Orientadores: Li Li Min, Carlos Alberto Mantovani Guerreiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T09:49:14Z (GMT). No. of bitstreams: 1 Porto_PriscilaMoraesdePaulaToledo_M.pdf: 27692610 bytes, checksum: c07d7ccfeb66ece991e3c602c7d501c6 (MD5) Previous issue date: 2010 / Resumo: A epilepsia é considerada como um sério problema de saúde pública com um risco de mortalidade precoce 2 ou 3 vezes superior à população. Historicamente, a mortalidade por epilepsia, c uma questão negligenciada e as mortes relacionadas com a epilepsia não são bem compreendidas. Esse processo social de desconhecimento resulta na subestimação da morte sem considerar que, em sua grande maioria é um evento que pode ser evitado e prevenido, o que dificulta ainda mais a adoção de medidas adequadas de controle e manejo que previnam essa morte. A hipótese que se sugere é que o problema de subregistro que tem sido evidenciada em outros estudos de mortalidade esteja acontecendo principalmente em relação ã epilepsia nas estatísticas oficiais. Apesar de o Brasil estar entre um dos poucos países emergentes que disponibiliza grande quantidade de informações de saúde, as fontes de dados geradas pelos diferentes sistemas de informação não se relacionam, tornando as informações vitais dispersas e desarticuladas entre os sistemas. Entre algumas estratégias utilizadas por países que apresentam estatísticas de qualidade discutível, cita-se o relacionamento de bancos de dados que visa agregar várias informações provenientes de diversas fontes relacionadas ao indivíduo e o estudo de causas múltiplas de morte que considera todas as condições que contribuíram para a morte levando em conta todas as causas mencionadas na declaração de óbito. É objetivo deste estudo analisar conjuntamente todas as causas declaradas na declaração de óbito, verificando se a epilepsia foi mencionada como causa básica ou associada de morte. Num segundo momento, realizar busca de informações em mais duas fontes de registros: registros de ambulatório e de internação do Hospital das Clínicas da UNICAMP, para investigar se. pacientes com epilepsia atendidos no Hospital das Clínicas da UNICAMP, teriam o diagnóstico mencionado em um dos campos do atestado de óbito. Trata-se de um estudo que envolveu as pessoas falecidas com o diagnóstico de epilepsia no Município de Campinas. Foram analisadas as declarações de óbito para os anos de 2000-2004. Um total de 100 pessoas faleceram com o diagnóstico de epilepsia na declaração de óbito. A doença constava como causa básica da morte em 34/Í00 desses casos. Do total de falecimentos de pessoas com epilepsia atendidos pelo Hospital das Clinicas da UNICAMP. cerca de 73% dos casos, morreram sem ter o diagnóstico mencionado na declaração de óbito, o que contribui para a subestimação da epilepsia. O estudo aponta perda de informações e o número de mortes de pessoas com epilepsia é subestimado com evidências de fragilidade e descompasso entre os registros de morte. Este estudo mostrou a possibilidade de se explorar conjuntamente diversas fontes de informação em saúde e íimimizar a informação disponível na declaração de óbito. Espera-se contribuir com uma nova consciência sobre a dimensão pouco divulgada da morte por epilepsia, pois com base cm informações confiáveis, podem-se implantar, de fato. programas abrangentes e efetivos na melhoria da qualidade da assistência à saúde de pacientes com epilepsia e, assim, caminhar no sentido da prevenção e redução da mortalidade por epilepsia / Abstract: Epilepsy is considered as a serious public health issue with an increased risk of early death 2 to 3 times higher than in the general population. Historically, mortality from epilepsy, is a neglected issue and epilepsy related deaths are not well understood. This social problem of knowledge results in underestimation of death without considering that the great majority are avoidable and preventable events, which further hinders the adoption of appropriate control and management to prevent this death. The hypothesis suggested is that the problem of underreporting has been shown in other studies of mortality is happening particularly in relation to epilepsy in our official statistics. Brazil is one of the few developing countries that provides a significant amount of health information, nevertheless, a limitation of real information still remains, as the data obtained from different information systems is not compatible among them, which leads to a scattering of vital information and often disjointed amidst different systems. In countries where the quality of information remains somewhat debatable, one of the strategies used in order to overcome these limitations is the linkage of data banks, also known as record linkage, that method's objective is