, this association generally being stronger than for more familiar markers of risk such as the blood cholesterol level. There may well be an interaction between fibrinogen and blood pressure, the occurrence of high levels of both increasing CAD or stroke risk to a greater extent than would be expected from the sum of their separate effects. Several pathological and clinical observations support a “hypercoagulable state” not simply as a concept but as a demonstrable abnormality in which characteristics of the circulating blood influence the course of events. These include the effects of anti-thrombotic agents (particularly oral anticoagulants) on re—infarction rates and the likelihood that high VIIc levels lead to increased levels of thrombin production. The general epidemiology of VIIc and fibrinogen is consistent with the view that high levels of each are of pathogenetic significance. Thus, increasing age, obesity, oral contraceptive usage, the occurrence of the menopause and diabetes are all associated with high levels of VIIc and fibrinogen and with an increased risk of CAD. Psychosocial influences may increase the risk of CAD through effects on the plasma fibrinogen level. There is strong evidence that dietary habit, particularly the consumption of fat, is a leading determinant of the VIIc level. A substantial proportion of the relationship between cigarette smoking and CAD is probably mediated through the plasma fibrinogen level. The most radical implication of a “hypercoagulable state” is for the pharmacological prophylaxis of CAD which, it may turn out, is better approached by anti—thrombotic measures than by the use of lipid-lowering agents.
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Reports on the topic "Epidemiology Case studies"

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Bhattarai, Sankalpa, Hsien-Yao Chee, Andrew Japri, Elvan Wiyarta, and Benjamin Anderson. The Epidemiology of Human Respiratory Viruses in Indonesia: A Systematic Review. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, November 2022. http://dx.doi.org/10.37766/inplasy2022.11.0015.

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Review question / Objective: To identify published articles related to the epidemiology of human respiratory viruses in Indonesia. Condition being studied: Viral respiratory disease among humans in Indonesia. Eligibility criteria: The inclusion and exclusion criteria for English and Indonesian language journal articles included published scientific journal entries which were also epidemiological investigations or clinical case reports conducted on humans in Indonesia. All reviews, commentaries, perspectives, and personal opinions were excluded, along with any entry that was a diagnostic assay evaluation.
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Liang, R., D. Liu, HB Li, and ZG Zhai. The efficacy and safety of traditional Chinese medicine formulas in the treatment of chronic obstructive pulmonary disease complicated with pulmonary hypertension: a systematic review and meta-analysis study. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2022. http://dx.doi.org/10.37766/inplasy2022.10.0041.

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Review question / Objective: This systematic review and meta-analysis was intended to evaluate the efficacy and safety of traditional Chinese medicine(TCM) formulas in the treatment of chronic obstructive pulmonary disease(COPD) complicated with pulmonaryhypertension (PH). Condition being studied: Chronic obstructive pulmonary disease(COPD) complicated with pulmonary hypertension(PH) is classified as the third group PH.According to epidemiology, the most common cause of PH associated with lung diseases and/or hypoxia is COPD, but the prevalence rate of COPD with PH range from 20% to 91% variously. In China, many TCM formulas are regularly used in COPD patients , thus TCM formulas therapy is worth considering.
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Jenkins, J. Lee, Edbert B. Hsu, Anna Russell, Allen Zhang, Lisa M. Wilson, and Eric B. Bass. Infection Prevention and Control for the Emergency Medical Services and 911 Workforce. Agency for Healthcare Research and Quality (AHRQ), November 2022. http://dx.doi.org/10.23970/ahrqepctb42.

