Effectiveness of chlamydia screening: systematic review

BACKGROUND: Screening programmes are promoted to control transmission of and prevent female reproductive tract morbidity caused by genital chlamydia. The objective of this study was to examine the effectiveness of register-based and opportunistic chlamydia screening interventions. METHODS: We searched seven electronic databases (Cinahl, Cochrane Controlled Trials Register, DARE, Embase, Medline, PsycINFO and SIGLE) without language restrictions from January 1990 to October 2007 and reference lists of retrieved articles to identify studies published before 1990. We included studies examining primary outcomes (pelvic inflammatory disease, ectopic pregnancy, infertility, adverse pregnancy outcomes, neonatal infection, chlamydia prevalence) and harms of chlamydia screening in men and non-pregnant and pregnant women. We extracted data in duplicate and synthesized the data narratively or used random effects meta-analysis, where appropriate. RESULTS: We included six systematic reviews, five randomized trials, one non-randomized comparative study and one time trend study. Five reviews recommended screening of women at high risk of chlamydia. Two randomized trials found that register-based screening of women at high risk of chlamydia and of female and male high school students reduced the incidence of pelvic inflammatory disease in women at 1 year. Methodological inadequacies could have overestimated the observed benefits. One randomized trial showed that opportunistic screening in women undergoing surgical termination of pregnancy reduced post-abortal rates of pelvic inflammatory disease compared with no screening. We found no randomized trials showing a benefit of opportunistic screening in other populations, no trial examining the effects of more than one screening round and no trials examining the harms of chlamydia screening. CONCLUSION: There is an absence of evidence supporting opportunistic chlamydia screening in the general population younger than 25 years, the most commonly recommended approach. Equipoise remains, so high-quality randomized trials of multiple rounds of screening with biological outcome measures are still needed to determine the balance of benefits and harms of chlamydia screening.

A spatial-temporal approach to surveillance of prostate cancer disparities in population subgroups

BACKGROUND: Prostate cancer mortality disparities exist among racial/ethnic groups in the United States, yet few studies have explored the spatiotemporal trend of the disease burden. To better understand mortality disparities by geographic regions over time, the present study analyzed the geographic variations of prostate cancer mortality by three Texas racial/ethnic groups over a 22-year period. METHODS: The Spatial Scan Statistic developed by Kulldorff et al was used. Excess mortality was detected using scan windows of 50% and 90% of the study period and a spatial cluster size of 50% of the population at risk. Time trend was analyzed to examine the potential temporal effects of clustering. Spatial queries were used to identify regions with multiple racial/ethnic groups having excess mortality. RESULTS: The most likely area of excess mortality for blacks occurred in Dallas-Metroplex and upper east Texas areas between 1990 and 1999; for Hispanics, in central Texas between 1992 and 1996: and for non-Hispanic whites, in the upper south and west to central Texas areas between 1990 and 1996. Excess mortality persisted among all racial/ethnic groups in the identified counties. The second scan revealed that three counties in west Texas presented an excess mortality for Hispanics from 1980-2001. Many counties bore an excess mortality burden for multiple groups. There is no time trend decline in prostate cancer mortality for blacks and non-Hispanic whites in Texas. CONCLUSION: Disparities in prostate cancer mortality among racial/ethnic groups existed in Texas. Central Texas counties with excess mortality in multiple subgroups warrant further investigation.

(Table 1) Concentration of pollutants in hair of East Greenland polar bears (Ursus maritimus)

Hair sampled from 96 East Greenland polar bears (Ursus maritimus) over the periods 1892-1927 and 1988-2009 was analyzed for cortisol as a proxy to investigate temporal patterns of environmental stress. Cortisol concentration was independent of sex and age, and was found at significantly higher (p<0.001) concentrations in historical hair samples (1892-1927; n = 8) relative to recent ones (1988-2009; n = 88). In addition, there was a linear time trend in cortisol concentration of the recent samples (p< 0.01), with an annual decrease of 2.7%. The recent hair samples were also analyzed for major bioaccumulative, persistent organic pollutants (POPs). There were no obvious POP related time trends or correlations between hair cortisol and hair POP concentrations. Thus, polar bear hair appears to be a relatively poor indicator of the animal's general POP load in adipose tissue. However, further investigations are warranted to explore the reasons for the temporal decrease found in the bears' hair cortisol levels.

