Introdução - A diarréia ainda se apresenta como uma das principais causas de morbimortalidade em crianças menores de um ano de idade em países em desenvolvimento. Disparidades nas taxas globais de morbimortalidade entre regiões têm sido observadas em todo o mundo. Estudos recentes apontam redução na mortalidade associada à diarréia. Entretanto, a morbidade pela doença não seguiu a mesma tendência. Considerando a existência de poucos estudos em território nacional a respeito do comportamento da mortalidade e internações por diarréia, considerou-se oportuna a análise da tendência das diarréias sob este ponto de vista. Objetivo - Analisar a tendência das internações e da mortalidade por diarréia em crianças menores de um ano, nas capitais do Brasil, no período de 1995 a 2005, e encontrar possíveis padrões no comportamento dos indicadores. Métodos - Foi realizado um estudo ecológico de séries temporais utilizando dados secundários do Sistema de Informação Hospitalar (SIH) e do Sistema de Informação sobre Mortalidade (SIM) do Ministério da Saúde. Para as análises das tendências das taxas de internações e de mortalidade foram utilizados modelos de regressão polinomial. Resultados - O Brasil e treze capitais brasileiras apresentaram redução tanto nas internações por diarréia quanto na mortalidade infantil por diarréia. Oito capitais tiveram queda somente na mortalidade por diarréia enquanto que três capitais apresentaram decréscimo somente nas taxas de internação por diarréia. Na análise conjunta dos indicadores de diarréia e dos indicadores gerais, observou-se que somente no Brasil e em quatro capitais houve um decréscimo em todas as séries históricas. Conclusões Os resultados encontrados indicam que as medidas empregadas para prevenção e controle da diarréia parecem ter efeito positivo na internação e mortalidade por esta doença em algumas das capitais brasileiras e no Brasil como um todo, necessitando, ainda, de reforço nas ações de prevenção. / Introduction The diarrhea still is presented as one of main causes of morbidity and mortality in children under one year old in developing countries. Differences in the global morbidity and mortality rates among regions have been observed in the whole world. Recent global studies point out a reduction in the mortality associated with the diarrhea. However, the morbidity for the illness did not follow the same trend. There are few studies witches analyzing the trends of the hospitalization and mortality rates by diarrhea in Brazil. Objectives To analyze the trend of hospital admission rates and mortality rates for diarrhea in children under one year old in Brazil as a whole and in its capitals between 1995 and 2005 and to find standards behaviors. Methods This was an ecological study using time-series analysis. The date of hospital admission and mortality rates were collected from Ministry of Health\'s Hospitalization Data System (SIH-SUS) and from Mortality Data System (SIM-MS). Trends were estimated using polynomial regression models. Results Trends for hospital admission rates as well as mortality rates for Brazil as a whole and in thirteen capitals had decreased. Eight capitals had only had reduction in diarrhea mortality rates whereas three capitals had only presented decrease in diarrhea hospitalization rates. The combined analysis of diarrhea indicators and general indicators revealed that only in Brazil as a whole and in four capitals there was a decrease in all the historical series. Conclusions The results indicate that the official measures for prevention and control of the diarrhea seem to have positive effect in the hospital admission rates and mortality rates for the disease in some of the Brazilian capitals and in Brazil as a whole.

