Epidemiology. 2. Strategic Prevention Framework Overview
Epidemiology. Clostridium difficile infection (CDI) is now firmly established as a significant healthcare issue and is the leading cause of infectious nosocomial diarrhoea in the developed world. The unprecedented rise in prevalence in recent years, starting in the late 1990s with outbreaks in the US and Canada, has resulted in CDI becoming endemic in the North American and European healthcare systems. In the USA, the CDC reported a total of 350,000 cases in 2010 (Figure 2: Data from HCUP Statistical Brief #124 and CDC National Vital Statistic Reports) although reliable estimates put the annual number of cases at around 500,000. Although the rise in prevalence seems to have halted in the US, figures over the last few years suggest that a plateau has been reached at around 4 fold more cases than reported in 1993. Overall, this has placed an enormous financial and human welfare burden on the healthcare system. Healthcare costs in the US are estimated at >$1bn p.a and the individual cost of each CDI case in the EU is €33,840. The management of patients with CDI often requires isolation and environmental decontamination and in the case of outbreaks may necessitate cohort isolation and waxx xlosure. Although CDI is a disease that disproportionally affects the elderly or immunocompromised, increasing numbers of cases are being reported in previously low risk groups such as the young. There is increasing awareness of CDI as an emerging community issue with community onset CDI now being linked with higher risk of associated colectomy. A similar picture has been reported in the UK where a dramatic rise in prevalence resulted in a peak of >55,000 cases in 2006 and although significant efforts in the UK have reduced the number of cases, recent data suggests a stabilisation at around 20,000 p.a. The wider European picture continues to show an increasing number of cases in Denmark, Finland, Germany and Spain and an on-going north to south spread of the disease across the continent. Although now endemic in the EU and USA, CDI in Eastern Asia and Australia has recently started to emerge as a significant issue. Although Australia has historically had a relatively well controlled level of CDI with few cases progressing to severe disease in 2011 the first cases of CDI due to hypervirulent BI/NAP1/027 strains were encountered and a similar picture has been emerging in Japan.
Epidemiology. Partner agrees to make data generated pursuant to clinical trials in the Field that are relevant to the epidemiology of any disease in the Field publicly available within [*****] of the generation of such data.
Epidemiology. Colorectal cancer is a worldwide concern, comprising about 9.7% of the global cancer burden, with an annual incidence of approximately 1.3 million cases and a mortality of 700,000 cases (6, 7). This burden is anticipated to increase by 60% to over 2.2 million new cases and 1.1 million cancer deaths by 2030 (8). Although approximately 55% of cases occur in more developed regions such as Australia/New Zealand, Europe, North America and Eastern Asia, mortality is lower (8.5% of total) compared to mortality rates of over 52% in less developed and economically transitioning regions such as Central and Eastern Europe (7, 9). In 2013, Ferlay and colleagues reported that Europe faced a 13% burden of colorectal cancer, probably due to some of its countries’ still budding cancer screening programs (10, 11). A retrospective study conducted in Tanzania by Chalya et al found that regardless of the lack of information on colorectal cancer, the incidence and mortality were significant (4.7% and 10.5% respectively) as a result of an increasing “westernized” lifestyle. Most patients presented late at a relatively young age with advanced disease (12). In the United States, despite a measurable decline in incidence and mortality over the past two decades, colorectal cancer remains the third most common cancer among men and women combined. The American Cancer Society estimates that 95,270 new cases of colon cancer and 39,220 new cases of rectal cancer will be diagnosed in 2016; 70,820 new cases of colorectal cancer are expected in men and 63,670 in women. The United States, one of few countries that have shown a downward trend in incidence rates, has largely attributed this progress to improved risk factor profiles, lifestyle modification and an increase in colorectal cancer screening among adults 50 years of age and older. This trend, however, has been noted to differ by age, declining by 4.5% per year among adults 50 years and older, but increasing by 1.8% per year among those younger than 50 years (4, 13). Reasons for this difference remain unclear. It is expected that 49,190 deaths from colorectal cancer will occur in the United States in 2016. A decrease in the number of deaths per 100,000 population per year, due in part to enhanced early detection and treatment of colorectal cancer, has increased the 5-year overall survival to about 65%, with variation across socioeconomic status, race and ethnic subgroups (13-15). Survival of colorectal cancer is also highly dependent...
Epidemiology. Proposed research • How previous infections and previous vaccinations affect the effectiveness of the influenza vaccine? • Vaccine effectiveness in some risk groups: pregnant women, patients with chronic conditions (e.g. diabetes, obesity) • How to increase uptake of influenza vaccination • From contact with which age group or groups do the elderly most commonly acquire influenza infection? • Focus on epidemiological disease burden or social studies (acceptance of vaccination) assessing influenza across all age ranges.
