Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2006. / LICL has E-Thesis 0016 ; please contact computer services.

Thesis (M.S.P.H.)--University of Michigan, 1932.

Thesis (Ph. D.)--Ohio State University, 2009. / Title from first page of PDF file. Includes vita. Includes bibliographical references (p. 154-172).

No description available.

Orientador: Mary Angela Parpinelli / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T14:35:41Z (GMT). No. of bitstreams: 1 Matias_JacintaPereira_D.pdf: 7455343 bytes, checksum: 539cc9a97df5792813218e5f0cde9a01 (MD5) Previous issue date: 2008 / Resumo: Objetivos: analisar a tendência da mortalidade de mulheres em idade reprodutiva por grupos de causas, enfatizando a mortalidade materna. Métodos: estudo populacional de série temporal, através de banco de dados eletrônico com informações da declaração de óbito (DO) emitido pela Fundação SEADE, correspondente ao total de óbitos de mulheres de 10 a 49 anos, residentes no município de Jundiaí, São Paulo, no período de 1985 a 2006. Realizou-se a conversão das causas básicas de todas as DO anteriores a 1996, codificadas pela Classificação Internacional de Doenças (CID), 9ª revisão, e a recodificação pela CID, 10ª. revisão. Calcularam-se os coeficientes específicos de mortalidade por capítulos da CID10, por algumas causas e por subgrupos etários por 100.000 mulheres. As estimativas populacionais e o número de nascidos vivos (NV) foram obtidos dos registros da Fundação SEADE. A análise de tendência foi realizada pelo método de regressão de Poisson ajustado pelos períodos de 1985-89, 1990-94, 1995-99, 2000-06, e por faixa etária. Os riscos relativos e os intervalos de confiança de 95% (IC95%) foram calculados. Calculou-se a razão de morte materna (RMM) oficial e corrigida para o período de 1999 a 2006. A investigação das causas maternas declaradas ou presumíveis foi realizada através dos arquivos do comitê municipal de investigação da morte materno-infantil (CMIMM). Resultados: a mortalidade geral de mulheres em idade reprodutiva apresentou tendência decrescente a partir do período de 1995-99, RR 0,85 (0,77-0,93), e de 2000-06, RR 0,47 (0,43-0,51). As doenças cardiovasculares (DCV), as neoplasias e as causas externas foram os principais grupos de causas. As mortes por DCV reduziram significativamente a partir de 1995 e passaram para a 2a causa de morte no período de 2000-06. A mortalidade por neoplasias manteve-se estável, com pequena variação nos coeficientes (23,8 em 1985-89 para 25,7 em 2000-06) e passou a ocupar a primeira causa de morte, no último período. Os coeficientes de mortalidade por causas externas foram significativamente decrescentes, no último período, e mantiveram-se como a terceira causa de morte. Não houve tendência de redução da mortalidade por agressões e por AIDS. A mortalidade materna foi a 10a causa de morte no último período. A RMM corrigida foi de 29,4 mortes por 100.000 NV, para o período de 1999 a 2006, com subnotificação de 50% e fator de correção 2. As mortes maternas foram por causas majoritariamente diretas, sendo as síndromes hipertensivas e a infecção as mais prevalentes. Conclusões: os resultados mostraram melhoria das condições de vida e de saúde das mulheres, entretanto a ausência de queda da mortalidade por causas evitáveis, como agressões e AIDS, aponta para a necessidade de políticas públicas sociais e de programas preventivos. A prevalência das causas obstétricas diretas, principalmente as síndromes hipertensivas, sugere a necessidade de revisão de protocolo assistencial e falha na integração entre os níveis de assistência obstétrica ambulatorial e hospitalar. É necessário aperfeiçoar a atribuição da causa materna de morte e promover a publicação periódica da investigação das mesmas pelo CMIMM / Abstract: Objectives: to analyze the mortality trend of reproductive age women per causal groups, emphasizing maternal mortality. Methods: a time series population study with death certificate (DC) information, through electronic database issued by the SEADE Foundation, corresponding to the total number of deaths from women age 10 to 49 years old, residing in the municipality of Jundiaí, São Paulo, in the period from 1985 to 2006. The basic cause of all DC conversion before 1996 was performed. Causes were coded by the International Classification of Diseases (ICD), 9th revision, recoding was performed by the ICD, 10th revision, was performed. The specific rates of mortality per ICD 10 chapters were calculated by some causes and age subgroups per 100.000 women. The population estimates and the number of live births (LV) were obtained from the SEADE Foundation records. The trend analysis was performed by the Poisson regression model adjusted for the periods of 1985-89, 1990-94, 1995-99, 2000-06, and age group. The related risks and confidence intervals of 95% (CI 95%) were calculated. The official maternal mortality ratio (MMR) was calculated and corrected for the period from 1999 to 2006. The investigation of the stated or presumptive maternal causes was performed through the files of ¿Comitê Municipal de Investigação da Morte Materno-infantil¿ (CMMMI). Results: the general mortality of reproductive age women displayed a decreasing trend from the period of 1995-99, RR 0.85 (0.77-0.93), and of 2000-06, RR 0.47 (0.43-0.51). The cardiovascular diseases (CVD), neoplasm and external causes were the main groups of causes. The deaths per CVD were reduced from 1995, with significant trend and turned into the second cause of death in the period of 2000-06. The mortality per neoplasm was kept stable, with little rate variation (23.8 in 1985-89 to 25.7 in 2000-06) and started occupying the first cause of death in the latter period. The mortality rates per external causes decreased, with a significant trend in the latter period, and continued as the third cause of death. There wasn¿t decrease in mortality per aggressions and AIDS. The maternal mortality was the 10th cause of death in the latter period. The corrected MMR was 29.4 deaths per 100.000 LB, for the period from 1999 to 2006, with an underreporting rate of 50% and a correction factor of 2. The maternal deaths were mostly direct causes and hypertensive syndromes and infection predominated. Conclusions: the results point out to an improvement in and health and quality of life in these women. However, an increase in mortality for avoidable causes, such as aggressions and AIDS, points to the need of social public policies and prevention programs. The prevalence of direct obstetric causes as determining factors, mainly the hypertensive syndromes, suggests the need of healthcare protocol review and possible failure of integration between the obstetric outpatient and healthcare levels. It is necessary to improve the attribution of the maternal mortality cause and promote periodic publication of death causes investigation by the CMMMI / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

