Abstract The purpose of this study was to compare the effectiveness, costs and benefits of screening for diabetic retinopathy with retinal photography and with ophthalmoscopic examination in health care centres by primary care physicians, and also to study the quality of life and mortality of visually impaired diabetics. There are about 150 000 diabetics in Finland. There were 881 visually impaired persons due to diabetic retinopathy in the Finnish Register of Visually Impaired Patients in 1994 (1122 in 1997). Laser photocoagulation has proved to be an effective treatment in diabetic retinopathy preventing visual loss. The screening methods are ophthalmoscopic examination and retinal photography. The incidence of retinopathy was calculated from the photogaphy screening in the Oulu Health Care Centre in 1987 (N = 1015), in 1991–92 (N = 1844) and in 1993–94 (N = 1484). The ophthalmoscopy screening was studied from patients' records (N = 242) in the Raahe Health Care Centre. Out of 120 visually impaired persons with diabetic retinopathy in the province of Pohjois-Pohjanmaa, 50 were interviewed by the health care secretary. The study included cost-benefit analysis for the costs of screening and treatment of diabetic retinopathy compared with the costs of visual impairment. Furthermore the quality of life of patients with visual impairment due to diabetic retinopathy was studied using the Nottingham Health Profile questionaire (NHP) and compared with diabetic patients without visual impairment. The mortality rate of visually impaired patients was compared to that of diabetic retinopathy patients who had been treated with laser photocoagulation. The incidence of all diabetic retinopathy was 9.4 per cent per year and 2.8 per cent per year for moderate to severe retinopathy, and in patients with no insulin in their treatment the incidence of all retinopathy was 3.0 and 1.2 per cent per year respectively. The screening costs per diabetic person screened were 148 Finnish marks (FIM) in the photographic method and 68 FIM in the ophthalmoscopic method. It was calculated that 156 visual impairment cases could be prevented per year in Finland with the photographic method. The screening and treating costs in finding one preventable case of visual impairment were 185 000 FIM. The costs of visual impairment were 594 000 FIM per patient. So retinal photography screening and treatment of diabetic retinopathy could lead to savings of 63.9 million FIM per yearly screening in Finland. The quality of life of visually impaired persons was worse than that of other diabetics in two dimensions of the NHP, Energy and Mobility. In the second part of the NHP, the quality of life of visually impaired persons was worse than that of other diabetics in all questions except working. The mortality rate of visually impaired persons, 14.5 per cent per year was twice as high as that of diabetic patients treated with laser photocoagulation. The incidence of diabetic retinopathy in Finland was about the same as in other industrialized countries. Retinal photography seemed to be a cost-effective screening method for preventing visual impairment and the cost benefit ratio of screening and treating diabetic retinopathy was 3.2. The quality of life of visually impaired patients was worse and mortality risk higher than that of other diabetics. / Tiivistelmä Tarkoituksena oli tutkia perusterveydenhuollossa silmänpohjakuvauksella tai oftalmoskopialla tehdyn diabeettisen retinopatian seulonnan vaikuttavuutta, kustannuksia ja hyötyjä näkövammaisuuden ehkäisyssä sekä diabeettisen retinopatian ilmaantuvuutta, ja sen vuoksi näkövammaisten elämänlaatua ja kuolleisuutta. Suomessa on noin 150 000 diabeetikkoa. Diabeettisen retinopatian aiheuttama näkövamma oli Näkövammarekisterin mukaan vuoden 1994 alussa 881:lla suomalaisella (vuoden 1997 lopussa 1122:lla suomalaisella). Diabeettisen retinopatian aiheuttamaa näkövammaisuutta voidaan ehkäistä ajoissa toteutetulla silmänpohjan laser-fotokoagulaatiohoidolla. Uusien tautitapausten löytämiseksi käytetään oftalmoskopiaa ja silmänpohjakuvausta. Diabeettisen retinopatian ilmaantuvuus laskettiin Oulussa vuosina 1987 (N = 1015), 1991–92 (N = 1844) ja 1993–95 (N = 1484) toteutettujen silmänpohjakuvausten perusteella. Diabeettisen retinopatian oftalmoskooppista toteamista tutkittiin Raahen seudun terveyskeskuksen diabetesvastaanoton potilaiden sairauskertomuksista (N = 242). Seulontamenetelmien tehokkuutta arvioitiin kustannusvaikuttavuusanalyysillä ja diabeettisen retinopatian seulonnan ja hoidon hyötyä näkövammaisuuden ehkäisyssä kustannus-hyötyanalyysillä. Pohjois-Pohjanmaalta diabeettisen retinopatian johdosta näkövammarekisteriin ilmoitetuista (N = 120) haastateltiin tavoitetut 50 henkilöä. Haastatelluilla näkövammaisille sekä Oulussa vuosina 1991–92 silmänpohjakuvaukseen osallistuneille tehtiin elämänlaatukysely NHP-mittarilla. Elämänlaatua ja kuolleisuutta tutkittiin tapaus-verrokki asetelmalla. Tutkimuksen mukaan Diabeettisen retinopatian koko ilmaantuvuus oli 9,4 % vuodessa ja diabeetikoilla, joiden hoidossa ei käytetty insuliinia, ilmaantuvuus oli 3,0 % vuodessa. Vaikean tausta- ja proliferatiivisen retinopatian ilmaantuvuus oli vastaavasti 2,8 % ja 1,2 % vuodessa. Silmänpohjakuvaukseen perustuvan seulonnan ja laserhoidon kustannukset olivat 192 mk seulottua kohti. Silmänpohjakuvausseulonnalla olisi tämän tutkimuksen mukaan mahdollista estää Suomessa vuosittain 156 näkövammaa kustannusten ollessa noin 185 000 mk estettyä näkövammaa kohti. Yhden näkövamman kustannukset olivat yhteensä 594 000 mk. Silmänpohjakuvaukseen perustuvalla seulonnalla olisi mahdollista säästää noin 63,9 milj. mk vuodessa edellyttäen, että tulokset ovat yleistettävissä koko maahan. Diabeettisen retinopatian johdosta näkövammaisten elämänlaatu oli selvästi muita diabeetikkoja huonompi NHP-mittarin ulottuvuuksilla tarmokkuus ja liikkuminen sekä useilla keskeisillä elämänalueilla. Näkövammaisten diabeetikkojen kuolemanriski oli yli kaksinkertainen laserhoidettuhin näkönsä säilyttäneiisiin diabeettista retinopatiaa sairastaviin verrattuna. Tutkimuksen mukaan diabeettisen retinopatian ilmaantuvuus oli Suomessa samalla tasolla kuin muissa teollistuneissa maissa. Silmänpohjakuvaussseulonta osoittautui taloudellisesti kannattavaksinäkövammojen ehkäisyssä. Näkövammaisuus heikensi diabeetikkojen elämänlaatua ja lisäsi kuolemanriskiä.

This thesis presents an energy prediction tool for photovoltaic (PV) modules, based on the measure-correlate-predict principle. The tool allows quantification of the impact of the different environmental factors influencing PV device efficiency for different sites as they deviate from standardised test conditions and combines their effects for energy yield prediction of different module technologies operating in different climates. Amongst these environmental influences, the impact of angle of incidence has been particularly under-researched. In this work, a systematic investigation of the influence of angle of incidence on PV module performance is realised. This is achieved using both short-term module characterisation and long-term energy yield measurement campaigns. A customised purpose built dual axis tracker for mounting paired sets of modules on a fixed south-facing, 45-degree tilted rack is used to investigate the differences in module performance. The quality and quantity of the composition of the incident irradiance is described for various sky conditions at high latitude locations. Furthermore, an understanding of the entangled effects on photocurrent of both the angle of incidence and spectral variation is presented. This is achieved by analysing data from a system developed especially in this work which integrates an instantaneous all-sky mapping of irradiance from a monochromatic CCD camera with precision measurements of small-aperture normal irradiance from a collimated pyranometer in the short-term measurement campaign. The proposed energy prediction tool is validated using long-term datasets from several locations and is compared to other current methods. This was conducted under the European-funded PV-Catapult and IP Performance projects. The tool's prediction uncertainty falls within the ±5% for crystalline and ±10% for thin films, which is the same accuracy as other methods and within the measurement uncertainty of outdoor measurements.