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Objectives. To summarize current evidence on exposures to infectious pathogens in the emergency medical services (EMS) and 911 workforce, and on practices for preventing, recognizing, and controlling occupationally acquired infectious diseases and related exposures in that workforce. Review methods. We obtained advice on how to answer four Guiding Questions by recruiting a panel of external experts on EMS clinicians, State-level EMS leadership, and programs relevant to EMS personnel, and by engaging representatives of professional societies in infectious diseases and emergency medicine. We searched PubMed®, Embase®, CINAHL®, and SCOPUS from January 2006 to March 2022 for relevant studies. We also searched for reports from State and Federal Government agencies or nongovernmental organizations interested in infection prevention and control in the EMS and 911 workforce. Results. Twenty-five observational studies reported on the epidemiology of infections in the EMS and 911 workforce. They did not report demographic differences except for a higher risk of hepatitis C in older workers and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in minorities. EMS clinicians certified/licensed in Advanced Life Support have a high risk for blood and fluid exposure, and EMS clinicians had a higher risk of hospitalization or death from SARS-CoV-2 than firefighters whose roles were not primarily related to medical care. Eleven observational studies reported on infection prevention and control practices (IPC), providing some evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Research on IPC in EMS and 911 workers has increased significantly since the SARS-CoV-2 pandemic. Conclusions. Moderate evidence exists on the epidemiology of infections and effectiveness of IPC practices in EMS and 911 workers, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. Most evidence is observational, with widely varying methods, outcomes, and reporting. More research is needed on personal protective equipment effectiveness and vaccine acceptance, and better guidance is needed for research methods in the EMS and 911 worker setting.
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Shpigel, Nahum Y., Ynte Schukken, and Ilan Rosenshine. Identification of genes involved in virulence of Escherichia coli mastitis by signature tagged mutagenesis. United States Department of Agriculture, January 2014. http://dx.doi.org/10.32747/2014.7699853.bard.

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Mastitis, an inflammatory response of the mammary tissue to invading pathogenic bacteria, is the largest health problem in the dairy industry and is responsible for multibillion dollar economic losses. E. coli are a leading cause of acute mastitis in dairy animals worldwide and certainly in Israel and North America. The species E. coli comprises a highly heterogeneous group of pathogens, some of which are commensal residents of the gut, infecting the mammary gland after contamination of the teat skin from the environment. As compared to other gut microflora, mammary pathogenic E. coli (MPEC) may have undergone evolutionary adaptations that improve their fitness for colonization of the unique and varied environmental niches found within the mammary gland. These niches include competing microbes already present or accompanying the new colonizer, soluble and cellular antimicrobials in milk, and the innate immune response elicited by mammary cells and recruited immune cells. However, to date, no specific virulence factors have been identified in E. coli isolates associated with mastitis. The original overall research objective of this application was to develop a genome-wide, transposon-tagged mutant collection of MPEC strain P4 and to use this technology to identify E. coli genes that are specifically involved in mammary virulence and pathogenicity. In the course of the project we decided to take an alternative genome-wide approach and to use whole genomes bioinformatics analysis. Using genome sequencing and analysis of six MPEC strains, our studies have shown that type VI secretion system (T6SS) gene clusters were present in all these strains. Furthermore, using unbiased screening of MPEC strains for reduced colonization, fitness and virulence in the murine mastitis model, we have identified in MPEC P4-NR a new pathogenicity island (PAI-1) encoding the core components of T6SS and its hallmark effectors Hcp, VgrG and Rhs. Next, we have shown that specific deletions of T6SS genes reduced colonization, fitness and virulence in lactating mouse mammary glands. Our long-term goal is to understand the molecular mechanisms of host-pathogen interactions in the mammary gland and to relate these mechanisms to disease processes and pathogenesis. We have been able to achieve our research objectives to identify E. coli genes that are specifically involved in mammary virulence and pathogenicity. The project elucidated a new basic concept in host pathogen interaction of MPEC, which for the best of our knowledge was never described or investigated before. This research will help us to shed new light on principles behind the infection strategy of MPEC. The new targets now enable prevalence and epidemiology studies of T6SS in field strains of MPEC which might unveil new geographic, management and ecological risk factors. These will contribute to development of new approaches to treat and prevent mastitis by MPEC and perhaps other mammary pathogens. The use of antibiotics in farm animals and specifically to treat mastitis is gradually precluded and thus new treatment and prevention strategies are needed. Effective mastitis vaccines are currently not available, structural components and effectors of T6SS might be new targets for the development of novel vaccines and therapeutics.
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Yogev, David, Ricardo Rosenbusch, Sharon Levisohn, and Eitan Rapoport. Molecular Pathogenesis of Mycoplasma bovis and Mycoplasma agalactiae and its Application in Diagnosis and Control. United States Department of Agriculture, April 2000. http://dx.doi.org/10.32747/2000.7573073.bard.

