Causas Múltiplas de Morte Associadas à Parada Cardiorrespiratória Pediátrica de 1996 a 2019 no Brasil / Multiple Causes of Death Associated with Pediatric Cardiopulmonary Arrest from 1996 to 2019 in Brazil

Resumo Fundamento: Em pediatria, a parada cardiorrespiratória (PCR) está associada a alta mortalidade e graves sequelas neurológicas. Informações sobre as causas e mecanismos de morte abaixo de 20 anos poderiam fornecer subsídios teóricos para a melhoria da saúde de crianças e adolescentes. Objetivos: Realizar uma análise populacional das taxas de mortalidade por causas primárias e múltiplas de morte abaixo de 20 anos, em ambos os sexos, no período de 1996 a 2019, no Brasil, e identificar a frequência com que a PCR foi registrada nas declarações de óbito (DOs) desses indivíduos e os locais de ocorrência dos óbitos, a fim de promover estratégias para melhorar a prevenção de mortes. Método: Estudo ecológico de séries temporais de óbitos em indivíduos menores de 20 anos, no período de 1996 a 2019, avaliando as taxas de mortalidade (TMs) e a mortalidade proporcional (MP) por causa básica de morte. Foram analisados os percentuais de PCR registrados em qualquer linha da DO e o local de ocorrência dos óbitos. Foram calculadas as TMs por 100 mil habitantes e a MP por causa básica de morte nos menores de 20 anos segundo sexo e faixa etária, os percentuais de óbito por causas básicas por faixa etária quando a PCR foi descrita em qualquer linha das Partes I e II da DO, e o percentual de óbitos por causas básicas segundo o local de ocorrência. Os dados foram retirados do DATASUS, IBGE e SINASC. Resultados: De 1996 a 2019, ocorreram 2.151.716 óbitos de menores de 20 anos, no Brasil, gerando uma taxa de mortalidade de 134,38 por 100 mil habitantes. A taxa de óbito foi maior entre os recém-nascidos do sexo masculino. Do total de óbitos, 249.334 (11,6%) tiveram PCR registrada em qualquer linha da DO. Especificamente, a PCR foi registrada 49.178 vezes na DO na faixa etária entre 1 e 4 anos e em 88.116 vezes entre 29 e 365 dias, correspondendo, respectivamente, a 26% e 22% dos óbitos nessas faixas etárias. Essas duas faixas etárias apresentaram as maiores taxas de PCR registradas em qualquer linha da DO. As principais causas básicas de óbito quando a PCR foi registrada na sequência de óbitos foram doenças respiratórias, hematológicas e neoplásicas. Conclusão: As causas perinatais e externas foram as principais causas de morte, com maior TM nos menores de 20 anos no Brasil de 1996 a 2019. Quando consideradas as causas múltiplas de morte, as principais causas primárias associadas à PCR foram as doenças respiratórias, hematológicas e neoplásicas. A maioria dos óbitos ocorreu no ambiente hospitalar. Melhor compreensão da sequência de eventos nesses óbitos e melhorias nas estratégias de ensino em ressuscitação cardiopulmonar pediátrica são necessárias.

Abstract Background: In pediatrics, cardiopulmonary arrest (CPA) is associated with high mortality and severe neurologic sequelae. Information on the causes and mechanisms of death below the age of 20 years could provide theoretical support for health improvement among children and adolescents. Objectives: To conduct a population analysis of mortality rates due to primary and multiple causes of death below the age of 20 years in both sexes from 1996 to 2019 in Brazil, and identify the frequency in which CPA was recorded in the death certificates (DCs) of these individuals and the locations where the deaths occurred, in order to promote strategies to improve the prevention of deaths. Method: Ecological time-series study of deaths below the age of 20 years from 1996 to 2019, evaluating the mortality rates (MRs) and proportional mortality (PM) by primary cause of death. We analyzed the percentages of CPA recorded in any line of the DC and the location where the deaths occurred. We calculated the MRs per 100,000 inhabitants and the PM by primary cause of death under the age of 20 years according to sex and age group, the percentages of death from primary causes by age group when CPA was described in any line of Parts I and II of the DC, and the percentage of deaths from primary causes according to their location of occurrence. We retrieved the data from DATASUS, IBGE, and SINASC. Results: From 1996 to 2019, there were 2,151,716 deaths below the age of 20 years in Brazil, yielding a mortality rate of 134.38 per 100,000 inhabitants. The death rate was highest among male neonates. Of all deaths, 249,334 (11.6%) had CPA recorded in any line of the DC. Specifically, CPA was recorded in 49,178 DCs between the ages of 1 and 4 years and in 88,116 of those between the ages of 29 and 365 days, corresponding, respectively, to 26% and 22% of the deaths in these age groups. These two age groups had the highest rates of CPA recorded in any line of the DC. The main primary causes of death when CPA was recorded in the sequence of death were respiratory, hematologic, and neoplastic diseases. Conclusion: Perinatal and external causes were the primary causes of death, with highest MRs under the age of 20 years in Brazil from 1996 to 2019. When multiple causes of death were considered, the main primary causes associated with CPA were respiratory, hematologic, and neoplastic diseases. Most deaths occurred in the hospital environment. Better understanding of the sequence of events in these deaths and improvements in teaching strategies in pediatric cardiopulmonary resuscitation are needed.

A COMMUNITY-BASED SURVEY TO ASSESS THE PREVALENCE AND ETIOLOGICAL FACTORS FOR TYPE II DIABETES MELLITUS IN THE TWO REGIONAL STATES OF SOUTHERN INDIA–A PILOT STUDY

Objective: The concurrent study aimed to assess and analyse the prevalence and etiological factors responsible for the occurrence of Type 2 diabetes mellitus among the labour population. A cross-sectional study was conducted among the labour in the two regional states of southern India. This study was conducted for 6 mo in the two states of the southern region of India.Methods: A questionnaire was designed with various questions to study the prevalence and scrutinize the causes responsible for the occurrence of type 2 diabetes among the labour population. A total number of n=104 respondents participated, out of which 57 were diabetic and were further analysed. The results were compiled and subjected to the statistical analysis (Chi-square test).Results: In the demographics, the majority of the participants were females (n=33), while the remaining were males. 75% of the participants were with age groups between 31-60 y, about 50% were uneducated and belonged to lower income category. Etiological factors like family history (>50%) and comorbid conditions (n=43) were more responsible for the prevalence of Type 2 diabetes. In the food habits assessment, carbohydrates and non-vegetarian consumption were more in majority (>45%) of the respondents. 86% of the participants were on medication, along with only 57.8% were recorded with HbA1c. Diet restrictions and timely intake of food were up to the level after the diagnosis of the disease. Nearly 50% of diabetics were confident about the management of the disease and 54 respondents were spotted to have a keen interest in acquiring knowledge further.Conclusion: The findings concluded that the diabetic participants followed the necessary diet requirements and were on medication for the treatment of type 2 diabetes mellitus.

