De que morrem as crianças de 5 a 14 anos no estado do Rio de Janeiro? Análise do período 2000-2019 / What do children aged 5 to 14 years die from in the state of Rio de Janeiro, Brazil? Trend analysis of the period 2000-2019

Resumo Objetivou-se investigar a magnitude e a tendência da mortalidade de crianças de 5 a 14 anos por causas, no estado do Rio de Janeiro, de 2000 a 2019. Estudo ecológico de tendência temporal utilizando dados do Sistema de Informações sobre Mortalidade (SIM). Calcularam-se taxas de mortalidade por 100 mil crianças, por capítulos, grupos e categorias (CID-10). Estimou-se a série temporal por regressão joinpoint. As taxas de mortalidade de 10 a 14 anos foram superiores às da faixa de 5 a 9 anos. As cinco principais causas foram as mesmas de 5 a 14 anos, com diferente ordem de importância. As duas principais foram causas externas e neoplasias (31% e 15% para 5 a 9 anos; 45% e 11% para 10 a 14 anos). De 5 a 9 anos, a tendência da mortalidade teve declínio anual (8%) entre 2011 e 2015. De 10 a 14 anos, o declínio anual foi 1,3%, de 2000 a 2019. A mortalidade por causas externas decresceu em ambas as faixas, menos para a categoria "Agressão por arma de fogo" (meninos,10-14 anos) e "Afogamento" (meninos, 5-9 anos). A mortalidade por neoplasias ficou estável para todos. Doenças infecciosas e respiratórias decresceram de forma diferenciada entre os grupos. A maioria das causas de morte é evitável ou tratável, apontando necessidade de investimentos em saúde e intersetoriais.

Abstract This study investigated the magnitude and trends of cause-specific mortality among children 5 to 14 years of age in the state of Rio de Janeiro (RJ) from 2000 to 2019. We performed an ecological study, using data from the Mortality Information System (MIS). We calculated mortality rates per 100,000 children by chapters, groups, and categories of causes of death (ICD-10). Trends were estimated by joinpoint regression. Mortality rates among children aged 10 to 14 years were higher than those among children 5 to 9. The five leading causes of death were the same in both age groups, but they ranked differently. The two leading ones were external causes and neoplasms (31% and 15% among children aged 5 to 9 years; 45% and 11% among children aged 10 to 14 years). Among children 5 to 9 years, the mortality trend showed an annual decline (8%) from 2011 to 2015. Among children aged 10 to 14 years, the annual decline was 1.3% from 2000 to 2019. Mortality due to external causes decreased in both age groups, except for the category "Assault by unspecified firearm" (boys, 10 to 14 years) and "Unspecified drowning and submersion" (boys, 5 to 9 years). Mortality caused by neoplasms remained steady in both age groups. Infectious and respiratory diseases decreased differently between the two groups. Most causes of death are preventable or treatable, indicating the need for health and intersectoral investments.

Population-based study: breast cancer mortality trend in women in the state of Paraná from 2000 to 2017

Objective: Breast cancer is one of the main challenges in Brazilian public health due to the high associated mortality. Mortality has different patterns according to age group, usually increasing with age. The demographic stability in Paraná, with the growth of the elderly population, has a direct impact on the epidemiology of this disease. This study aimed to assess, on a population-based basis, the rates and trends of mortality from breast cancer among the age groups of women in the state of Paraná from 2000 to 2017. Methods: A statistical descriptive retrospective series study was carried out to analyze, on a population-based basis, the trend in breast cancer mortality rates among the age groups of women in the state of Paraná, from 2000 to 2017. The trend analysis of annual mortality rates was carried out through the software and simple linear regression models. Results: The population-based analysis showed that women aged 45­54 and 55­64 years had the highest number of deaths during the study period. However, when calculating the mortality rates by age group, it was observed that the mortality pattern increases proportionally to the longevity of the female population in the state. Trend analyses indicated an upward trend in mortality among women aged 25­34 years throughout the study period. The same trend was observed in women aged 35­44 years, but in a shorter period, from 2005 to 2017. Conclusion: Mortality rates, per 100,000 women, were directly proportional to age, increasing with age, indicative of greater mortality from the disease in elderly women. There was a trend of increasing mortality, with statistical significance, in the age groups from 25 to 34 and 35 to 44. The others were considered stable trends.

Asma en Chile: tendencia de la mortalidad 1992-2017 / Asthma in Chile: mortality trend 1992-2017

OBJETIVOS: El asma, un problema de salud pública, tiene tasas de mortalidad global variables. En Chile, no existen estudios que informen respecto a la situación nacional. Analizamos la tendencia de mortalidad en adultos chilenos durante un período de 26 años. MÉTODOS: Utilizando datos del Departamento de Estadísticas e Información de Salud y el Instituto Nacional de Estadísticas se calcularon las tasas de mortalidad por asma 1992-2017 en personas ≥ 15 años de edad. Para evitar el impacto de los cambios por edad, las tasas de mortalidad ajustadas se calcularon mediante un método de ajuste directo utilizando la población de 2017 como referencia. Se usó Joinpoint para calcular la pendiente de las tasas ajustadas y para análisis de datos se utilizó Excel STATA versión13. RESULTADOS: Durante el período de 26 años, hubo 5.749 muertes relacionadas con el asma, con un promedio de 221 eventos / año. Las tasas de mortalidad ajustadas por edad disminuyeron significativamente de 3,26 en 1992 a 1,4 por 100.000 habitantes en 2017, con un promedio de disminución anual de -3,3%. La mayor proporción de defunciones se produjo en personas de 65 años o más, representando 79% de los casos en 1992 y 88% de los casos en 2017. CONCLUSIONES: las tendencias de las tasas de mortalidad por asma en Chile, ajustadas por edad, muestran una disminución significativa en los 26 años que abarca este estudio, disminución que es menos acentuada en los últimos 15 años.

