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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
21

Nationwide pediatric mortality: drug toxicology, unknown causes of death, and autopsy rates

Reilly, Michael P. 12 March 2016 (has links)
Deaths among the pediatric population encompass a small percentage of the total number of fatalities across the United States. Since the deaths of infants, children, and adolescents are rare, there is little forensic literature concerning this age group. Autopsies, if performed completely, can reveal additional information surrounding circumstances of a case and leads to a determination of a cause of death or a diagnosis of exclusion. Yet studies report that nationwide autopsy rates are low, despite an increase of drugs in the environment and the prevalence of ill-defined causes of death. With the use of the Centers of Disease Control and Prevention (CDC) internet database Wide-ranging Online Data for Epidemiologic Research (WONDER), all deaths of individuals 19 years old and under were analyzed for years 2000, 2005, and 2010. The three main areas that were examined through the WONDER database were poisoning deaths for all ages, ill-defined causes of death for the infant age group, and overall autopsy rates for the three age groups with the highest crude rate of death. The crude death rate for all pediatric age groups have decreased within the examined decade. The infant age group comprised the majority of all pediatric fatalities and had the highest crude death rate. Individuals in the 15 to 19 year age group had the second highest crude death rate of the pediatric population. With a low number of total pediatric poisoning deaths, there has been a steady increase in crude death rate over the decade. The 15-19 age group encompassed the majority of these types of fatalities, with a total of 942 in 2010. It was also discovered that not every pediatric victim was autopsied when a death was diagnosed as a poisoning death when examined by a forensic pathologist. Infant ill-defined causes of death consisted of just over 12% nationwide for all years studied. However approximately 70% of all infant ill-defined causes of death were diagnosed as Sudden Infant Death Syndrome (SIDS) in 2000 and 2010. When examining autopsy rates for the year 2010, autopsies were performed for 32.9% of infant deaths, 55.1% of child deaths between 1-4 years of age, and 59.8% of teenage deaths between 15-19 years of age. In 2010, implementation of autopsies is uncertain for 2,454 deaths under 1 year, 255 deaths between 1 and 4 years, and 666 between 15 and 19 years. Measures need to be put in place nationwide to increase the rate of autopsies for the pediatric population and there needs to be strict accountability when it is not reported on a death certificate whether or not an autopsy was performed. Standard operating procedures should be applied for all autopsies of pediatric victims, with a toxicology examination always being included in an investigation.
22

Avaliação das células de Langerhans na língua de pacientes autopsiados com AIDS em estágio avançado / Expression of Langerhans cells in the tongue of autopsied patients with advanced AIDS