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Mycoplasma bovis and M. agalactiae are two phylogenetically related mycoplasmas which cause economically significant diseases in their respective bovine or small ruminant hosts. These organisms cause persistent asymptomatic infections that can result in severe outbreaks upon introduction of carrier animals into susceptible herds. Little is known about the mechanisms underlying mycoplasma-host interaction, variation in virulence, or of the factors enabling avoidance of the host immune system. In recent years it has become apparent that the ability of pathogenic microorganisms to rapidly alter surface antigenic structures and to fine tune their antigenicity, a phenomena called antigenic variation, is one of the most effective strategies used to escape immune destruction and to establish chronic infections. Our discovery of a novel genetic system, mediating antigenic variation in M. bovis (vsp) as well as in M. agalactiae (avg) served as a starting point for our proposal which included the following objectives: (i) Molecular and functional characterization of the variable surface lipoproteins (Vsp) system of M. bovis and comparison with the Vsp-counterpart in M. agalactiae (ii) Determination of the role of Vsp proteins in the survival of M. bovis when confronted by host defense factors, (iii) Assessment of Vsp-based genetic and antigenic typing of M. bovis and M. agalactiae for epidemiology of infection and (iv) Improvement of diagnostic tests for M. bovis and M. agalactiae based on the vsp-and vsp-analogous systems. We have carried out an extensive molecular characterization of the vsp system and unravelled the precise molecular mechanism responsible for the generation of surface antigenic variation in M. bovis. Our data clearly demonstrated that the two pathogenic mycoplasma species possess large gene families encoding variable lipoprotein antigens that apparently play an important role in immune evasion and in pathogen-host interaction during infection. Phase variable production of these antigens was found to be mediated by a novel molecular mechanism utilizing double site-specific DNA inversions via an intermediate vsp configuration. Studies in model systems indicate that phase variation of VspA is relevant in interaction between M. bovis and macrophages or monocytes, a crucial stage in pathogenesis. Using an ELISA test with captured VspA as an antigen, phase variation was shown to occur in vivo and under field conditions. Genomic rearrangements in the avg gene family of M. agalactiae were shown to occur in vivo and may well have a role in evasion of host defences and establishment of chronic infection. An epidemiological study indicated that patterns of vsp-related antigenic variation diverge rapidly in an M. bovis infected herd. Marked divergence was also found with avg-based genomic typing of M. agalactiae in chronically infected sheep. However, avg-genomic fingerprints were found to be relatively homogeneous in different animals during acute stages of an outbreak of Contagious Agalactiae, and differ between unrelated outbreaks. These data support the concept of vsp-based genomic typing but indicate the necessity for further refinement of the methodology. The molecular knowledge on these surface antigens and their encoding genes provides the basis for generating specific recombinant tools and serological methods for serodiagnosis and epidemiological purposes. Utilization of these methods in the field may allow differentiating acutely infected herds from chronic herds and disease-free herds. In addition the highly immunogenic nature of these lipoproteins may facilitate the design of protective vaccine against mycoplasma infections.
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6

Grumet, Rebecca, and Benjamin Raccah. Identification of Potyviral Domains Controlling Systemic Infection, Host Range and Aphid Transmission. United States Department of Agriculture, July 2000. http://dx.doi.org/10.32747/2000.7695842.bard.

