Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-28Bitstream added on 2014-06-13T18:39:59Z : No. of bitstreams: 1 viana_rc_me_botfm.pdf: 312488 bytes, checksum: 9cbe96e60f2b8c72151c29154796ac9e (MD5) / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / Realizar uma revisão da literatura mundial e nacional sobre mortalidade materna, descrevendo a população vulnerável, os fatores de risco, as causas, as difi culdades para obtenção dos dados e as medidas de prevenção, de forma a subsidiar as ações de saúde. A coleta dos dados foi realizada por meio de pesquisa de artigos nas bases eletrônicas, SCIELLO, PUBMED, LILACS e MEDLINE, além de materiais publicados por organizações mundiais e nacionais. Foram selecionados estudos publicados no periodo de janeiro de 2000 a maio de 2011, utilizando-se os seguintes descritores: “maternal mortality”[MeSH Terms] OR (“maternal”[All Fields] AND “mortality”[All Fields]) OR “maternal mortality”[All Fields], nos idiomas português, inglês e espanhol. Foram selecionados 36 artigos que atendiam aos critérios de inclusão. O óbito materno está diretamente relacionado com as condições de vida da população e apresenta elevada disparidade entre as diversas regiões sócio-econômicas. Embora a mortalidade materna seja o melhor indicador de saúde da população feminina, seus números muitas vezes são apresentados de forma irreal, pela difi culdade da identifi cação dos casos nos registros de óbito. Medidas de prevenção associadas a diagnóstico e tratamento precoces e adequados são fatores benéfi cos na redução desses óbitos maternos. Apesar da tecnologia avançada e do reconhecimento de algumas medidas de prevenção, um grande número de mulheres morre diariamente por complicações no ciclo gravídico-puerperal. É evidente que para a redução desta tragédia é necessário o comprometimento político, social e econômico com a saúde, para promover as reformas necessárias na assistência ao ciclo gravídico-puerperal / Accomplishing a review of worldwide and Brazilian literature on maternal mortality, describing the vulnerable population, risk factors, causes, and difficulties in obtaining the data and preventive measures, in order to subsidize health actions. The data collection was accomplished through a search for articles in the electronic data basis SCIELLO, PUBMED, LILACS and MEDLINE, in addition to published materials from worldwide and Brazilian organizations. Studies published between January 2000 and May 2011 have been selected using the following reference: “maternal mortality” [MeSH Terms] OR (“maternal”[All Fields] AND “mortality” [All Fields]) OR “maternal mortality” [All Fields], in Portuguese, English and Spanish languages. 36 articles that fi tted the criteria for inclusion have been selected.. Maternal death is directly related to the quality of life of the population and presents high disparity among the diverse social-economic regions. Even though maternal mortality is the most accurate health indicator for the female population, its numbers many a time are presented in unreal manners, due to the diffi culties in identifying the cases based on obit registries. Preventing measures associated to early diagnosis and proper treatment are benefi cial factors to the decrease of such maternal deaths. In spite of advanced technology and the recognition of some preventive measures, a large number of women decease daily out of complications through the pregnant and puerperal cycle. It is evident that in order to reduce such tragedy, political, social and economical commitment to Health is necessary to promote the needed reforms in the pregnant and puerperal cycle assistance