Orientador: Edmur Franco Carelli, Helder Jose Lessa Zambelli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T10:27:48Z (GMT). No. of bitstreams: 1 DalFabbro_Mateus_M.pdf: 627253 bytes, checksum: e7dc6279817a6c66308fc4d45f8d1a59 (MD5) Previous issue date: 2008 / Resumo: Introdução: A hidrocefalia congênita é uma condição freqüente, estando associada a um terço de todas as malformações congênitas do sistema nervoso. O conhecimento clínico e epidemiológico da hidrocefalia congênita e dos variados fatores etiológicos e prognósticos a ela relacionados são até o momento insuficientes para a compreensão global e otimização do tratamento desta complexa patologia. Objetivos: analisar o prognóstico comparativo de hidrocéfalos com e sem mielomeningocele. Métodos: trata-se de um estudo retrospectivo descritivo, através da revisão dos prontuários de 168 neonatos nascidos no Centro de Assistência Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM - UNICAMP), Campinas - SP - Brasil, divididos em duas amostras: grupo 1 (G1), composto de 98 neonatos com hidrocefalia congênita não associada a mielomeningocele; grupo 2 (G2), composto por 70 neonatos com hidrocefalia congênita associada a mielomeningocele. Foram estudadas as comparativamente as seguintes características: idade materna, número de gestações, realização de pré-natal, apresentação fetal, tipo de parto, idade gestacional ao diagnóstico, idade gestacional ao nascimento, índice de Apgar ao 1o e 5o minutos, incidência de baixo peso, graduação ecográfica da hidrocefalia, tratamento cirúrgico de hidrocefalia, complicações dos shunts, duração da primeira internação, mortalidade na primeira internação, mortalidade no seguimento, incidência de retardo neuropsicomotor (RDNPM). Resultados: seguimento médio: G1 42 meses, G2 60 meses; parto cesáreo: G1 69,4%, G2 91,2% (p<0,05); baixo peso: G1 32,7%, G2 10% (p<0,005); Apgar 1o minuto < 8: G1 58,2%, G2 30% (p<0,025); hidrocefalia acentuada: G1 59,2%, G2 28,6% (p<0,005); realização de derivação ventrículo-peritoneal (DVP) na 1a internação: G1 34,7%, G2 71,4% (p<0,005); mortalidade na 1a internação G1 24,4%, G2 10% (p<0,05); internação menor que 5 dias G1 46,9%, G2 12,8% (p<0,005); RDNPM no seguimento G1 70,8%, G2 42,8% (p<0,05). Conclusão: os resultados revelam um prognóstico ruim para a hidrocefalia congênita, caracterizado por alto índice de mortalidade e alta incidência de RDNPM. Os pacientes com hidrocefalia acentuada (grave) pela ecografia apresentam pior prognóstico. A maior incidência de baixo peso, de hidrocefalias acentuadas, de óbitos no período neonatal e de RDNPM no grupo 1 revelam um pior prognóstico dos neonatos com hidrocefalia não associada a mielomeningocele quando comparada aos neonatos com hidrocefalia associada a mielomeningocele. / Abstract: Introduction: Congenital hydrocephalus is a frequent condition, and it is associated with one third of all Central Nervous System (CNS) malformations. The clinical and epidemiological knowledge about congenital hydrocephalus and the related risk and outcome predicting factors are still insufficient for the thorough comprehension of such a complex condition and for the optimization of its treatment. Objectives: to study comparatively the prognosis of hydrocephalic newborns with and without meningomyelocele (MMC). Methods: this is a retrospective study, based on the review of newborn and/or their mother's medical files, comprising 168 patients born at the State University of Campinas, Campinas - SP - Brazil, divided in two groups: group 1 (G1), consisting of 98 hydrocephalic newborns without MMC; group 2 (G2), consisting of 70 hydrocephalic newborns with MMC. These characteristics were comparatively analyzed between the groups: maternal age, number of pregnancies, prenatal diagnosis, fetal presentation, delivery type, gestational age at diagnosis, gestational age at birth, Apgar score at the 1st and 5th minute, low-weight incidence, ecographic severity of hydrocephalus, surgical treatment of hydrocephalus, shunt malfunctions, length of first hospital stay after birth, mortality on 1st hospital stay, mortality on follow-up, incidence of neurodevelopmental delay. Results: mean follow-up: G1 42 months, G2 60 months; cesarean section: G1 69,4%, G2 91,2% (p<0,05); low weight: G1 32,7%, G2 10% (p<0,005); Apgar score at 1st minute < 8: G1 58,2%, G2 30% (p<0,025); severe hydrocephalus: G1 59,2%, G2 28,6% (p<0,005); ventriculoperitoneal (VP) shunt insertion at 1st hospital stay: G1 34,7%, G2 71,4% (p<0,005); mortality at 1st hospital stay: G1 24,4%, G2 10% (p<0,05); length of 1st hospital stay up to 5 days: G1 46,9%, G2 12,8% (p<0,005); neurodevelopmental delay on follow-up: G1 70,8%, G2 42,8% (p<0,05). Conclusion: the results depict a bad outcome related to congenital hydrocephalus, characterized by high mortality and high neurodevelopmental delay rates. Patients harboring severe hydrocephalus on ultrasound present worse outcome. The higher low weight incidence, as well as higher rates of severe hydrocephalus, neonatal deaths and neurodevelopmental impairments on group 1 reveal a worse outcome in newborns with congenital hydrocephalus not related to MMC compared to MMC related hydrocephalic newborns. / Mestrado / Neurologia / Mestre em Ciências Médicas

