Evolução da completude das informações sobre suicídios no estado de Pernambuco, Brasil, 1996 a 2015 / Evolution of the information completeness on suicides in the state of Pernambuco, Brazil, from 1996 to 2015

Resumo Introdução O suicídio representa um importante problema de saúde pública no mundo. Considerado um fenômeno complexo, está associado a fatores sociais, biológicos e demográficos. A qualidade dos dados registrados na declaração de óbito é fundamental para conhecer a magnitude deste problema e subsidiar a construção de indicadores epidemiológicos que contribuem para a eficiência da gestão em saúde. Objetivo Analisar a evolução da completude dos registros de suicídio do Sistema de Informações sobre Mortalidade (SIM) no estado de Pernambuco, entre 1996 e 2015. Métodos Calculou-se a proporção de completude das variáveis da Declaração de Óbito. Para análise da tendência da completude, empregou-se o modelo de regressão Joinpoint. Resultados Houve tendência de aumento de completude das variáveis analisadas, com destaque para "raça/cor", "estado civil" e "escolaridade", com aumento superior a 60,0%. Conclusão A análise de tendência temporal mostrou melhoria no preenchimento dos dados sobre suicídio no SIM, porém, ainda figura o desafio de alcançar menos de 5,0% de incompletude para todas as variáveis. A avaliação da completude dos registros de suicídio contribui com o sistema de vigilância e com o aprimoramento das estatísticas vitais relacionadas às causas externas.

Abstract Background Suicide represents an important public health problem in the world. Considered a complex phenomenon it is associated with social, biological and demographic factors. The quality of the data registered in the Death Certificate is fundamental to know the magnitude of this problem and subsidizes the construction of epidemiological indicators that contribute to the efficiency of health management. Objective To analyze the evolution of the completeness of suicide records in the mortality information system (SIM) of the state of Pernambuco, between 1996 and 2015. Method The proportion of completeness of the death certificate variables was calculated. For the analysis of the completeness trend, the Joinpoint Regression model was used. Results There was a tendency to increase the completeness of the variables analyzed, with an emphasis on "race/color", "marital status", and "education level", with an increase of more than 60%. Conclusion Analysis of temporal trends showed an improvement in the filling of suicide data into the SIM. However, the challenge remains to reach less than 5% incompleteness across all variables. The assessment of the completeness of suicide records in the SIM is relevant for contributing to the suicide surveillance system and for the improvement of vital statistics related to external causes.

Analysis of the completeness of self-harm and suicide records in Pernambuco, Brazil, 2014-2016.

INTRODUCTION: Suicides and suicide attempts are major public health problems, and coping strategies are hampered by insufficient or inadequate notifications. Data accuracy influences the formulation of public and mental health policies and suicide prevention strategies. The objective of this study was to analyze the completeness of self-harm and suicide records in the state of Pernambuco, Brazil, 2014-2016. METHODS: This is an evaluative study with a descriptive design. The data were collected from suicide attempt records from the Notifiable Diseases Information System and suicide records from the Mortality Information System. Probabilistic linkage was used to relate these databases, and the degree of completeness of the variables was calculated. Completeness was classified into the following categories: good (≥ 75.1%), regular (50.1%-75.0%), low (25.1%-50.0%), and very low (≤ 25.0%). RESULTS: In the analyzed period, 1,404 notifications of self-harm were studied, with an overall mean completeness of 86.2%. In addition, 1,050 suicide records were analyzed, with an overall mean completeness of 95.8%. Most variables referring to suicide attempts had good completeness, with the exception of the variables "occupation" and "education." The completeness of all suicide-related variables was rated as good. After linkage, a significant improvement was observed in the degree of completeness of the variable "occupation". CONCLUSION: The results of this study showed that the completeness of self-harm and suicide variables improved from the first to the last year. The integration of data from different information systems provides an opportunity to improve suicide prevention programs and the quality of available information. Continuous efforts to increase the completeness and reliability of suicide surveillance systems are fundamental to describe the epidemiological profile and, consequently, plan preventive actions, in addition to contributing to the development and reformulation of strategies aimed at reducing morbidity and mortality related to suicidal behavior.

Impact of the COVID-19 pandemic on the number of births in Pernambuco Brazil.