Infections in patients hospitalized for external causes in Intensive Care Units / Infecciones en pacientes hospitalizados por causas externas en Unidades de Cuidados Intensivos / Infecções em pacientes internados por causas externas em Unidades de Terapia Intensiva

Background and Objectives: given the great demand for hospitalization due to external causes, as well as the growing number of cases of infections in health services, it can be said that these are important issues and that they represent a huge challenge to be faced by professionals and health managers around the world. Therefore, this article aims to describe the profile of individuals hospitalized for external causes in an Intensive Care Units (ICUs) who underwent a culture test and identify the main microorganisms that cause infection. Methods: a cross-sectional study carried out with patients suffering from external causes, admitted to an ICU of a general hospital in Bahia. The data were analyzed using descriptive statistics, presented in absolute and relative frequencies. Results: a total of 259 admissions to the ICU due to external causes were identified, of which 59 (22.78%) underwent cultures, of which 48 (81.35%) were men, 43 (72.88%) were brown, 32 (54.24%) did not have a partner and 35 (59.32%) suffered transport accidents. Regarding the use of devices, 54 (91.52%) patients were on invasive mechanical ventilation, 54 (91.50%) used an indwelling urinary catheter and 54 (91.52%) had a central venous catheter. The main microorganisms identified in the culture were of the genera Staphylococcus (17; 28.9%) and Pseudomonas (10; 16.9%). Conclusion: it is concluded that admissions to ICU resulting from external causes in patients who underwent culture were of men, who suffered transport accidents, used invasive devices, and the main infections are related to microorganisms of the genus Staphylococcus.(AU)

Antecedentes y Objetivos: Dada la gran demanda de hospitalización debido a causas externas, así como el creciente número de casos de infecciones en servicios de salud, se puede decir que estos son temas importantes y representan un enorme desafío a enfrentar por profesionales y gestores de salud en todo el mundo. Por lo tanto, este artículo tiene como objetivo describir el perfil de los individuos hospitalizados por causas externas en Unidades de Cuidados Intensivos (UCI) que se sometieron a una prueba de cultivo e identificar los principales microorganismos que causan infección. Métodos: Se realizó un estudio transversal con pacientes que sufrían causas externas, admitidos en una UCI de un hospital general en Bahía. Los datos se analizaron utilizando estadísticas descriptivas, presentadas en frecuencias absolutas y relativas. Resultados: Se identificó un total de 259 ingresos a la UCI debido a causas externas, de los cuales 59 (22,78%) se sometieron a cultivos, de los cuales 48 (81,35%) eran hombres, 43 (72,88%) eran pardos, 32 (54,24%) no tenían pareja y 35 (59,32%) sufrieron accidentes de transporte. En cuanto al uso de dispositivos, 54 (91,52%) pacientes estaban en ventilación mecánica invasiva, 54 (91,50%) usaron catéter urinario de demora y 54 (91,52%) tenían un catéter venoso central. Los principales microorganismos identificados en el cultivo fueron del género Staphylococcus (17; 28,9%) y Pseudomonas (10; 16,9%). Conclusión: Se concluye que los ingresos a la UCI resultantes de causas externas en pacientes que se sometieron al cultivo fueron de hombres, que sufrieron accidentes de transporte, usaron dispositivos invasivos, y las principales infecciones están relacionadas con microorganismos del género Staphylococcus.(AU)

Justificativa e Objetivos: Dada a grande demanda por hospitalização devido a causas externas, assim como o crescente número de casos de infecções em serviços de saúde, pode-se dizer que esses são temas importantes e representam um enorme desafio a ser enfrentado por profissionais e gestores de saúde ao redor do mundo. Portanto, este artigo tem como objetivo descrever o perfil dos indivíduos hospitalizados por causas externas em Unidades de Terapia Intensiva (UTIs) que se submeteram a um teste de cultura e identificar os principais microrganismos que causam infecção. Métodos: Um estudo transversal foi realizado com pacientes que sofriam de causas externas, admitidos em uma UTI de um hospital geral na Bahia. Os dados foram analisados utilizando estatísticas descritivas, apresentadas em frequências absolutas e relativas. Resultados: Um total de 259 internações na UTI devido a causas externas foi identificado, dos quais 59 (22,78%) foram submetidos a culturas, sendo 48 (81,35%) homens, 43 (72,88%) pardos, 32 (54,24%) não tinham parceiro e 35 (59,32%) sofreram acidentes de transporte. Em relação ao uso de dispositivos, 54 (91,52%) pacientes estavam em ventilação mecânica invasiva, 54 (91,50%) usaram cateter urinário de demora e 54 (91,52%) tinham um cateter venoso central. Os principais microrganismos identificados na cultura foram dos gêneros Staphylococcus (17; 28,9%) e Pseudomonas (10; 16,9%). Conclusão: Conclui-se que as internações na UTI decorrentes de causas externas em pacientes que se submeteram à cultura foram de homens, que sofreram acidentes de transporte, usaram dispositivos invasivos, e as principais infecções estão relacionadas a microrganismos do gênero Staphylococcus. (AU)

Research Progress of Monogenic Mutation in the Pathogenesis of Steroid-Resistant Nephrotic Syndrome / 罕见病研究

Steroid-resistant nephrotic syndrome (SRNS) is the second cause of chronic kidney disease in children. The SRNS has high risk of rapid progression to end-stage renal disease. With the advancement of high-throughput sequencing technology, more than 70 monogenic mutation having the Mendelian inheritance patterns are identified to be associated with SRNS. Most of these genes are involved in podocyte function. Accurate diagnosis of monogenic mutation in SRNS patients helps with guiding clinical treatment protocols and genetic counseling, avoiding the excessive use of steroids/immunosuppressive therapy, and opening up possibilities for targeted therapies in SRNS patients. In this article, our research team summarizes and generalizes the molecular mechanisms, genetic testing, and specific treatment for the major types of monogenic mutations associated with SRNS.