No description available.

Abstract The aim of this population-based cohort study was to evaluate the incidence and relative risk ratios of gynaecological cancers and the mortality of women with at least five children (GM women) compared to the average of Finnish women. We linked together the data of the Population Register (1974–1997), the Finnish Cancer Registry and the national cause-of death files of Statistics Finland (1974–2001) by using a personal identification code. The study population consisted of 86 978 GM women (1974–1997), including 3 752 women with at least 10 children (GGM women). Altogether 7 604 cancer diagnoses and 18 870 deaths were recorded. The incidence (SIR) of breast (0.55, 95% CI 0.52–0.58), endometrial (0.57, 95% CI 0.52–0.63) and ovarian cancer (0.64, 95% CI 0.55–0.73) decreased, and that of cervical cancer (1.13, 95% CI 0.98–1.29) increased in GM women. In multivariate analysis, the increase in parity from five to eight increased the protection against breast and endometrial cancer, but not in ovarian or cervical cancer. A young age at first birth decreased the breast cancer risk, while an older age at first birth decreased the risk for endometrial and cervical cancer. A short premenopausal delivery-free period and a long birth period were risk reducers in women who contracted endometrial cancer after menopause. The mortality (SMR) of breast (0.64, 95% CI 0.59–0.69), endometrial (0.68, 95% CI 0.56–0.80), ovarian cancer (0.68, 95% CI 0.60–0.75) as well as for dementia (0.80, 95% CI 0.72–0.84) decreased. The SMR of kidney (1.38, 95% CI 1.21–1.56) cancer increased in the GM group. The SMR of ischemic heart diseases (1.10, 95% CI 1.08–1.13) and diabetes mellitus (1.42, 95% CI 1.29–1.55) increased. The overall SMR of GM women was 5% less than expected (95% CI 0.94–0.95; deficit 949 deaths), but among GGM women it coincided with the national average (1.01, 95% CI 0.93–1.08). Multiparity affected the spectrum of diseases and causes of death in a specific way: the pregnancy-specific hormonal milieu is responsible for the low SIR and SMR of hormone-dependent cancers, and increased body weight is lightly responsible for the high SMR of cardiovascular and metabolic diseases. These observations advocate for delivering the first child at an age younger than 30 years and to start measures for careful weight control not only during and after pregnancies but even later and permanently.

Magister Scientiae (Physiotherapy) - MSc(Physio) / In addition to football and basketball, volleyball has become a very popular sport globally over the last 30 years. The International Federation of Volleyball represents about 150 million players in approximately 170 countries. While a large body of research has been conducted regarding the nature and prevalence of volleyball injuries internationally, very little has been done locally or on the African continent to assess the status of injuries incurred at professional or amateur levels. The aim of this study is to determine the prevalence of injuries sustained by professional volleyball players of a club in the WPVU in one season. An exploratory, descriptive, nonexperimental approach was used for this study on 42 volleyball players at the University of the Western Cape Volleyball Club. A self–administered questionnaire that was based on a questionnaire used in a Dutch national volleyball study was used in the present study. A response rate of 89.4% was obtained. The collected data were captured and analysed by means of the Statistical Package for Social Science version 14.0 (SPSS). The associations between variables were evaluated by means of the chi-square test and a 5% level of significance was used. The results were displayed using tables, bar chart, and pie chart. Most of the volleyball players sustained one or more injuries in the season, giving a prevalence rate of 88.1%. The incidence rate was 1.2 injuries per player. Injuries prevalence was higher among male players 54.1% than female players 45.9%. Among the injured players, ankle and knee injuries showed the highest injury prevalence with 25.5% for each followed by 19.6% for shoulder injuries. The study revealed 69.2% injury prevalence with a higher significance (p=0.04) that players who are injured in the ankle were in contact. Half of the injuries (50%), which occurred gradually, were prevalent in the shoulder, followed by the knee (28.6%), then the ankle and fingers (14.3%). Players in the left and right front row were significantly (p=0.008) more prone to be injured during spiking. Awareness programmes highlighting prevention strategies and physiotherapy intervention are required for coaches and players at the University of the Western Cape Volleyball Club to assist in the prevention of volleyball injuries