to gather information from varied sources related to the individual and other resource tool that has been increasingly used is the study of multiple causes of death that strategy caters for that, as it considers all the morbid conditions that eventually led to death, as well as all the causes mentioned in the death certificate. The aim of this study was to evaluate the causes of death, so that we could verify whether epilepsy was mentioned as a cause of death in any of the fields of the death certificate. Other than that, record linkage also could provide information if patients with epilepsy who were followed at the Hospital de Clínicas (HC) da UNICAMP had this diagnosis mentioned in any of the fields in their death certificates. We designed a descriptive, retrospective and transversal study comprising people who had died with a diagnosis of epilepsy in the city of Campinas between the years 2000 and 2004. Out of a total of deaths, 100 persons died with a diagnosis of epilepsy mentioned in their death certificates. The condition was the main cause of death in 34/100 cases and in 66/100 it was an additional cause of death. Among all the persons with epilepsy followed at the HC da Unicamp who had died, 73% died without any mention of epilepsy in any of the fields of their death certificates, which contributes to the underestimation of epilepsy. The study indicates a loss of information and the number of deaths in people with epilepsy is underestimated with evidence of mismatch between death records. This study showed the possibility to jointly explore sources of health information and maximize the available information on the death certificate. Expected to contribute to a new consciousness about little known dimension of death from epilepsy because based on reliable information, can be implanted, in fact, comprehensive and effective programs to improve the quality of health care of patients with epilepsy, and thus moving towards prevention and reduction of mortality from epilepsy / Mestrado / Ciencias Medicas / Mestre em Ciencias Biomédicas

Orientador: Flavio Antonio Maes dos Santos / Texto em portugues e ingles / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-07-26T15:01:41Z (GMT). No. of bitstreams: 1 Ramos_FlavioNunes_M.pdf: 5212765 bytes, checksum: e79e2ea9811a28fb5756b47b8d49eb6e (MD5) Previous issue date: 2000 / Resumo: O objetivo deste estudo foi conhecer a regeneração das plântulas e jovens de Enterolobium glaziovii ao redor dos adultos. Esta espécie é uma árvore de dossel, descídua, e os seus adultos apresentam baixa densidade. Esse estudo foi realizado no estado do Rio de Janeiro, Brasil, em quatro parcelas circulares com 30 m de raio, tendo um indivíduo reprodutivo de E. glaziovii no centro de cada uma. Em todas as parcelas, valores de cobertura de dossel e graus de declividade, a chuva de frutos de E. glaziovii, o recrutamento de novos indivíduos, o padrão espacial, o crescimento e a sobrevivência de jovens coespecíficos, foram estimados anualmente de 1996 a 1999. Houve diferenças na topografia em cada parcela, apesar de todas as parcelas estarem em terreno inclinado. Os indivíduos jovens de E. glaziovii se encontravam sob alta cobertura de dossel (> 80%). O tamanho e a arquitetura da copa das plantas parentais e a inclinação do terreno influenciam a distribuição espacial dos frutos e jovens de E. glaziovii. O crescimento dos jovens de E. glaziovii é afetado negativamente pela densidade de coespecíficos, enquanto que o efeito da planta parental parece não ser importante. As plântulas desta espécie são capazes de sobreviver e crescer em uma grande amplitude de sombreamento por pelo menos 6 meses, mas apresentam maior incremento de altura em ambientes com mais de 80% de cobertura. E. glaziovii apresenta características de espécie tolerante a sombra. Essa espécie é capaz de geminar, se estabelecer, crescer e sobreviver em ambientes pouco iluminados. A taxa anual de mortalidade de indivíduos pequenos foi significativamente maior do que as taxas dos indivíduos médios e grandes. Não houve diferença entre o número de recrutamento observado e esperado tanto embaixo e fora da copa da planta parental, como em parcelas com alta e baixa densidade de frutos coespecíficos. A taxa de mortalidade não foi afetada embaixo da copa da planta parental nem em parcelas com alta densidade de jovens. Portanto, os resultados parecem indicar que os processos ocorrendo na escala espacial e temporal deste estudo não explicam a baixa densidade de adultos de E. glaziovii. Provavelmente, os processos que promovem o esparso padrão espacial dos adultos devem ocorrer em uma maior escala espacial e / ou temporal / Abstract: The purpose of this study was to know how was the regeneration pattem of Enterolobium glaziovii