Research Progress of Monogenic Mutation in the Pathogenesis of Steroid-Resistant Nephrotic Syndrome / 罕见病研究

Steroid-resistant nephrotic syndrome (SRNS) is the second cause of chronic kidney disease in children. The SRNS has high risk of rapid progression to end-stage renal disease. With the advancement of high-throughput sequencing technology, more than 70 monogenic mutation having the Mendelian inheritance patterns are identified to be associated with SRNS. Most of these genes are involved in podocyte function. Accurate diagnosis of monogenic mutation in SRNS patients helps with guiding clinical treatment protocols and genetic counseling, avoiding the excessive use of steroids/immunosuppressive therapy, and opening up possibilities for targeted therapies in SRNS patients. In this article, our research team summarizes and generalizes the molecular mechanisms, genetic testing, and specific treatment for the major types of monogenic mutations associated with SRNS.

Factors associated with external causes in elderly attended by the mobile emergency care service / Factores asociados a causas externas en ancianos atendidos por el servicio de atención móvil de urgencia / Fatores associados às causas externas em idosos atendidos pelo serviço de atendimento móvel de urgência

ABSTRACT Objective: To analyze the prevalence and factors associated with external causes in elderly people attended by the mobile emergency care service. Method: Cross-sectional study with 1,972 pre-hospital care records of elderly victims of external causes from 2019 to 2020. A descriptive and bivariate analysis was performed, with a significance level of 5% (p<0.05). Results: The prevalence of external causes in elderly people attended by the mobile emergency service was 12.2%. Falling was the most frequent occurrence. The associations of the occurrence of falls with age from 90 years old (OR=29.31; p<0.001) and female gender (OR=5.38; p<0.001) stood out, as well as the suspicion of ingestion of alcoholic beverages with occurrence of violence (OR=4.17; p<0.001) and traffic accidents (OR=1.97; p<0.001). Conclusion: The study showed factors associated with injuries due to external causes in theelderly and may support the formulation of coping strategies for this problem.

RESUMEN Objetivo: Analizar la prevalencia y los factores asociados a causas externas en ancianos atendidos por el servicio de atención móvil de urgencia. Método: Estudio transversal con 1.972 registros de atención pre hospitalaria de ancianos víctimas de causas externas en el período de 2019 a 2020.Se realizó un análisis descriptivo y bivariado, con un nivel de significación del 5% (p<0,05). Resultados: La prevalencia de causas externas en adultos mayores atendidos por el servicio de emergencia móvil fue de 12,2%. La caída fue la ocurrencia más frecuente. Se destacaron las asociaciones de la ocurrencia de caídas con la edad a partir de 90 años (OR=29,31; p<0,001) y el género femenino (OR=5,38; p<0,001), así como la sospecha de ingesta de bebidas alcohólicas con la ocurrencia de violencia (OR=4,17; p<0,001) y accidentes de tránsito (OR=1,97; p<0,001). Conclusión: El estudio mostró factores asociados a las lesiones por causas externas en ancianos y puede apoyar la formulación de estrategias de enfrentamiento de este problema.

RESUMO Objetivo: Analisar a prevalência e fatores associados a causas externas em idosos atendidos pelo serviço de atendimento móvel de urgência. Método: Estudo transversal com 1.972 fichas de atendimento pré-hospitalar de idosos vítimas de causas externas no período de 2019 a 2020. Realizou-se análise descritiva e bivariada, com nível de significância de 5% (p<0,05). Resultados: A prevalência de causas externas em idosos atendidos pelo serviço móvel de urgência foi de 12,2%. A queda foi a ocorrência mais frequente. Destacaram-se as associações da ocorrência de queda com a idade a partir de 90 anos (OR=29,31; p<0,001) e o sexo feminino (OR=5,38; p<0,001), bem como da suspeita de ingestão de bebida alcoólica com a ocorrência de violência (OR=4,17; p<0,001) e acidentes de trânsito (OR=1,97; p<0,001). Conclusão: O estudo evidenciou fatores associados aos agravos por causas externas em idosos e poderá subsidiar formulação de estratégias de enfrentamento a essa problemática.

Impacto directo e indirecto del COVID-19 en la esperanza de vida al nacer de Chile en el año 2020 / Direct and indirect impact of COVID-19 on life expectancy at birth in Chile in 2020 / Impacto direto e indireto da COVID-19 na expectativa de vida ao nascer no Chile em 2020

Resumen: El artículo muestra el impacto directo e indirecto del COVID-19 en la esperanza de vida de Chile durante el año 2020, utilizando las estadísticas de defunciones definitivas publicadas en marzo del año 2023. Para ello, se estimó una mortalidad contrafactual para año 2020 sin el COVID-19, siguiendo el patrón de mortalidad según causas de muerte desde 1997 a 2019, se elaboraron tablas de mortalidad para calcular la esperanza de vida para los años 2015 a 2020 y para el año 2020 estimado, y luego se descompuso la diferencia entre la esperanza de vida esperada y observada del año 2020 según grupos de edad y causas de muerte. La esperanza de vida del año 2020 quiebra la tendencia a su aumento entre 2015 y 2019, mostrando un retroceso, en hombres y en mujeres, con respecto al año 2019, de 1,32 y 0,75 años respectivamente. Con respecto al año 2020 estimado, la esperanza de vida del 2020 observado es 1,51 años menor en hombres y 0,92 en mujeres, pero el impacto directo del COVID-19 en pérdida de esperanza de vida fue mayor, 1,89 para los hombres y 1,5 para las mujeres, concentrándose en las edades entre los 60 y 84 años en hombres y entre 60 y 89 años en mujeres. El impacto directo negativo del COVID-19 a la esperanza de vida en parte fue contrarrestado por impactos indirectos positivos significativos en dos grupos de causas de muerte, las enfermedades del sistema respiratorio y las enfermedades infecciosas y parasitarias. El estudio muestra la necesidad de distinguir los impactos directos e indirectos del COVID-19, por la incidencia que pueden tener en la salud pública cuando el COVID-19 baje su intensidad y se eliminen las restricciones de movilidad.

Abstract: This article shows the direct and indirect impacts of COVID-19 on life expectancy in Chile in 2020, based on mortality statistics published in March 2023. To this end, a counterfactual mortality was estimated for 2020 without COVID-19; based on the pattern of mortality by cause of death from 1997 to 2019, mortality charts were created to calculate life expectancy from 2015 to 2020 and an estimation for 2020, and the difference between expected and observed life expectancy in 2020 was then separated by age group and cause of death. Life expectancy in 2020 interrupted the upward trend from 2015 to 2019, showing a decline of 1.32 years in men and 0.75 years in women compared to 2019. Compared to the estimated 2020, life expectancy was 1.51 years lower in men and 0.92 years lower in women, but the direct impact of COVID-19 on the decrease in life expectancy was greater (1.89 for men and 1.5 for women) in the 60-84 age group in men and the 60-89 age group in women. The direct negative impact of COVID-19 on life expectancy was partially mitigated by significant positive indirect impacts on two groups of causes of death: diseases of the respiratory system and infectious and parasitic diseases. This study shows the need to differentiate direct and indirect impacts of COVID-19, due to the implications for public health when the intensity of COVID-19 decreases and mobility restrictions are suspended.