Philosophiae Doctor - PhD / Over the last two decades, budgetary allocations to both the Health and Education sectors have been on the increase in Nigeria, while a counter-factual feedback on its effects for various economic groups and distributional effect for different population households has not been defined and well known. The resultant effect has been gross inefficiency and sub-optimality in terms of observed outcomes of the fiscal framework. In-addition, there have been a continuous quest by the citizenry for increased allocations to these sectors because of its supposed impact on the poverty index and standard of living. Although this is a compelling reason, but what is worrisome and equally troubling, is that the increasing incidence of poverty and expanding inequality in the Nigerian society have not mitigated, despite the scaling up of funding on the social sectors. Furthermore, the current level of socioeconomic development in Nigeria is not in tandem with the distributive outcome targets set by the 2004 reforms. Thus, understanding the current structure of poverty in Nigeria as well as beneficiaries of public sector spending provides a sound basis for tackling inequality and redesigning the current pro-poor frameworks. However, our analysis is focused on the distributional spread of beneficiaries from services and the counterfactual reciprocity of expenditure benefits rather than measuring the exact value to recipients of government-sponsored services. Our research methodology used the 2004 Nigerian Living Standard Survey; 2010 Harmonized Nigerian Living Standard Survey; Recent Cros-sectional data (2014) in South East Nigeria and secondary sources. Econometric methods (Error Correction Method); Marginal Odds estimation techniques, Concentration Curves and Ordered Logistic Regression were used for our analysis. Statistical and Econometric Software’s (E-Views; SPSS; DAD and STATA) were used for estimations. Econometric results showed misalignments between population dynamics and public sector expenditure on education, health and economic services. The government consumption expenditure was not sensitive to demographic changes. The derived adjustment coefficients of -1.38, -1.51 and 0.51 respectively, for education, health and economic services indicate huge gaps in terms of what optimal spending should have been, giving the population dynamics. Our benefit incidence analysis indicates that substantive gains have been made at the primary education and health care level, at the state level for SE Nigeria but there is a gross misapplication of funds at the secondary and tertiary levels of both education and health sectors. Results show that the state governments’ is subsidizing the rich at the levels of both secondary and tertiary for education and health care. In addition, country wide results indicate that apart from public primary education and health care for urban residents, no other level of social service was absolutely progressive in general terms, by gender or by location while the tertiary level of both services were regressive as shown by the 2010 survey results, in comparism to the 2004 survey results. Using the Ordered Logistic Regression, our result inclines to the lifecycle hypothesis which maintains that poverty oscillates depending on the age. At a younger age, it tends to be on the high side and decreases during the middle ages and increases with age. Our results discards the feminization of poverty general framework that women or female headed households are more prone to poverty due principally to low education and lack of opportunity to own assets such as land amongst others. This wasn’t the case for the South East Region of Nigeria. Estimates indicate that education status, health status and access to health facilities affected the category of welfare of head of households and invariable, the entire household. In general, our analysis shows misalignment of social expenditure for various population groups, both at the federal and state levels; making doubtful the realization of basic MDGs. Nigeria has to combine growth policies and assuring that demographics count, with the poor fully participating in economic development. Also, the need for a refocusing in resource allocation taking into cognizance gender dimensions cannot be overemphasized. A general re-allocation of spending going to females and the poorer households would lead to improvement in gender equality and health status of women and children. Expediting actions towards qualitative education will lead directly to an acceleration of many of the other MDGs, especially those focusing on the reduction of poverty and inequality. To attain MDG targets (post 2015) within a shorter period of time, there is the need to improve the quality of social infrastructure and services. Furthermore, research should be focused on improving knowledge and understanding of what policies, technologies and investments matter for sustained growth in the country. This will create the much needed multiplier effect on other aggregates. The degree to which the poor participate in the growth process and share in its proceeds matter; both in the pace and pattern of growth. It is therefore important to have categorization of the population into economic groups when formulating a developmental framework for poverty reduction programmes. The study recommends sequencing of interventions, strengthening of institutions and other several interrelated areas to attain effectiveness of public sector spending.

