Mortality after discharge from a public tertiary cardiovascular referral hospital.

It is critically important for stakeholders with distinct foci of attention on healthcare to understand patient evolution in the presence of an established diagnosis or with a suspected diagnosis of various diseases, specially considering death as an outcome. To study the long-term mortality of patients at a cardiovascular referral hospital. Deterministic binding (selection of pairs of registers from the hospital electronic health records and the mortality records of São Paulo state) from 2002 to 2017 was performed. Studied variables were: age, sex, hospital treatment unit where the first visit occurred (Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostics Services), treatment type, elapsed time between the first visit and death, diagnosis at first and last visits and variables related to death. Statistical Methods: descriptive, survival (with Kaplan-Meier method), correspondence and competitive risks analyses; in case of nonoccurrence of death until the end of 2017, the patients were considered alive. Statistical significance was set at values of P < .05. Median age at the first visit to the Hospital was 51.9 years. Birth locations included 4496 cities, 17.33% in São Paulo, 0.41% in Rio de Janeiro, 0.40% in Osasco, 24.04% in other cities. Sex included females (46.7%), males (44.2%), not defined (6.3%), and other (2.8%). We observed an association between diseases in ICD-10 Chapter 16 (certain conditions originating in the perinatal period) and Chapter 17 (congenital malformations, deformations, and chromosomal abnormalities), both as diagnoses and underlying causes of death, as well as between neoplasms as diagnoses and as the underlying cause of death. In this sample, there was an association between admission diagnoses and underlying causes of death, such as neoplasms, cardiovascular diseases, and congenital heart malformations. Additionally, patients who underwent a cardiac intervention had a smaller less mortality rate than those who were not operated on. There were also differences in cardiovascular mortality between distinct treatment units of the hospital ((Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostic Services).

Temporal Trend and Risk Factors for Respiratory Distress Syndrome-Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country.

OBJECTIVE: This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths. STUDY DESIGN: This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI. RESULTS: A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: -6.50%; 95% CI: -9.11 to -3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09-1.29), zero to three prenatal care visits (1.25; 1.18-1.32), multiple pregnancy (1.24; 1.16-1.33), vaginal delivery (1.29; 1.22-1.36), GA 22 to 27 weeks (106.35; 98.36-114.98), GA 28 to 31 weeks (20.12; 18.62-21.73), male sex (1.16; 1.10-1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08-7.47) and 4 to 6 (3.97; 3.72-4.23). CONCLUSION: During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants. KEY POINTS: · RDS is associated with preterm live births.. · Impact of RDS-associated neonatal mortality in middle-income countries is scarce.. · Qualified perinatal care can reduce RDS-associated neonatal mortality..

O registros de acidentes do trabalho no meio rural paulista: as culturas sucroalcooleira e de frutas cítricas entre 1997 e 1999 / Records of work-related accidents in the rural area of the state of São Paulo: citrus fruit and sugarcane crops from 1997 to 1999

Objetivo. Este é um estudo descritivo de corte transversal com cálculo anual das taxas de incidência acumulada, mortalidade e letalidade para os registros de Acidentes do Trabalho-AT ocorridos no meio rural, entre 1997 e 1999 no Estado de São Paulo, que enfocou as categorias profissionais envolvidas nas culturas sucroalcooleiras e cítricas. Métodos. Elaborou-se uma base de dados, a partir de uma pesquisa realizada pela Fundação Seade/Fundacentro, com informações sobre registros de AT, notificados nas agências da Previdência Social do Estado de São Paulo através da CAT. Resultados. Dos 57.867 acidentes de trabalho registrados em áreas rurais entre 1997 e 1999, 43 por cento eram trabalhadores da cultura sucroalcooleira e 4 por cento da cultura cítrica. Neste período, observou-se um crescimento relevante entre os registros de acidentes do trabalho da cultura cítrica, de cerca de 44 por cento. Enquanto, a cultura sucroalcooleira apresentou as mais elevadas taxas de incidência acumulada calculada para a população trabalhadora residente na Estado de São Paulo e contribuinte de Instituto de Previdência Oficial. A distribuição geográfica estadual paulista indicou que as áreas que apresentaram as maiores incidências acumuladas foram aquelas próximas a municípios onde se concentram grandes centros agroindustriais, principalmente, os de frutas cítricas e os de cana-de-açúcar, locais estes onde o trabalho formal está instituído. Conclusões. Apesar de compreender somente os trabalhadores assegurados, a CAT constitui importante material de análise, fornecendo subsídios para o entendimento da questão acidentária. No meio rural, os acidentes do trabalho são um grave problema de saúde pública, assim como, nas culturas sucroalcooleiras e cítricas.

Acidentes do trabalho rural no interior paulista / Agricultural employment-related accidents in the São Paulo

No interior paulista, coabitam alta tecnologia e acidentes do trabalho estritamente manuais, ou seja, o alto índice de tecnologia utilizada na agropecuária não descartou a possibilidade de existirem acidentes com trabalhadores rurais, que exercem atividades com baixo padrão tecnológico, sobretudo as vinculadas ao plantio e corte de cana-de-açúcar. Onde eles, em sua maioria, sofrem acidentes no exercício diário de sua profissão.