OBJETIVES: Asthma, a public health problem, has variable global mortality rates. In Chile, there are no studies to report on the national situation. This study analyzes the mortality trend in Chilean adults over a period of 26 years. METHODS: Using data from the Department of Health Statistics and Information and the National Institute of Statistics, asthma mortality rates 1992-2017 were calculated in people ≥ 15 years-old. To avoid the impact of age changes, adjusted mortality rates were calculated using a direct adjustment method using the 2017 population as a reference. Joinpoint was used to calculate the slope of adjusted rates, and Excel STATA version13 was used for data analysis. RESULTS: Over the 26-year period, there were 5,749 asthma-related deaths, with an average of 221 events per year. Age-adjusted mortality rates decreased significantly from 3.26 in 1992 to 1.4 per 100,000 inhabitants in 2017, with an average annual decline of -3.3%. The highest proportion of deaths occurred in people 65 years of age or older, accounting for 79% of cases in 1992 and 88% of cases in 2017. CONCLUSIONS: In Chile trends in asthma mortality rates age-adjusted show a significant decrease in the 26 years covered by this study, a decrease that is less pronounced in the last 15 years.

Mortalidad y factores sociales del cáncer de próstata para la gestión de políticas públicas. veracruz, méxico

Introducción: Las elevadas tasas de mortalidad por cáncer de próstata en Veracruz indican la necesidad de gestionar políticas públicas equitativas para su control. Por ello, es necesario analizar las tendencias de mortalidad y los factores sociales relacionados con la salud de la población. Métodos: Cálculo de las tasas de mortalidad a nivel nacional y estatal por edad, y en Veracruz, por regiones económicas; en relación con su grado de rezago social. Resultados: La tasa de mortalidad por cáncer de próstata en Veracruz es mayor que la tasa nacional. Dentro del estado, la región del Papaloapan presentó la mayor mortalidad, y un grado de rezago social medio. Conclusiones: De acuerdo con los datos analizados, las regiones con las tasas más altas de mortalidad en Veracruz no corresponden a las regiones con alto grado de rezago social.

Introduction: The high rates of mortality caused by prostate cancer in Veracruz indicate the need to manage equitable public policies for its control. For this reason, it is necessary to analyze mortality trends and social factors related to population health. Methods: Calculation of mortality rates at national-state level, by age; and for Veracruz, by economic regions; in relation to its degree of social lag. Results: The mortality rate of prostate cancer in Veracruz is higher than the national rate. Within the state, the Papaloapan region presented the highest mortality, and an average degree of social lag. Conclusions: In Veracruz, according to the data analyzed, the regions with the highest mortality rates do not correspond to regions with a high degree of social lag.

Introdução: As altas taxas de mortalidade por câncer de próstata em Veracruz indicam a necessidade de gerenciar políticas públicas equitativas para seu controle. Para isso, é necessário analisar tendências de mortalidade e fatores sociais relacionados à saúde da população. Métodos: Cálculo das taxas de mortalidade a nível nacional e estatal, por idade; e para Veracruz, por regiões econômicas; em relação ao seu grau de atraso social. Resultados: A taxa de mortalidade por câncer de próstata em Veracruz é superior à taxa nacional. Dentro do estado, a região de Papaloapan apresentou a maior mortalidade e um grau de atraso social médio. Conclusões: De acordo com os dados analisados, em Veracruz, as regiões com maiores taxas de mortalidade não correspondem a regiões com alto grau de atraso social.

Tasa de mortalidad y años potenciales de vida perdidos por suicidio en comunas y barrios de Medellín, Colombia, 2010 y 2012 / Mortality and potential years of life lost by suicide by Commune and neighborhoods of Medellin, Colombia, 2010 and 2012

Introducción: El suicidio es un problema de salud pública por el impacto negativo que ha tenido sobre los colectivos. Se calcula la tasa de mortalidad y los años potenciales de vida perdidos (APVP) por suicidio además de la distribución geográfica. Materiales y métodos: Estudio descriptivo, con información secundaria facilitada por el Departamento Nacional de Estadística (DANE); se calcularon las tasas de mortalidad y de los APVP por suicidio, tomando como referente la esperanza de vida al nacer de Medellín para los años 2010 y 2012, además de la construcción de la distribución geográfica del suicidio por comuna y barrio de la ciudad de Medellín. Resultados: En Medellín, para los dos años de estudio, se presentaron 253 suicidios, de los cuales el 81,4% fueron hombres. Las tasas de mortalidad para 2010 y 2012 fueron de 5,2 y 5,4 por cada cien mil habitantes, respectivamente. Las personas de los grupos de edad de 20 a 29 años, seguido del de 10 a 19 años fueron los que mayor APVP aportaron. Se destacó el hecho de que las comunas La Candelaria y El Poblado contribuyeron en mayor magnitud con los APVP en ambos sexos y en los barrios Calle Nueva, Guayaquil, Pablo VI y Caribe y Cerro Nutibara se presentó situación ídem. Discusión: Aunque el suicidio es un evento probablemente evitable, aún tiene gran incidencia especialmente en los hombres en edad productiva., lo que sugiere intervenciones en salud mental que apunten a la disminución de tal flagelo