Various research efforts have focused on Banana streak badnavirus (BSV), the causal agent of banana streak disease (BSD), since the discovery of endogenous sequences of the virus in the nuclear genome of several Musa (banana and plantain) species. In vitro propagation of Musa was identified as one of the main activation triggers of integrated BSV sequences to cause systemic (episomal) BSD. This was especially observed in B genome-containing tetraploid hybrids. Although, the South African banana industry is based on Cavendish varieties, some plantations with tetraploid hybrids have been established. In order to investigate the occurrence of episomally expressed BSV, a survey was done in the Kiepersol area of South Africa and episomal BSV was detected in six out of seven locations sampled. No episomal BSV was detected in the Cavendish cultivars sampled in close proximity to BSV infected cultivars. To determine the risk of vector-assisted spread of endogenous BSV, which has become episomally activated after tissue culture, transmission studies with local mealybug species (Planococcus citri (Risso), P. ficus (Signoret), Dysmicoccus brevipes (Cockerell) and Pseudococcus longispinus (Targioni-Tozzetti)) were conducted under controlled conditions. Virus-free FHIA-21 was multiplied in vitro and resulting progeny with, putatively episomally activated BSV, served as sources for mealybug-assisted transmissions to Cavendish. Activated, episomal BSV was transmitted by three mealybug species to Cavendish. Transmission with P. ficus was demonstrated for the first time. Limited antiserum stocks against BSV occur worldwide and detection of the virus remains crucial for the safe movement of Musa germplasm between continents. Antiserum is needed in order to detect the episomal form of the virus that causes BSD. Using conventional immunization methodology, antisera against a wide spectrum of BSV isolates were produced. Twenty diverse BSV isolates were characterized by IC-PCR and selected as sources for the production of the polyclonal antiserums in two animal species. An effective triple antibody sandwich (TAS) enzyme linked immunosorbent assay (ELISA) system; able to detect various serologically different species of BSV was developed. BSV was screened with a synthetically manufactured phage displayed antibody library; however, no satisfactory polyclonal or monoclonal antibodies were obtianed in using this approach. / Dissertation (MSc (Microbiology))--University of Pretoria, 2007. / Microbiology and Plant Pathology / unrestricted

Abstract Schizophrenia is a complex mental health disorder and its etiology can be investigated based on different theoretical prerequisites. The present thesis examines schizophrenia from the neurodevelopmental and psychosis continuum perspectives. Neurodevelopmental theories of schizophrenia see abnormalities in the developing nervous system as early predictors of vulnerability to the disease. Schizophrenia can be seen also as a progressive disorder and a continuum of symptomatology from personality traits (schizotypy) to full-blown schizophrenia. The aim of the present thesis is to study incidence of schizophrenia; prevalence of schizotypy; and associations between schizophrenia and schizotypy with early motor developmental milestones. The research design includes prospective cohort studies and systematic review, and meta-analysis. In two successive Northern Finland Birth Cohorts (NFBC) studies, 20 years apart (1966 and 1986), the incidence of schizophrenia remained the same, but the incidence of other psychoses and therefore all psychoses was higher in NFBC 1986. In