A mortalidade por câncer no Estado de São Paulo vem crescendo em importância à medida em que se processam as transições demográfica e epidemiológica. Atualmente, cerca de 13 por cento das mortes no Estado se devem ao câncer, prevendo-se aumento futuro nessa proporção. As neoplasias malignas mais frequentes como causa de morte foram, em 1993, as de pulmão, estômago, próstata, leucemias e linfomas e de boca e faringe, nos homens, enquanto, nas mulheres, foram as de mama, colo do útero e útero não especificado, estômago, cólon-reto e leucemias e linfomas. Houve diferenças regionais na mortalidade por câncer dentro do Estado de São Paulo, destacando-se a região administrativa de Santos, cujas taxas padronizadas foram as maiores, em ambos os sexos. Houve decréscimo das taxas padronizadas de mortalidade pelo conjunto dos cânceres entre 1972 e 1992, maior nas mulheres (-7,1 por cento), que nos homens (-3,7 por cento). As tendências temporais idade-específicas para o conjunto dos cânceres foram examinadas por análise de regressão que utiliza a distribuição de Poisson, com resultados significativos indicando quedas da mortalidade nas idades até 69 anos, nos dois sexos, estabilidade nas mulheres acima de 70 anos e aumento nos homens dessa idade. A maior redução de taxas, tanto padronizadas quanto idade-específicas, ocorreu para o câncer de estômago, em ambos os sexos, com resultados significativos em todas as idades. Ao contrário do câncer gástrico, as neoplasias malignas do pulmão, mama feminina e próstata apresentaram aumento das taxas padronizadas, entre 1970 e 1992; no entanto, para algumas faixas etárias mais jovens, o câncer de pulmão registrou quedas significativas de taxas em ambos os sexos. Enquanto isso, o câncer do colo do útero e as leucemias permaneceram estáveis, mas nestas últimas notou-se queda de mortalidade nas crianças até 9 anos. Tratando-se de doenças distintas, cuja etiologia é complexa. e geralmente não conhecida, exceto por alguns fatores de risco e mesmo estes, apenas para algumas delas, as tendências declinantes observadas nos mais jovens não têm uma explicação única, mas, ao contrário, devem-se, com maior probabilidade, a uma combinação peculiar de fatores específicos para cada câncer, não se podendo desprezar a contribuição advinda dos progressos materiais, sociais e tecnológicos ocorridos nas últimas décadas. / Cancer mortality has becoming progressively more important in the State of São Paulo as the demographic and epidemiologic transitions progress. Currently, around 13 percent of ali deaths in the State are due to the malignant neoplasms, and it is reasonable to anticipate a further increase in that proportion. The most frequent cancers causing deaths were, in 1993, those of the lungs, stomach, prostate, the leukemias and lymphomas and cancers of the mouth and pharinx, in males, and those of breast, uterus, stomach, colon and rectum and the leukemias and lymphomas, in females. There were regional differentials in cancer mortality within the State: the administrative region of Santos presented the highest age-adjusted mortality rates, both for males and females. There has been a decrease in the age-adjusted death rates between 1970 and 1992, with rates for females decreasing more (less 7,1 per cent) than those for males (less 3,7 per cent). Age-specific time trends for ali cancer mortality were evaluated by means of the technique of regression analysis using the Poisson distribution. Significant decreases in rates were found throughout ali age-groups up to 69 years, for both sexes. For the eldest, stable mortality rates were found among women, whereas a trend for an increase was observed among men. The largest reductions in rates were observed for stomach cancer, for both sexes, with decreases both in age-standardized as in age specific death rates; in the latter, significant decreases in rates were observed for all age-groups. lnversely, cancers of the lung, breast and prostate ali experienced increases in their age-adjusted rates between 1970 and 1992, while cervical cancer and the leukemias remained fairly stable, but, for the latter, a significant fali in mortality was observed in younger ages. As different cancers are distinct diseases, whose causation is complex and usually not known in full detail, except for a number of risk factors and only for some of them, reasons for the declining mortality in the youngest should be due to a number of factors peculiar to each cancer considered, although the contribution of material, social and technological progresses that happened in the last decades should not be omitted.