Gondak, Rogério de Oliveira, 1978- 16 August 2018 (has links)
Orientador: Pablo Agustin Vargas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-16T16:11:10Z (GMT). No. of bitstreams: 1 Gondak_RogeriodeOliveira_M.pdf: 4633053 bytes, checksum: caf2bde22b30d4aa164517dc0dd6ffaf (MD5) Previous issue date: 2010 / Resumo: A língua de pacientes com AIDS é acometida freqüentemente por infecções oportunistas e neoplasias. O objetivo deste estudo foi quantificar as células de Langerhans (CL) presentes em regiões lesionais e não lesionais na língua de pacientes autopsiados com AIDS em fase avançada, correlacionando a diminuição das CL com a presença de patologias infecciosas em diferentes regiões da língua (anterior, média, posterior e lateral) e comparar estes achados com a língua de pacientes HIV negativos. Foram utilizadas neste trabalho as línguas de 40 pacientes autopsiados com AIDS divididos em 04 grupos (10 com candidose lingual, 10 com herpes lingual, 10 com leucoplasia pilosa oral e 10 sem lesões em língua) e as línguas de 23 pacientes autopsiados (grupo controle) que morreram por outras patologias não associadas à AIDS e que não apresentaram patologias em língua. Realizamos estudo imunoistoquímico com os marcadores HLA-DR, CD1a e CD83 para identificar as CL e quantificá-las por meio de análise histomorfométrica. O índice de positividade foi obtido através da leitura de 7 campos seqüenciados orientados por ocular micrométrica. As células positivas foram contadas para cada um dos anticorpos nas quatro diferentes regiões da língua e os resultados expressos em células positivas por área de epitélio e por comprimento de membrana basal. O anticorpo HLA-DR mostrou a presença média das CL na língua dos pacientes com AIDS (LA=24,28/mm2 e 3,64/mm, LM=24,60/mm2 e 3,68/mm, LP=20,95/mm2 e 3,14/mm, LL=19,84/mm2 e 2,97/mm) e no grupo controle (LA=68,18/mm2 e 10,23/mm, LM=60,73/mm2 e 9,11/mm, LP=62,94/mm2 e 9,44/mm, LL=50,24/mm2 e 7,53/mm). O anticorpo CD1a mostrou a presença média das CL na língua dos pacientes com AIDS (LA=17,30/mm2 e 2,59/mm, LM=21,11/mm2 e 3,16/mm, LP=13,48/mm2 e 2,02/mm, LL=15,55/mm2 e 2,33/mm) e no grupo controle (LA=205,38/mm2 e 30,81/mm, LM=218,36/mm2 e 32,75/mm, LP=167,29/mm2 e 25,09/mm, LL=223,60/mm2 e 33,54/mm). O anticorpo CD83 mostrou a presença média das CL na língua dos pacientes com AIDS (LA=6,19/mm2 e 0,92/mm, LM=6,34/mm2 e 0,95/mm, LP=6,82/mm2 e 1,02/mm, LL=7,14/mm2 e 1,07/mm) e no grupo controle 68,18/mm2 e 10,23/mm, LM=68,46/mm2 e 10,27/mm, LP=69,28/mm2 e 10,39/mm, LL=63,49/mm2 e 9,52/mm), sendo que foram extremamente significantes as diferenças entre ambos os grupos em todas as regiões e anticorpos estudados (p<0,001). Portanto, podemos concluir que as CL estavam degeneradas e diminuídas em número em todas as regiões da língua e em todos os grupos com AIDS em relação ao grupo controle e as lesões infecciosas orais oportunistas não influenciaram na depleção das CL nas línguas / Abstract: The tongues of AIDS patients can be affected by opportunistic infections and neoplasms. Objectives: to quantify and compare the expression of Langerhans cells (LC) in lesional and non lesional areas in the tongue from patients with and without AIDS (control group), using autopsy material. Methods: we analysed the expression of CD1a, HLA-DR and CD83 using immunohistochemistry to identify and quantify LC in the tongues of AIDS patients (n=40), which were divided into 04 groups (10 lingual candidiasis, 10 lingual herpes, 10 oral hairy leukoplakia and 10 none lesions), and 23 tongues from HIV-negative controls. The immunoreactivity rate was obtained after reading at least seven fields sequenced driven ocular micrometer. The positive LC were detected in the lingual surface epithelium in four different regions (anterior, middle, posterior and lateral) and the results expressed as positive cells per area of epithelium and basement membrane length. Results: LC showed the following immunoreactivity for CD1a in the tongue of AIDS patients (LA=17.30/mm2 and 2.59/mm, LM=21.11/mm2 and 3.16/mm, LP=13.48/mm2 and 2.02/mm, LL=15.55/mm2 and 2.33/mm), and in the control group (LA=205.38/mm2 and 30.81/mm, LM=218.36/mm2 and 32.75/mm, LP=167.29/mm2 and 25.09/mm, LL=223.60/mm2 and 33.54/mm); HLA-DR (AIDS patients) (LA=24.28/mm2 and 3.64/mm, LM=24.60/mm2 and 3.68/mm, LP=20.95/mm2 and 3.14/mm, LL=19.84/mm2 and 2.97/mm), and the control group (LA=68.18/mm2 and 10.23/mm, LM=60.73/mm2 and 9.11/mm, LP=62.94/mm2 and 9.44/mm, LL=50.24/mm2 and 7.53/mm); CD83 (AIDS patients) (LA=6.19/mm2 and 0.92/mm, LM=6.34/mm2 and 0.95/mm, LP=6.82/mm2 and 1.02/mm, LL=7.14/mm2 and 1.07/mm), and the control group (LA=68.18/mm2 and 10.23/mm, LM=68.46/mm2 and 10.27/mm, LP=69.28/mm2 and 10.39/mm, LL=63.49/mm2 and 9.52/mm). The statistical analysis identified significant differences in the both groups and in all regions, and among the 3 antibodies (p<0.001). Conclusions: LC were degenerated and reduced in number in all regions of the tongue of AIDS patients in relation to the control group and the depletion of LC in the tongues of AIDS patients is not associated with oral opportunistic infections / Mestrado / Patologia / Mestre em Estomatopatologia
23