NFBC 1966, mean schizotypy scores were among the lowest and the highest scores among 24 general population studies. When early motor developmental milestones were investigated in the meta-analyses (3 to 5 studies), a significant small effect size for walking, sitting, and standing unsupported was found with respect to adult schizophrenia. When schizotypy outcome was studied in the NFBC 1966, later achievement of turning from back to tummy, touching thumb with index finger, standing up, sitting unsupported, and walking with support were found to be associated with an increase in schizotypy scales and varied somewhat by gender. To conclude, there have been changes in the incidence of all psychoses but not in schizophrenia between the two NFBCs. This is in line with other studies on the trends of incidence of psychoses, which highlights the role of changes in diagnostic systems and practices that can influence rates. In this project, mean schizotypy scores were both among the highest and the lowest estimates in the studies on schizotypy in the general population. Early motor developmental milestones were both predictors of schizophrenia and schizotypy, and thus this finding supports both the neurodevelopmental and psychosis continuum approaches to the aetiology of schizophrenia. / Tiivistelmä Skitsofrenia on monimuotoinen mielenterveyden häiriö, jonka etiologiaa voidaan tutkia erilaisissa teoreettisissa viitekehyksissä. Tämä väitöskirja tutkii skitsofreniaa neurologisen kehityksen ja psykoosin jatkumon näkökulmista. Skitsofrenian neurokehitykselliset teoriat pitävät kehittyvän keskushermoston poikkeavuuksia varhaisina skitsofrenian alttiuden ennustajina. Skitsofreniaa voidaan pitää myös progressiivisena sairautena ja oireiden jatkumona persoonallisuuden piirteistä (skitsotypaalisuudesta) täysimittaiseen skitsofreniaan. Tämän väitöskirjatutkimuksen tavoitteena on tutkia skitsofrenian ilmaantuvuutta, skitsotypaalisten piirteiden yleisyyttä ja skitsofrenian ja skitsotypaalisten piirteiden yhteyttä varhaiseen motoriseen kehitykseen. Tutkimusasetelmina ovat prospektiiviset syntymäkohortit, systemaattinen katsaus ja meta-analyysi. Kahdessa peräkkäisessä 20 vuoden välein kerätyssä Pohjois-Suomen syntymäkohortissa (1966 ja 1986) skitsofrenian ilmaantuvuus pysyi samana, mutta muiden psykoosien ja siten kaikkien psykoosien ilmaantuvuudet olivat korkeampia vuoden 1986 syntymäkohortissa. Vuoden 1966 syntymäkohortissa negatiivisen skitsotypaalisuuden piirteet olivat korkeita ja positiivisen skitsotypaalisuuden piirteet alhaisia verrattuna 24 muuhun väestöaineistoon. Varhaisen motorisen kehityksen ja aikuisiän skitsofrenian välistä yhteyttä tutkittiin meta-analyysin (3–5 tutkimusta) avulla. Tilastollisesti merkitsevä pieni negatiivinen yhteys löytyi aikuisiän skitsofrenian ja kävelemään, istumaan ja seisomaan oppimisen välillä. Pohjois-Suomen vuoden 1966 syntymäkohortissa skitsotypaaliset piirteet liittyivät hitaampaan vatsalleen kääntymisen, peukalo-etusormi otteen, seisomisen, tuetta istumisen ja tuen kanssa kävelemisen oppimiseen. Näissä yhteyksissä oli vaihtelua tutkittavan sukupuolen mukaan. Yhteenvetona voidaan todeta, että psykoosien ilmaantuvuus on kasvanut Pohjois-Suomen syntymäkohorteissa, mutta skitsofrenian ei. Tämä on linjassa aikaisempien tutkimusten kanssa. On kuitenkin huomioitava myös diagnostisten järjestelmien ja käytäntöjen merkitys näiden muutosten arvioimisessa. Varhainen motorinen kehitys ennusti sekä skitsofreniaa että skitsotypaalisia piirteitä. Havainto tukee sekä neurokehityksellistä että psykoosin jatkumoon liittyvää lähestymistapaa skitsofrenian etiologiassa.