(Table 2) Organochlorine concentrations in polar bears (Ursus maritimus) from East Greenland 1999-2001

Persistent organochlorine (OC) contaminants (PCBs, DDTs, chlordanes (CHLs), dieldrin, hexachlorocyclohexanes (HCHs), chlorobenzenes (CBzs)) were determined in adipose tissue of 92 polar bears (Ursus maritimus) sampled between 1999 and 2001 in central East Greenland (69°00'N to 74°00'N). OC data were presented from subadults (S: females: <5 years and males: <6 years), adult females (F: >=5 years) and adult males (M: >=6 years). Summed chlorobiphenyl (SumCBs) concentrations (41 congeners including co-eluters), SumCHLs and SumDDTs were the dominant classes of OCs. SumCBs concentrations were found to be 6470, 8240 and 9100 ng/g lipid weight (lw) i subadults, adult females and adult males, respectively. The corresponding figures were: 2010 (S), 2220 (F) and 1710 (M) ng/ g lw for SumCHLs and 462 (S), 462 (F) and 559 (M) ng/g lw for SumDDTs. The dominant CB congeners were CB153 (32.3%), CB180 (21.4%), CB170 (12.2%) and CB138 (11.0%). The metabolite p,p'-DDE (88.2%) dominated the SumDDTs, while oxychlordane was the dominant (57.1%) CHL-related compound. Concentrations of SumCBs, SumCBzs, SumDDTs, mirex and dieldrin were highest in adult males, whereas concentrations of SumHCHs were lower than in adult females but not than those in subadults. Adult females had the lowest concentrations of SumCBzs, mirex and dieldrin. Concentrations of SumCHLs were lowest in adult males, intermediate in subadults and highest in adult females. SumCB, SumHCH and SumCHL concentrations showed high seasonal variability in adult females but remained relatively constant in adult males and subadults. In general, the OC levels in females appeared to be highest in March and lowest in January or September. Concentrations of SumCBzs and dieldrin showed seasonal variability in all three groups, with a maximum in March in adult females. SumCBz concentrations in adult males and subadults of both sexes peaked in April-July, and dieldrin concentrations peaked in April-July in subadults, but not until August in adult males. SumDDT concentrations increased from January to a maximum in April-July for subadults and in August for adults. Temporal trends within the last decade were examined by comparing the present data to the concentrations reported in samples from 1990 from the same region. SumCB, p,p'-DDE and SumHCH concentrations in 1999-2001 were 22.1%, 66.3% and 39.3% lower than the 1990 concentrations, respectively. in contrast, SumCHL and dieldrin concentrations showed differences amongst sex and age groups in the temporal trends, where present concentrations are between 24.4% to 69.3% and 27.0% to 69.0% lower, respectively, relative to the 1990 levels. However, power analysis suggested that firm conclusions could not be drawn regarding the general time trend based on these two sampling periods. The range of half-lives of the various OC classes were estimated to lie between 4.5 and 20.6 years depending on the age and sex groups considered.

Mercury content and isotopic composition of teeth, and sex and age of skulls of polar bears collected in Svalbard

We examined the use of mercury (Hg) and nitrogen and carbon stable isotopes in teeth of polar bear (Ursus maritimus) from Svalbard as biotracers of temporal changes in Hg pollution exposure between 1964 and 2003. Teeth were regarded as a good matrix of the Hg exposure, and in total 87 teeth of polar bears were analysed. Dental Hg levels ranged from 0.6 to 72.3 ng/g dry weight and increased with age during the first 10 years of life. A decreasing time trend in Hg concentrations was observed over the recent four decades while no temporal changes were found in the stable isotope ratios of nitrogen (d15N) and carbon (d13C). This suggests that the decrease of Hg concentrations over time was more likely due to a lower environmental Hg exposure in this region rather than a shift in the feeding habits of Svalbard polar bears.