Óbitos por causas externas em menores de 18 anos na cidade de Campinas - SP / Deaths by external causes in children under 18 years in the city of Campinas - SP

Fraga, Andrea de Melo Alexandre, 1968- 20 August 2018 (has links)
Orientador: Joaquim Murray Bustorff-Silva / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T07:02:38Z (GMT). No. of bitstreams: 1 Fraga_AndreadeMeloAlexandre_D.pdf: 1835249 bytes, checksum: adcb75e4140a6b909cecdf5644ace0fe (MD5) Previous issue date: 2012 / Resumo: A doença trauma é considerada, mundialmente, a primeira causa de óbito na população entre um e 44 anos de idade. Entre as causas de trauma incluem-se os acidentes e a violência, correspondendo a causas externas intencionais ou não intencionais. Na infância, as principais causas externas que cursam com óbito em países desenvolvidos, estão relacionadas a acidentes de trânsito, seguidas por afogamento. O objetivo deste estudo retrospectivo baseado em laudos de necropsia foi descrever o perfil epidemiológico de óbitos por causas externas em menores de 18 anos de idade na cidade de Campinas, Brasil, no período entre 2001 e 2008. Entre os 2170 óbitos observados em menores de 18 anos, independente da causa, constatou-se que 530 foram por causas externas, com predomínio do sexo masculino, na proporção de 3.4:1. Houve um predomínio de óbitos no grupo etário de 10-17 anos (76%). O principal mecanismo observado foi ferimento por projétil de arma de fogo (FPAF - 47%). No período entre 2005-2008, houve uma diminuição no número de óbitos em consequência da redução dos homicídios. Outros mecanismos frequentes foram acidentes relacionados a trânsito (26%; sendo a maioria vítima de atropelamento - 57,2%) seguido por afogamento (10,4%). Asfixia/sufocação foi o mecanismo de morte em 72% dos casos com idade inferior a um ano; afogamento predominou entre 1-4 anos (30,8%); acidentes relacionados a trânsito foram frequentes nos grupos de 5-9 anos (56%) e de 10-14 anos (40,4%) e FPAF teve a maior incidência (68%) no grupo 14-17 anos. Cinquenta e um porcento dos óbitos ocorreram na própria cena e 15%, durante o atendimento pré hospitalar. Conclui-se que houve um predomínio de óbitos em crianças e adolescentes do sexo masculino, na faixa etária de 15-17 anos, principalmente por FPAF, sendo homicídio a intenção predominante / Abstract: Trauma disease is considered the first cause of death worldwide in the population from 1 to 44 years of age. Among trauma causes are accidents and violence, comprising intentional and non-intentional external causes. In childhood, in developed countries, the major external causes resulting in death are traffic accidents, followed by drowning. This retrospective study based in autopsy examinations describes the epidemiology profile of death by external causes in individuals younger than 18 years from 2001 to 2008 in Campinas city, Brazil. There were 2170 deaths of all causes in < 18 years, 530 of which were due to external causes, with male predominance 3.4:1. The age distribution reveled 76% of deaths in the group 10-17 years. The most predominant trauma mechanism was firearm injuries (47%), but there was a decrease of deaths in the period 2005-2008 in consequence of homicides reduction. Other frequent mechanisms were transport related injuries (138 - 26%; pedestrian struck in 57.2% of these deaths) and drowning (55 - 10.4%). Asphyxia/suffocation was the mechanism of injury in 72% of deaths in group < 1 year; drowning (30.8%) was predominant in group 1-4; transport related deaths were frequent in the groups 5-9 (56%) and 10-14 (40.4%); and firearm had the highest frequency (68%) in the group 14-17 years. 51% of deaths occurred at the scene and 15% at the pre-hospital care. In conclusion, there was predominance of death in children and adolescents males, between 15-17 years old, mainly by firearm mechanism, predominantly due to homicide intent / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências
24

Analysis of dendritic cells in tongue, cervical lymph nodes and palatine tonsils of autopsied patients with acquired immunodeficiency syndrome = Análise das células dendríticas na língua, linfonodos cervicais e tonsilas palatinas de pacientes autopsiados com Síndrome da Imunodeficiência Adquirida / Análise das células dendríticas na língua, linfonodos cervicais e tonsilas palatinas de pacientes autopsiados com Síndrome da Imunodeficiência Adquirida