Introduction: Suicide is a public health problem because of the negative impact it has had on the collectives. The mortality rate and the years of potential life lost (YPLL) by suicide are estimated in addition to their geographical distribution. Materials and methods: Descriptive study, with secondary information provided by the National Department of Statistics (DANE); the mortality rates and the YPLL by suicide were calculated, taking as a reference the life expectancy at birth of Medellin for the years 2010 and 2012, in addition to the construction of the geographical distribution of suicide by commune and neighborhood of the city of Medellin. Results: In Medellin, for the two years of study, there were 253 suicides, 81.4% of which were men. The mortality rates for 2010 and 2012 were 5.2 and 5.4 per hundred thousand inhabitants, respectively. People in the age groups from 20 to 29 years, followed by the 10 to 19 years were the ones with the greatest contribution of YPLL. It was noted that the communes La Candelaria and El Poblado contributed to a greater extent with the YPLL in both genders, and in the suburbs Calle Nueva, Guayaquil, Pablo VI, Caribe and Cerro Nutibara a similar situation was found. Discussion: Although suicide is an event possibly avoidable, it still has a large impact especially in men in productive age, which suggests the need of future that mental health interventions in order to decrease this scourge

Child Survival Status in India.

The National Health Mission (NHM, previously called National Rural Health Mission) was launched by Government of India in 2005 to make architectural correction of the Health system. One of the primary Goals of the Mission was to reduce Under five Mortality rate (U5MR) vis a vis Global commitment made under Millennium development Goals especially Goal numbering 4. Although, India still contributes to about one fifth of U5MR and Maternal Mortality rate but unfortunately it contributes to one third of Global Neonatal Mortality Rate. In sheer numbers alone, these rates are alarming. However, India has achieved a faster pace of reduction in U5MR by 46.5% in comparison to 41% for the entire world. In this article, data from Sample Registration System of the Registrar General of India which is available for most of the States/UTs has been analyzed for child health indicators in the country. In the next NHM phase, focused efforts need to be made with state specific Goals so as that the desired targets could be achieved.

Evaluación de la calidad de la atención de la taquipnea transitoria en recién nacidos afiliados al Seguro Médico Siglo XXI / Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program

Introducción: La evaluación de la calidad de la atención del recién nacido con complicaciones es un elemento indispensable para las estrategias de mejora orientadas a reducir las tasas de mortalidad neonatal. El objetivo de este trabajo fue evaluar la calidad de atención técnica e interpersonal en el manejo de la taquipnea transitoria del recién nacido (TTRN) de pacientes afiliados al Seguro Médico Siglo XXI. Métodos: Se realizó un estudio transversal en 61 hospitales de la Secretaría de Salud, que durante el primer semestre de 2011 reportaron al menos dos casos de TTRN. Se analizaron diferentes variables con respecto a la madre, el embarazo, el nacimiento y las complicaciones neonatales, así como intervenciones realizadas al recién nacido y condiciones de salud al egreso. Para medir la calidad de atención, se definieron y validaron indicadores de calidad en los ámbitos de la prevención, diagnóstico y tratamiento. Resultados: Se analizaron 256 expedientes de casos con diagnóstico de TTRN. El 8.9% de las madres tenía alguno de los factores de riesgo (asma, diabetes) y el 53.5% presentó complicaciones en el embarazo. El 60% de los casos de TTRN nacieron por cesárea; un tercio tuvieron bajo peso al nacimiento y el 14% fueron trasladados a otro hospital. En cuanto a los indicadores de calidad, en el rubro de prevención se identificó que en más del 90% se registraron los factores de riesgo (tabaquismo, asma, parto por cesárea); los de diagnóstico reflejaron que en el 86-98% se buscaron manifestaciones de insuficiencia respiratoria. Los de tratamiento lograron cifras satisfactorias para las medidas de monitorización y soporte. Conclusiones: Los resultados permiten considerar que la mayoría de los casos con TTRN recibieron un tratamiento apropiado. Es recomendable desarrollar estrategias efectivas, como reducir la creciente tasa de partos por cesárea, para prevenir la TTRN.

Background: Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". Methods: A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. Results: We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. Conclusions: Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries.

Causa mortis e taxas de mortalidade: aspectos históricos a partir de registros de óbitos, 1916-1929 / Causa mortis and mortality rates: historical aspects coming from death certificates, 1916-1929

As pesquisas em livros de óbitos, com enfoque histórico, são reveladoras de aspectos cotidianos inexistentes em outros tipos de documentos oficiais. Além de possuírem informações que possibilitam a elaboração de taxas de mortalidade e das respectivas causa mortis, pode-se inferir sobre o número de médicos que atestaram óbitos em determinado local e espaço de tempo, sobre os locais aonde ocorriam os óbitos, bem como sobre aspectos oficiais relacionados ao registro civil das pessoas naturais. Este artigo é resultado da análise de 433 registros de óbitos de Marques de Souza, Rio Grande do Sul, do período de julho de 1916 a dezembro de 1929, presentes no livro C-1, pertencente ao acervo do Tabelionato e Registro Civil de Marques de Souza. Os aportes teóricos e metodológicos desta pesquisa baseiam-se na demografia histórica. Como resultados identificamos as causas de morte que acometeram a população marquesense, o cotidiano dos atendimentos médicos, além da proporção de óbitos no período estudado (1916-1929). Deparamo-nos com a problemática da causa mortis "natural", que abrange a maioria dos registros (70,66 por cento), sendo um forte indicativo da precariedade e da falta de serviços adequados, tanto na parte da medicina quanto na registral, mas que fazem parte de um contexto histórico-social específico.

