Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Stroke, which has an increasing incidence with age, causes an irreversible brain damage which may lead to impairment, disability and decreased life satisfaction or death. Risk factors for death, recurrent stroke and myocardial infarction, were analyzed in 409 stroke patients treated at the Stroke Unit, Department of Medicine, Umeå University Hospital, between Jan. 1, 1978 and Dec. 31, 1982. The causes of death were related with the time of survival. In fully co-operable (n=62) 4-6 year stroke survivors, the occurrence of motor and perceptual impairments, of self-care (ADL) disability and of self-reported decreased life satisfaction due to stroke was determined. The probability of survival was 77% three months after stroke, 69% after one year, and 37% after five years. Multivariate statistical analysis indicated that impairment of consciousness was the most important risk factor for death followed by age, previous cardiac failure, diabetes mellitus, intracerebral hemorrhage and male sex. During the first week, cerebrovascular disease (90%) was the most dominant primary cause of death, from the second to the fourth week pulmonary embolism (30%), bronchopneumonia during the second and third months and cardiac disease (37%) later than three months after stroke. The risk of recurrence was 14% during the first year after stroke and the accumulated risk of stroke recurrence after 5 years was 37% after stroke. The estimated probability of myocardial infarction was 7% at one year and 19% at 5 years. High age and a history of cardiac failure increased the risk of recurrent stroke. The risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus. The highest risk of epilepsy was found between 6 and 12 months after stroke. Motor impairment prevailed in 36% of the long-term survivors, perceptual impairments in up to 57% and decreased ADL-capacity in 32%. As regards ecological perception, perceptual function variables were distinctly grouped into low and high level perception which together with motor function explained 71% of the variance of self-care ADL. While levels of global and of domain specific variables of life satisfaction appeared stable in clinically healthy reference populations aged 60 and 80 years, the stroke had produced a decrease in one or more aspects of life satisfaction for 61% of the long-term survivors. Although significantly associated with motor impairments and ADL disability, these changes could not only be attributed to physical problems. / <p>S. 1-48: sammanfattning, s. 49-114: 5 uppsatser</p> / digitalisering@umu

The study aims to describe the external causes of death (ECD) mortality, specifically suicide and traffic death in Estonia 1970-2002 in relation to the political and economic development with a special focus on the unemployment and alcohol use impact. This analyse bases on the Statistical Office of Estonia and other governmental institutions published information. The highest mortality rates occurred for traffic accidents 1990-91 and for suicides 1994-95. Middle-age man excess ECD mortalityoccurred in early 1990s with the greatest politico-economic changes accompanied by high psychosocial stress before the population could acquire appropriate coping strategies. Impact of the first main reforms on the population health has been ascertained. Price liberalisation was followed by immense inflation and real wage fall in early 1990s. Privatisation and monetary reform influenced on the basic living security of the population. People faced unexpected living difficulties as work and dwelling insecurity, decreased real income, insufficiency to meetessential expenditures, declined living standard, social status loss, population stratification and inadequate social protection. Unemployment was just introduced and did not play a significant role for the high mortality. Traffic accidents’ fatal consequences decreased with growing GDP as cars and roads became safer however accidents’ number did not decrease. Western cars appearance euphoria could influence more than alcohol consumption. It could plausibly increase accidents but the reason and role of alcohol consumption in the intentional actions needs more information. Suicide could have been influenced mainly by social and traffic accidents mortality mainly by environmental factors. Earlier findings about the unemployment and alcohol consumption impact on the transition’s high injurymortality have not been confirmed by the current study. Current paper provides framework within population worsening health factors during politico-economic changes could be better understood. The strongest impact on Estonia’s population health could come from transition’s political and economic reforms influencing dwelling and incomesecurity. Low salary and low purchasing power could hurt a human dignity even more than possible unemployment / <p>ISBN 91-7997-094-X</p>