This study aimed at analysing the potential effects of the COVID-19 pandemic on the time series and spatial patterns of live births in the state of Pernambuco, Brazil, from 2010 to 2021. This is an ecological study that applied intervention analysis in time series, with the goal to identify how projected data behaved in relation to observed data in the months December 2020 to November 2021, i.e. months representing conceptions from March2020 to April 2021. For the state of Pernambuco, a discrepancy up to +5.7% was found between the observed and projected data, while the respective difference for the São Francisco mesoregion showed the opposite trend with maximum discrepancy of -9%. The results did not indicate a clear change in the number of live births but supported the expected continuation of the downward trend of the previous years. Considering the importance of the number of live births in the context of demography, economy and public health, monitoring must be maintained to analyse the possible future impact of the COVID-19 pandemic on live birth projections.

Spatial dynamics of fetal mortality and the relationship with social vulnerability.

OBJECTIVES: To analyze the spatial-temporal patterns of fetal mortality according to its relationship with social vulnerability, identifying priority areas for intervention. METHODS: Ecological study conducted in the state of Pernambuco, Northeast region of Brazil, from 2011 to 2018. The mean fetal mortality rate per city was calculated for the studied period. A cluster analysis was performed to select cities with homogeneous characteristics regarding fetal mortality and social vulnerability, then the Attribute Weighting Algorithm and Pearson correlation techniques were employed. In the spatial analysis it was used the local empirical Bayesian modeling and global and local Moran statistics. RESULTS: Twelve thousand nine hundred and twelve thousand fetal deaths were registered. The fetal mortality rate for the period was 11.44 fetal deaths per 1,000 births. The number of groups formed was 7, in which correlation was identified between fetal mortality and dimensions, highlighting the correlations between fetal mortality rate and the Index of Social Vulnerability urban infrastructure for the municipalities in group 1 and 5, the values of the correlations found were 0.478 and 0.674 respectively. The spatial analysis identified areas of higher risk for fetal mortality distributed in regions of medium, high and very high social vulnerability. CONCLUSIONS: The study allowed observing the existing correlations between fetal mortality and social vulnerability and identifying priority areas for intervention, with a view to reducing fetal mortality in the state.

Spatial patterns of avoidable fetal mortality and social deprivation.

OBJECTIVE: To develop a social need index for stratification of municipalities and identification of priority areas for reducing fetal mortality. METHODS: ecological study, carried out in the state of Pernambuco, between 2010 and 2017. The technique of factor analysis by main components was used for the elaboration of the social need index. In the spatial analysis, the local empirical Bayesian estimator was applied and Moran's spatial autocorrelation was verified. RESULTS: The social deprivation index selected two factors that, together, explained 77.63% of the total variance. The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births (low deprivation), 8.1 per thousand (medium deprivation), 8.8 per thousand (high deprivation), and 10.7 per thousand (very high social deprivation). Some municipalities in the São Francisco and Sertão Mesoregions had both high fetal and preventable fetal mortality, in addition to a very high social deprivation rate. Conclusion: The spatial analysis identified areas with the highest risk for fetal mortality. The social deprivation index listed some determinants of fetal deaths in areas with worse living conditions. Priority areas for intervention in public policies to reduce fetal mortality and its determinants were detected.

Analysis of Factors Associated with the Risk of Suicide in a Brazilian Capital: Cross-Sectional Study.

Suicide and suicide attempts are considered global health problems. With regard to the main causes of unnatural deaths, Brazil ranks as the eighth country with the highest absolute number of suicides. The aim of this study was to analyze the factors associated with the risk of suicide in a metropolitan city in Brazil. This was a cross-sectional study carried out in Recife, in the northeast region of Brazil. Epidemiological surveillance was conducted on the information systems regarding attempted suicide, suicide, and undetermined deaths in the period from 2007 to 2017. A record linkage between the information systems was performed. Descriptive statistics, bivariate analysis, and logistic regression were performed with an adopted a significance level of 5%. In the city of Recife, there were 4495 suicide attempts in the period, and the most frequent suicide attempts were by single females, aged between 20 and 39 years old, and who used either medication or poison to die by suicide. A total of 141 individuals died by suicide, and exogenous intoxication was the most common method. Knowing the common characteristics and associated factors of those who attempt and die by suicide is key for the development of prevention policies and intervention strategies for suicide.