The studies of obituary books with a historical approach reveal everyday details that are non-existent in other types of official documentation. Besides having some information that enables the elaboration of mortality rates and the respective causa mortis, it is possible to deduce about the number of physicians who certificated deaths in a given place and space of time, as well as about the places where these deaths occurred and about the official aspects related to civil registration of natural people. This paper results from the analysis of 443 death certificates from Marques de Souza, state of Rio Grande do Sul, Brazil, over a period that goes from July 1916 until December 1929, registered at the C-1 book which belongs to the Registrar's office of Marques de Souza city. The theoretical and methodological basis of this research is based on historical demography. The results identify death causes that affected Marques de Souza population, the medical care daily routine and the death proportion during the study period (1916-1929). We face the problem of "natural" causa mortis, which is found in most of the records (70,66%), as a strong indication of the precariousness and lack of adequate medical and registrar's services, but are part of a specific socio-historical context.

Muertes por intoxicación accidental aguda por alcohol y drogas de abuso en Costa Rica entre 2006 y 2010 / Accidental poisoning deaths acute alcohol and drug abuse in Costa Rica between 2006 and 2010

En este artículo se presenta el análisis de 15642 autopsias realizadas en el Departamento de Medicina Legal de Costa Rica entre los años 2006 a 2010, de las cuales se extrajeron aquellas cuyas causa de muerte fue una intoxicación accidental (sobredosis) por alcohol o drogas de abuso. Se encontraron 210 casos que arrojaron el siguiente perfil de las víctimas: sexo masculino, edad entre 30 y 59 años, habitantes de Guanacaste o San José, que fallece los fines de semana o a fin y principio de año, de una intoxicación aguda por alcohol si es costarricense o nicaragüense o de una intoxicación por cocaína o heroína si se trata de un norteamericano o europeo. Asimismo se demostró que en el período en estudio ha habido un aumento significativo de la tasa de mortalidad por esta causa...

Mortalidad neonatal en 2007 y 2008 en un centro de tercer nivel de atención / Newborn mortality in 2007 and 2008 in a tertiary level care center

Introducción. La mortalidad neonatal es un indicador sensible y específico que nos permite conocer el estado de salud de un país y plantear estrategias para mejorarlo. Resulta de una cadena compleja de determinantes como los biológicos, los socioeconómicos y los de salud. El objetivo de este trabajo fue conocer la tasa de mortalidad neonatal general, por peso y edad gestacional, en un instituto de tercer nivel de atención durante 2007 y 2008. Métodos. Se analizaron todos los casos provenientes del comité de mortalidad perinatal y neonatal, de 2007 y 2008, desde 22 semanas de gestación en adelante. El análisis estadístico se realizó mediante medidas de tendencia central y dispersión para las variables cuantitativas y para las variables cualitativas frecuencia, porcentaje, χ² y razón de momios con nivel de significación estadística < 0.05. Resultados. La tasa de mortalidad para el año 2007 fue de 17.7 × 1000 nacidos vivos y para el 2008 de 19.7 × 1000 nacidos vivos. En relación con el peso y con la edad gestacional no se encontró aumento de riesgo al comparar los resultados de ambos años. Las malformaciones ocuparon el mayor porcentaje entre las causas de defunción. Conclusiones. Las tasas de mortalidad en 2007 y 2008 fueron de 17.7 y 19.7 × 1000 nacidos vivos, respectivamente. Las principales causas de defunción fueron las malformaciones cardiacas.

Background. Mortality is a sensitive and specific indicator for determining the health status of a country in order to implement improvement strategies. It is the result of biological, social, economic and health factors. The aim of this study was to determine neonatal general mortality and its relationship with weight and gestational age at a third-level health institution from 2007 to 2008. Methods. We analyzed all patients >22 weeks of gestational age from the perinatal mortality service. Statistical analysis was done using measures of central tendency and dispersion for quantitative variables and χ2, percentage and frequency for qualitative variables; odds ratios were calculated with significance level <0.05. Results. The mortality rate for 2007 was 17.7 per 1000 live births, and for 2008 it was 19.7 per 1000 live births. When we compared both years, we did not find an increased risk for weight and gestational age. Malformations occupied the largest causes of death. Conclusions. For years 2007 and 2008, mortality rates were 17.7 and 19.7 per 1000 live births, respectively, and the main cause of deaths were cardiac malformations.

Cuatro décadas en la mortalidad por enfermedades cardiovascularesen Venezuela: 1965 a 2007 / Four decades on cardiovascular diseases mortality in Venezuela: 1965-2007

La tasa de mortalidad (TM) es un indicador básico en el sector salud, además de ser usado en la toma de decisiones macro-económicas y sociales. Esperando contribuir con la diseminación efectiva de esta información, presentamos cuatro décadas en la mortalidad por enfermedades cardiovasculares en Venezuela, 1965 al 2007. Se calcularon las TM por enfermedades del sistema Cardiocirculatorio correspondientes a CIE-10 (Códigos I00 a I99) usando datos oficiales. Se ajustaron las tasas (TMA) según el método directo a la población mundial estándar dela OMS. La TMA en defunciones por 100 000 habitantes: Total: 249 (304- 208), Hombres: 281 (338-239) y Mujeres 216: (271-178). Tanto la TMA en hombre como en mujeres se comportan de manera similar a la TMA Total, la TMA en hombres es mayor que en mujeres para todo el período. Entre 1995 y 2007 el porcentaje de defunciones por ECV en la mortalidad total fue mayor en mujeres (mediana: 36,5% rango 35,3% a 44,0%) que en hombres (mediana: 29,3% rango 27,6% a 34,3%), y globalmente la mediana fue: 32,2% (rango30,7% a 37,6). En América Latina, el año 2000 Venezuela ocupó la octava posición respecto a la TMA total, según PAHO; y la tercera posición según nuestros cálculos. Existe necesidad de desarrollar los sistemas de vigilancia epidemiológicas en el ámbito de las enfermedades crónicas que permitan preparar, implementar y evaluar programas de capacitación, programas de control de calidad y la efectiva diseminación de la información.