Modelos Estadísticos Dinámicos para Análisis de Evolución de Tasas de Accidentes: Metodología y Herramientas Computacionales

Los accidentes del tráfico son un fenómeno social muy relevantes y una de las principales causas de mortalidad en los países desarrollados. Para entender este fenómeno complejo se aplican modelos econométricos sofisticados tanto en la literatura académica como por las administraciones públicas. Esta tesis está dedicada al análisis de modelos macroscópicos para los accidentes del tráfico en España. El objetivo de esta tesis se puede dividir en dos bloques: a. Obtener una mejor comprensión del fenómeno de accidentes de trafico mediante la aplicación y comparación de dos modelos macroscópicos utilizados frecuentemente en este área: DRAG y UCM, con la aplicación a los accidentes con implicación de furgonetas en España durante el período 2000-2009. Los análisis se llevaron a cabo con enfoque frecuencista y mediante los programas TRIO, SAS y TRAMO/SEATS. b. La aplicación de modelos y la selección de las variables más relevantes, son temas actuales de investigación y en esta tesis se ha desarrollado y aplicado una metodología que pretende mejorar, mediante herramientas teóricas y prácticas, el entendimiento de selección y comparación de los modelos macroscópicos. Se han desarrollado metodologías tanto para selección como para comparación de modelos. La metodología de selección de modelos se ha aplicado a los accidentes mortales ocurridos en la red viaria en el período 2000-2011, y la propuesta metodológica de comparación de modelos macroscópicos se ha aplicado a la frecuencia y la severidad de los accidentes con implicación de furgonetas en el período 2000-2009. Como resultado de los desarrollos anteriores se resaltan las siguientes contribuciones: a. Profundización de los modelos a través de interpretación de las variables respuesta y poder de predicción de los modelos. El conocimiento sobre el comportamiento de los accidentes con implicación de furgonetas se ha ampliado en este proceso. bl. Desarrollo de una metodología para selección de variables relevantes para la explicación de la ocurrencia de accidentes de tráfico. Teniendo en cuenta los resultados de a) la propuesta metodológica se basa en los modelos DRAG, cuyos parámetros se han estimado con enfoque bayesiano y se han aplicado a los datos de accidentes mortales entre los años 2000-2011 en España. Esta metodología novedosa y original se ha comparado con modelos de regresión dinámica (DR), que son los modelos más comunes para el trabajo con procesos estocásticos. Los resultados son comparables, y con la nueva propuesta se realiza una aportación metodológica que optimiza el proceso de selección de modelos, con escaso coste computacional. b2. En la tesis se ha diseñado una metodología de comparación teórica entre los modelos competidores mediante la aplicación conjunta de simulación Monte Cario, diseño de experimentos y análisis de la varianza ANOVA. Los modelos competidores tienen diferentes estructuras, que afectan a la estimación de efectos de las variables explicativas. Teniendo en cuenta el estudio desarrollado en bl) este desarrollo tiene el propósito de determinar como interpretar la componente de tendencia estocástica que un modelo UCM modela explícitamente, a través de un modelo DRAG, que no tiene un método específico para modelar este elemento. Los resultados de este estudio son importantes para ver si la serie necesita ser diferenciada antes de modelar. b3. Se han desarrollado nuevos algoritmos para realizar los ejercicios metodológicos, implementados en diferentes programas como R, WinBUGS, y MATLAB. El cumplimiento de los objetivos de la tesis a través de los desarrollos antes enunciados se remarcan en las siguientes conclusiones: 1. El fenómeno de accidentes del tráfico se ha analizado mediante dos modelos macroscópicos. Los efectos de los factores de influencia son diferentes dependiendo de la metodología aplicada. Los resultados de predicción son similares aunque con ligera superioridad de la metodología DRAG. 2. La metodología para selección de variables y modelos proporciona resultados prácticos en cuanto a la explicación de los accidentes de tráfico. La predicción y la interpretación también se han mejorado mediante esta nueva metodología. 