Introduction: Suicide is a global public health and social problem affecting the most productive age group, and the elderly. In Addis Ababa, despite high suicide rates there is no proper registration and certification that is meant for public health purpose. This study is conducted to look into the incidence and explore societal views towards suicide in Addis Ababa. Methods: Secondary data was collected from registers of Forensic Pathology Department at Menilik II Hospital and Homicide Crimes Investigation Unit at Addis Ababa Police Commission. Qualitative data was also collected from experts having experience in helping suicide victims.   Results: Between January 01 and December 31st 2015, 267 residents of Addis Ababa, majority of who are males, died due to suicide. Hanging being the most frequently used means, social isolation, mental illness, family conflict, economic problems and lack of religious commitment are perceived causes of suicide. Unavailability helping institutions and individual preference as to the method of suicide and individual nature of suicide are conditions that get the attention. While respect for social and religious values is considered as protective factors, the act of suicide is religiously criminal act. The victims of suicide include family and community members.   Conclusion: There is a need to consider policy and programmatic actions directed towards suicide prevention and control. In addition to conducting community wide research in suicide, it is important to preserve social and cultural values; institutionalize traditional family conflict resolution practices and strengthen mental health institutions. / <p>Enbart abstract.</p>

Delirium é um estado confusional agudo caracterizado por um distúrbio de consciência, alteração na cognição e curso flutuante ao longo do dia. É a complicação mais comum observada em idosos hospitalizados. É freqüente no pós-operatório de cirurgia cardíaca, e pode chegar a taxas tão altas quanto 73% em pacientes mais idosos. Pacientes com delirium apresentam maior risco de morte, demência e institucionalização, aumento do tempo de internação hospitalar e dos custos. Os objetivos deste estudo foram: 1) determinar a incidência do delirium no pós-operatório de cirurgia cardíaca em idosos; 2) identificar fatores predisponentes e precipitantes neste contexto; 3) avaliar a relação entre delirium e morbimortalidade por até 18 meses de seguimento. Este estudo foi observacional, prospectivo, tipo coorte, realizado no Hospital de Messejana no período de Setembro/2011 à Dezembro/2013. Foram estudados 173 pacientes com idade > 60 anos. Antes da cirurgia, os pacientes foram avaliados quanto à função cognitiva através do MEEM e TFV, e pelo CAM, para determinar a presença de delirium pré-operatório, motivo de exclusão do estudo. Foram registradas variáveis referentes aos dados demográficos, doenças prévias, medicações utilizadas, e calculado o risco de mortalidade cirúrgica para cada paciente através do EuroSCORE II. Resultados de exames pré-operatórios como ECG, ecodopplercardiograma, cateterismo cardíaco, Doppler de carótidas e exames laboratoriais também foram registrados. Durante a cirurgia, as variáveis avaliadas foram o tempo de CEC e clampeamento de aorta, duração da cirurgia e anestesia e uso de hemoderivados. Como variáveis pós-operatórias foram analisados o TIOT, tempo de permanência na UTI, presença de disfunção renal, hipoxemia. O delirium foi avaliado pelo CAM-ICU no pós-operatório. Para o desfecho composto foram registrados óbitos por todas as causas, infecções e IAM perioperatório identificados até a alta hospitalar ou 30 dias após a cirurgia. Os pacientes foram seguidos por um período de 12 a 18 meses e registrados eventos como óbitos, reinternações e demência, através de nova avaliação com MEEM e TFV. Após análise univariada foi realizada análise multivariada por regressão logística múltipla para identificar as variáveis independentes. A idade média dos pacientes foi 69,5 + 5,8. Cerca de 75,14% eram hipertensos e 39,88% eram diabéticos. A média do EuroSCORE II foi 4,06 + 3,86. Cerca de 30,06% eram analfabetos. A média do grau de