A partir da metodologia utilizada por PUFFER e GRIFFTH, 1967, PUFFER e SERRANO, 1973, GUIMARÃES, 1979, LAURENTI e cal. 1988 e MELLO JORGE, 1988, foi possível caracterizar o óbito das mulheres de Diadema/SP. A maioria da população alvo era de mulheres idosas (64 por cento acima de 50 anos), oriundas principalmente do Nordeste, com baixa escolaridade (51,4 por cento de analfabetas), com baixo nível sócio-econômico (66,7 por cento com até um salário mínimo/pessoa na casa). Das que tinham assistência em saúde (86,3 por cento ), quase 70 por cento eram seguradas pelo INAMPS. Encontrou-se alto índice de alcoolismo nessa população. As principais causas de óbito foram as Doenças do aparelho circulatório, Neoplasias e Causas externas. No grupo de mulheres em idade fértil as principais causas foram Causas externas e Complicações da gravidez, do parto e do puerpério. As principais queixas pré-existentes foram a hipertensão e o diabetes. O coeficiente de mortalidade materna foi o de 289, 32/cem mil nascidos vivos, considerado muito alto entre os países aos quais foi comparado. A metodologia permitiu também alteração nas causas de óbito, assim sendo, houve aumento das Doenças das glândulas endócrinas, das Complicações da gravidez, do parto e do puerpério; o aparecimento das causas Transtornos mentais; e a diminuição da Doenças do aparelho respiratório e das causas mal definidas. / Starting with the methodology used by PUFFER & GRIFFTH (1967), PUFFER & SERRANO (1973), GUIMARÃES (1979), LAURENTI et al (1988), and MELLO JORGE (1988), it was possible to characterize the deads of Diadema/SP women on 1985/6. This population as being formed of old women (64 per cent over 50 years), mainly from the Northeastern Brazil, poor literacy (51. 4 per cent illiterate), with low social-economic level (66.7 per cent with up to one minimum salary earned by each person in the house). Almost 70 per cent of those who had medical and hospital assistance (86.3 per cent ) were insured by INAMPS. A high rate of alcoholism was found in the population. The main death causes were circulatory system Diseases, Neoplasias and external Causes. In the prolific age group of women, the main causes were external Causes and pregnancy, delivery, and puerperium Complications. The main pre-existing complains were hypertension and diabetes. The mortality death rate was 289.32/º born alive, which was found to be very high in comparison to other countries. The methodology also enabled an al teration in death causes. Thus, there was an increase of endocrinous gland Diseases, pregnancy, delivery, and puerperium Complications; an emergence of mental perturbations Causes, and a decrease in the respiratory system Diseases and badly defined Causes.