Abstract The aim of this study was to evaluate the treatment, course and outcome of pregnancy in Finland using two cohorts of diabetic women. The clinical cohort consisted of data from all 210 women with Type 1 diabetes and their 296 pregnancies managed between 1986 and 1995 in the two northernmost provinces of Finland. The register-based study population included all 1442 mothers with a singleton birth who had insulin treatment during pregnancy in 1991-1995 according to the Medical Birth Register. Of these mothers, 954 (66%) had pre-existing diabetes. Insulin-treated diabetes complicated 4.5/1000 births in Finland in 1991-1995, the prevalence of Type 1 diabetes being 2.9/1000 in the whole country and 3.3/1000 in Northern Finland. In the 1990's the care of these women shifted from tertiary level only to include the secondary level hospitals as well, and was more often carried out on an out-patient basis. This care policy in association with the self-monitoring of blood glucose levels contributed to an obvious improvement in glycaemic control during pregnancy. Despite that, the high proportion (73%) of women entering pregnancy with unsatisfactory glycaemic control did not decrease during the study period. Retinopathy complicated 134 (45.3%) diabetic pregnancies, while clinical nephropathy was found in 23 (7.8%) cases. Although retinopathy was more often aggravated during the first pregnancy, the occurrence of retinopathy or its severe form was not increased at the beginning of consecutive pregnancies. Of the mothers, 50 (16.9%) had pre-eclampsia during pregnancy, and in 28% of these cases it was classified as superimposed. It was found more often among primiparous than multiparous (25.6% vs. 11.0%, respectively), and its occurrence rose with the severity of diabetes. In both cohorts, the rates of preterm deliveries, Caesarean sections and large for gestational age (LGA) infants were significantly (p &lt; 0.001) higher in Type 1 diabetic pregnancies than in the background population. The rates of congenital anomalies (CA) were 540-629/10000 in two study populations, both being 2-3-fold as compared to the background population. Cardiac malformations were most common, with anomalies in the genitourinary tract and the musculoskeletal organs being next in frequency. Sixty-three percent of malformed infants were boys. Though pregnancy itself was not found to worsen the prognosis of diabetes, at least in the short term, pregnancy in diabetic women still remains a high risk state with an increased rate of prematurity, operative deliveries, CAs and peri- and neonatal mortality. In order to decrease the mortality rate in diabetic births, attention should be directed at both the prevention of CA and at identifying the foetuses at risk for intrauterine death. The postneonatal mortality rate is also high, reflecting a shift in the deaths from the early neonatal period to a later age. Therefore, a combined mortality, including induced abortions, stillborns and infant deaths, would give a more realistic idea of the outcomes in diabetic pregnancies.

Article 334 of the Constitution of India (1950) stipulates that certain electoral districts in each state should be reserved for minority groups, namely the “Scheduled Caste”(SC) and the Scheduled Tribe”(ST), through the reservation of seats in the states' legislative assemblies. Even though the original article stated that the reservation policy would be in place for just twenty years, it has been amended several times and is still in effect. This dissertation examines the impact of the policy on the education and health outcomes of the SC population. Variations in seat quotas are generated by the timing of elections in different states and the states’ fluctuating SC populations. The first paper on education uses data from 25 Indian States and 3 Union Territories for the years 1990-2011 to form a panel dataset to estimate the impact of the quota system on both enrollment and dropout rates among SC students in all levels of schooling. I use the fixed effect regression to test the mechanisms through which an elected SC legislator could have an influence on the education outcomes for the SC population in the represented state. I then use the resulting variables as my controls to identify the causal relationship using the dynamic panel data model. I find that a SC legislator has the potential to influence the number of schools built, as well as the amount of education and welfare expenditure allocated to the SC population. Moreover, I find that the SC political reservation has a positive and statistically significant impact on the SC enrollment rates and a negative and significant impact on the dropout rates, in all levels of schooling. Likewise, I use the NFHS-3 dataset and the Cox Proportional Hazard Model to estimate the hazard rates (risks of dying) of children under the age of 12 months (IMR) and under the age of 60 months (U5MR) as influenced by different SC quota share quintiles. I find that the 50-60% quota-share quintile has the biggest impact in reducing the IMR and U5MR among the SC children.