Resumo: Este artigo apresenta os impactos direto e indireto da COVID-19 na expectativa de vida no Chile em 2020 a partir de estatísticas de mortalidade publicadas em março de 2023. Para tanto, foi estimada uma mortalidade contrafactual para 2020 sem a COVID-19; a partir do padrão de mortalidade por causa de morte de 1997 a 2019, foram criadas tabelas de mortalidade para calcular a expectativa de vida para o período de 2015 a 2020 e para o ano estimado de 2020 e, em seguida, a diferença entre a expectativa de vida esperada e observada em 2020 foi separada por faixa etária e causa de morte. A expectativa de vida em 2020 interrompe a tendência de aumento entre 2015 e 2019, mostrando um declínio com relação a 2019 de 1,32 ano nos homens e 0,75 ano nas mulheres. Com relação ao ano estimado de 2020, a expectativa de vida observada é 1,51 ano menor nos homens e 0,92 nas mulheres, mas o impacto direto da COVID-19 na diminuição da expectativa de vida foi maior (1,89 para homens e 1,5 para mulheres), concentrando-se nas idades entre 60 e 84 anos nos homens e entre 60 e 89 anos nas mulheres. O impacto direto negativo da COVID-19 na expectativa de vida foi parcialmente atenuado por impactos indiretos positivos significativos em dois grupos de causas de morte: doenças do sistema respiratório e doenças infecciosas e parasitárias. Este estudo mostra a necessidade de diferenciar impactos diretos e indiretos da COVID-19, devido às implicações para a saúde pública quando a intensidade da COVID-19 diminuir e as restrições de mobilidade forem suspensas.

Survival and mortality profile among people living with HIV in a cohort in the Northeastern region of Brazil

ABSTRACT Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 - 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths.

Temporal trend in fetal mortality according to two death avoidability classifications / Tendencia temporal de la mortalidad fetal según dos clasificaciones de muerte evitable / Tendência temporal da mortalidade fetal segundo duas classificações de evitabilidade do óbito

ABSTRACT Objective: To analyze the temporal trend of fetal mortality and its components, of avoidable and ill-defined causes according to two avoidability classifications in Recife, Pernambuco, 2010-2021. Method: Ecological study of temporal trends of fetal mortality in Recife, 2010-2021. The Brazilian List of Avoidable Causes of Death for fetal deaths (LBE-OF) and Brazilian List of Avoidable Causes of Death for children under five years of age (LBE < 5) were used. The Joinpoint regression model was applied to analyze the temporal trends. Results: Trends in fetal mortality and its components were stationary. The group of avoidable causes presented higher mortality rates in both classifications, with an increasing trend according to the LBE-OF (Annual Percentage Change-APC: 2,1; p = 0,018) and stationary according to the LBE < 5. There was a decreasing trend in mortality from ill-defined causes only according to the LBE-OF (APC: -12,3; p < 0,001). Conclusion: The results showed the stagnation of the temporal trend in fetal mortality, the avoidability of most deaths, and the potential of LBE-OF in monitoring the quality of information on the basic causes and avoidability of fetal deaths.

RESUMEN Objetivo: Analizar la tendencia temporal de la mortalidad fetal y sus componentes, causas evitables y mal definidas según dos clasificaciones de evitabilidad en Recife, Pernambuco, 2010-2021. Metodología: Estudio ecológico de tendencias temporales de la mortalidad fetal en Recife, 2010-2021. Se utilizó la Lista Brasileña de Causas Evitables de Muerte para muertes fetales (LBE-OF) y la Lista Brasileña de Causas Evitables de Muerte para niños menores de cinco años (LBE < 5). Se aplicó el modelo de regresión Joinpoint para analizar las tendencias temporales. Resultados: Las tendencias en la mortalidad fetal y sus componentes se mantuvieron estacionarias. El grupo de causas evitables presentó mayores tasas de mortalidad en ambas clasificaciones, con tendencia creciente según LBE-OF (Variación Porcentual Anual-APC: 2,1; p = 0,018) y estacionaria según LBE < 5. Hubo tendencia decreciente para la mortalidad por causas mal definidas sólo según LBE-OF (APC: -12,3; p < 0,001). Conclusión: Los resultados mostraron el estancamiento de la tendencia temporal de la mortalidad fetal, la evitabilidad de la mayoría de las muertes y el potencial del LBE-OF para monitorear la calidad de la información sobre las causas básicas y la evitabilidad de las muertes fetales.

RESUMO Objetivo: Analisar a tendência temporal da mortalidade fetal e de seus componentes, das causas evitáveis e mal definidas segundo duas classificações de evitabilidade no Recife, Pernambuco, 2010-2021. Método: Estudo ecológico de tendência temporal para a mortalidade fetal no Recife, 2010-2021. Foram utilizadas as classificações de evitabilidade Lista Brasileira de Causas de Morte Evitáveis para óbitos fetais (LBE-OF) e Lista Brasileira de Causas de Morte Evitáveis para menores de cinco anos (LBE < 5). O modelo de regressão Joinpoint foi aplicado para analisar as tendências temporais. Resultados: As tendências da mortalidade fetal e de seus componentes foram estacionárias. O grupo de causas evitáveis apresentou maiores taxas de mortalidade nas duas classificações, com tendência crescente segundo a LBE-OF (Variação Percentual Anual-APC: 2,1; p = 0,018) e estacionária segundo a LBE < 5. Houve tendência decrescente para a mortalidade por causas mal definidas apenas conforme a LBE-OF (APC: -12,3; p < 0,001). Conclusão: Os resultados evidenciaram a estagnação da tendência temporal da mortalidade fetal, a evitabilidade da maior parte dos óbitos, e a potencialidade da LBE-OF no monitoramento da qualidade das informações sobre as causas básicas e evitabilidade dos óbitos fetais.