p. 1-204 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-25T19:29:53Z No. of bitstreams: 1 3333333333.pdf: 1820220 bytes, checksum: 86a606b3784bfb57fb53abe9467d767e (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:36:49Z (GMT) No. of bitstreams: 1 3333333333.pdf: 1820220 bytes, checksum: 86a606b3784bfb57fb53abe9467d767e (MD5) / Made available in DSpace on 2013-05-04T17:36:49Z (GMT). No. of bitstreams: 1 3333333333.pdf: 1820220 bytes, checksum: 86a606b3784bfb57fb53abe9467d767e (MD5) Previous issue date: 2007 / Introdução: Existe uma razoável produção acadêmica em algumas áreas do conhecimento que aponta piores condições de vida para a população brasileira afro descendente. Entretanto, são poucos os estudos na área de saúde que abordam a raça/cor da pele como importante determinante da falta de equidade entre grupos. Objetivos: analisar os diferenciais da mortalidade por causas externas, segundo a raça/cor em Salvador, Bahia, Brasil, no período 1998-2003. Material e Métodos: O primeiro dos três artigos que compõem o presente trabalho corresponde a uma revisão de literatura sobre desigualdades sociais em saúde no Brasil e nos Estados Unidos contemplando estudos que abordaram a raça/cor da pele, publicados em periódicos da área de Saúde Pública/ Epidemiologia no período de 1996 a 2005. O segundo é um estudo descritivo no qual se calculou o número de anos potenciais de vida perdidos (APVP) por causas externas por sexo, faixa etária e tipo de causa externa, segundo a raça/cor da pele. O terceiro artigo se constitui em um estudo ecológico espacial, que teve como unidade de análise as áreas de ponderação de Salvador. Mediante modelagem de Regressão Binomial Negativa foi testada a hipótese de que áreas com maior proporção de população masculina negra entre 15 e 49 anos apresentavam maior mortalidade por todas as causas externas em conjunto e por homicídio. Resultados: Dos 56 estudos norte-americanos e 7 brasileiros revistos, 68,7% foram publicados entre 2002 e 2005, 41 eram do tipo transversal (65,0%), 11 do tipo inquérito (17,5%), 6 eram de vigilância (9,5%), 3 ecológicos (4,8%) e 2 longitudinais (3,2%). Desses 60,3% se referiram à saúde da população e 39,7% a saúde de grupos populacionais específicos. A variável raça/cor da pele/etnia esteve associada ao efeito estudado em 84,4% dos estudos analíticos e as diferenças observadas se mostraram estatisticamente significantes em todos os estudos descritivos em que os autores utilizaram algum teste estatístico. Todavia, enquanto nos artigos dos Estados Unidos se observou uma tendência de superação das limitações observadas nesses tipos de estudos, no Brasil essa literatura está apenas começando a descrever a existência desse tipo de desigualdade. No segundo artigo verificou-se que os homens negros perderam 21,8 vezes mais anos potenciais de vida quando comparados aos homens brancos. As diferenças observadas no APVP/100.000hab. e nas razões de APVP/100.000 se mantiveram mesmo após a padronização por idade. No último estudo verificou-se que áreas com altas taxas de mortalidade por todas as causas externas e por homicídio tenderam a se aglomerar e tinham como características comuns uma maior proporção de população negra masculina com idade entre 15 e 49 anos. Áreas com maior proporção de população masculina negra entre 15 e 49 anos apresentavam maior mortalidade por causas externas (RR=1,18; p=0,03 para a associação entre proporção da população masculina negra com idade de 15 a 49 anos e taxa de mortalidade por todas as causas externas ajustada por proporção de chefes de família negros com renda de ≤2SM ). Conclusões: Foram produzidas evidências de que a população negra, especificamente a masculina negra com idade entre 15 e 49 anos, morre mais precocemente e apresenta maior risco de óbito por causas externas e, especialmente por homicídios. Entende-se que foram reveladas apenas uma das facetas de um problema bastante complexo, porém, espera-se que tais resultados estimulem e subsidiem a discussão sobre a falta de equidade em saúde segundo a raça/cor da pele e contribuam para a formulação de políticas públicas especificas. / Salvador