o presente estudo teve como objetivo a identificação de fatores de risco relativo de morte em criancas de um a sessenta meses de idade residentes em áreas de pobreza da cidade de Recife. O delineamento utilizado é do tipo caso-controle. Estudou-se o papel de variáveis relacionadas com o saneamento básico, bem como a renda, a educacão dos pais, a densidade demográfica intra-familiar, a história reprodutiva da mãe, o aleitamento materno e a assistência à saúde. Foram estudados 149 óbitos - \"casos\", e número igual de sobreviventes - \"controles\", pareados segundo a idade e o local de residência. Estimaram-se riscos relativos de morrer em análises univariadas para o total da amostra e para estratos segundo faixas etárias e causas básicas de ocorrência do óbito. Mediante modelos de regressão logística foram conduzidas análises multivariadas para todas as causas e idades e para dois sub-qrupos: o de menores de um ano e o de óbitos por causas gastrointestinais e seus \"controles\". Foi constatado elevado risco relativo de morte nas criancas das famílias com mais de três pré-escolares no domicílio. Em todas as análises univariadas realizadas o risco dessas criancas foi superior a 3.6 (P < 0.01) cheqando a 7.8 (P < 0,01) na análise multivariada conduzida para estimar o risco de morte por causas gastrointestinais. Com relacio ao tratamento intra-domiciliar da água, foi observado risco relativo superior a 3.8 (P < 0.01) na análise univariada; porém, nos modelos ajustados pela condição de amamentação e alfabetismo materno o risco de óbito gastrointestinal tornou-se inexistente. Na maioria das análises, foi também elevado o risco relativo nas crianças das mães com alta fecundidade materna. Igualmente o acesso aos servicos de saúde - medidas através da falta de atenção pré-natal - constitui risco relativo de morte, confirmando-se nas análises multivariadas finais, referentes à morte por causas gastrointestinais (OR = 11.11; P < 0.05). O aleitamento também mostrou ser fator preditivo de morte pós-neonatal por causas gastrointestinais (OR = 3.3;P < 0,05). Com base nestes resultados recomenda-se: (a) realizar investimentos de base ampla destinados a melhorar as condições de saneamento básico da cidade; (b) fornecer uma infra-estrutura de apoio para os cuidados das criancas a nível comunitário e/ou nos lugares de trabalho; (c) promover o espaçamento adequado entre os nascimentos; (d) aumentar a cobertura dos serviços de saúde, fomentando estratégias simplificadas de atenção primária com ativa participacão comunitária; (e) estimular ações permanentes e rotineiras de promoção do aleitamento ademais das campanhas eventuais. Estes resultados fornecem subsídios para a elaboração de políticas sociais destinadas a acelerar o processo de queda da mortalidade nos menores de cinco anos e identifica novos indicadores para entender os mecanismos que levam ao óbito nos estratos sócio-econômicos urbanos dos países em vias de desenvolvimento. / The aim of this case-control study was the identification of relative risk factors of mortality in children of 1 to 60 months of age resident in poor areas of the city of Recife. Sanitation, income, parent´s education, family density, mother´s reproductive history, breastfeeding and health care were studied and their roles as exposure factors were established. The sample consisted of 149 \"cases\" (dead children) and of the same number of \"controls\" (survivors) case-matched according to age and place of residence. Odds ratios (OR) were estimated through univariate analysis for the whole sample and for specific strata by age and cause of death. Multivariate modelling was then performed for infants and for gastrointestinal deaths and their \"controls\". High relative risk of death in families with more than three preschool children was verified. According to the univariate analysis the relative risk for multivariate analysis performed for gastrointestinal causes of death. Children whose families were not in the habit of treating water at home had a relative risk of gastrointestinal death of more than 3.8 (P < 0.01) in the univariate analysis. Whe adjusted for breast-feeding and mother´s literacy condition - through multivariate analysis - this risk was negligible. Most analysis showed important relative risk for children whose mothers had high fecundity. Likewise lack of access to health care - measured in terms of pre-natal care - was associated to a significant gastrointestinal causes (OR = 11,11; P< 0.05). Breastfeeding also shown to be a predictive factor of post-neonatal death due to gastrointestinal causes (OR = 3,3; P < 0.05). Based on these results it is recommended that: a) Sanitation be improved; b) an infrastructure for the day-care of children at community level be improved; c) an adequate intergestational interval be promoted; d) increase of health service coverage throught the strategy of primari health care with active comunity participation; e) the implementation of permanent activities (integrated to health service routine) with the aim of encouraging the practive of breastfeeding. It is, this considered that these results provide a basis for the formulation of social policies aiming at the acceleration of the decrease infant mortality. Also this study indicates new elements for understanding of the mechanism of death in poor urban areas.

Class of 2013 Abstract / Specific Aims: The purpose of this project was to determine inpatient charges, as well as define the frequency and mortality associated with the various sites of melanoma metastasis. Methods: Data was taken from the national database Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (H-CUP) Nationwide Inpatient Sample (NIS) and was collected on patients admitted into hospital with any diagnosis of melanoma with disease progression of distant metastasis. Logistic multivariate regression was used to find odds ration by patient characteristic. Overall charges were assessed using a gamma multivariant regression. Multiariant regression was used to determine other patient demographics. Main Results: Average inpatient charges for stage IV melanoma was $32,296 per patient with a national inpatient total bill of $5.56 billion. The metastatic sites associated with the highest inpatient charges were genitourinary tract (exp B = 1.276), gastrointestinal tract (exp B=1.146), bone (exp B=1.132), lung (exp B=1.097), and lymph (exp b=1.092). The most common sites of melanoma dissemination for in-patient mortality cases were lymph (21.7%), lung and respiratory (19.2%), central nervous system (17.1%), and bone (17.1%). Conclusion: The annual average hospital charges per patient for melanoma with distant metastasis is about $32,000. We suggest that metastases of the genitourinary tract, gastrointestinal tract, bone, lung, and lymphatic system are associated with the highest hospital charges, while metastases to the CNS, bone, liver, lung, GI, and wide dissemination are associated with increased mortality.