3. Se ha implementado una metodología para profundizar en el conocimiento de la relación entre las estimaciones de los efectos de dos modelos competidores como DRAG y UCM. Un aspecto muy importante en este tema es la interpretación de la tendencia mediante dos modelos diferentes de la que se ha obtenido información muy útil para los investigadores en el campo del modelado. Los resultados han proporcionado una ampliación satisfactoria del conocimiento en torno al proceso de modelado y comprensión de los accidentes con implicación de furgonetas y accidentes mortales totales en España. ABSTRACT Road accidents are a very relevant social phenomenon and one of the main causes of death in industrialized countries. Sophisticated econometric models are applied in academic work and by the administrations for a better understanding of this very complex phenomenon. This thesis is thus devoted to the analysis of macro models for road accidents with application to the Spanish case. The objectives of the thesis may be divided in two blocks: a. To achieve a better understanding of the road accident phenomenon by means of the application and comparison of two of the most frequently used macro modelings: DRAG (demand for road use, accidents and their gravity) and UCM (unobserved components model); the application was made to van involved accident data in Spain in the period 2000-2009. The analysis has been carried out within the frequentist framework and using available state of the art software, TRIO, SAS and TRAMO/SEATS. b. Concern on the application of the models and on the relevant input variables to be included in the model has driven the research to try to improve, by theoretical and practical means, the understanding on methodological choice and model selection procedures. The theoretical developments have been applied to fatal accidents during the period 2000-2011 and van-involved road accidents in 2000-2009. This has resulted in the following contributions: a. Insight on the models has been gained through interpretation of the effect of the input variables on the response and prediction accuracy of both models. The behavior of van-involved road accidents has been explained during this process. b1. Development of an input variable selection procedure, which is crucial for an efficient choice of the inputs. Following the results of a) the procedure uses the DRAG-like model. The estimation is carried out within the Bayesian framework. The procedure has been applied for the total road accident data in Spain in the period 2000-2011. The results of the model selection procedure are compared and validated through a dynamic regression model given that the original data has a stochastic trend. b2. A methodology for theoretical comparison between the two models through Monte Carlo simulation, computer experiment design and ANOVA. The models have a different structure and this affects the estimation of the effects of the input variables. The comparison is thus carried out in terms of the effect of the input variables on the response, which is in general different, and should be related. Considering the results of the study carried out in b1) this study tries to find out how a stochastic time trend will be captured in DRAG model, since there is no specific trend component in DRAG. Given the results of b1) the findings of this study are crucial in order to see if the estimation of data with stochastic component through DRAG will be valid or whether the data need a certain adjustment (typically differencing) prior to the estimation. The model comparison methodology was applied to the UCM and DRAG models, considering that, as mentioned above, the UCM has a specific trend term while DRAG does not. b3. New algorithms were developed for carrying out the methodological exercises. For this purpose different softwares, R, WinBUGs and MATLAB were used. These objectives and contributions have been resulted in the following findings: 1. The road accident phenomenon has been analyzed by means of two macro models: The effects of the influential input variables may be estimated through the models, but it has been observed that the estimates vary from one model to the other, although prediction accuracy is similar, with a slight superiority of the DRAG methodology. 2. The variable selection methodology provides very practical results, as far as the explanation of road accidents is concerned. Prediction accuracy and interpretability have been improved by means of a more efficient input variable and model selection procedure. 3. Insight has been gained on the relationship between the estimates of the effects using the two models. A very relevant issue here is the role of trend in both models, relevant recommendations for the analyst have resulted from here. The results have provided a very satisfactory insight into both modeling aspects and the understanding of both van-involved and total fatal accidents behavior in Spain.