Gondak, Rogério de Oliveira, 1978- 22 August 2018 (has links)
Orientadores: Pablo Agustin Vargas, Luiz Paulo Kowalski / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T08:56:49Z (GMT). No. of bitstreams: 1 Gondak_RogeriodeOliveira_D.pdf: 3115921 bytes, checksum: 6a0ba84f4ad5ecaa9e8dbd843e421cf0 (MD5) Previous issue date: 2013 / Resumo: Na infecção pelo HIV, as células dendríticas (CDs) podem desempenhar vários papéis, incluindo a provável captação inicial do HIV, transporte para os linfonodos, e posterior transferência para células T, desempenhando um importante papel no sistema imune. As manifestações orais observadas em pacientes infectados pelo HIV, incluindo aquelas associadas ao HSV-1 podem estar diretamente relacionadas à injúria das CDs. A proposta deste estudo foi identificar e quantificar as CDs intersticiais na língua de pacientes autopsiados com AIDS e portadores de infecção herpética lingual (n=10), pacientes com AIDS e sem lesões linguais (n=10) e pacientes sem AIDS e sem lesões linguais (n=10) por meio de reações imunoistoquímicas. Além disso, investigamos a população de CDs nos linfonodos e tonsilas palatinas de pacientes com AIDS (n=32) e sem AIDS (n=21). Nos tecidos linguais, foram utilizados os anticorpos contra CD1a e CD83 para identificação das CDs e o anticorpo contra HSV-1 para detecção do vírus da herpes simples tipo 1. Nos linfonodos e tonsilas palatinas foi utilizados além dos anticorpos contra CD1a e CD83, o anticorpo contra fator XIIIa. Para a quantificação das CDs nos tecidos linguais foi utilizado análise histomorfométrica convencional e nos tecidos linfóides foi aplicado o método analítico Positive Pixel Count (software Image Scope). Os resultados mostraram uma intensa depleção na população de CDs em tecidos linguais e linfóides de pacientes com AIDS e a infecção lingual pelo HSV-1 não potencializou a redução de CDs / Abstract: During HIV infection, dendritic cells (DCs) may play several roles, including the probable initial uptake of HIV, transport to the lymph nodes, and subsequent transfer to T cells. Oral opportunistic infections observed in HIV-infected patients, including those associated with HSV-1 may be directly related to injury of DCs. The purpose of this study was to identify and quantify the interstitial DCs in the tongue of autopsied patients with AIDS and lingual herpes (n = 10), AIDS patients with normal tongues (n = 10) and non-AIDS patients with normal tongues (n = 10) by immunohistochemistry. Furthermore, we investigated the DCs population in lymph nodes and palatine tonsils of AIDS patients (n = 32) and non-AIDS patients (n = 21). CD1a and CD83 antibodies were carried out to identify DCs in lingual tissues and HSV-1 antibody for detection of herpes simplex virus type 1. In lymphoid tissues, CD1a, CD83 and factor XIIIa antibodies were carried out to identify DCs. Interstitial DCs were measured by conventional histomorphometry whereas the lymphoid DCs were measured by Positive Pixel Count Algorithm method using ImageScope software. The results showed a decreased population of DCs in lingual and lymphoid tissues of AIDS patients independently of the presence of concomitant infection by HSV-1 / Doutorado / Patologia / Doutor em Estomatopatologia
25

Sudden Death and Isolated Right Ventricular Noncompaction Cardiomyopathy: Report of 2 Autopsied Adult Cases

Ilyas, Sadaf, Ganote, Charles, Lajoie, Dawn, Robertson, Julie, Cline-Parhamovich, Karen 01 September 2013 (has links)
A predominantly right ventricular variant of isolated noncompaction cardiomyopathy is a potentially lethal disease entity, which only recently has become recognized in the clinical and cardiac imaging literature. There are currently few established morphologic criteria for the diagnosis other than right ventricular dilation and presence of excessive regional trabeculation. To date, there have been no autopsy reports of cases following either clinical diagnosis or sudden death. We report 2 adult cases of sudden unexpected death in which unexplained right ventricular dilation and prominent apical hypertrabeculation were the principal findings. The gross and microscopic results suggest pathological similarities between, or coexistence of, right ventricular noncompaction and arrhythmogenic right ventricular cardiomyopathies.
26

Sudden Death and Isolated Right Ventricular Noncompaction Cardiomyopathy: Report of 2 Autopsied Adult Cases