Introducción: La enfermedad COVID-19 que apareció a finales del año 2019 en China fue declarada como pandemia por la OMS, que recomendó implementar medidas de control a nivel mundial, a pesar de ello, la repercusión es alarmante. Perú es uno de los países con mayor mortalidad por esta enfermedad, diversos estudios realizados en residentes a nivel del mar, establecieron factores de riesgo como sexo masculino, edad avanzada, grupo sanguíneo y padecer enfermedades crónicas. Sin embargo, no existen estudios que identifiquen los factores de riesgo de mortalidad por COVID-19 en poblaciones de altura. Objetivo: Determinar los factores de riesgo de ingreso a UCI o mortalidad en pacientes hospitalizados por COVID-19 en dos hospitales de Puno, Perú. Material y métodos: Estudio de cohortes retrospectivo. Se incluirá por censo un mínimo de 214 historias clínicas de pacientes hospitalizados de abril a diciembre del 2020 con prueba molecular positiva, se evaluarán características sociodemográficas, funciones vitales, comorbilidades, exámenes auxiliares, tiempo de enfermedad, tratamiento recibido y su asociación a mortalidad. Se utilizará regresión de Poisson con varianza robusta para calcular RR crudos y ajustados con IC95%

Background. Little is known about the current clinical profile and outcomes of patients with infective endocarditis (IE) in South Africa. Methods. We conducted a retrospective review of the records of patients admitted to Groote Schuur Hospital between 2009 and 2016 fulfilling universal criteria for definite or possible IE, in search of demographic, clinical, microbiological, echocardiographic, treatment and outcome information. Results. 105 patients fulfilled the modified Duke criteria for IE. The median age of the cohort was 39 years (IQR 29-51), with a male preponderance (61.9%). The majority of patients (72.4%) had left-sided native valve endocarditis, 14% had right-sided disease, and 13.3% had prosthetic valve endocarditis. A third of the cohort had rheumatic heart disease. Although 41.1% of patients with left-sided disease had negative blood cultures, the three most common organisms cultured in this subgroup were Staphylococcus aureus (18.9%), Streptococcus spp. (16.7%) and Enterococcus spp. (6.7%). Participants with right-sided endocarditis were younger (29 years (IQR 27-37)), were predominantly intravenous drug users (IVDU; 73.3%) and the majority cultured positive for S. aureus (73.3%) with frequent septic pulmonary complications (40.0%). The overall in-hospital mortality was 16.2%, with no deaths in the group with right-sided endocarditis. Predictors of death in our patients were heart failure (OR 8.16, CI 1.77-37.70; p=0.007) and an age > 45 years (OR 4.73, CI 1.11- 20.14; p=0.036). Valve surgery was associated with a reduction in mortality (OR 0.09, CI 0.02-0.43; p=0.003). Conclusions. Infective endocarditis in a typical teaching tertiary care centre in South Africa remains an important clinical problem. In this setting, it continues to affect mainly young people with post-inflammatory valve disease and congenital heart disease. IE is associated with an in-hospital mortality that remains high. Intravenous drug-associated endocarditis caused by S. aureus is an important IE subset, comprising approximately 10% of all cases, a fact which was not reported 15 years ago, and culture-negative endocarditis remains highly prevalent. Heart failure in IE carries significant risk of death and needs a more intensive level of care in hospital. Finally, cardiac surgery was associated with reduced mortality, with the largest impact in those patients with heart failure.

Icebergs - Why start a thesis thinking about icebergs? Death from medical conditions represents the tip of an iceberg. What causes death in some, will maim, injure or leave damaged in others. Death remains a parameter with which to measure part of the effect of a disorder on the mother or fetus. What will prevent mortality will prevent morbidity and it is largely towards the prevention of the latter that modern medicine is aimed.

No description available.

Thesis (M.S.)--Boston University