offspring around reproductive ones. This is a canopy and deciduous species and its adults present low density. The study was carried out in four circular plots of 30 m of radius, centered by a reproductive tree of E. glaziovii in Rio de Janeiro State, Brazil. From alI the plots the folIowing estimates were made: canopy coverage values and the declivity degrees, as welI as the E. glaziovii seed shadow, recruitment of new individuaIs, its spatial pattem, its growth, and the survival of its offspring, were estimated yearly from 1996 to 1999. Although alI the studied plots were situated on slope areas, there were differences in topography in each plot. E. glaziovii offspring were under high canopy coverage values (> 80%). The size and architecture of the parental crown and the slope influence the spatial pattem of E. glaziovii ftuit and offspring. Its growth is negatively affected by conspecific density, while the parental effect is not important to it. Seedlings of this species are capable of survive and grow in a broad range of shade levels, at least for 6 months, but they present greater height increments at environments of >80% of shade. E. glaziovii presents several characteristics of a shade-tolerant, "non-gap" species. It is capable to germinate, establish, growth and survive Ín a low light environment. Small individuaIs presented higher annual mortality rate than medium and large ones. There was no significant difference between the recruitment number expect and observed both under and outside of the parental crown and in plots with high and low density of conspecific fruit. The annual mortality rate of offspring was not affected either by offspring density or under parental crown. Therefore, It seems that the processes occurring at spatial and temporal scale of this study do not explain the low density of the E. glaziovii adults. Probably, the processes that explain the sparse spatial pattern of its adults might be occurring in a larger spatial and / or temporal scale / Mestrado / Mestre em Ecologia

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-11-30T12:48:11Z No. of bitstreams: 2 Dissertação - Juliete Teresinha Silva - 2017.pdf: 2775678 bytes, checksum: d9432664d8d88f044032b78414a5c6e5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-11-30T12:50:10Z (GMT) No. of bitstreams: 2 Dissertação - Juliete Teresinha Silva - 2017.pdf: 2775678 bytes, checksum: d9432664d8d88f044032b78414a5c6e5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-11-30T12:50:10Z (GMT). No. of bitstreams: 2 Dissertação - Juliete Teresinha Silva - 2017.pdf: 2775678 bytes, checksum: d9432664d8d88f044032b78414a5c6e5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-08-29 / Maternal mortality is still a problem of public health in all the world, mainly when we take a look at the developing countries. The reason for maternal mortality (RMM) enables the visualization of the place that women occupy in a society and how the health system takes care of their specific need based on the principle of equity. During the pre-natal a careful attention can identity pregnant women that have a bigger risk making it possible that we make a planned approach that will avoid occurrences of emergency situations that are always accompanied by bigger chances of maternal and neonatal morbimortality. Evaluate the perception of the professionals in the health field, their practice in the care of pregnancy in the primary assistance for the elaboration of a proposal of a permanent education program in health, as a strategy to reduce the maternal mortality in the county of Jataí in the state of Goiás. It was done a descriptive, exploratory, transversal study, of a qualitative approach in the health education. The secondary data referring maternal mortality in Brazil in these five years (2011 to 2015) were extracted from information of the ministry of health (SIM – System of Information of Mortality). The collecting of data referring the perception of professionals about permanent health education was obtained through a focal group. The analysis of the data was done through content analysis. The RMM in the county of Jataí in the year of 2015 was 142 deaths/100,000 born alive, similar to the year of 1990 when it was established as a goal of the 5th ODM that this indicator reached the level of 35 deaths / 100,000 born alive in 2015. The pre natal is done by a multiprofessional team that knows their role in the care of pregnancy in APS, however fragile points were pointed concerning the quality of this assistance, the team work and the knowledge and practice of EPS. The professionals involved in the research do not know the PNEPS, and there is not a practice of EPS in the work place considering that the knowledge of the health education limits