Ilyas, Sadaf, Ganote, Charles, Lajoie, Dawn, Robertson, Julie, Cline-Parhamovich, Karen 01 September 2013 (has links)
A predominantly right ventricular variant of isolated noncompaction cardiomyopathy is a potentially lethal disease entity, which only recently has become recognized in the clinical and cardiac imaging literature. There are currently few established morphologic criteria for the diagnosis other than right ventricular dilation and presence of excessive regional trabeculation. To date, there have been no autopsy reports of cases following either clinical diagnosis or sudden death. We report 2 adult cases of sudden unexpected death in which unexplained right ventricular dilation and prominent apical hypertrabeculation were the principal findings. The gross and microscopic results suggest pathological similarities between, or coexistence of, right ventricular noncompaction and arrhythmogenic right ventricular cardiomyopathies.
27

Analysis of causes of death at home and in a public hospital Capricorn District of Limpopo Province

Ntuli, Sam Thembelihle January 2015 (has links)
Thesis (Ph. D. (Science)) -- University of Limpopo, 2015 / The objectives of the study were to examine the demographic profile and causes of death of people dying in a hospital and community; and to determine mortality rates, specifically age- and gender-specific mortality rates in a community. The study also compared causes of death assigned to hospital records with causes of death obtained from verbal autopsy reports. Methodology The data used in this thesis were collected in two phases. The first phase involved a retrospective review of all deaths that occurred in the Pietersburg/Mankweng Hospital Complex from 1st January, 2011 to 31st December, 2012. The second phase involved a community-based study using a verbal autopsyto determine cause of death in Dikgale HDSS for the same period. Results A total of 5402 deaths were reported in the hospital and 625 in the community. The majority of deaths in the hospital involved adults in the 15 to 49 year old age group, while in the community more deaths were recorded amongst adults aged 15 to 49 years of age and those in the 65+ year old age group. There were more male deaths in the hospital, while in the community a higher proportion of deaths occurred amongst females. v In children less than1 year old, the cause of death in the hospital was predominantly due to perinatal conditions, particularly preterm birth, low birth weight and birth asphyxia; while in the community, of the 5 deaths in this age group, infectious diseases were recorded as the main cause of death. Amongst children in the 1 to 4 year old age groups causes of hospital deaths were dominated by infectious diseases, injuries and malnutrition; while in the community infectious diseases were the main cause of death. Stillbirths were noted in the hospital with a stillbirth rate of 29.1/1000 deliveries. In the community no stillbirths were reported. More than half of the stillbirths were caused by unexplained intrauterine foetal causes followed by maternal hypertension in pregnancy and placenta abruption. For adults in the 15 to 49 year old age groups infectious diseases, such as HIV/AIDS and tuberculosis, were the leading causes of death in both the hospital and in the community. The proportion of deaths due to HIV/AIDS and tuberculosis was significantly greater in the community than in the hospital. Amongst adults in the 50+year old age group non-communicable diseases, particularly cardiovascular diseases and cancers were the most common causes of death. In this age group, the hospital recorded more cancer deaths than did the community; while the community recorded more cardiovascular deaths than did the hospital. vi The overall mortality rate in the community was 8.4 deaths per 1000 person-year, with more deaths occurring amongst males (8.9 deaths per 1000 person-year). The mortality rate was high amongst adults in the 65+ year old age group (48.9 deaths per 1000 person-year). When comparing cause-specific mortality between hospital cause of death notification forms and cause of death determined by verbal autopsy reviews, the same top five underlying causes of death were observed, namely: cardiovascular diseases, infectious diseases, diabetes mellitus, malignant neoplasms and respiratory infections. The agreement between causes of death reported on cause of death notification forms and cause of death as a result of a verbal autopsywas 48%. For individual causes, agreement of more than 80% was achieved between cause of death recorded on cause of death notification forms and from verbal autopsy reviews for respiratory infections, diabetes, malignancies and injuries. Infectious diseases (68.5%) and cardiovascular diseases (74.1%) achieved the lowest agreement. In other words, in only 68.5% and 74.1% respectively was the cause of death as recorded on the “cause of death notification” forms the same as the cause of death when reviewed verbally. Furthermore, 13 deaths were recorded as being due to cardiovascular diseases on the “cause of death notification” forms, however, in only 5 of these cases was the cause of death recorded as the same in the verbal autopsy report. In 21 cases cause of death was attributed to infectious diseases on the cause of death notification form, vii while in only 13 of these cases was the cause of death similarly ascribed after verbal autopsy review. Conclusion This study showed that the verbal autopsy instrument has the potential to identify causes of death in a population where deaths occur outside of health facilities. Procedures for death certification and coding of underlying causes of death need to be streamlined in order to improve the reliability of registration data. This will be achieved if medical students and trainee specialists are trained in the completion of cause of death notification forms. Foetal autopsies should be introduced at tertiary hospitals to determine the causes of stillbirths.Antenatal care education for pregnant women should be encouraged because the level of antenatal care has an influence on the health of mothers and their newborns. The government should continue to focus on improving the socio-economic status of the population, while adequate foetal monitoring by health workers may reduce neonatal deaths resulting from preterm births, low birth weight and birth asphyxia. Innovative injury prevention strategies, interventions to control infectious diseases, cancer screening and lifestyle program may reduce adult mortality.
28