This diploma thesis analyzes trends in life expectancy of long-living people in the Czech Republic. Aim of this study is to compare developments in life expectancies for long-living people in the Czech Republic and Austria between 1960-2014, both in terms of predetermined age groups and between both sexes. This work also includes a projection of mortality rates and life expectancy. Projections are calculated for year 2050, specifically for people of 60 years and older, and it is based on mortality projections from the Czech Statistical Office. Values are given for men and women separately. While calculations and estimates show that life expectancy is extending, it impacts most developed countries with the burden of aging population, manifested by overal decline in mortality rates and increasing amount of elderly people. Historically in most societies an 80 year old, or older person was a rarity, but in recent years their number is increasing to the point of being a new normal. This trend is obviously positive, but it does pose a number of challenges for the respective societies, especially for their pension, social security and medical systems.

Indicators of child mortality in the lowest age reflect the status of health care and maturity of the country. The most frequent indicator in this area is the infant mortality rate. This thesis is focused on evaluation of development of infant, neonatal and early neonatal rate in the European union between 1960 and 2010 from the perspective of time series, aplication of Box-Jenkins methodology and assessment of the relation between infant mortality rate and life expectancy at birth.

The decline in mortality was the most important cause of the great increase in population in Sweden in the 19th century. Especially important was the part played by the decline in infant mortality and mortality among small children. The purpose of this study has been to investigate on the basis of a local example, Linköping during the period 1860-94, the changes in morbidity and mortality in different population groups, and to analyse what factors played a significant role in bringing about the changes. The study is not only epidemiological. It also deals with new technology, new ideas and different actors. The focus is on three arenas: the societal level, the environmental level and the individual level. By the societal level is meant the central arena and the decisions that were taken there. The environmental level contains the study of local public health and a reconstruction of how water and drainage progressed and what properties it came to year by year. The individual level involves the study of a number of variables which the individuals themselves can have influenced in different degrees. / Den här studien behandlar utvecklingen i Linköping 1860-94, en period som kännetecknades av en medveten strävan från samhällets sida att påverka hälsoförhållandena till det bättre. Från år 1860 förbättrades dödsorsaksstatistiken och strax därefter, 1863, genomfördes kommunreformen som gjorde genomgripande samhällsinsatser möjliga. Undersökningsperioden slutar 1894. Det viktigaste källmaterialet, de datoriserade kyrkböckema, upphhör då, men många av de studerade skillnadema mellan olika befolkningsgrupper har också reducerats betydligt. En senare tidsperiod kräver andra verktyg än de som används här. Avhandlingens syfte är att utifrån ett lokalt exempel studera hur förändringen i dödlighet (och i någon mån sjuklighet) gick till i olika befolkningsgrupper och analysera vilka faktorer som varit betydelsefulla för den. Avhandlingen är inte enbart epidemiologisk utan handlar i lika hög grad om ny kunskap, ny teknologi, nya ideer och deras spridning samt de olika aktörema på såväl lokal som central nivå i det expanderande Sjukvårdssverige. Att studera en lokal miljö ger många möjligheter att observera sådant som är omöjligt via aggregerade data på nationell nivå. Mängder av variabler kan kontrolleras, men i vilken grad speglar resultaten från Linköping förhållanden i andra städer i Sverige och Västeuropa? Till detta återkommer vi senare.