A mortalidade infantil e seus componentes continuam sendo um parÃmetro importante para se avaliar a melhoria das condiÃÃes de saÃde das crianÃas. Objetivos: a) Determinar a evoluÃÃo da mortalidade infantil e neonatal e das variÃveis preditoras associadas aos nascimentos e Ãbitos neonatais no MunicÃpio de Fortaleza no perÃodo de 2004-2008; b) Analisar a relaÃÃo entre tipo de parto, peso ao nascer e idade gestacional dos nascimentos de crianÃas ocorridos no mesmo perÃodo. MÃtodo: estudo de sÃrie temporal. Todos os nascimentos vivos ocorridos no municÃpio de Fortaleza registrados no Sistema de InformaÃÃes de Nascidos Vivos e todos os Ãbitos neonatais provenientes do Sistema de InformaÃÃes de Mortalidade, no perÃodo de 2004 a 2008. Os dados foram obtidos por meio do acesso eletrÃnico aos relatÃrios do Tab Net, no site oficial da Secretaria de SaÃde do MunicÃpio de Fortaleza. TambÃm foram estudados os Ãbitos de menores de um ano de idade. Foram calculados os valores absolutos e suas proporÃÃes das variÃveis preditoras para nascimentos e Ãbitos para cada ano de estudo. Teste de qui-quadrado de tendÃncia foi calculado com base no programa Epi-info 6.04d. A variaÃÃo de proporÃÃo entre o ano de 2004 e o de 2008 para todas as variÃveis estudadas foi determinada. Para analisar as variaÃÃes das proporÃÃes dessas variÃveis foi utilizada a ferramenta comparaÃÃo de proporÃÃes, qui-quadrado de tendÃncia, calculado no comando Stat Calc do programa Epi-info 6.04d. Resultados: Ocorreu reduÃÃo da mortalidade infantil em Fortaleza de aproximadamente 17% (3,4% ao ano) para Mortalidade Neonatal a reduÃÃo foi de 15%, mantendo-se em 17,8%O, reduÃÃo que nÃo alcanÃou significÃncia estatÃstica (p=0,18). Maior reduÃÃo foi verificada para o componente neonatal tardio (30% vs 9,1%). A contribuiÃÃo da mortalidade neonatal para a taxa de Mortalidade Infantil alcanÃou 68% no Ãltimo ano estudado. O grupo de variÃveis preditoras para nascimentos com melhor desempenho no perÃodo foi: Apgar no quinto minuto menor do que sete escolaridade materna e ocorrÃncia de gravidez na adolescÃncia, para as mÃes residentes em Fortaleza. Para as mÃes nÃo residentes, a melhora foi menor e expressa na escolaridade, Apgar no quinto minuto e ocorrÃncia de gravidez na adolescÃncia. No que se refere Ãs mÃes adolescentes, mudanÃas positivas ocorreram nos seguintes indicadores: Apgar no quinto minuto, escolaridade materna, baixo peso ao nascer e reduÃÃo no prÃ-natal incompleto ou ausente. Partos cesarianos aumentaram em 15% para toda amostra, sendo que na Ãrea privada tais Ãndices alcanÃaram 89,8%. ConclusÃo: No perÃodo estudado ocorreu queda da Mortalidade Infantil de 17%; o componente neonatal precoce praticamente se manteve inalterado. Melhora expressiva ocorreu para as seguintes variÃveis preditoras dos nascimentos e Ãbitos: escolaridade materna, reduÃÃo nos partos em adolescentes, Apgar no quinto minuto menor que sete.