itself to the education destined to SUS users. Acting at APS by the practice of a permanent education in health is the proposal strategy to contribute for the changing of the scenary of maternal mortality in the place of the studies. / A mortalidade materna continua sendo um problema de saúde pública no mundo todo, principalmente quando lançamos o olhar sobre os países em desenvolvimento. A razão da mortalidade materna (RMM) possibilita a visualização do lugar que a mulher ocupa na sociedade e como o sistema de saúde cuida de suas necessidades específicas, com base no princípio da equidade. Durante o pré-natal uma atenção cuidadosa pode identificar gestantes de maior risco permitindo que se faça uma abordagem planejada que evitará ocorrências de situações emergenciais, que são sempre acompanhadas de maiores chances de morbimortalidade materna e neonatal. Este estudo procurou compreender a percepção dos profissionais da área de saúde sobre suas práticas no cuidado à gravidez na Assistência Primária, para a elaboração de uma proposta de um programa de Educação Permanente em Saúde, como estratégia para redução da mortalidade materna no município de Jataí, no estado de Goiás. Trata-se de uma pesquisa qualitativa exploratória, sendo que a coleta de dados referentes à percepção dos profissionais sobre Educação Permanente em Saúde, assistência pré-natal e mortalidade materna foram obtidos através da técnica do grupo focal.A análise dos dados obtidos foi realizada por meio da Análise de conteúdo Temática, proposta por Bardin e revisitada por Minayo.Os dados secundários referentes à mortalidade materna no Brasil e em Jataí entre os anos de 2011 a 2015 foram extraídos de informações do Sistema de Informação de mortalidade do Ministério de Saúde (SIM). A RMM no município de Jataí no ano de 2015 foi de 142 mortes/100.000 nascidos vivos, igual ao ano de 1990 quando foi estabelecido como meta do 5º ODMque este indicador alcançasse o patamar de 35 mortes/100.000 nascidos vivos em 2015. O pré-natal é realizado por uma equipe multiprofissional, não sendo caracterizado um trabalho em equipe interprofissional. Foram identificados pontos frágeis quanto à qualidade da assistência pré-natal, ao trabalho em equipe e aos saberes e prática de EPS. Os profissionais envolvidos na pesquisa desconhecem a PNEPS, não havendo no local do trabalho a prática da EPS, sendo que o conhecimento de educação em saúde se limita à educação destinada ao usuário do SUS. Atuar na APS por meio da prática de uma Educação Permanente em Saúde é a estratégia proposta para contribuir na mudança do cenário da mortalidade de mães no local do estudo.

Utilizando-se como estratégia geral o estudo das mudanças na estrutura da mortalidade infantil (MI), o presente trabalho visa aproximar-se dos determinantes da evolução deste indicador na cidade de São Paulo. O estudo centra-se no periodo de 1973 a 1983, caracterizado pela queda acelerada e ininterrupta da variável. Compararou-se o nível e a estrutura (por idade e por causas) da MI, no município, no início da década de 70, com valores hipotéticos, calculados para essa realidade, constatando-se excesso de mortalidade por diarréia em crianças de 7 dias a 6 meses. Relacionou-se esta situação com os baixos índices de amamentação existentes na época. Estes antecedentes e a elaboração de um marco teórico da determinação da mortalidade por diarréia em crianças menores de 6 meses forneceram a base para hipóteses referentes à evolução da MI e de seus determinantes no período de 1973 a 1983. A partir de informações de registros oficiais e de pesquisas conduzidas no municipio, avaliou-se a coerência entre a evolução das variáveis (dependente e independentes) e as hipóteses propostas. Observou-se que 40 por cento da queda da MI se deveu ao declínio das causas diarréicas e que a intensidade da redução destas aumentou em razão inversa à idade. Entre os determinantes, o abastecimento de água mostrou a maior variação e a mais clara concomitência com a evolução da mortalidade por diarréia. Menos evidenter o aleitamento materno e o atendimento à sadde também mostraram particularmente após 1980. Descarta-se a possibilidade de serem as variáveis sócio-econômicas e demográficas, determinantes fundamentais da queda da MI no período. Argumenta-se a favor de uma compensação dos efeitos negativos do desmame sobre a diarréia em crianças menores através do acesso à água. Como decorrência, discute-se: a) a possibilidade de que a generalização do desmame precoce - em situação de baixa cobertura da água - tenha sido importante deteminante da elevação da MI na década de 60 em São Paulo e em outras áreas subdesenvolvidas, e b) a possibilidade de que o acesso à água tenha seus efeitos auffientados sobre a diarréia infantil em populações