Como estamos indo? Estudo do deslocamento ativo no Brasil

Introdução: O deslocamento ativo tem estreita relação com problemas de saúde pública da atualidade e sua promoção pode contribuir para melhorias quanto à mobilidade urbana, estado de saúde e proteção do meio ambiente. Entretanto, a maior parte das pesquisas sobre o tema tem sido desenvolvida em países de renda alta. A presente tese busca ampliar a investigação sobre o deslocamento ativo no Brasil. Objetivos: i) Descrever a frequência, a distribuição e a variação temporal de indicadores do deslocamento ativo em populações brasileiras; ii) Avaliar o impacto de mudanças no padrão de transporte da população sobre o deslocamento ativo, o tempo sedentário e desfechos de saúde em populações brasileiras. Métodos: Tese composta por sete manuscritos. O primeiro apresenta revisão sistemática de estudos com informações sobre a prática de deslocamento ativo na América Latina e Caribe; o segundo descreve estimativas representativas da população brasileira sobre a prática de deslocamento ativo para o trabalho; o terceiro e o quarto descrevem a frequência e tendência temporal do deslocamento ativo na Região Metropolitana de São Paulo (ciclistas e escolares); o quinto discute a questão da mobilidade urbana e do direito à cidade em São Paulo; o sexto e o sétimo avaliam o impacto de mudanças no padrão de mobilidade da metrópole paulistana sobre a prática de deslocamento ativo, tempo não-ativo de deslocamento e tempo total de deslocamento, bem como sobre a poluição do ar e saúde da população. Resultados: A prevalência mediana de deslocamento ativo encontrada em diferentes locais do Brasil foi de 12 por cento , variando entre 5,1 por cento em Palmas (Tocantins) a 58,9 por cento em Rio Claro (São Paulo) (Manuscrito 1). Um terço dos homens e das mulheres desloca-se a pé ou de bicicleta de casa para o trabalho no país. Em ambos os sexos, esta proporção diminui com o aumento da renda e da escolaridade e é maior entre os mais jovens, entre os que residem em áreas rurais, e na região Nordeste. Em todas as regiões metropolitanas estudadas, o quinto das pessoas de menor renda apresenta uma maior frequência de deslocamento ativo (Manuscrito 2). Entre os anos de 2007 e 2012, observamos redução no número de ciclistas em São Paulo e diferenças expressivas na proporção de ciclistas entre homens e mulheres (9,7 por mil habitantes versus 1,4 por mil habitantes em 2012) (Manuscrito 3). Também verificamos uma queda na proporção de crianças que se deslocam ativamente para a escola entre os anos de 1997 e 2012 (Manuscrito 4). O cenário epidemiológico do deslocamento ativo no país é resultante da disputa pelo direito à cidade, com repercussões na transição de mobilidade humana e na saúde e qualidade de vida da população, como podemos observar no caso de São Paulo (Manuscrito 5). A construção de uma São Paulo mais inclusiva, com menores distâncias para os deslocamentos cotidianos e maior frequência de caminhada e bicicleta, levaria à substancial redução do tempo total e do tempo sedentário despendidos nos deslocamentos, sem diminuir a duração do deslocamento ativo (Manuscrito 6). Traria também ganhos à saúde da população, sobretudo pelo aumento da prática de atividade física e da redução da poluição do ar (Manuscrito 7). Conclusões: A prática de deslocamento ativo no Brasil apresenta marcadas diferenças segundo região e características sociodemográficas. De um modo geral, esta prática vem diminuindo no país, o que deve contribuir negativamente para a saúde da população. A promoção de cidades mais inclusivas e compactas, com o favorecimento a modos ativos de deslocamento, pode contribuir para reverter esta preocupante tendência.

