No abstract

Material and MethodsTo check the deduction stemming from the theoretical model of physician behavior on part of possible impairment of quality under market monopoly we exploited competing risk modeling having in mind 2 types of subsequent admissions:-the same cause as in previous admission; -different cause. It ensures us to use two types of censoring, both informative and non-informative. The non-informative censoring tells on termination of tracing before the next admission. The majority of cases demonstrated non-informative censoring. Informative censoring denotes admission due to the different cause then previous. Absence of censoring refers to subsequent admission due to the same cause as previous. Yet another, third type of censoring related to lethality. It's known as terminal event censoring. It's actually the informative censoring that precludes any following censoring or risk accumulation. If we denote Т ij as j th admission episode in і th patient with the same cause as previous Y ij -with different cause, С ij -censoring because of termination of tracing, each period between successive admissions can be classified by: 1) admission due to the same cause with frailty Z 1 with gamma distribution resulted from sum of independent gamma distributed variables Y 0 and Y 1 ;2) admission due to the different cause with gamma distributed frailty Z 2 resulted from sum of independent gamma distributed variables Y 0 and Y 2 ;3) terminal event with gamma distribution resulted from sum of independent gamma distributed variables Y 0 and Y 3 .The mutual variable Y 0 serves commonality in individual risks. Indeed, all three events induced by health problem of particular patient, the fact captured by Y 0 . To get into practicalities we used:This ensures simple first and second moments of frailties distributions:Therefore, co-variation between Z 1 and Z 2 is:With simple correlation formulae (ρ):Specification of events rendered by particular independent variables Y 1 , Y 2 , and Y 3 . Event specification also ingrained into specific linear predictors.Thereby, competing risks incorporated into mixed proportional hazard model (MPH) by:-censoring system (1), incorporating each admission due to the same cause precludes admission due to the different cause and counterwise; lethality introduces another competing risk that upon happening terminates exposure to competing risks; -expression of Z 1 and Z 2 as gamma distributed with common elements of shape and scale k 0 (2), thereby ensuring certain commonality in risks of competing events under consideration; -correlation coefficient ρ between frailties Z 1 and Z 2 , evaluating competing risks commonalities;-association between frailties Z 1 and Z 2 and frailty of terminal event Z 3 through common Y 0 . Copula.mode <-multivPenal(Surv(Between,Censored1)~ cluster(ID) + T + Dep + Exigent+ Order + Status1 + Holiday + Office + Age + Sex + Occupationc + CharlsonI + Ecallc + dStatus + Monthc + Diagnose1 + event2(Censored2) + terminal(Censored3), formula.Event2 =~ T + Exigent + Status2 +...

Background: notoriously known worldwide cause of morbidity and disability duodenal (DU) and gastric ulcer (GU) experience their rise in Ukraine, demonstrating formidable increase by 38,4 % in last decade with the prevalence of 2299 per 100 000 population. Every second patient is treated in-patiently, every third experiences disability spell annually. Reduction in related risks confined not so much by absence of effective therapy but rather shortcomings in patient management and patient devotion. By WHO data 50 % of patients fail to follow physician prescriptions, 60 % can’t recollect physician recommendations in first 20 minutes. Ubiquitous belated timing of rehabilitation initiation in post hospital stage appeared to be cardinal obstacle of its efficiency with low (up to 20 %) coverage, and ensuring clinical effect in 8 % cases only. Aim: to evaluate efficacy of rehabilitation program detailed at first episode of in-patient treatment at gastroenterological department. Data: organized by cohort design. Control cohort comprised 180 patients with first episode of hospitalization due to DU or GU in gastroenterological Vinnitsa city department in 2009–2010 years. Experimental cohort consisted of 220 alike patients who enter rehabilitation program (RP). RP was administered randomly. Randomness was statistically verified on principal confounders. Cases were traced 4 years. Methods: we applied three modifications of semi-parametric frailty model to study effect of program on the risk of recurrent hospitalization. Results: all three modifications coincided in that program secured typically at least 39 days to recurrent hospitalization per patient with drop in risk at least at RR=0,774.

Introduction: For primary health care patients with concomitant morbidity are usual phenomena. Combination of gastropathy with arterial hypertension is increasingly being studied. However, the assessing of the medical and economic effectiveness of treatment of patients with concomitant morbidity still methodologically challenging. The issue aggravated by different cushion programs aimed to alleviate financial burden to indigent population. These cover non-expensive drugs with probable hazard to concomitant morbidity. The aim: to evaluate the effectiveness of the gastropathy risk reduction program in patients with arterial hypertension (AH). Materials and methods: data on 150 patients with AH collected by panel design with dynamic cohort traced up to 17 years. We have elaborated a program for the prevention of gastropathy in patients taking antihypertensive therapy. Program is based on regulations of the Ministry of Health of Ukraine, adapted clinical guidelines, and other official sources of information, since holistic prevention of gastropathy is not depicted in any source. Two main cohorts were distinguished: those in prevention program (PP) and patients with usual treatment. 6 built in cohorts (Group№0-№5) helped to diversify PP across groups of different severity. Event of interest was incidence or aggravation of gastropathy (gastroduodenitis mainly). We used Poisson model to study average treatment effect of PP on annual number of aggravations. Results: The main effect of program participation is significant in a model of fixed effects (β = -0.269; p = 0.0156), and even more supportive in the mixed model (β = -0.282; p = 0.0097). Other components with a variable “PP participation”, namely participation in the program given the group, participation in the program given GP duration, participation in the program given compliance, appeared to be nonsignificant, that suggest absence of substantial selection bias due to non-randomness of allocation. The greatest risk reduction due to program participation was in patients of Group0, that is, in patients with hypertension who do not receive antihypertensive therapy. In groups №1-№5 with more aggressive hypertension treatment the effects of program participation are obvious but less pronounced. Conclusions: The elaborated program differentiates patients by groups and furthermore allows one to consider each patient characteristics, taking into account income, age, gender, progression of the disease, comorbidity, drugs the patient takes. The established program based on cooperation of patient, general practitioner, and gastroenterologist. We reduced selection bias due to possible randomness blemishes in allocation to the PP by control function method. The main effect of program participation is significant in a model of fixed effects (β = -0.269; p = 0.0156), and even more supportive in the mixed model (β = -0.282; p = 0.0097).

Annotation. A combined (retrospective + prospective) study was conducted, involving 150 patients from gynecological departments of three different hospitals in the city who were hospitalized due to the need for surgical treatment of uterine fibroids and/or ovarian cysts. The purpose of this part of the study was to conduct a descriptive analysis of the data collected during the study and to determine the correlations between the factors that affect the length of stay of patients in gynecological departments. Statistical, epidemiological, and sociological methods of analysis were used in the study. The data obtained during the study made it possible to determine the factors affecting the length of stay in the hospital of patients with uterine fibroids and ovarian cysts, which included: the patient's diagnosis (r = 0.13166842); the presence of complications of the main diagnosis (r = 0.240506326); the presence of complications due to the surgical intervention (r = 0.266602573); the presence of concomitant pathology in female patients (r = 0.021249784); type of surgical intervention (r = 0.266390698); volume of surgical intervention (r = 0.1424499). The given results can be useful for more optimal use of the bed fund of inpatient gynecological departments.