Avoidability and temporal trend of neonatal mortality in Niteroi/RJ, 2012 to 2022 / Evitabilidade e tendência temporal da mortalidade neonatal em Niterói/RJ, 2012 a 2022

Abstract Objectives: to analyze neonatal deaths according to avoidability and to analyze the temporal trend of neonatal mortality rate (NMR) in Niterói/RJ, 2012-2022. Methods: ecological time series study. Data from Sistema de Informação sobre Nascidos Vivos and Sistema de Informação sobre Mortalidade. NMRs were calculated according to maternal and neonatal variables and trends were estimated using the joinpoint regression. Results: the annual number of live births (LB) fell, with a decreasing trend among adolescents and those with low education level. Of the 324 deaths, most occurred early (0-6 days), by preventable causes in 68.6%, predominating those reducible by adequate care during pregnancy. The overall NMR remained stable, ranging from 4.2 to 6/1,000 LB, being higher at the extremes of maternal age (12.7 and 8.6/1,000 LB in 2022, adolescents and over 35 years old, respectively), in low education level mothers (27.6/1,000 LB in 2022), in neonates <1,500g and <32 weeks (293.1 and 250/1,000 LB in 2022, respectively). NMR trend was upward in low schooling women, white-colored, adolescents and those ≥35 years, in babies weighing <1,500g and >2,500g, and for avoidable causes. Conclusions: the high proportion of preventable causes reveals the reduction potential. There was inequality in NMR and its trend, demanding more equitable health actions.

Resumo Objetivos: analisar os óbitos neonatais segundo evitabilidade e a tendência temporal da taxa de mortalidade neonatal (TMN) em Niterói/RJ, de 2012-2022. Métodos: estudo ecológico de série temporal. Dados provenientes do Sistema de Informações sobre Nascidos Vivos e Sistema de Informação sobre Mortalidade. As TMN foram calculadas segundo variáveis maternas e neonatais e as tendências estimadas pela regressão joinpoint. Resultados: o número anual de nascidos vivos (NV) diminuiu, com tendência decrescente entre mães adolescentes e de baixa escolaridade. Dos 324 óbitos, a maioria ocorreu precocemente, por causas evitáveis (68,6%), predominando aquelas reduzíveis por adequada atenção à gestação. A TMN global mostrou estabilidade, entre 4,2 e 6,0/1000NV, mais elevada nos extremos etários maternos (12,7 e 8,6/1.000 NV em 2022, adolescentes e maiores de 35 anos, respectivamente), nas mães com baixa escolaridade (27,6/1.000 NV em 2022), nos neonatos <1.500g e <32 semanas (293,1 e 250/1.000 NV em 2022, respectivamente). A tendência da TMN foi crescente entre mulheres de baixa escolaridade, brancas, adolescentes e ≥35 anos, nas faixas de peso <1.500g e >2.500g, e por causas evitáveis. Conclusões: a elevada proporção de causas evitáveis revela o potencial de redução. Houve desigualdade da TMN e sua tendência, demandando ações de saúde mais equânimes.

Pronóstico de defunciones según enfermedad crónica de pacientes ingresados en un hospital público / Prognosis of Deaths According to Chronic Disease of Patients Admitted to a Public Hospital

Introducción: Las enfermedades crónicas repercuten en gran medida en la calidad de vida de los pacientes, ya sea por sus características inherentes o por las complicaciones derivadas que ocasionan emergencias recurrentes. Objetivo: Pronosticar los días de hospitalización hasta el desenlace de pacientes con enfermedad crónica ingresados en un hospital público peruano. Métodos: Se realizó una investigación descriptiva, retrospectiva y transversal, entre julio y agosto del 2022, con 488 pacientes con enfermedad crónica ingresados en el Hospital Regional Docente de Cajamarca. Los datos demográficos de ingreso y el tipo de diagnóstico de los pacientes fueron proporcionados por la oficina de estadística del hospital. El análisis univariado se realizó con distribuciones absolutas y relativas, junto a sus intervalos de confianza al 95 por ciento y la relación pronóstica con Log Rank (Mantel-Cox) - ji al cuadrado, análisis de supervivencia de Kaplan-Meier (p < 0,05) y tablas de mortalidad. Resultados: El 53,1 por ciento de pacientes fueron mujeres, con 67,1 años de edad promedio, ingresaron al hospital por el servicio de emergencia (66,0 por ciento) y la enfermedad crónica fue la causa principal (79,1 por ciento). El promedio de hospitalización fue de 67,5 días, con mayor número en la hipertensión arterial (63 días), las diferencias numéricas en el tiempo de hospitalización según enfermedad crónica no se reflejan a nivel estadístico (p = 0,130). Las defunciones ocurrieron dentro del primer mes de hospitalización. Conclusión: Los días de hospitalización hasta el desenlace no son independientes de la enfermedad crónica de los pacientes, pues en ambos casos pueden ocurrir defunciones si sus características clínicas son irrecuperables(AU)

Introduction: Chronic diseases greatly impact the quality of life of patients, either due to their inherent characteristics or due to the derived complications that cause recurrent emergencies. Objective: To predict the days of hospitalization until the outcome of patients with chronic disease admitted to a Peruvian public hospital. Methods: A descriptive, retrospective and cross-sectional investigation was carried out from July to August 2022, with 488 patients with chronic disease admitted to Cajamarca Regional Teaching Hospital. Admission demographic data and type of patient diagnosis were provided by the hospital statistics office. The univariate analysis was performed with absolute and relative distributions, along with their 95percent confidence intervals and the prognostic relationship with Log Rank (Mantel-Cox) - chi square, Kaplan-Meier survival analysis (p < 0.05) and mortality tables. Results: 53.1percent of patients were women, with average age of 67.1 years, who were admitted to the hospital through the Emergency Service (66.0percent) and chronic disease was the main cause (79.1percent). The average hospitalization time was 67.5 days, with greater number in high blood pressure (63 days). The numerical differences in hospitalization time, according to chronic disease, are not reflected at a statistical level (p = 0.130). Deaths occurred within the first month of hospitalization. Conclusion: The days of hospitalization until the outcome are not independent of the patients' chronic illness, since in both cases deaths can occur if their clinical characteristics are irrecoverable(AU)

Factores sociodemográficos en la dinámica del comportamiento delictivo: análisis descriptivo de criminalidad en Colombia, año 2022 / Socio-demographic factors in the dynamics of criminal behaviour: descriptive analysis of criminality in Colombia, year 2022 / Fatores sociodemográficos na dinâmica do comportamento criminal: análise descritiva da criminalidade na Colômbia, ano de 2022

El presente estudio de carácter descriptivo y analítico tiene como objetivo principal presentar el comportamiento criminal en Colombia para el 2022, desde un enfoque cuantitativo empleado para la extracción, análisis e interpretación de los registros administrativos del Sistema de Información Estadístico, Delincuencial, Contravencional y Operativo (SIEDCO), constituyéndose como un insumo para aquellos interesados en el estudio de la dinámica criminal, así como para quienes se encargan de diseñar estrategias para la contención del delito y la generación de política pública en materia de seguridad. En este sentido y en el marco de las dinámicas sociodemográficas, en una primera parte se aborda de manera general el proceso de homogenización de los registros administrativos llevado a cabo por la Policía Nacional y la Fiscalía General de la Nación. Y en una segunda parte, con especial énfasis en el homicidio intencional, se presenta el análisis de la información que permitió identificar las principales variables que influyen en la comisión del delito, de acuerdo con las cifras contenidas en el SIEDCO, en el periodo comprendido entre el 1 de enero y el 31 de diciembre de 2022, comparado con la misma temporalidad del 2021, en el que se detallan los delitos que afectan la integridad personal y el patrimonio económico de quienes habitan el territorio colombiano; se hallaron incrementos considerables en estos y se resaltan los factores de oportunidad para su comisión, situación contraria a la que se evidenció sobre las afectaciones a la vida y la integridad, conjunto de conductas que, según lo registrado, decrecieron en el periodo analizado. Finalmente, se ofrece un aporte a la contención desde la actividad de policía y una serie de conclusiones que permitan ampliar la visión sobre los diversos fenómenos y enriquecer la generación de conocimiento en el campo de la criminología.