Spatial patterns of avoidable fetal mortality and social deprivation / Padrões espaciais da mortalidade fetal evitável e carência social

ABSTRACT: Objective: To develop a social need index for stratification of municipalities and identification of priority areas for reducing fetal mortality. Methods: ecological study, carried out in the state of Pernambuco, between 2010 and 2017. The technique of factor analysis by main components was used for the elaboration of the social need index. In the spatial analysis, the local empirical Bayesian estimator was applied and Moran's spatial autocorrelation was verified. Results: The social deprivation index selected two factors that, together, explained 77.63% of the total variance. The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births (low deprivation), 8.1 per thousand (medium deprivation), 8.8 per thousand (high deprivation), and 10.7 per thousand (very high social deprivation). Some municipalities in the São Francisco and Sertão Mesoregions had both high fetal and preventable fetal mortality, in addition to a very high social deprivation rate. Conclusion: The spatial analysis identified areas with the highest risk for fetal mortality. The social deprivation index listed some determinants of fetal deaths in areas with worse living conditions. Priority areas for intervention in public policies to reduce fetal mortality and its determinants were detected.

RESUMO: Objetivo: Elaborar um índice de carência social para a estratificação dos municípios e a identificação de áreas prioritárias para a redução da mortalidade fetal. Métodos: Estudo ecológico, realizado no estado de Pernambuco, entre 2010 e 2017. Utilizou-se a técnica de análise fatorial por componentes principais para a elaboração do índice de carência social. Na análise espacial, aplicou-se o estimador bayesiano empírico local, e verificou-se a autocorrelação espacial de Moran. Resultados: O índice de carência social selecionou dois fatores que, juntos, explicaram 77,63% da variância total. A taxa de mortalidade fetal evitável apresentou aumento entre estratos de carência social, com taxas de 8 por mil nascimentos (baixa carência), 8,1 por mil (média carência), 8,8 por mil (alta carência) e 10,7 por mil (muito alta carência social). Alguns municípios das mesorregiões São Francisco e Sertão tiveram, simultaneamente, elevada mortalidade fetal e fetal evitável, além de índice de carência social muito alto. Conclusão: A análise espacial identificou áreas com maior risco para a mortalidade fetal. O índice de carência social relacionou alguns determinantes das mortes fetais em áreas com piores condições de vida. Detectaram-se áreas prioritárias para a intervenção das políticas públicas de redução da mortalidade fetal e seus determinantes.

SPATIAL PATTERNS OF AVOIDABLE FETAL MORTALITY AND SOCIAL LACK / PADRÕES ESPACIAIS DA MORTALIDADE FETAL EVITÁVEL E CARÊNCIA SOCIAL

Objective: to develop a social need index for stratification of municipalities and identification of priority areas for reducing fetal mortality. Methods: ecological study, carried out in the state of Pernambuco, between 2010 and 2017. The technique of factor analysis by main components was used for the elaboration of the social need index. In the spatial analysis, the local empirical Bayesian estimator was applied and Moran's spatial autocorrelation was verified. Results: the social deprivation index selected two factors that together explained 77.63% of the total variance. The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births (low deficiency), 8.1 per thousand (average deficiency), 8.8 per thousand (high deficiency) and 10.7 per thousand (very high social need). Some municipalities in the São Francisco and Sertão Mesoregions had both high fetal and preventable fetal mortality, in addition to a very high social deprivation rate. Conclusion: the spatial analysis identified areas with the highest risk for fetal mortality. The social deprivation index listed some determinants of fetal deaths in areas with worse living conditions. Priority areas for intervention in public policies to reduce fetal mortality and its determinants were detected.

Objetivo: elaborar um índice de carência social para a estratificação dos municípios e a identificação de áreas prioritárias para a redução da mortalidade fetal. Métodos: estudo ecológico, realizado no Estado de Pernambuco, entre 2010 e 2017. Utilizou-se a técnica de análise fatorial por componentes principais para a elaboração do índice de carência social. Na análise espacial, aplicou-se o estimador bayesiano empírico local e verificou-se a autocorrelação espacial de Moran. Resultados: o índice de carência social selecionou dois fatores que, juntos, explicaram 77,63% da variância total. A taxa de mortalidade fetal evitável apresentou aumento entre estratos de carência social, com taxas de 8,0 por mil nascimentos (baixa carência), 8,1 por mil (média carência), 8,8 por mil (alta carência) e 10,7 por mil (muito alta carência social). Alguns municípios das Mesorregiões São Francisco e Sertão tiveram simultaneamente elevada mortalidade fetal e fetal evitável, além de índice de carência social muito alto. Conclusão: a análise espacial identificou áreas com maior risco para a mortalidade fetal. O índice de carência social relacionou alguns determinantes das mortes fetais em áreas com piores condições de vida. Detectaram-se áreas prioritárias para a intervenção das políticas públicas de redução da mortalidade fetal e seus determinantes.

