ABSTRACT
Validação da causa básica de óbitos por causas externas e acidentes de trabalho, de homens e mulheres, de 10 a 69 anos de idade, residentes na Região Metropolitana de Salvador, Bahia, Brasil. Comparação e quantificação do índice de concordância entre a causa básica de óbitodeclarada no sistema de informação oficial com a causa reconstituída pela pesquisa, mediante descrição das circunstâncias da morte e situações de trabalho, obtidas em entrevista domiciliar e codificada segundo a CID-10. Calculadas sensibilidade, especificidade e valores preditivos dacausa atestada no sistema oficial. Identificados 126 óbitos por acidentes de trabalho, correspondentes a 19,4% das mortes por causas externas. Estimados subregistro das mortes no trabalho (92,6%); sensibilidade (7,14%); especificidade (99,81%); valor preditivo positivo(90,0%); valor preditivo negativo (81,66%). Elevado índice de discordância entre as causas básicas de óbito (52,8%); maior entre mulheres (61,4%); em maiores de 30 anos de idade (64,0%); acidentes de transporte (84,7%) e suicídios (82,8%). Sensibilidade muito baixa do Sistema de Informações sobre Mortalidade para identificação das mortes no trabalho, indicando necessidade de ações intersetoriais para melhoria da qualidade dessas informações.
Study the validity and accuracy of underlying cause of death due to work related injuries and other external causes on people 10 to 64 years of age, inhabiting Salvador city and its outskirts, state of Bahia, Brazil. Comparison and quantification of agreement indexes between officiallydeclared cause of death and information retrieved by the research, by means of description of death circumstances and work situations, obtained by domiciliary interviews and coded according to ICD 10. Specificity, sensitivity and predictive values for the officially declared causes were calculated. The number of deaths due to work injuries (126) was estimated in 19.4% of all external causes; the under-reporting of work related deaths was 92.6%; estimated sensibility (7.14%), specificity (99.8%); positive predictive value (90%), and negative predictive value(81.66%). High disagreement indexes between underlying causes of death (52.8%) were found; this was higher for women (61.4%), for people older than 30 years age (64.0%), transportation accidents (84.7%) and suicides (82.8%). The SIM (Brazilian national mortality information system) has shown very low sensibility to identify work related deaths. Inter-sectional actions are needed in order to produce more accurate health information.
ABSTRACT
To investigate the causes of death in patients with spontaneous subarachnoid hemorrhage, 460 consecutive patients with a subarachnoid hemorrhage were reviewed. Angiography was not performed in 78 patients due to poor clinical conditions or discharge against admission. Of all these patients, 54(69.2%) died, 28 from serious clinical condition, 21 from rebleeding, 3 from pulmonary complications. 1 from vasospasm, and 1 with unknown causes. Thirty-eight patients were angiographically negative, of which 6(15.8%) died, 3 due to rebleeding, 2 due to poor clinical condition, and 1 due to cerebral infarction caused by vasospasm. Of the 344 patients who had an aneurysmal subarachnoid hemorrhage. 74 were discharged against admission or died before the surgery. The remaining 270 patients underwent aneurysm clipping. Early surgery(within 72 hours after subarachnoid hemorrhage) was performed in 151 patients, intermediate surgery (between Day 4 and 7 post SAH) in 74, and late surgery(Day 8 or later after SAH) in 45. Fifty-one patients (18.9%) died after aneurysm clipping. The remaining 270 patients underwent aneurysm clipping. Early surgery(within 72 hours after subarachnoid hemorrhage) was performed in 151 patients, intermediate surgery(between Day 4 and 7 post-SAH) in 74, and late surgery(Day 8 or later after SAH) in 45, Fifty-one patients(18.9%) died after aneurysm clipping. The causes were vasospasm in 17, complications related to surgery in 13, poor clinical condition in 12, preoperative rebleeding in 7, and other systemic condition in 2. A total of 59 patients suffered at least one rebleeding after the initial hemorrhage ; these patients had a mortality rate of 76.3% and the highest rate of rebleeding occurred within the first 24 hours after initial hemorrhage. Vasospasm and rebleeding were the leading causes of mortality in addition to the initial bleeding. Predictors for mortality included poor clinical grade, early surgery in patients aged 60 years or more, and association with intracerebral hematoam, intraventricular hemorrhage, or subdural hematoma.
Subject(s)
Humans , Aneurysm , Angiography , Cause of Death , Cerebral Infarction , Hematoma, Subdural , Hemorrhage , Mortality , Subarachnoid HemorrhageABSTRACT
In the world-wide literature the role of predators and food shortage are considered as responsible for mortality of eggs and nestlings. In synantropic altricial hole-nestling birds such as sparrows Passer domesticus (L.) and Passer montanus (L.) the predation plays unimportant role and in spite of this, mortality of eggs and nestlings can exceeded 50%. The role of microorganisms, heavy metals, pesticides and food shortage were investigated as possible causes of embryo and nestling deaths. About 70% of eggs that not hatched were infested with such pathogens as Escherichia coil, Staphylococcus epidermitis and several, more rarely occurring others. Considerable percentage of nestlings died due to pathogenic impact of such factors as Escherichia coli, Isospora lacazei, Candida spp., heavy metals and pesticides. As one effect of such interaction, the level of sublethal doses of heavy metals and pesticides are much lower that reported in the literature.