The main objective of this descriptive and analytical study is to present criminal behaviour in Colombia for 2022, from a quantitative approach used for the extraction, analysis and interpretation of the administrative records of the Statistical, Criminal, Contraventional and Operational Information System (SIEDCO), constituting an input for those interested in the study of criminal dynamics, as well as for those responsible for designing strategies for the containment of crime and the generation of public policy on security. In this sense, and within the framework of socio-demographic dynamics, the first part of the paper deals in a general way with the process of homogenisation of administrative records carried out by the National Police and the Attorney General's Office. The second part, with special emphasis on intentional homicide, presents the analysis of the information that made it possible to identify the main variables that influence the commission of the crime, according to the figures contained in SIEDCO, in the period between 1 January and 31 December 2022, compared with the same period in 2021, in which the crimes that affect the personal integrity and economic patrimony of those who live in Colombian territory are detailed; considerable increases were found in these and the factors of opportunity for their commission are highlighted, contrary to the situation that was evidenced in the affectations to life and integrity, a group of conducts that, according to what was recorded, decreased in the period analysed. Finally, we offer a contribution to containment from the police activity and a series of conclusions that allow us to broaden the vision of the diverse phenomena and enrich the generation of knowledge in the field of criminology.

O principal objetivo deste estudo descritivo e analítico é apresentar o comportamento criminal na Colômbia para 2022, a partir de uma abordagem quantitativa utilizada para a extração, análise e interpretação dos registros administrativos do Sistema de Informação Estatística, Criminal, Contravencional e Operacional (SIEDCO), constituindo um insumo para os interessados no estudo da dinâmica criminal, bem como para os responsáveis pela elaboração de estratégias para a contenção do crime e a geração de políticas públicas de segurança. Nesse sentido, e dentro da estrutura da dinâmica sociodemográfica, a primeira parte do artigo trata de forma geral do processo de homogeneização dos registros administrativos realizado pela Polícia Nacional e pela Procuradoria Geral da República. A segunda parte, com ênfase especial no homicídio doloso, apresenta a análise das informações que permitiram identificar as principais variáveis que influenciam o cometimento do crime, de acordo com os números contidos no SIEDCO, no período entre 1º de janeiro e 31 de dezembro de 2022, em comparação com o mesmo período de 2021, no qual são detalhados os crimes que afetam a integridade pessoal e o patrimônio econômico daqueles que vivem em território colombiano; Neles foram encontrados aumentos consideráveis e são destacados os fatores de oportunidade para seu cometimento, ao contrário da situação que se evidenciou nas afetações à vida e à integridade, grupo de condutas que, segundo o que foi registrado, diminuiu no período analisado. Finalmente, oferecemos uma contribuição para a contenção da atividade policial e uma série de conclusões que nos permitem ampliar a visão dos diversos fenômenos e enriquecer a geração de conhecimento no campo da criminologia.

Caracterización de la mortalidad por diabetes mellitus en la provincia Cienfuegos durante los primeros nueve meses del 2020

Fundamento: según la Organización Mundial de la Salud la diabetes causa 300 000 muertes al año en América Latina y el Caribe y en la provincia Cienfuegos desde el año 2020 se ubica como séptima causa de fallecimientos. Objetivo caracterizar la mortalidad por diabetes mellitus en la provincia Cienfuegos en los primeros nueve meses del año 2020. Métodos: se realizó una investigación en sistemas y servicios de salud de tipo descriptiva a partir de una serie de casos para caracterizar la mortalidad por diabetes mellitus en Cienfuegos en los primeros nueve meses del año 2020. Los fallecidos se compilaron teniendo en cuenta: sexo, edad, color de la piel, nivel de escolaridad, lugar de residencia, estrato territorial, enfermedad, factores de riesgo asociados y causas de muertes directas. Se emplearon la media aritmética y la desviación estándar. Los resultados se presentan en forma de tablas y gráficos. Resultados la mayor afectación estuvo en las últimas décadas de la vida para el género femenino, así como la residencia en un territorio urbano, están entre las primeras causas directas de muerte el tromboembolismo pulmonar, así como la insuficiencia renal crónica agudizada, se destaca el desequilibrio hidroelectrolítico en un número considerable de las defunciones. Conclusiones las últimas décadas de la vida fueron las más afectadas y el sexo femenino, las principales causas de muerte fueron: el tromboembolismo pulmonar y la insuficiencia renal crónica agudizada. El desequilibrio hidroelectrolítico sobresale en un considerable número de los fallecidos.

Foundation: according to the World Health Organization, diabetes causes 300,000 deaths a year in Latin America and the Caribbean and in the Cienfuegos province since 2020 it ranks as the seventh cause of death. Objective: to characterize mortality from diabetes mellitus in the Cienfuegos province in the first nine months of 2020. Methods: a descriptive investigation was carried out on health systems and services based on a series of cases to characterize mortality from diabetes mellitus in Cienfuegos in the first nine months of 2020. The deceased were compiled taking into account: sex, age, skin color, educational level, place of residence, territorial stratum, disease, associated risk factors and direct causes of death. The arithmetic mean and standard deviation were used. The results are presented in the form of tables and graphs. Results: the greatest affectation was in the last decades of life for the female gender, as well as residence in an urban territory, among the first direct causes of death are pulmonary thromboembolism, as well as acute chronic renal failure; hydroelectrolytic imbalance stands out in a considerable number of deaths. Conclusions: the last decades of life were the most affected and the female sex, the main causes of death were: pulmonary thromboembolism and acute chronic renal failure. The hydroelectrolytic imbalance stands out in a considerable number of the deceased.