onde o desmame precoce é prática muito frequente. / This study seeks to create an approach to the identification of the causal factors behind the recent trend in infant mortality (IM) in the city of São Paulo by an analysis of the structure of and changes in the age and causes of infant deaths. The levels and structure (by age and causes of death) of IM in São Paulo at the beginning of the period are compared with the values \"expected\" for this context. An excess of diarrhoeal mortality in infants aged from 7 days to 6 months was verified and is understood to be related to the fact that the practice of breast-feeding was extremely uncommon in the city. These antecedents, together with an analytical framework proposed for diarrhoeal mortality in children under 6 months of age, have provided a basis for hypothesis relating to changes in IM and its determinant factors during the period 1973-1983. The basic information for the study was drawn from official registration records and surveys. It was found that 40 per cent of the decline in IM was due to the reduction in diarrhoeal causes, which is inversely related to age. Among the determinants, water supply showed the greatest variation and it was clearly concomitant to infant diarrhoeal mortality. Though less evidently, the practice of breast-feeding and the action of the health services seem to have made a positive contribution, particularly after 1980. Socioeconomic and demographic variables are shown not to be main determinants of the decline in IM in the period under study. It is argued that the accessibility of watersupply may have counterbalanced the negative effects of early weaning on diarrhoeal mortality in younger infants. The following corollaries are discussed: a) where the water supply is uncertain wide-spread early weaning may haye been an important cause of the increase in IM in São Paulo, in the sixties, as also in other underdeveloped areas; b) access to water supply may have had increased beneficial effect on infat diarrhoeal mortality in those populations where early weaning is widespread.

Orientador: Helenice Bosco de Oliveira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T19:14:03Z (GMT). No. of bitstreams: 1 Saita_NanciMichele_M.pdf: 1460308 bytes, checksum: d19dc519e319a0f8f79a8ac7220393bd (MD5) Previous issue date: 2012 / Resumo: A tuberculose (TB) é uma doença infecto-contagiosa com características sociais, atingindo a classe economicamente ativa nos países desenvolvidos e em desenvolvimento. O Brasil está na lista dos 22 países em desenvolvimento que são responsáveis por 80% dos casos mundiais da doença. Após o surgimento da Aids, ocorreu aumento no número de casos notificados de TB entre as pessoas infectadas pelo vírus desta doença, gerando, dessa forma, novas estratégias para o controle da TB. Este trabalho teve como objetivo descrever a série histórica da tuberculose e da Aids na década atual, caracterizar e analisar o perfil dos pacientes com tuberculose que foram a óbito e comparar o período de 2001-2009 com o da década de 1990. Trata-se de um estudo descritivo sobre a dimensão epidemiológica da TB, da Aids e da coinfecção TB-Aids, dos indivíduos residentes na cidade de Campinas, Estado de São Paulo, Brasil, que morreram durante o tratamento da tuberculose e também dos óbitos notificados após a morte entre janeiro de 2001 a dezembro de 2009. A fonte utilizada foi o Banco de Dados para a Vigilância da Tuberculose da Universidade Estadual de Campinas (TB-WEB), o Banco de Óbitos da Secretaria Municipal de Campinas e o Centro de Referência e Treinamento DST-Aids do Estado de São Paulo. O número de casos de tuberculose, Aids, coinfecção TB-Aids e o número de óbitos encontrados nos sistemas de informação foram utilizados para visualizar a tendência epidemiológica. A letalidade por tuberculose foi utilizada para complementar o estudo do óbito por tuberculose. Para a análise dos dados foram utilizados recursos do Microsoft Excel versão 2007 e Epi-info versão 6.04, utilizando o teste qui-quadrado, considerando valor p < 0,05. Foi observado decréscimo dos casos de TB e tendência de estabilização para a Aids e coinfecção TB-Aids. A proporção de testes anti-HIV não realizados, entre pacientes com tuberculose, foi elevada (27,5%). A letalidade geral da tuberculose apresentou decréscimo nos três triênios (2001- 2003, 2004-2006, 2007-2009) estudados. Entre os pacientes que foram a óbito, foi verificada maior proporção entre os casos novos em todos os triênios. Houve predomínio da letalidade entre o sexo feminino com Aids e destaque para os casos sem a presença da Aids no sexo masculino. A letalidade aumentou entre os casos com Aids nos casos novos e de retratamento nas formas pulmonar e extrapulmonar. A vigilância epidemiológica