Integritet av IT-forensiska verktyg för automatisk analys / Integrity of IT-forensic tools regarding automated analysis

Canovas Thorsell, Roberto January 2021 (has links)
IT-relaterad brottslighet ökar lavinartat och Polismyndigheten står inför nya utmaningar i att identifiera gärningsmän. Allt mer mjukvaror och tjänster blir automatiserade och det gäller även mjukvarorna som Polismyndigheten använder sig av. En av utmaningarna är den oerhörda mängd data som måste processas och analyseras i undersökningar och då förutsätts det att verktygen presenterar data med bibehållen integritet. Verktygen som används är nästan alltid tredjepartsmjukvara och då är det viktigt att rätt data plockas ut och att datan är korrekt. Denna studie har som mål att jämföra två mjukvaror i hur de identifierar och presenterar data. Studien görs i samverkan med Polismyndigheten vid Regionalt IT-brottscentrum Väst – Skövde och hoppas inbringa nya insikter och kunskaper i de verktyg som jämförelsen grundas på och med hjälp av kunskaperna kunna värdesätta integriteten hos verktygen. Resultatet som framträder i studien är att verktygen presenterar data med bibehållen integritet. / Cybercrime is on the rise in society and the Swedish Police is facing new challenges in identifying criminals. More tools and services are becoming automated, and this also applies to the tools that the Swedish Police uses. One of the challenges is the enormous amount of data that must be processed and analyzed during investigations. The tools used are always third-party programs and IT-forensics needs to rely on the organization that makes the software. This study aims to evaluate two different tools in how they identify and present artifacts. The study is conducted in collaboration with the Police Authority at the Regional IT Crime Center West - Skövde and hopes to bring new insights and knowledge into the tools on which the comparison is based on and with the help of the knowledge be able to value the integrity of the tools. The result that the study presents is that the tools are presenting data with preserved integrity.
29

Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh

Biswas, Animesh January 2015 (has links)
Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to  deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.
30

Estudo epidemiológico da distribuição das mortes de pacientes traumatizados num hospital universitário de referência terciária com avaliação dos atendimentos por painel de revisão de óbitos e dados de autópsiasatendimentos por painel de revisão de óbitos e dados de autopsias / The hole of autopsies in the current medical education

Marino, Roberto 19 March 2019 (has links)
As autópsias sempre foram consideradas como um exame de grande valia para o diagnóstico da real causa de morte dos pacientes, avaliação da eficácia do tratamento empregado e como importante ferramenta para o ensino médico. Durante as últimas décadas, houve um declínio importante na realização do número de autópsias acadêmicas, em grande parte pela desmotivação pela equipe profissional ao solicitá-la e realiza-la (clínicos e patologistas), justificando ser algo ultrapassado e de pouca validade, perda de interesse pelos alunos também, fatores culturais, religiosos, econômicos e de comportamento de familiares. Este estudo visa analisar a importância das autópsias como importante instrumento de ensino médico, desvendar os reais motivos pela sua decadência nas universidades, quais as consequências no futuro para a formação médica e medidas que podem ser tomadas para reverter esse processo de desvalorização do exame / Autopsies have always been considered as a valuable test for diagnosis ofthJ cause ofdeath of patients, evaluation ofthe efficacy ofthe treatment used an important tool for medical teaching. During the last decides, there has been.l decline in the number ofacademic autopsies, largely due to the lack of motim the professional team when requesting and performing them(clini=ans and consequentes for medical training and what steps can be taken to reverso th devaluation ofthe exam

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