Patterns and causes of maternal mortality in tertiary care hospital in Maharashtra, India: a 10-year retrospective study

Background: Maternal death is a catastrophe, as death of a mother can the entire family. The aim of present study is to find out major patterns, reasons and complications leading to maternal deaths. Methods: A retrospective study was conducted for last 10 years from January 2013 to December 2022 by studying the records of a tertiary care hospital to study the maternal mortalities and complications leading to death. Maternal deaths were analyzed by considering different facets, such as age at death, gravida, locality of residence, admission death interval and direct and indirect cause/s of death, etc. Results: During the study period, total of 107753 live births and 202 maternal deaths have been recorded. The average maternal mortality rate of last ten years was 187.46/100000 live births. Age wise maternal mortality during the study period was high in the age 19 to 25. Major direct cause of maternal mortality was postpartum hemorrhage, (23%) and major indirect cause observed was anemia (43%). Admission to death interval time indicates that delay in provision of treatment and referral to tertiary care hospital might be the reason responsible for high maternal deaths. Conclusions: Maternal deaths can be prevented by improving the health care facilities, ensuring skilled attendants and required basic medication. This is high time to mobilize universal, national, regional, and community-based commitment to decrease maternal mortalities.

Causes and trends in maternal mortality in a tertiary health facility in North Central Nigeria

Background: Nigeria remains one of the top three countries with the highest maternal mortality worldwide. Due to poor vital registration in the country, hospital-based maternal mortality statistics still remain an important source for tracking trends and causes of maternal mortality. The aim of the study was to determine the causes and trends of maternal mortality in a tertiary health facility in North Central Nigeria.Methods: This was a retrospective review of cases of maternal deaths at the Jos University Teaching Hospital from 1st January 2016 to 31st December 2022. Case records of patients that died from pregnancy-related complications were retrieved from the medical records department and other service points of the hospital. The information extracted was maternal socio-demographic characteristics, clinical diagnosis on admission, and duration of hospital stay before demise. The maternal mortality ratio was calculated per 100,000 live births.Results: There were 80 maternal deaths during the period, and 10,348 live births during the same period, giving a maternal mortality ratio of 773/100,000 live births. The mean age of the women was 27.0±8.1 years, 12.5% were teenage mothers, 6.4% were women ?40 years. About 27.5% were nulliparous, 16.5% para 5 or more. For women where information on educational level were available 68(85.0%), 48.5% had only primary education or no formal education, 42.5% had no antenatal care. About 72.5% of the maternal deaths were due to direct causes-pre-eclampsia/eclampsia (30.0%), maternal sepsis (17.5%), complications of unsafe abortion (12.5%), obstetric haemorrhage and uterine rupture 6.3%. The main causes of indirect maternal deaths were sickle cell disease, cardiac disease, diabetes mellitus and liver disease in pregnancy. Most (41.3%) of the maternal deaths occurred within the 24 hours of admission. There was no consistent trend noted in maternal mortality between 2016 and 2019; however, a remarkable increase was observed during the Covid-19 period from 2020-2021.Conclusions: The maternal mortality ratio in Jos, North Central Nigeria remains high, with major causes related to pre-eclampsia/eclampsia, maternal sepsis, unsafe abortion and obstetric haemorrhage. The global Covid-19 pandemic led to an increased maternal mortality in the health facility.

Mortalidade por agressões em um estado da região norte do brasil de 2000 a 2019: tendência em séries temporais / Mortality due to assaults between 2000 and 2019 in a state from the brazilian north region: trend in time series / Mortalidad por agresiones en un estado de la región norte de brasil entre 2000 y 2019: tendencia en series temporales

RESUMO Objetivo: analisar a tendência temporal de mortalidade por agressões no Estado do Acre, de acordo com o sexo. Método: estudo ecológico de análise de série temporal com dados extraídos do Sistema de Informações de Mortalidade correspondentes às mortes provocadas por agressões (CID X85-Y09), ocorridos no estado do Acre - Brasil, de 2000 a 2019. A análise dos dados foi realizada utilizando o modelo de análise linear generalizada de Prais-Winsten com nível de significância estatística de 5%. Resultados: houve maior mortalidade por causas externas em indivíduos adultos do sexo masculino. Foi observada uma tendência crescente dos homicídios para o sexo masculino com variação percentual anual de 3,13%, p=0,002 e para ambos os sexos de 2,92%, p=0,003. Conclusão: essas informações apontam a necessidade emergente de combate e prevenção das violências. Destaca-se a importância do profissional de enfermagem na mobilização social e participação na reformulação de políticas públicas de combate a violência.

ABSTRACT Objective: to analyze the time trend of mortality due to assaults in the state of Acre, according to gender. Method: an ecological study of time series analysis with data extracted from the Mortality Information System for Deaths Caused by Assaults (ICD X85-Y09) in the state of Acre, Brazil, from 2000 to 2019. Data analysis was performed using the Prais-Winsten generalized linear analysis model with a 5% statistical significance level. Results: there was higher mortality due to external causes in male adults. A growing trend of homicides was observed for the male gender, with an annual percent change of 3.13% (p=0.002); for both genders, the annual percent change was 2.92% (p=0.003). Conclusion: these findings indicate the emerging need to fight against and prevent acts of violence. The importance of Nursing professionals in social mobilization and participation in the reformulation of public policies to combat violence is emphasized.

RESUMEN Objetivo: analizar la tendencia temporal de la mortalidad por agresiones en el Estado de Acre, según el sexo. Método: estudio ecológico de análisis de series temporales con datos extraídos del Sistema de Información de Mortalidad correspondientes a las muertes causadas por agresión (CIE X85 a Y09), ocurridas en el estado de Acre, Brasil, de 2000 a 2019. El análisis de datos se realizó utilizando el Modelo de análisis lineal generalizado de Prais-Winsten con un nivel de significación estadística del 5%. Resultados: hubo mayor mortalidad por causas externas en los adultos del sexo masculino. Se observó una tendencia creciente en los homicidios en el sexo masculino con una variación porcentual anual del 3,13% (p=0,002) y en ambos sexos del 2,92% (p=0,003). Conclusión: Esta información indica que hay una necesidad emergente de combatir y prevenir la violencia. Se destaca la importancia del profesional de enfermería en la movilización social y participación en la reformulación de políticas públicas contra la violencia.