Mortality rates (MR) are basic health indicators also use for decision making on macro-economic and social issues. Hoping to help with the efficient dissemination of information, we present four decades of cardiovascular disease mortality in Venezuela 1965-2007. MR per 100 000 inhabitants were calculated and adjusted (ADR) by the direct method to the WHO’s standard population due to cardiovascular diseases (CVD) according to IDC-10 (I00 a I99) by using official data. ADR are presented in median (range), ADR Total: 249 (304- 208), ADR Male: 281 (338-239) y ADR Female: 216: (271-178). Trends ADR were similar for male and female; male’s ADR were higher that female for all the period. From 1995 to 2007 the proportion of CVD in the total mortality was higher for female (median: 36.5% range 35.3% to 44.0%) than male (29.3%; 27.6%- 34.3%), globally (32.2%; 30.7%-37.6 %). In Latin America, for the year 2000, Venezuela held the 8th position on ADR for CVD, according to PAHO but 3er according to our calculations. There is a need to develop chronic diseases surveillance systems to address issues concerning capacity building, quality assurance of data and effective dissemination of information.

Transporte neonatal seguro en la población abierta del estado de Jalisco: impacto del programa S.T.A.B.L.E. en la morbilidad y mortalidad / Safe neonatal transport in Jalisco state: impact of S.T.A.B.L.E. program on morbidity and mortality

Introducción. El transporte neonatal desde las unidades médicas hasta las unidades de tercer nivel en muchos casos es desorganizado y arriesgado, situación que compromete aún más el estado de salud del neonato enfermo. El objetivo del estudio fue analizar el impacto del programa S.T.A.B.L.E. (de las siglas en inglés: Sugar and Safe care, Temperature, Airway, Blood, Lab work, Emotional support) en la morbimortalidad de los neonatos trasladados del interior del estado de Jalisco y de la zona metropolitana de Guadalajara, a la Unidad de Cuidados Intensivos Neonatales Externos (UCIN-EX) del Hospital Civil de Guadalajara. Métodos. Se diseñó un estudio prospectivo de 2005 a 2009. El proceso de intervención se basó en la aplicación del programa S.T.A.B.L.E. a todo neonato que requirió ser trasladado. Esto se logró con la intervención de los médicos reguladores del Sistema de Atención Médica de Urgencias (SAMU) del estado de Jalisco. Se implementó un curso de capacitación para el personal médico y paramédico de los centros de atención que refieren pacientes a nuestra unidad, con el fin darles a conocer el programa S.T.A.B.L.E. y su forma de aplicación. Resultados. Un total de 3,277 neonatos fueron incluidos en el estudio, 384 antes de implementar el programa y 2,893 con la aplicación del programa S.T.A.B.L.E. En el grupo con intervención se observó una frecuencia mayor de pacientes con temperatura corporal normal a su ingreso a la unidad receptora [516 (87%) vs. 227 (59%) p < 0.01 ], así como cifras de glicemia en rangos normales [690 (93%) vs. 173 (45%) p < 0.001]. La mortalidad durante el periodo de hospitalización en la unidad receptora fue menor en el grupo con intervención [405 (14%) vs. 84 (22%) p < 0.05]. Después del proceso de intervención, más pacientes fueron trasladados en incubadora [2,806 (97%) vs. 200 (52%) p < 0.001]; de igual forma, en más pacientes se aplicaron métodos de monitoreo de oximetría de pulso [2,575 (89%) vs. 235 (61 %) p < 0.01 ]. En cuanto al número de transportes neonatales regulados y autorizados por el sistema SAMU, se observó un incremento a favor del grupo con intervención [2,806 (97%) vs. 234(61%) p < 0.001]. La frecuencia de defunciones durante el transporte neonatal no presentó diferencias [30 (1 %) vs. 10 (2.6%) p = NS]. Conclusiones. El traslado de neonatos enfermos al tercer nivel de atención médica en el estado de Jalisco se realizó de forma segura, con una mejoría importante en la morbilidad. El programa S.T.A.B.L.E. fue altamente eficiente y de fácil aplicación. La disminución de la mortalidad de los pacientes con intervención del programa durante el periodo de hospitalización requiere estudios especialmente diseñados para establecer posibles asociaciones.