Epidemiology. Proposed research Measles vaccination of HCWs: It is clear that many HCWs are not immune to measles and this must change. Strengthening the legal instruments at the EU level would be advantageous but before that it may be good with more in depth analysis of number of susceptible individuals in a representative sample through sero-epidemiological studies in 5-10 countries What is the level of protection of 2 measles-containing vaccination decades after the second dose? What is the public health implication of this result? Is a new booster of measles-containing vaccination necessary if there is a decrease in the level of protection? Who (target group) and what criteria are required for measles booster (3 doses3rd. dose) vaccination? Sero-epidemiological study of measles immunity in many countries (including countries with different vaccination schedules) Comprehensive review of measles transmission from vaccinated individuals Duration of protection: For measles it would be important to understand duration of protection following the MMR two-dose schedule in the second year of life. In the current epidemiological situation this is the best schedule to build solid immunity early in life with a 0-dose offered in addition in geographical areas with on-going outbreaks. Is a third dose of MMR vaccine necessary?3rd dose of MMR in early adulthood before pregnancy: It is likely that a higher dose of virus will be needed to boost the immune response. Early studies suggest that from Finland and the Netherlands (5). This has been the case for varicella and zoster vaccines, so it is natural that a higher dose to break through the low antibody response will be needed, but needs to be tested in a dose-response phase 1-2 study. Measles outbreaks have been occurring in Europe during last years, albeit more children in the European Region are being vaccinated against measles than ever before and more countries have included mandatory recommendations in their NIPs. There is still a gap in identifying people who have missed the vaccination in the past and the susceptible population, including HCWs. The frequent occurrence of measles among HCWs in several EU/EEA countries is a matter of concern and Member States might consider specific interventions such as ensuring all healthcare workers are immune to measles, with proof/documentation of immunity or immunization as a condition of enrolment into training and employment. The research proposal is to perform a serol...
Epidemiology. 1 Risk Factors. 3 Prevention 3 Diagnosis and Treatment Modalities. 4 Geographic Differences in Colorectal Cancer Survival. 5 Rural-Urban Classifications and Access to Colorectal Cancer Care. 6 Rationale and specific aims 8 Chapter 2. Manuscript. 10 Introduction. 10 Materials and Methods. 12 Data Source 12 Study Population 12 Study Variables 14 Statistical Analysis 16 Results. 17 Demographic and Cancer Characteristics 17 Survival Analysis 18 Multivariate Analyses of Cancer-Specific Mortality 19 Discussion. 20 Strengths and Limitations 24 Chapter 3. Conclusion. 27 Public Health Implications. 27 Future Recommendations. 27 References. 29 Tables and Figures. 34
Epidemiology. 4. Disease investigation; and
Epidemiology. 7.4.4 Combination of Approaches 7.5 Responsibilities of Risk Managers in Commissioning and Guiding a Risk Assessment 7.5.1 Forming the Risk Assessment Team
Epidemiology. A meta-analysis was conducted in 2004 into the prevalence of antenatal depression (Xxxxxxx et al., 2004). The meta-analysis included studies published since 1980. Twenty-one studies were identified, with seven based on clinical diagnoses of depression rated through structured clinical interviews (Schedule for Affective Disorders and Schizophrenia; SADS). The remaining studies were based on ratings of depression using self-report measures such as the Edinburgh Postnatal Depression Scale (EPDS) and the Xxxx Depression Inventory (BDI). The authors reported the point prevalence of depression by trimester, with rates of 7.4% in the first, 12.8% in the second and 12.0% in the third trimester. Prevalence estimated through structured interviews did not differ significantly from rates attained through the EPDS, but were significantly lower that rates attained through the BDI. Xxxxx and colleagues (2005), reviewed studies where depression during pregnancy had been rated only through structured clinical interviews (Xxxxx et al., 2005). They reported a period prevalence rate (conception to birth) for MDD of 12.7%. In both studies there were methodological flaws, such as the exclusion of women with previous psychiatric histories and of low socioeconomic status. Given that both of these factors are well-known risk factors for depression (Xxxxxx and Xxxxxx, 2008), it is likely that these are conservative estimates. One of the potential mechanisms that might underlie the association between the experience of childhood abuse, an early-life adversity, and depression in pregnancy is through the long-term alteration of the neuroendocrine system. Specifically, and as reviewed below, childhood abuse (especially in the context of adult depression) leads to persistent activation of the main hormonal stress system, the hypothalamic-pituitary- adrenal (HPA) axis. In turn, pregnancy in itself is also associated with a persistent activation of the HPA axis, and therefore it is plausible that this makes pregnancy a particular “risk period” for the development of depression following childhood abuse.