Muerte accidental por consumo combinado de cocaína y etanol Revisión bibliográfica / Accidental death from combined cocaine and ethanol use. Literature review

La autopsia médico legal en Costa Rica, en casos sospechosos de intoxicación por cocaetileno se debe realizar bajo las normas establecidas en la Guía de estándares de trabajo para la Sección de Patología Forense del Departamento de Medicina Legal. El análisis del mecanismo fisiopatológico de cómo estas sustancias provocan alteraciones en el organismo que pueden conllevar a un eventual fallecimiento corresponde a parte del análisis requerido en la investigación ante la sospecha de esta causa de muerte. Por lo anterior, el objetivo de este artículo es describir los mecanismos fisiopatológicos que ocurren durante el consumo combinado de cocaína y etanol, los mecanismos que conllevan a la muerte de personas consumidoras de estas sustancias y las consideraciones médico legales a tomar en cuenta para el diagnóstico de esta causa de muerte. Se realizó revisión de artículos científicos, sobre los efectos del uso combinado de la cocaína y el etanol. La literatura describe que el uso combinado de cocaína y etanol potencia los efectos farmacocinéticos y bioquímicos de cada una de estas sustancias, que su derivado, el cocaetileno, es capaz de generar por sí mismo los mecanismos causantes de la muerte. Que los principales mecanismos fisiopatológicos que conllevan la muerte ante el uso combinado de estas sustancias son de origen cardiovascular y hepático. Como consideraciones médico legales a tomar en cuenta para el diagnóstico de esta manera de muerte accidental, en la Sección de Toxicología del Departamento de Ciencias Forenses de Costa Rica, la cuantificación del cocaetileno y las sustancias relacionadas no se realiza, aunque se encuentra actualmente en el desarrollo de un proyecto para la determinación de la estabilidad de las drogas en sangre bajo las condiciones de almacenamiento, con el fin de ofrecer la posibilidad de cuantificar ciertas drogas (en donde se podría incluir el cocaetileno) en un futuro próximo.

Medical-legal autopsy in Costa Rica, in suspected cases of cocaethylene poisoning must be performed under the regulations established in the Work Standards Guide for the Forensic Pathology Section of the Department of Legal Medicine. The analysis of the pathophysiological mechanism of how these substances cause alterations in the organism that can lead to eventual death corresponds to part of the analysis required in the investigation when this cause of death is suspected. Therefore, the objective of this article is to describe the pathophysiological mechanisms that occur during the combined consumption of cocaine and ethanol, the mechanisms that lead to the death of people who consume these substances, and the medico-legal considerations to be considered for the diagnosis. of this cause of death. A review of scientific articles was carried out on the effects of the combined use of cocaine and ethanol. The literature describes that the combined use of cocaine and ethanol enhances the pharmacokinetic and biochemical effects of each one of these substances, that its derivative, cocaethylene, can generate the mechanisms that cause death by itself. That the main pathophysiological mechanisms that lead to death in the combined use of these substances are of cardiovascular and hepatic origin. As legal medical considerations to take into account for the diagnosis of this type of accidental death, in the Toxicology Section of the Department of Forensic Sciences of Costa Rica, the quantification of cocaethylene and related substances is not carried out, although it is currently in the development of a project for the determination of the stability of drugs in blood under storage conditions, in order to offer the possibility of quantifying certain drugs (which could include cocaethylene) in the near future.

Incidence & factors influencing maternal near miss events in tertiary hospitals of Maharashtra, India

Background & objectives: Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future. Methods: This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals. Results: The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively. Interpretation & conclusions: The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.

Situation analysis of COVID-19 on Domestic Violence in Fiji

@#COVID-19, a highly contagious and deadly virus rapidly swept across the world from the year 2019 to 2020 killing more than two million people. Due to the magnitude of affect the virus was having, governments were forced into taking measures that required isolation of the infected from the unaffected, as mitigation to halt the spread. This brought about the “COVID-19 Lockdown”. Though the Pacific Island Countries (PICs) were with one of the least numbers of COVID-19 cases, similar measures were implemented as measure to prevent the virus from entering the countries. Like other countries, PICs like Fiji had a lockdown and this affected the lifestyles of the people. Amidst the lockdown, there was a rise in domestic violence cases. The literature review was done using databases; Medline, ProQuest, Embase, and Scopus. The research was done by using the relevant keywords in the field of COVID-19 which was aimed specifically on domestic violence during the pandemic. Moreover, local, and international publications, like media reports and published reports were also used. Upon carrying out this research it could be stated that there was a rise in the number of domestic violence cases in the wake of the COVID-19 pandemic lockdown. The literature review was aimed at identifying the consequences of COVID-19 and why it triggered a spike in domestic violence cases. The study concluded that the psychological impacts, and socio-economic state created as the result of the lockdown was the main contributing factor which gives rise to substance abuse, depression, which collectively lead to violence

Analyzing the current status of newly diagnosed occupational pneumoconiosis patients in Zhangdian District of Zibo City / 中国职业医学

Objective To analyze the distribution, survival conditions, and medical support of newly diagnosed occupational pneumoconiosis (hereinafter referred to as pneumoconiosis) patients in Zhangdian District, Zibo City. Methods A total of 1 189 newly diagnosed pneumoconiosis patients in Zhangdian District from 1956 to 2019 were selected as the study subjects using retrospective method. Data of their age of onset, years of occupational exposure, category of working industry, type of pneumoconiosis, and status of medical support was collected and analyzed. Results The median and the 25th-75th percentiles ［M (P25, P75)］ of the age of onset were 51.8 (45.5, 56.1) years, and the mortality was 37.0%. The majority of pneumoconiosis cases were silicosis (45.2%) and coal workers' pneumoconiosis (39.8%). The highest prevalence of pneumoconiosis was in the coal mining and washing industry (42.4%), followed by manufacturing (33.4%). Pneumoconiosis patients in stage Ⅰ,Ⅱ, and Ⅲ accounted for 89.1%, 8.7%, and 2.2%, respectively. The M (P25, P75) of the length of work exposed to dust were 24.1 (16.5, 29.9) years.The higher stage of pneumoconiosis the shorter of the length of work exposed to dust among these pneumoconiosis patients(all P<0.05). The overall survival rate, the 5-year survival rate and the 10-year survival rate of these pneumoconiosis patients were 63.0%, 92.3% and 85.9%, respectively. Among the 749 surviving cases, 60.8% were aged 60.0 to <80.0 years. In terms of social security, 100.0% surviving cases enjoyed basic medical insurance, meanwhile, 96.1% and 81.8% patients were covered by major medical insurances and occupational injury insurances, respectively. The M (P25, P75) of age at death were 73.1 (64.0, 77.1) years. The main causes of death were respiratory diseases (59.3%) and malignant tumors (20.4%). Conclusion The prevalent types of pneumoconiosis in Zhangdian District, Zibo City, are coal workers' pneumoconiosis and silicosis. Medical support and assistance are relatively limited. The pneumoconiosis prevention and control focus should be on silicosis and coal workers' pneumoconiosis, particularly in the manufacturing industry.