Mortality by suicide in the State of Pernambuco, Brazil (1996-2015).

OBJECTIVE: To describe the epidemiological characteristics of suicide mortality in the state of Pernambuco, from 1996 to 2015. METHOD: Study with data from the Sistema de Informações sobre Mortalidade. The simple linear regression model was used to verify the trend in the period analyzed. RESULTS: There were 6,229 suicides, of which 3,390 (54.4%) occurred in the second decade of study. The mortality rate was 4.7 per 100,000 inhabitants. The temporal trend presented a decrease of 23.5% (p=0.031). For the male sex and the age range between 20 and 39 years, there was a decline in self-inflicted death of 23.8% (p=0.018) and 26.1% (p=0.046), respectively. CONCLUSION: The temporal analysis revealed a reduction in suicide mortality coefficients. This observation may contribute to better targeting of health interventions, optimizing resources and efforts, especially in suicide prevention.

Mortality by suicide in the State of Pernambuco, Brazil (1996-2015) / Mortalidad por suicídio en el Estado de Pernambuco, Brasil (1996-2015) / Mortalidade por suicídio no Estado de Pernambuco, Brasil (1996-2015)

ABSTRACT Objective: To describe the epidemiological characteristics of suicide mortality in the state of Pernambuco, from 1996 to 2015. Method: Study with data from the Sistema de Informações sobre Mortalidade. The simple linear regression model was used to verify the trend in the period analyzed. Results: There were 6,229 suicides, of which 3,390 (54.4%) occurred in the second decade of study. The mortality rate was 4.7 per 100,000 inhabitants. The temporal trend presented a decrease of 23.5% (p=0.031). For the male sex and the age range between 20 and 39 years, there was a decline in self-inflicted death of 23.8% (p=0.018) and 26.1% (p=0.046), respectively. Conclusion: The temporal analysis revealed a reduction in suicide mortality coefficients. This observation may contribute to better targeting of health interventions, optimizing resources and efforts, especially in suicide prevention.

RESUMEN Objetivo: Describir las características epidemiológicas de la mortalidad por suicidio en el estado de Pernambuco, en el período de 1996 a 2015. Metodo: Estudio con los datos del Sistema de Informaciones sobre Mortalidad. Se utilizóel modelo de regresión lineal simple para verificar la tendencia en el período de estudio. Resultados: Se registraron 6.229 suicidios, de los cuales 3.390 (el 54,4%) ocurrieron en la segunda década de estudio. El coeficiente de mortalidad fue de 4,7 por 100.000 habitantes. La tendencia temporal presentó una disminución del 23,5% (p=0,031). E nel sexo masculino y el grupo de edad de 20 a 39 años se observó un descenso en la muerte autoprovocada del 23,8% (p=0,018) y el 26,1% (p=0,046), respectivamente. Conclusion: El análisis temporal reveló una reducción de los coeficientes de mortalidad por suicidio. Esta observación puede contribuir a mejores formas de intervenciones en salud, optimizando los recursos y esfuerzos, sobre todo en la prevención del suicidio.

RESUMO Objetivo: Descrever as características epidemiológicas da mortalidade por suicídio no estado de Pernambuco, no período de 1996 a 2015. Método: Estudo com dados do Sistema de Informações sobre Mortalidade. Utilizou-se o modelo de regressão linear simples para verificar a tendência no período estudado. Resultados: Foram registrados 6.229 suicídios, dos quais 3.390 (54,4%) aconteceram na segunda década de estudo. O coeficiente de mortalidade foi de 4,7 por 100.000 habitantes. A tendência temporal apresentou decréscimo de 23,5% (p=0,031). No sexo masculino e faixa etária de 20 a 39 anos observou-se declínio na morte autoprovocada de 23,8% (p=0,018) e 26,1% (p=0,046), respectivamente. Conclusão: A análise temporal revelou redução dos coeficientes de mortalidade por suicídio. Essa observação poderá contribuir para melhores direcionamentos de intervenções em saúde, otimizando recursos e esforços, sobretudo na prevenção do suicídio.