Introduction: The Mortality–Incidence Ratio complement [1 – MIR] is an indicator validated in various populations to estimate five-year cancer survival, but its validity remains unreported in Peru. This study aims to determine if the MIR correlates directly with five-year survival in patients diagnosed with the ten most common types of cancer in metropolitan Lima. Materials and methods: The Metropolitan Lima Cancer Registry (RCLM in Spanish) for 2004–2005 was used to determine the number of new cases and the number of deaths of the following cancers: breast, stomach, prostate, thyroid, lung, colon, cervical, and liver cancers, as well as non-Hodgkin’s lymphoma and leukaemia. To determine the five-year survival, the five-year vital status of cases recorded was verified in the National Registry of Identification and Civil Status (RENIEC in Spanish). A linear regression model was used to assess the correlation between [1 – MIR] and total observed five-year survival for the selected cancers. Results: Observed and estimated five-year survival determined by [1 – MIR] for each neoplasia were thyroid (66.7%, 86.7%), breast (69.6%; 68%), prostate (64.3%, 63.8%) and cervical (50.1%, 58.5%), respectively. Pearson’s r coefficient for the correlation between [MIR – 1] and observed survival was = 0.9839. Using the coefficient of determination, it was found that [1 – MIR] (X) captures the 96.82% of observed survival (Y). Conclusion: The Mortality–Incidence Ratio complement [1 – MIR] is an appropriate tool for approximating observed five-year survival for the ten types of cancers studied. This study demonstrates the validity of this model for predicting five-year survival in cancer patients in metropolitan Lima.

Indiana University-Purdue University Indianapolis (IUPUI) / Twice as many African American infants die each year when compared to white infants. While infant mortality rates have declined for all ethnic groups in the United States over the past fifty years, the racial gap has remained persistent, and is not fully understood despite numerous quantitative studies. The purpose of this study was to understand the lived experiences of African American women in relationship to the black gap in infant mortality. Thirteen African American women participated in either a focus group or in–depth interviews. Women were asked to use their life experiences to identify factors that would increase the understanding of African American infant mortality. Several themes emerged indicating that the experience of stress and racism are constant factors in African American women’s lives and are inseparable from their pregnancy experience.