Background. Transporting newborn infants to third-level units is often disorganized, thus entailing several risks that may further compromise the health of newborn patients. Methods. A prospective study was designed in orderto assess the impact ofthe S.T.A.B.L.E. program (Sugarand Safe Care, Temperature, Airway, Blood, Lab work, Emotional support) from 2005 to 2009 in regard to morbidity and mortality rates of newborn patients who had to be transferred from other regions within Jalisco state or within Guadalajara's metropolitan area to the Neonatal Intensive Care Unit ofthe Civil Hospital in Guadalajara. The intervention process was based on applying the S.T.A.B.L.E. program to all newborns who needed to be transferred and was achieved with the intervention ofthe physicians regulating the Emergency Medical Assistance System (SAMU) of the state of Jalisco. A training course, as well as an educational brochure, was given to medical and paramedical staff from the medical assistance centers referring patients to our unit in orderto provide them with information on the S.T.A.B.L.E. program and its implementation. Results. A total of 3,277 newborn infants were included in the study, 384 before the intervention program and 2,893 once the S.T.A.B.L.E. program was implemented. Within the group transferred after the program's implementation, we observed a greater incidence of patients with normal body temperature upon admission to the receiving unit [516 (87%) vs. 227 (59%); p < 0.01 ] as well as with blood glucose figures within the normal range [690 (93%) vs. 173 (45%); p < 0.001]. Mortality during the hospitalization period in the receiving unit was lower in the group treated after the program's implementation [405 (14%) vs. 84 (22%); p < 0.05]. After the intervention process, more patients were transported in incubators [2,806 (97%) vs. 200 (52%); p < 0.001] and equally, pulse oximetry monitoring methods were applied in a greater number of patients [2,575 (89%) vs. 235 (61 %); p < 0.01 ]. With regard to the number of transfers of newborns that were regulated and authorized by the SAMU system, we also observed an increase in such numbers for the group treated after the intervention program [2,806 (97%) vs. 234 (61 %); p < 0.001]. There was no difference in the incidence of death during the newborns' transport [30 (1%) vs. 10 (2.6%); p = NS]. Conclusions. Transfer of ill newborns to third-level medical care units in the state of Jalisco was safely undertaken with a significant improvement in morbidity rates. The S.T.A.B.L.E. program was highly effective and easy to implement. The decrease in mortality during the hospitalization period of patients treated after the intervention program merits further studies especially designed to establish possible associations.

Cuatro décadas en la mortalidad por hipertensión arterial en Venezuela: 1969 a 2008 / Four decades on mortality due to high blood pressure in Venezuela: 1968-2008

La tasa de mortalidad es un indicador básico en el sector salud, además de ser usado en la toma de decisiones macro-económicas y sociales. Esperando contribuir con la diseminación efectiva de esta información, presentamos cuatro décadas en la mortalidad por hipertensión arterial en Venezuela 1968-2008. Se calcularon las tasas de mortalidad por hipertensión arterial, CIE-10 (Códigos I10 a I15), usando datos oficiales. Se ajustaron las tasas de mortalidad ajustadas según el método directo a la población mundial estándar de la OMS. El rango en la tasa de mortalidad ajustada en defunciones por 100 000 habitantes: Total: 18,0 a 29,2; hombres: 17,2 a 30,1 y mujeres 16,7 a 28,3. La tasa de mortalidad ajustada tiene comportamiento multimodal, observándose diferencias importantes según género. La tasa de mortalidad ajustada difiere del patrón en las tasas específicas al grupo de 45-64 y ≥65 años. Entre 1995 y 2008 el rango porcentual de defunciones por hipertensión arterial en la mortalidad por enfermedad cardiovascular fue mayor en mujeres (rango 9,3% a 14,4%). Existe necesidad de desarrollar los sistemas de vigilancia epidemiológicas en el ámbito de las enfermedades crónicas que permitan preparar, implementar y evaluar programas de capacitación, programas de control de calidad y la efectiva diseminación de la información.

Mortality rates (MR) are basic health indicators also use for decision making on macro-economic and social issues. Hoping to help with the efficient dissemination of information, we present four decades of mortality due to high blood pressure in Venezuela 1968-2008. Mortality rates per 100 000 inhabitants were calculated and adjusted (ADR) by the direct method to the WHO’s standard population due to high blood pressure, IDC-10 (I10 to I15) using official data. ADR are presented in range, ADR Total: 18.0 to 29.2; ADR male: 17.2 a 30.1 and ADR female 16.7 a 28.3. Trends ADR have a multimodal profile for both male and female, with gender differences. Trend on ADR differ from age specific mortality rates (45-64 and ≥65 years old) from higher that female for all the period. From 1995 to 2008 the proportion of high blood pressure in the mortality due to CVD was higher for female (range 9.3 % to 14.4 %). There is a need to develop chronic diseases surveillance systems to address issues concerning capacity building, quality assurance of data and effective dissemination of informationA.

Análisis Médico Legal de los homicidios en Costa Rica en el 2008 / Medical legal analysis of the homicides in Costa Rica in 2008

Recientemente se ha comentado mucho en la opinión pública de temas como la seguridad ciudadana, la criminalidad y en general de la violencia social y su aumento en Costa Rica. Con el fin de brindar un panorama actualizado de un indicador objetivo como los homicidios se realizó el presente trabajo, en el cual se revisaron todas las autopsias de 2008 (un total de 3264) efectuadas en el Departamento de Medicina Legal de Costa Rica. Se obtuvo que una sexta parte de las mismas correspondió a homicidios, lo cual generó una tasa de mortalidad de 11,36 por 100000 habitantes, por mucho la más alta en la historia contemporánea de nuestro país. El perfil predominante de las víctimas fue: ser de sexo masculino, en edad económicamente productiva, con fatalidades acaecidas en la noche, los fines de semana, en la capital y las provincias portuarias, con fallecimiento en el sitio del suceso por heridas por proyectil de arma de fuego en cabeza, cuello y tórax, con presencia de alcohol y cocaína en un porcentaje significativo de las víctimas. A pesar de la complejidad de los factores que originan este fenómeno, se insiste en la prevención de la violencia social desde el núcleo familiar.