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-21T14:17:15Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertacao_versaofinal.pdf: 1059482 bytes, checksum: c0a9d49ea4461e5f4da07fbfdfd5c83a (MD5) / Made available in DSpace on 2017-07-21T14:17:15Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertacao_versaofinal.pdf: 1059482 bytes, checksum: c0a9d49ea4461e5f4da07fbfdfd5c83a (MD5) Previous issue date: 2015-03-02 / CNPQ / Uma parte considerável da população rural nos países em desenvolvimento vive em um ambientedeescassezdeágua,responsávelporaltastaxasdemortalidadeinfantildevidoàsdoenças relacionadasàáguacontaminada. Aliteraturaexistenteteminvestigadooimpactodemelhorias nosistemadeágua(englobandooefeitodaexpansãodarededeabastecimentodeágua,qualidadedaáguaetratamentodeesgoto)sobreasaúdeinfantileoimpactodechoquesdechuvaem áreas secas. O presente estudo contribui para este debate por inferir o efeito causal isolado de expansãodaofertadeáguasobreamortalidadeinfantilpordoençasdiarreicas,particularmente para as zonas semiáridas, explorando um programa que distribui cisternas entre os municípios situadosnosemiáridomaisdensamentepovoadodomundo. Aoexploraravariaçãoexógenana intervençãodoprogramanosmunicípios,juntamentecomotempodetaldecisão,verificou-se queoprogramateveumimpactosignificativosobreataxademortalidadeinfantilpordoenças diarreicasparaafaixaetáriade0a4anos. / Aconsiderablepartofruralpopulationindevelopingcountrieslivesinawaterscarceenvironment,responsibleforhighratesofchildmortalityduetounsafewaterrelateddiseases. Previous literaturehasinvestigatedtheimpactoninfanthealthofwatersystemimprovements(confoundingtheeffectofwatersupplynetworkexpansion,waterqualityandsewagetreatment)andthe impactofrainfallshocksindryareas. Thepresentstudycontributestothisdebatebyinferring theisolatedcausaleffectofwatersupplyexpansiononinfantmortalityfromdiarrhealdiseases, particularly for semiarid zones, as it exploits a program that distributes cisterns among municipalities placed on the most densely populated semiarid zone in the world. By exploring exogenousvariationinmunicipalitiesprogramintervention,alongwiththetimingofsuchdecision,ithasbeenobservedthattheprogramhadasignificantimpactontheinfantmortalityrate fromdiarrhealdiseasesinthegroupof0to4yearso

Se evalúa la eficacia/efectividad de las intervenciones basadas en la comunidad, destinadas a disminuir la mortalidad neonatal. Se realizó una revisión sistemática de ensayos controlados aleatorizados, ensayos aleatorizados de comunidad y estudios de cohortes de intervenciones dirigidas a la mujer gestante, al neonato (hasta 28 días de nacido) o a ambos. Se evaluaron 34 estudios (n=844,989): 20 en mujeres gestantes (n=406,172); 6 en neonatos (n=24,994), y 8 en ambos grupos (n=413,823). El riesgo de sesgo fue generalmente bajo. Hubo heterogeneidad entre los tipos de intervenciones. Las intervenciones educación materna en salud y cuidado en casa de madres y neonatos estuvieron asociadas con disminución de mortalidad neonatal en la mitad de los seis estudios de cada grupo. La suplementación materna con multimicronutrientes, el cuidado de madre canguro y la suplementación materna prenatal con vitamina A no disminuyeron la mortalidad neonatal. Pocas intervenciones comunitarias heterogéneas han demostrado disminuir la mortalidad neonatal. / Programa de Apoyo a la Reforma del Sector Salud-PARSALUD II, Lima, Perú / Revisión por pares

Tennessee ranks high for infant mortality (IM) in the United States. Despite public health efforts, the IM rate for Blacks is twice that of Whites mimicking what is observed nationally. Several risk factors for IM have been identified; however, it was still unclear how places of residence and prenatal care (PNC) affect IM for Tennesseans. The purpose of this study was to assess the relationship between places of residence (conceptualized by rurality and racial concentration), PNC, and IM among racial groups across Tennessee and to determine if race modified these associations. This was a cross-sectional study using data from the Tennessee PRAMS survey (2009-2011) and geocoded to 2010 U.S. Census Bureau and U.S. Department of Agriculture data. The study was grounded on the theory of racial residential segregation and concentrated poverty. General linear model and hierarchical binomial logistic regression were used to analyze the data. High racial concentration was associated with IM for Non-Hispanic women and remained significant even after controlling for demographic variables (aOR = 5.33, 95%CI [1.11, 25.67]). Disparity in PNC access for Blacks, Other races, and Hispanics were observed based on racial concentration and rurality; however, PNC was not a risk factor for IM. Black race modified the relationship between high racial concentration and IM. Implications for social change include greater public awareness, education on risk factors, advocacy to decrease disparities in access to care, and resource allocation to highly impacted areas potentially mitigating health outcomes for the most vulnerable women and infants.