do município, os serviços de saúde e os profissionais de saúde podem utilizar as informações sobre o óbito por TB para avaliação das ações desenvolvidas para esses pacientes, utilizando-as inclusive para rever e planejar novas estratégias. Esse cenário também revela a extensão epidemiológica da TB e da Aids e a necessidade de integração dos bancos de dados nas atividades de planejamento e controle / Abstract: Tuberculosis (TB) is an infectious contagious disease with social characteristics which reaches the economically active classes of both developed and developing countries. Brazil is on the list of 22 developing countries that are responsible for 80% of the World's TB cases. Since the emergence of AIDS, there has been an increase in the number of reported TB cases among people affected by the virus, thereby creating new strategies for the control of TB. The aim of the present study was to describe the historical series of tuberculosis and AIDS cases in the current decade while characterizing and analyzing the profiles of TB patients that died and comparing data from the period between 2001 and 2009 with data from the 1990's. This is a descriptive study on the epidemiological scale of TB, AIDS and the coinfection of TB-AIDS among residents of the city of Campinas, in the state of São Paulo, Brazil that died during TB treatment. Deaths that were reported at a later time between January 2001 and December 2009 were also studied. The following sources were employed in this study: the Tuberculosis Surveillance database of the state University of Campinas (TB-WEB); the data bank of deaths of the municipality of Campinas and the DST-Aids Reference and Training Center of the state of São Paulo. The numbers of tuberculosis, AIDS, and TB-AIDS coinfection cases, as well as the number of deaths found in the information systems were used to view the epidemiological trend. Mortality from TB was also used to complement the study of deaths from TB. Data analysis was carried out using Microsoft Excel version 2007, Epi-info version 6.04, and the chi-square test with the significance level set at p < 0.05. A decrease in TB cases and a trend of stabilization for AIDS and the TB-AIDS coinfection were found. The proportion of anti-HIV tests that were not performed among TB patients was high (27.5%). The overall mortality of TB decreased in the three studied triennia (2001-2003, 2004-2006, 2007-2009). A greater proportion of new cases were confirmed among patients that died in all triennia. Mortality was predominant among females with AIDS and males without AIDS. Mortality increased in new AIDS cases and cases of retreatment of pulmonary and extra-pulmonary forms. Epidemiological surveillance of the municipality, as well as health services and professionals may use this information about death from TB to assess the actions undertaken for these patients and to review and plan new strategies. The present study also highlights the epidemiological extent of TB and AIDS and the need to integrate databases into planning and control activities / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Class of 2012 Abstract / Specific Aims: To evaluate associations between hospital and patient characteristics and mortality and economic outcomes. Included records were of adult patients age 18 years or older with a diagnosis of primary or disseminated liver cancer. Methods: This study was a retrospective cohort design that utilized emergency department discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) National Emergency Department Sample (NEDS). Generalized linear models were used for analyses to assess outcomes of mortality and total charges. Logistic regression was utilized for mortality; gamma regression with log-link was utilized for charges. Main Results: Overall, 239,895 adult records were included in the study with diagnoses of ICD-9 155.x or 197.7. Total charges for all records were over $8.23 billion in 2009. The average age of the case was 65.07 (±13.8) years with 48.7% being female. Mortality (either in the ED or hospital) was 11.1% (n=26,701). The mean length of stay was 6.47 (±6.05) days. Charges for each record were $42,874.50 (±53,956.34). Increased mortality was associated the most with hospital teaching status and primary payer. Increased charges were associated with hospitals located in the Western region. Conclusions: The differences in clinical outcomes were primarily from different payers and economical outcomes differed greatly by the Western region hospital location. Data taken from the nationally-representative investigation reveals that primary and disseminated liver cancer still remains a clinical high burden-of-illness with an 11.1% mortality rate and total charges approaching $10.3 billion dollars.