Recently, in Costa Rica, topics like citizen security, crime rates and social violence have been a topic on public opinion. There are two positions: violence has increased and violence has not increased. We made this investigation for to give an update of the panorama of homicides in Costa Rica, one of the most important and objective indicator of social violence. We have analyzed all autopsies (a total of 3264) occurred during the year 2008 which were made by the Departamento de Medicina Legal de Costa Rica. From these revision, we obtained that one sixth of these autopsies were homicides, which means that the mortality rate was 11.36 per 100000 habitants, the highest of the modern Costa Rican history. The most common profile of the victims was: male, productive age, homicides occurred predominantly during nights, weekends in capital and main harbor provinces, with death at the scene by gunshot in head, neck or chest; a significant percentage were under alcohol and cocaine effects. We insist in the prevention by education fron the family care as a fundamental tool to avoid social violence.

Diferencias regionales en la mortalidad por cáncer de mama y cérvix en México entre 1979 y 2006 / Regional differences in breast and cervical cancer mortality in Mexico between 1979-2006

OBJETIVO: Explorar las diferencias regionales en la mortalidad por cáncer de mama (CaMa) y cervical (CaCu) en México. MATERIAL Y MÉTODOS: Se calcularon tendencias de mortalidad por CaMa y CaCu mediante modelos probabilísticos ajustados por estado, grado de marginación y lugar de residencia (urbano/rural). RESULTADOS: La tendencia de mortalidad por CaMa ha sido ascendente, de una tasa estandarizada de 5.6 muertes por cada 100 000 mujeres en 1979 a 10.1 en 2006. La mortalidad por CaCu alcanzó un pico en 1989 y a partir de esa fecha se redujo a 9.9 en 2006. Las tasas más altas de mortalidad por CaMa se encuentran en la capital (13.2) y la región norte (11.8), mientras en el sur se registra la mortalidad por CaCu más alta (11.9). DISCUSIÓN: El número de muertes por CaMa aumenta de forma gradual a lo largo del tiempo a nivel nacional y persisten elevadas tasas de mortalidad por CaCu en áreas marginadas.

OBJECTIVE: Explore the regional differences in breast (BC) and cervical cancer (CC) mortality in Mexico. MATERIAL AND METHODS: We estimated mortality trends for BC and CC using probabilistic models adjusted by state marginalization level and urban and rural residence. RESULTS: BC mortality shows a rising trend, from a rate of 5.6 deaths per 100000 women in 1979 to 10.1 in 2006. The CC mortality rate reached a peak in 1989 and after this decreased significantly to 9.9 in 2006. The highest BC mortality rates are found in Mexico City (13.2) and the northern part of the country (11.8). As for CC, the highest mortality rates are found in the south (11.9 per 100000 women the). DISCUSSION: The number of BC cases are increased gradually at the national level during the last three decades and high rates of CC mortality persist in marginalized areas.

Mortality rate estimation for eelgrass Zostera marina (Potamogetonaceae) using projections from Leslie matrices

The main goal of this study is to provide estimations of mean mortality rate of vegetative shoots of the seagrass Zostera marina in a meadow near Ensenada Baja California, using a technique that minimizes destructive sampling. Using cohorts and Leslie matrices, three life tables were constructed, each representing a season within the period of monthly sampling (April 1999 to April 2000). Ages for the cohorts were established in terms of Plastochrone Interval (PI). The matrices were projected through time to estimate the mean total number of individuals at time t, n(t) as well as mortality. We found no statistical differences between observed and predicted mean values for these variables (t=-0.11, p=0.92 for n(t) and t=0.69, p=0.5 for mean rate of mortality). We found high correlation coefficient values between observed and projected values for monthly number of individuals (r=0.70, p=0.007) and monthly mortality rates (r=0.81, p=0.001). If at a certain time t a sudden environmental change occurs, and as long as the perturbation does not provoke the killing of all the individuals of a given age i for 0 ≤ i ≤ x - 1, there will be a prevailing number of individuals of age or stage x at a time t+1. This nondestructive technique reduces the number of field visits and samples needed for the demographic analysis of Z. marina, and therefore decreases the disturbance caused by researches to the ecosystem. Rev. Biol. Trop. 56 (3): 1015-1022. Epub 2008 September 30.

El propósito principal de este estudio es el de proveer estimaciones de tasas promedio de mortalidad de tallos vegetativos de Zostera marina en una pradera cercana a Ensenada Baja California, utilizando una técnica que minimiza los muestreos destructivos para estos pastos marinos. Mediante la utilización de cohortes y matrices de Leslie, se construyeron tres tablas de vida, cada una representando a una estación dentro de período anual de muestreos mensuales (Abril 1999 a Abril 2000). Las edades de los cohortes fueron estimadas en términos de Intervalos de Plastocrono (IP). Las matrices de Leslie fueron proyectadas a través del tiempo para estimar el número total de individuos a un tiempo t, n(t) así como las tasas de mortalidad. No se encontraron diferencias significativas entre los valores medios observados y proyectados para estas variables (t=0.11, p=0.92 para n(t) y t=0.69, p=0.5 para la tasa media de mortalidad). Se encontraron altas correlaciones los valores observados y proyectados tanto en el número de individuos (r=0.70, p=0.007) como las tasas mensuales de mortalidad (r=0.81, p=0.001). Si a cierto tiempo t ocurre un cambio ambiental repentino, de tal manera que la perturbación no provoque la muerte de todos los individuos de una edad i para 0 ≤ i ≤ x-1, prevalecerá un número de individuos de edad o estadio x al tiempo t+1. Esta técnica no destructiva reduce el número de visitas al campo y de muestras necesarias para un análisis demográfico de Z. marina y por lo tanto decrece el disturbio causado al ecosistema.