Since the mid-1980s, mortality rate improvements in urban areas have outpaced those in rural areas, leading to substantial urban-rural disparities in mortality. Research on urban-rural mortality disparities has focused exclusively on differences in mortality between urban and rural areas and has not examined differences in the amount of inequality in the length of life within these areas. Lifespan variation is an important dimension of health inequality that complements traditional metrics of mortality (i.e., mortality rates and life expectancy) by indicating the amount of inequality of lifespans within a population. This dissertation provides several contributions to our understanding of urban-rural differences in lifespan variation through three interrelated studies. First, I document trends in life expectancy and lifespan variation from 1990 to 2017 and show that nonmetropolitan populations have had smaller declines in lifespan variation than metropolitan populations. The urban-rural disparity in lifespan variation is mostly due to greater improvements in mortality in metropolitan areas but recent mortality increases among nonmetropolitan working-age adults have also contributed. Next, I investigate the extent of the rural mortality penalty among White and Black populations, an underexamined area in the rural mortality literature. Generally, I find that Black Americans living in rural places face an additional penalty; their lifespans are not only shorter but more variable. For Whites, improvements in large central metros are driving the urban-rural disparity. For Blacks, lower mortality rates in large suburbs are driving the disparity. This study underscores the importance of including Black Americans in studies of rural mortality. Finally, I show that most of the difference in lifespan variation between metro and nonmetro populations is due to preventable mortality among working-age adults (ages 25-64). Analyses of age and cause-specific mortality rates among working-age adults show that the largest disparities in preventable mortality are due to suicide and motor vehicle accidents in younger adults and heart disease and cancer in middle-aged adults. The results of these studies show that people living in rural places face an additional penalty; their lives are not only shorter, but the timing of death is more variable and uncertain.

Long-term outcomes for patients admitted to intensive care units (ICUs) are recognised to be of increasing importance. Published studies indicate that ICU survivors have significant physical impairment, impaired quality of life, and excess mortality during the post-ICU period. The period of excess mortality has been variously estimated as lasting from one to 16 years after ICU discharge. Remarkably little information about long-term mortality and healthcare resource use exists for critical care populations, and outcomes relative to a non-ICU control population are unknown. The aims of the studies presented in the thesis were (i) to describe long-term (five year) mortality and identify factors associated with mortality for patients admitted to ICUs in Scotland (ICU admission cohort) and those surviving to be discharged from hospital alive (ICU survivor cohort); (ii) to compare mortality rates with control populations after adjustment for relevant confounders; (iii) to evaluate the extent of, and factors associated with, long-term (five year) major healthcare resource use of survivors of critical illness (ICU survivor cohort); and (iv)to compare major healthcare resource use with a control hospital inpatient population. I undertook a detailed systematic review of the international literature relating to healthcare resource use in ICU survivors to inform the design of the part of the study relating to resource use. This revealed a paucity of high quality studies but led to recommendations for improving the conduct and reporting of future research in this field. Using both retrospective cohort and matched cohort study designs, I analysed data relating to all patients admitted to Scottish ICUs in 2005 from the Scottish Intensive Care Society Audit Group (SICSAG) database. Two cohorts were defined: an ICU admission cohort, representing all ICU admissions, and a subcohort of those who survived to hospital discharge (ICU survivor cohort). Matched control cohorts of non-ICU hospital inpatients were selected from national datasets. The main outcomes were five-year mortality and major healthcare resource use obtained from linkage to national datasets. Major healthcare use was measured by number of hospital readmissions, number of days spent in hospital and hospital costs during the five years after hospital discharge. Five year mortality was 53% in the ICU cohort compared with 27% for the matched control hospital cohort and 16% for an age/sex-standardised general population. Among hospital survivors, ICU patients had higher five year mortality after adjustment for confounders (HR 1.3, 95%CI 1.2 to 1.4, p<0.001). Age, comorbidity, ICU admission diagnosis and deprivation quintile were independently associated with five-year mortality. The ICU diagnosis with greatest five year mortality (relative to self-poisoning) was variceal bleeding (HR 3.9, 95%CI 2.2 to 6.7, p<0.001). The readmission rate for the 5259 ICU patients surviving to hospital discharge declined from 1.7 readmissions per person in the first year to 0.9 in the fifth year of follow-up. Overall, ICU survivors spent a mean of 29 days in hospital over the five year follow up period, at a cost of £14593 per person. Previous number of admissions was the factor most strongly associated with resource use. ICU patients had a significant increased rate of hospital admission compared with the control cohort throughout the five year follow up period (admission rate ratio 1.21 (95%CI 1.14 to 1.29, p<0.001)). In the programme of work presented in this thesis, I have systematically reviewed evidence for resource use following critical illness, and have demonstrated that ICU patients are more likely to die compared with other hospital inpatients over a five-year horizon, even when only hospital survivor cohorts are considered. Furthermore, I have demonstrated that ICU survivors utilise a significant amount of excess acute hospital resource, which is relevant to health service planning and economic evaluations.