Abstract Radiographic oral and maxillofacial findings were recorded in a cohort of 293 home living elderly, in Helsinki, Finland, derived from a random sample of 8035 subjects, , born in 1904, 1909, and 1912, who participated in the Helsinki Ageing Study. They were 76, 81, and 86 years old at the commencement of the radiographic study. The relationships of potentially infectious findings with increased all-cause mortality over four years were studied. During the four-year follow-up, 18.5% of the subjects died. Of the 124 edentulous subjects, 17% had condylar findings, 13% radiopaque intraosseous findings, 9% retained roots, 6% maxillary sinus findings, 4% impacted teeth and 3% radiolucent findings. Edentulous women had more arthrotic condylar findings than men. The mean number of teeth in the 169 dentate subjects was 13.9, 15.5 in men and 13.2 in women. Carious teeth were found in 75%, radiolucent findings in 41%, teeth with vertical infrabony pockets in 51%, furcation lesions in 28%, calculus in 40%, and condylar findings in 25%. Periodontal attachment loss was slight in 18%, moderate in 31%, and advanced in 46%. 21% of the teeth had been endodontically treated. Periapical lesions were found in 17% of these teeth, and in 4% of the other teeth. 75% of the rootfillings were inadequate, exhibiting periapical lesions twice as often as the adequate ones. Men had more carious teeth, periapical lesions and furcation lesions than women, indicating better oral hygiene and/or utilisation of dental services in women. Compared with the previous studies carried out in Finland, slightly more teeth and less tooth-associated pathology were found in the present subjects. In contemporary Scandinavian studies, only a slightly better oral health status in the elderly has been reported. During the four-year follow-up, mortality was higher in the subjects with moderate to advanced infrabony pockets, OR 2.2, 1.0-4.7. In the previous studies, similar associations have been found in larger study cohorts including younger subjects. Our results indicate that oral foci may be more dangerous for the elderly than it has been previously thought, as the subjects who died had poorer dental health than those who survived.

Mortality in Cisleithania in 1881-1911 Abstract The aim of this thesis is to analyze mortality in Cisleithania in general and its parts within 1881-1911. Trends in mortality and its level during this period were significantly influenced by the contemporary social situation and economic development which were parts of the process of modernization. Therefore when analyzing mortality rates the economic and social situation of each country was taken into account. The analysis showed significant regional mortality differences. Important factor affecting the mortality level in the above mentioned period was proportion of the population working in industry and agriculture sectors and related proportion of the population living in urban and rural areas. The mortality analysis in this thesis is based on the standardized crude death rate, the infant mortality rate and abridged life tables. The changes in mortality level were additionally analyzed by various decomposition methods providing more comprehensive information about mortality in Cisleithania. Keywords: mortality, Cisleithania, process of modernization, proportion of the population working in industry and agriculture sectors, proportion of the population living in urban and rural areas, decomposition

Abstract Ischemic stroke is associated with cardiovascular autonomic nervous system (ANS) disturbances, including reduced heart rate (HR) variability and acute phase neurohumoral activation with elevated stress hormone levels. The impact of HR variability and neurohumoral factors such as natriuretic peptides on the long-term survival of patients with ischemic stroke has not been studied previously. This study was designed to evaluate cardiovascular autonomic regulation in ischemic stroke patients by assessing HR dynamics and various neurohumoral factors. The values of the assessed variables in predicting mortality were evaluated. HR variability assessments were performed in the acute phase of ischemic stroke and for a general elderly population. Various neurohumoral factors were also assessed in the acute phase of stroke. After follow-up, the survival of the subjects was assessed and the prognostic values of the measured factors were evaluated. Stroke