Calidad de vida después del tratamiento del cáncer cervical / Quality of life after treatment for cervical cancer / Qualidade de vida após o tratamento do câncer do colo do útero

Objective: Identify the quality of life of women treated for cervical cancer according to their clinical and socioeconomic characteristics. Methods: This was a analytical study on women who were treated for cervical cancer by means of surgery, radiotherapy and chemotherapy. To evaluate their quality of life, the WHOQOL-bref questionnaire was applied. The Mann-Whitney test was used to investigate associations between domains and variables. Results: There were associations (p < 0.05) between the WHOQOL-bref domains and the variables of income, conjugal situation, leisure activities and treatment undergone. The physical and psychological domains were associated with overall quality of life (R = 0.54 and R = 0.63, respectively). Conclusions: Socioeconomic conditions and the type of treatment undergone influenced the quality of life of these women after their treatment. There is a need to increase the reach of cervical cancer screening among women who are less economically favored; and, after treatment, to offer alternative measures that soften the secondary effects.

Objetivo: Identificar la calidad de vida de las mujeres tratadas por cáncer de cuello uterino según sus características clínicas y socioeconómicas. Métodos: Este fue un estudio analítico sobre mujeres que fueron tratadas por cáncer de cuello uterino mediante cirugía, radioterapia y quimioterapia. Para evaluar su calidad de vida, se aplicó el cuestionario WHOQOL-bref. La prueba de Mann-Whitney se utilizó para investigar asociaciones entre dominios y variables. Resultados: Hubo asociaciones (p < 0.05) entre los dominios WHOQOL-bref y las variables de ingreso, situación conyugal, actividades de ocio y tratamiento. Los dominios físicos y psicológicos se asociaron con la calidad de vida general (R = 0.54 y R = 0.63, respectivamente). Conclusiones: Las condiciones socioeconómicas y el tipo de tratamiento sufrido influyeron en la calidad de vida de estas mujeres después de su tratamiento. Es necesario aumentar el alcance de las pruebas de detección del cáncer cervicouterino entre las mujeres económicamente menos favorecidas; y, después del tratamiento, ofrecer medidas alternativas que suavicen los efectos secundarios.

Objetivo: Identificar a qualidade de vida de mulheres após o tratamento de câncer do colo uterino, de acordo com suas características clínicas e socioeconômicas. Métodos: Trata-se de um estudo analítico com mulheres com câncer que foram tratadas com cirurgia, radioterapia e quimioterapia. Para avaliar a qualidade de vida, aplicou-se o questionário WHOQOL-bref. O teste de Mann-Whitney foi utilizado para investigar associações entre domínios e variáveis. Resultados: Houve associações (p < 0,05) entre os domínios do WHOQOL-bref e as variáveis renda, situação conjugal, atividades de lazer e tratamento realizado. Os domínios físico e psicológico foram associados à qualidade de vida global (R = 0,54 e R = 0,63, respectivamente). Conclusões: Condições socioeconômicas e o tipo de tratamento influenciaram a qualidade de vida dessas mulheres após o tratamento. É preciso aumentar o alcance do rastreio do câncer de colo do útero entre as mulheres que são menos favorecidas economicamente; e, após o tratamento, oferecer medidas alternativas que minimizam os efeitos secundários.

Chromosome structure in man and Amphibia-Anura, restriction enzymes

Cromossomos metafásicos fixados de humano e de anuros poliplóides (Odontophynus amricanus, 4n = 44) foram tratados com enzimas de restriçäo MspI, Hpa II, EcoRI, Bgl II, Dra I e Hae III, seguidos pela coloraçäo Giemsa. Msp I (C CGG) e Hae III (GG CC) produziram bandas similares a G nos cromossomos humanos, indicando que as bandas säo causadas pela remoçäo de classes específicas de DNA ricas em CG. Contudo, padröes comparáveis de banda G foram também obtidos nos cromossomos humanos com Eco RI (G AATTC), Bgl II (A GATCT) e Dra I (TTT AAA), cujos sítios de digestäo näo revelam abundância particular em CG. Nos anuros 4n, Msp I removeu DNA cromossômico do braço longo de dois a três homólogos do grupo I (lq), da constricçäo secundária do grupo 11 bem como as bandas centroméricas, teloméricas e intercalares. Essas duas näo foram removidas pela Hpa II (C CGG), a qual näo corta DNA metilado. Eco RI causou bandas 2q e 3q. Os resultados sugerem que: 1. a açäo dessas enzimas depende da acessibilidade da enzima a regiöes cromossômicas com compactaçöes diferentes do DNA; 2. a obtençäo difícil de bandas intersticiais em Anura pode resultar da menor quantidade de seqüências ricas em CG provavelmente arranjadas em cachos menores, ou da maior condensaçäo cromatínica nos cromômeros