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Potyviruses form one of the largest and most economically important groups of plant viruses. Individual potyviruses and their isolates vary in symptom expression, host range, and ability to overcome host resistance genes. Understanding factors influencing these biological characteristics is of agricultural importance for epidemiology and deployment of resistance strategies. Cucurbit crops are subject to severe losses by several potyviruses including the highly aggressive and variable zucchini yellow mosaic virus (ZYMV). In this project we sought to investigate protein domains in ZYMV that influence systemic infection and host range. Particular emphasis was on coat protein (CP), because of known functions in both cell to cell and long distance movement, and helper component-protease (HC-Pro), which has been implicated to play a role in symptom development and long distance movement. These two genes are also essential for aphid mediated transmission, and domains that influence disease development may also influence transmissibility. The objectives of the approved BARD project were to test roles of specific domains in the CP and HC-Pro by making sequence alterations or switches between different isolates and viruses, and testing for infectivity, host range, and aphid transmissibility. These objectives were largely achieved as described below. Finally, we also initiated new research to identify host factors interacting with potyviral proteins and demonstrated interaction between the ZYMV RNA dependent RNA polymerase and host poly-(A)-binding protein (Wang et al., in press). The focus of the CP studies (MSU) was to investigate the role of the highly variable amino terminus (NT) in host range determination and systemic infection. Hybrid ZYMV infectious clones were produced by substituting the CP-NT of ZYMV with either the CP-NT from watermelon mosaic virus (overlapping, but broader host range) or tobacco etch virus (TEV) (non- overlapping host range) (Grumet et al., 2000; Ullah ct al., in prep). Although both hybrid viruses initially established systemic infection, indicating that even the non-cucurbit adapted TEV CP-NT could facilitate long distance transport in cucurbits, after approximately 4-6, the plants inoculated with the TEV-CPNT hybrid exhibited a distinct recovery of reduced symptoms, virus titer, and virus specific protection against secondary infection. These results suggest that the plant recognizes the presence of the TEV CP-NT, which has not been adapted to infection of cucurbits, and initiates defense responses. The CP-NT also appears to play a role in naturally occurring resistance conferred by the zym locus in the cucumber line 'Dina-1'. Patterns of virus accumulation indicated that expression of resistance is developmentally controlled and is due to a block in virus movement. Switches between the core and NT domains of ZYMV-NAA (does not cause veinal chlorosis on 'Dina-1'), and ZYMV-Ct (causes veinal chlorosis), indicated that the resistance response likely involves interaction with the CP-NT (Ullah and Grumet, submitted). At the Volcani Center the main thrust was to identify domains in the HC-Pro that affect symptom expression or aphid transmissibility. From the data reported in the first and second year report and in the attached publications (Peng et al. 1998; Kadouri et al. 1998; Raccah et al. 2000: it was shown that: 1. The mutation from PTK to PAK resulted in milder symptoms of the virus on squash, 2. Two mutations, PAK and ATK, resulted in total loss of helper activity, 3. It was established for the first time that the PTK domain is involved in binding of the HC-Pro to the potyvirus particle, and 4. Some of these experiments required greater amount of HC-Pro, therefore a simpler and more efficient purification method was developed based on Ni2+ resin.
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7

Evidence Synthesis and Meta-Analysis for Drug Safety. Council for International Organizations of Medical Sciences (CIOMS), 2016. http://dx.doi.org/10.56759/lela7055.

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At any point in the drug development process, systematic reviews and meta-analysis can provide important information to guide the future path of the development programme and any actions that might be needed in the post-marketing setting. This report gives the rationale for why and when a meta-analysis should be considered, all in the context of regulatory decision-making, and the tasks, data collection, and analyses that need to be carried out to inform those decisions. -- There is increasing demand by decision-makers in health care, the biopharmaceutical industry, and society at large to have access to the best available evidence on benefits and risks of medicinal products. The best strategy will take an overview of all the evidence and where it is possible and sensible, combine the evidence and summarize the results. For efficacy, the outcomes generally use the same or very similar predefined events for each of the trials to be included. Most regulatory guidance and many Cochrane Collaboration reviews have usually given more attention to assessment of benefits, while issues around combining evidence on harms have not been as well-covered. However, the (inevitably) unplanned nature of the data on safety makes the process more difficult. -- Combining evidence on adverse events (AEs), where these were not the focus of the original studies, is more challenging than combining evidence on pre-specified benefits. This focus on AEs represents the main contribution of the current CIOMS X report. The goal of the CIOMS X report is to provide principles on appropriate application of meta-analysis in assessing safety of pharmaceutical products to inform regulatory decision-making. This report is about meta-analysis in this narrow area, but the present report should also provide conceptually helpful points to consider for a wider range of applications, such as vaccines, medical devices, veterinary medicines or even products that are combinations of medicinal products and medical devices. -- Although some of the content of this report describes highly technical statistical concepts and methods (in particular Chapter 4), the ambition of the working group has been to make it comprehensible to non-statisticians for its use in clinical epidemiology and regulatory science. To that end, Chapters 3 and 4, which contain the main technical statistical aspects of the appropriate design, analysis and reporting of a meta-analysis of safety data are followed by Chapter 5 with a thought process for evaluating the findings of a meta-analysis and how to communicate these.
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