patients were found to have cardiovascular autonomic and hormonal disturbances manifested as reduced traditional time and frequency domain measures of HR variability, altered long-term HR dynamics and elevated levels of natriuretic peptides in the acute phase. Altered long-term HR dynamics in the acute phase of stroke predicted long-term mortality after stroke and cerebrovascular mortality in the general elderly population. Neuroendocrine activation involving elevated natriuretic peptide values that were associated with high cortisol and catecholamine levels was observed in the acute phase of ischemic stroke. Neurohumoral disturbance was prognostically unfavourable. The most powerful predictors of poststroke mortality were altered long-term HR dynamics and elevated levels of natriuretic peptides and cortisol, which predicted mortality independently of the conventional risk factors in multivariate analysis. Prognostically unfavourable cardiovascular autonomic dysfunction with disturbances in the long-term behaviour of HR dynamics was found to be related to ischemic stroke. Neurohormonal activation with elevated natriuretic peptide and cortisol levels in the acute phase predicts long-term mortality after ischemic stroke.

Magister Public Health - MPH / Background: Botswana has one of the highest TB incidence rates in the world. Tuberculosis in those without HIV infection accounts for 13% of adult mortality and in those living with TB and HIV in Botswana account for 40% of annual adult mortality. Francistown is a health district with TB mortality rates in excess of 5% of diagnosed TB patients yearly. The aim of this study was to assess patient related factors and early warning signs (predictors) of death among TB patients on treatment in Francistown clinics in order to identify possible interventions. Methodology: A retrospective case-control study design was used in this study. The records of all patients treated for TB from January 2010 to November 2015 who met the study inclusion criteria were extracted from the district electronic register (ETR). Socio-demographic variables, clinical variables and treatment outcome were collected and analysed. Univariate and multivariate logistic regression techniques were used to assess the predictors of death and the Kaplan Meier plot to determine time to death while on treatment. Result: A total of 1718 participants were included in the study. The median age of the study population was 35 years (IQR: 29, 42). Of the study population, 56% were male. Most of the participants had pulmonary TB (78%). There was a very high HIV prevalence among the study population (74%). About 44% of participants had smear results at the start and at the completion of TB treatment. Of the 1718 participants 161 (95% CI 8.0-10.8) died during the course of TB treatment. Univariate analysis showed HIV status, extra-pulmonary TB and a history of TB treatment default to be associated with earlier death. Multivariate analysis of selected variables showed that being older (≥ 55 years old), HIV-positive, having a history of TB and extra-pulmonary TB are independent predictors of death while on TB treatment. The overall median time to death was 52 days. Lack of HIV-related intervention during TB treatment was a significant independent predictor of time to death (adjusted HR = 1.79; 95% CI 1.03 – 3.1; p = 0.037). Conclusion: Of the 1718 adult patients treated for TB in Francistown clinics from January 2010 to November 2016, 161 (9%) died while on treatment. The predictors of death identified in the study include, prior history of TB infection, Extra-Pulmonary TB, HIV status, HIV-related intervention and over 55 years of age. Gender was not a predictor of death in this study. Their overall median time to death in the study was 52 days. Patients on treatment for the first time with no previous history of TB lived on average 150 days on TB treatment. All TB patients with HIV co-infection that did not receive Antiretroviral Therapy (ART) and or Cotrimoxazole Preventive Therapy (CPT) died during the intensive phase of TB treatment. More than half of all deaths recorded in this study occurred during the intensive phase of TB treatment. After adjusting for gender, age, treatment classification, treatment group and HIV status and the lack of HIV-related interventions during TB treatment was the significant predictor of earlier death among patients with TB/HIV co-infection in this study.