escolaridade foi 3,05 + 3,08 anos. A incidência do delirium foi 34,1%. Em 70% dos casos, o delirium foi detectado nos dois primeiros dias após a cirurgia. Foram identificados o grau de escolaridade (OR = 0,81; IC 95% 0,71 - 0,92; p=0,002), HAS (OR = 2,73; IC 95% 1,16 - 6,40; p=0,021) e a presença de valvopatia mitral ( OR = 2,93; IC 95% 1,32 - 6,50; p=0,008) como fatores predisponentes independentes para delirium. Como fator precipitante independente foi identificado o tempo de internação na UTI com OR=1,18; IC 95% 1,07 - 1,30 e p=0,001. O delirium foi fator de risco independente para o desfecho composto com OR=2,35; IC 95% 1,20 - 4,58 e p=0,012, além do TIOT > 900 minutos (OR=2,50; IC 95% 1,30 - 4,80; p=0,006) após análise multivariada. Não houve relação entre delirium e óbito após alta hospitalar, demência ou taxa de reinternação durante o seguimento / Delirium is an acute and transient syndrome with features of inattention and global cognitive dysfunction over the time. Among elderly hospitalized patients is the most common complication. The postoperative cardiac surgery delirium occurs in 73% in older patients. Delirium patients, have prominent risk factors for dementia, institutionalization, death, hospital care and increased cost of healthcare. The aims of this study were: 1) to determine the incidence of postoperative cardiac delirium, focusing particularly on elderly individuals; 2) to identify the predisposing and precipitating factors of delirium; 3) evaluate the morbi-mortality associated with delirium in a follow up of eighteen months. A prospective observational cohort study (n=173) patients, aged >= 60 years, admitted at Heart and Lung Messejana\'s Hospital between September/2011 to December/2013. Before the surgery, the Mini-Mental Status Examination (MMSE) and Verbal Fluency Test (VFT) were administered to assess patient\'s cognitive functioning. The patients were screened for delirium using the Confusion Assessment Method (CAM). Patients were excluded preoperatively if they met criteria for delirium. Variables related to demographic data, previous diseases, medications were recorded and EuroSCORE II calculated the risk of surgical mortality for each patient. Results of preoperative tests, like ECG, echocardiography, cardiac catheterization, carotid Doppler ultrassound and laboratory tests were also recorded. During the surgery, variables were ECC (extracorporeal circulation) and aortic clamping time, duration of surgery and anesthesia, and blood products were also recorded. Postoperative variables analyzed were: the orotracheal intubation time (OIT), length of stay in the ICU, renal dysfunction and hypoxemia. The postoperative delirium was accessed by CAM-ICU. Mortality from any cause, infection and perioperative myocardial infarction, identified until hospital discharge or 30 days after surgery were predefined as the composite endpoint. During a follow up of 12 to 18 months, a new assessment using MMSE and VFT were held; events such as, deaths, readmissions and dementia were recorded. Multivariate analysis was performed by multiple logistic regressions to identify independent variables. Patients aged 69.5 ± 5.8. About 75.14% were hypertensive; 39.88% were diabetic. The mean EuroSCORE II was 4.06±3.86. About 30.06% were illiterate; an average 3.05 ± 3.08 years of school. In 70% of cases, delirium was detected at the first two days after surgery with an incidence of 34.1%. The degree of literacy (OR = 0,81; 95% CI 0,71 - 0,92; p=0,002), hypertension (OR = 2,73; 95% CI 1,16 - 6,40; p=0,021) and mitral valve disease (OR = 2,93; 95% CI 1,32 - 6,50; p=0,008) were independently associated with delirium. Longer ICU length of stay (OR=1,18; 95% CI 1,07 - 1,30; p=0,001) was also independently associated with delirium as a precipitation factor. Delirium was an independent risk factor for the composite outcome (OR = 2.35; 95% CI 1.20 - 4.58 and p = 0.012); OIT > 900 minutes (OR = 2.50; 95% CI 1.30 - 4.80; p = 0.006) after multivariate analysis. There was no relationship between delirium and mortality after hospital discharge, as well as, dementia or hospital readmission during follow up