Ambient ozone pollution and daily mortality in three megacities in China

Thesis (Master's)--University of Washington, 2016-06

Freie Schulwahl und staatliche Steuerung. Neue Regelungen des Übergangs an weiterführende Schulen

In dem vorliegenden Beitrag werden neuere schulgesetzliche Initiativen erörtert, die u.a. eine Reform des Übertritts aus der Grundschule an weiterführende Schulen beabsichtigen. Diese Bemühungen ordnen sich in die schon lange zu beobachtende Tendenz zur Stärkung der individuellen Rechte von Schülern und Eltern ein, wie sie mit dem Prozeß der Verrechtlichung der Schule in der Bundesrepublik verbunden ist. Eine genauere Betrachtung der entsprechenden Regelungen und einiger dadurch ausgelöster gerichtlicher Konflikte weckt allerdings Zweifel an Voraussetzungen und insbesondere an Ergebnissen der eingeleiteten Politik: Handelt es sich nicht doch um eine versteckte Form der staatlichen Steuerung der Schulwahl? (DIPF/Orig.)

Oral cancer incidence and survival rates in the Republic of Ireland, 1994-2009

Background: Oral cancer is a significant public health problem world-wide and exerts high economic, social, psychological, and physical burdens on patients, their families, and on their primary care providers. We set out to describe the changing trends in incidence and survival rates of oral cancer in Ireland between 1994 and 2009. Methods: National data on incident oral cancers [ICD 10 codes C01-C06] were obtained from the National Cancer Registry Ireland from 1994 to 2009. We estimated annual percentage change (APC) in oral cancer incidence during 1994–2009 using joinpoint regression software (version 4.2.0.2). The lifetime risk of oral cancer to age 79 was estimated using Irish incidence and population data from 2007 to 2009. Survival rates were also examined using Kaplan-Meier curves and Cox proportional hazard models to explore the influence of several demographic/lifestyle covariates with follow-up to end 2012. Results: Data were obtained on 2,147 oral cancer incident cases. Men accounted for two-thirds of oral cancer cases (n = 1,430). Annual rates in men decreased significantly during 1994–2001 (APC = -4.8 %, 95 % CI: −8.7 to −0.7) and then increased moderately (APC = 2.3 %, 95 % CI: −0.9 to 5.6). In contrast, annual incidence increased significantly in women throughout the study period (APC = 3.2 %, 95 % CI: 1.9 to 4.6). There was an elevated risk of death among oral cancer patients who were: older than 60 years of age; smokers; unemployed or retired; those living in the most deprived areas; and those whose tumour was sited in the base of the tongue. Being married and diagnosed in more recent years were associated with reduced risk of death. Conclusion: Oral cancer increased significantly in both sexes between 1999 and 2009 in Ireland. Our analyses demonstrate the influence of measured factors such as smoking, time of diagnosis and age on observed trends. Unmeasured factors such as alcohol use, HPV and dietary factors may also be contributing to increased trends. Several of these are modifiable risk factors which are crucial for informing public health policies, and thus more research is needed.

The application of trend surface models to the analysis of time factors in Swiss cancer mortality.

To study different temporal components on cancer mortality (age, period and cohort) methods of graphic representation were applied to Swiss mortality data from 1950 to 1984. Maps using continuous slopes ("contour maps") and based on eight tones of grey according to the absolute distribution of rates were used to represent the surfaces defined by the matrix of various age-specific rates. Further, progressively more complex regression surface equations were defined, on the basis of two independent variables (age/cohort) and a dependent one (each age-specific mortality rate). General patterns of trends in cancer mortality were thus identified, permitting definition of important cohort (e.g., upwards for lung and other tobacco-related neoplasms, or downwards for stomach) or period (e.g., downwards for intestines or thyroid cancers) effects, besides the major underlying age component. For most cancer sites, even the lower order (1st to 3rd) models utilised provided excellent fitting, allowing immediate identification of the residuals (e.g., high or low mortality points) as well as estimates of first-order interactions between the three factors, although the parameters of the main effects remained still undetermined. Thus, the method should be essentially used as summary guide to illustrate and understand the general patterns of age, period and cohort effects in (cancer) mortality, although they cannot conceptually solve the inherent problem of identifiability of the three components.