Tendencia de la mortalidad por tumores cerebrales malignos en Chile: Análisis de tasas / Analysis of Chilean trends in mortality from malignant brain tumors

Objective: To analyse the Chilean trends in mortality from brain malignancies between 1985 and 1999. Methods: We calculated mortality rates from malignant brain tumors using data obtained from death certificates available at the National Statistics Office. The following International Classification of Diseases categories were selected: 191.0 to 191.9 (ICD-9), and C71.0 to C71.9 (ICD-10). The rates were adjusted using direct standardization. Prais-Winsten methodology was used for time correlation analysis. Results: Sex-specific rates varied from 0.9 to 1.75 per 100.000 in men and from 0.7 to 1.22 in women. The trend was toward a statistically significant increase in mortality from malignant brain tumors in both groups. The analysis by age group showed no statistically significant variation in those below 35 years old, and a statistically significant increase in those between 35 and 39 years old, and in those above 45 years old. Conclusions: The trend in mortality from malignant brain tumors, in Chile, shows a statistically significant increase in those between 35 and 39 years old, and in those above 45 years old.

Existe controversia en el aumento de la incidencia en las tasas de tumores primarios malignos de cerebro. Este incremento podría explicarse por el crecimiento exponencial en el número de Tomografías computarizadas. Objetivo: Evaluar la tendencia de la mortalidad por tumores cerebrales primarios malignos en Chile (TCM). Metodología: Estudio de tasas de mortalidad de datos obtenidos en índices demográficos (años 1985 a 1999). Se utilizó la población de Chile de los años estudiados y se ajustó a la población estimada de 1999. Se usó las categorías 191,0 a 191,9 y C 71-0 a C 71-9 de la Clasificación Internacional, correspondiendo al grupo de tumores malignos del SNC. Se estudiaron tasas específicas por edad y sexo. Se calculó la tendencia utilizando las tasas ajustada por edad y sexo. Se utilizó una prueba de regresión lineal (Prais-Winsten) para mediciones correlacionales en el tiempo (Stata 7). Resultados: Se obtuvo 2.304 TCM. Las tasas específicas por sexo varían entre 0,90 a 1,75 x 100.000 en hombres y de 0,7 a 1,22 en mujeres. La tendencia global de la mortalidad por tumores tiende al ascenso en ambos grupos y es significativamente más alta en hombres (0,47 95 % IC 0,18 a 0,42 p = < 0,005) El estudio por grupos etarios no muestra un aumento significativo en menores de 14 años, ni entre 15 y 34 años. En los grupos de 45 años y más es estadísticamente significativa. Conclusión: La tendencia a la mortalidad por TCM aparece en ascenso en los grupos etarios 35 a 39 años y 45 años y más.

Mortality Trends in Colorectal Cancer and Breast Cancer in Korea: Birth Cohort Effects? / 한국역학회지

PURPOSE: Cancer has been the leading cause of deaths since 1980s in Korea. Among them, colorectal cancer and breast cancer shows steadily increasing pattern, being the fourth and the fifth common site of cancer death in Korea, respectively. This analysis aimed to evaluate potential contribution of birth cohort effects to the recent increases in mortality of colorectal cancer and breast cancer since 1983 in Korea. METHODS: Mortality statistics on deaths of both cancers for the past 20 years of 1983~2002 were obtained from the National Statistical Office. The age-standardized mortality rates were calculated based on the census population of 1992 as a standard. RESULTS: Age-standardized mortality rate for colorectal cancer increased 4.7-fold in men and 3.6-fold in women, whereas 2.1-fold increase in breast cancer mortality during 1983~2002. Age-specific mortality rates for colorectal cancer were steadily increasing by age before 1991 in both genders. However, the mortality rates showed an exponentially increasing pattern for the age group of 70 and over during 1993~2001, which was more prominent in female. The birth cohort curves showed that there were 2- to 3-fold increases in the mortality rates of people who were born in 1931 for colorectal cancer compared to those of people who were born in 1921. Differences in mortality for breast cancer by birth cohort were 1.7-fold among age group of 45~49 and 50~54 between 1936 and 1946. CONCLUSIONS: This analysis suggests that recent increases in mortality of colorectal cancer and breast cancer could potentially be due to birth cohort effects, i.e. rapid changes in life-style in younger generation. The quantitative approach using age-period-cohort model should be pursued.

Relationship between structural characteristics and hospital mortality rates on tertiary referral hospitals in Korea / 예방의학회지

This study was to evaluate hospital characteristics as composition of manpower and facilities to the death rate of patient; and to earmark the factors affecting the overall hospital mortality rates. The data utilized were derived from survey material conducted by the Korean Hospital Association on 32 tertiary referral hospitals in Korea between 1986 and 1994. The findings are: 1. Those hospitals having the most capacity per bed had little difference to the mortality rates than the others. 2. Those hospitals having the most daily patients per specialist had significantly higher mortality rates than the others, but the number of daily patients per nurse had little effect on the mortality rates. 3. Those hospitals which had a relatively sufficient number of quality assurance activities revealed a lower mortality, and particularly in case where such effort was directed to the clinicians, the outcome was remarkable. we concluded that the major factor affecting the hospital mortality rates seems to be the number of specialists per number of beds, the degree of quality assurance assessment of the clinicians, the quality assurance activities of each hospital as a whole, and the number of daily patient per specialist. According to the findings of this study, the composition and quality of specialist and adequate quality assurance activities seemed to be the essential for the improvement of hospital care. Therefore, in this regard the proper implementation of policy and support is highly recommended. Due to lack of available research material, the personal characteristics of specialists haven't been considered in this study However, this longitudinal observation of 32 tertiary referral hospitals over a nine year period has significant merit alone.