Conselho Nacional de Desenvolvimento Científico e Tecnológico / The ever increasing close contact between dogs and human beings stimulated in last years the production of a great deal of scientific information in canine medicine. However, as the major part of such information stems from work carried on in foreign countries, it is common that Brazilian veterinary clinicians and veterinary pathologists alike have to transpose these data on disease prevalence generated abroad to our situation. Thus, the main objective of this study is to investigate the prevalence of the diseases that culminate with death or motivate the euthanasia of dogs from the midland region of the Midwest of Rio Grande do Sul State, Brazil. In order to achieve this goal the necropsy files of the Laboratório de Patologia Veterinária (LPV) of the Universidade Federal de Santa Maria (UFSM) were accessed and necropsy protocols of dogs necropsied between January 1965 and December 2004 were reviewed in search for information allowing to establish a definitive diagnosis. When circumstances did not allow for a definitive diagnosis the case was considered as inconclusive. During this period 4,844 reports of canine necropsies were filed at the LPVUFSM. The case distribution in relation to the disease categories diagnosed was as follows: infectious and parasitic diseases (1,693 [35.0%]); neoplasms (378 [7.8%]), disorders caused by physical agents (369 [7.6%]), degenerative diseases (342 [7.1%]); poisonings and toxinfections (112 [2.3%]); euthanasia due to convenience (101 [2.1%]), metabolic and endocrinological diseases (97 [2.0%]); iatrogenic disorders (83 [1.7%]); developmental disorders (25 [0.5%]), immune mediate diseases (10 [0.2%]); and nutritional disorders (6 [0.1%]). Other disorders, including multifactorial or idiopathic diseases contributed 80 (1.6%) cases. In 1,548 (32.0%) out of the 4,844 cases it was not possible to establish either cause of death or reason for euthanasia. Infectious and parasitic diseases (mainly canine distemper, parvoviral enteritis and intestinal parasitism), neoplasia (mainly mammary neoplasms and lymphoma), disorders caused by physical agents (mainly accidents caused by automotive vehicles) and degenerative diseases (mainly chronic renal failure, cirrhosis, and congestive heart failure) were the main disease categories that caused death or motivated euthanasia in dogs of this midland region. However when cases were evaluated in relation with the age of the dog, the disease prevalence differs. The main causes of death in puppies were infectious and parasitic disease (mainly parvoviral enteritis, canine distemper, and intestinal parasitism). In adult dogs the most important causes of death were canine distemper, neoplasia and trauma. In age dogs, approximately half of the deaths could be attributed to neoplasia and degenerative disease. / A crescente aproximação afetiva entre os cães e o homem fez com que nos últimos anos fosse gerada muita informação científica sobre medicina canina. Entretanto, como a maior parte dessas informações é obtida através da literatura internacional, é comum que os clínicos e patologistas veterinários brasileiros necessitem extrapolar dados referentes à prevalência das diferentes doenças que causam morte de cães para nossa realidade. Baseado nisso, este estudo tem como objetivo principal determinar a prevalência das doenças que culminam em morte ou que fazem com que os cães da Mesorregião do Centro Ocidental Rio- Grandense sejam submetidos à eutanásia. Para isso, foram revisados todos os protocolos de necropsia de cães, arquivados no Laboratório de Patologia Veterinária (LPV) da Universidade Federal de Santa Maria (UFSM), realizadas entre janeiro de 1965 e dezembro de 2004. Desses protocolos foram retiradas informações para se estabelecer um diagnóstico definitivo. Quando as evidências não permitiram estabelecer o diagnóstico definitivo, os casos foram considerados inconclusivos. Nos arquivos do LPV-UFSM foram encontrados 4.844 protocolos de necropsia de cães. A distribuição dos casos em relação às categorias de doenças diagnosticadas foi a seguinte: doenças infecciosas e parasitárias (1.693 [35,0%]), neoplasmas (378 [7,8%]), distúrbios causados por agentes físicos (369 [7,6%]), doenças degenerativas (342 [7,1%]), intoxicações e toxiinfecções (112 [2,3%]), eutanásia por conveniência (101 [2,1%]), doenças metabólicas e endocrinológicas (97 [2,0%]), distúrbios iatrogênicos (83 [1,7%]), distúrbios do desenvolvimento (25 [0,5%]), doenças imunomediadas (10 [0,2%]) e doenças nutricionais (6 [0,1%]). Outros distúrbios, que incluem doenças multifatoriais ou idiopáticas, contribuíram com 80 (1,6%) casos. Dos 4.844 casos, em 1.548 (32,0%) não foi possível estabelecer a causa da morte ou a razão para a eutanásia. Doenças infecciosas e parasitárias (principalmente cinomose, parvovirose e verminose intestinal), neoplasmas (principalmente neoplasmas mamários e linfoma), distúrbios causados por agentes físicos (principalmente atropelamento por veículos automotivos) e doenças degenerativas (principalmente insuficiência renal crônica, cirrose e insuficiência cardíaca congestiva) foram as principais categorias de doenças relacionadas com morte ou eutanásia de cães dessa mesorregião. Entretanto, quando os cães são avaliados de acordo com suas idades, tais categorias possuem prevalências diferentes. As principais causas de morte em filhotes foram as doenças infecciosas e parasitárias, principalmente parvovirose, cinomose e verminose intestinal. Em adultos, as causas de morte mais importantes foram cinomose, neoplasmas e trauma. Em idosos, neoplasmas e doenças degenerativas foram responsáveis por aproximadamente a metade das mortes.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / The necropsy reports of 335 horses necropsied at the LPV-UFSM between 1968-2007 were reviewed in order to determine the necropsy findings related with cause of death or reason for euthanasia. The distribution of these findings by organ system were as follows: digestive (79/335 [23.6%]), striated muscle and skeleton (47/335 [14.0%]), nervous (37/335 [11.0%]), respiratory (35/335 [10.4%]), integument (31/335 [9.3%]), hematopoietic (24/335 [7.2%]), cardiovascular (13/335 [3.9%]), reproductive (12/335 [3.5%]), urinary (7/335 [2.1%]), and endocrine (3/335 [0.9%]). The cause of death was not possible to be determined in 47 (14.0%) necropsied horses. Displacements of the intestines (17/79 [21.5%]) were the main findings in digestive system, followed by obstruction and impactation (14/79 [17.7%]). Torsion were the type of displacement more frequently observed in the intestines (14/17 [82.4%]). Among those the more prevalent affected the small intestine (7/14 [50%]). Most horses dying from fractured bones were 1-5-year-old. The most prevalent diseases in the nervous system were leukoencephalomalacia and trypanosomiasis, whereas respiratory depression due to anesthesia was the leading cause of death related to the respiratory system. Equine infectious anemia was the most diagnosed infectious disease and the main reason leading to euthanasia. / Os protocolos de necropsia de 335 eqüinos necropsiados no LPV-UFSM entre 1968-2007 foram revisados com o objetivo de determinar os achados de necropsia relacionados com a causa da morte ou razão de eutanásia. A distribuição desses achados de acordo com os sistemas afetados foi a seguinte: digestivo (79/335 [23,6%]), músculo-esquelético (47/335 ([14,0%]), nervoso (37/335 [11,0%]), respiratório (35/335 [10,4%]), tegumentar (31/335 [9,3%]), hematopoético (24/335 [7,2%]), cardiovascular (13/335 [3,9%]), reprodutor (12/335 [3,5%]), urinário (7/335 [2,1%]) e endócrino (3/335 [0,9%]). Não foi possível determinar a causa da morte em 47 (14,0%) eqüinos necropsiados. As principais afecções do sistema digestivo foram as alterações na posição dos intestinos (17/79 [21,5%]), seguidas pelas obstruções e impactações (14/79 [17,7%]). As torções foram as principais alterações da posição dos intestinos (14/17 [82,4%]). Dentre as torções, as mais prevalentes foram as localizadas no intestino delgado (7/14 [50%]). A maioria dos eqüinos que morreram em razão de fratura óssea tinham idades entre 1-5 anos. As duas doenças mais freqüentemente diagnosticadas no sistema nervoso foram leucoencefalomalacia e tripanossomíase. Depressão respiratória causada por anestesia foi a principal causa de morte relacionada com o sistema respiratório. A anemia infecciosa eqüina foi a doença infecciosa mais diagnosticada e a principal razão para eutanásia observada neste estudo.

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.

This diploma thesis analyzes mortality from external causes in the region of CZ between 2014 and 2018. The main focus is on external causes of death as a group, suicide rates, and mortality from traffic accidents. Another aim of this thesis is, besides the description of mortality from external causes, to identify regional correlation and differences in mortality from external causes and selected causes of death (suicides and traffic accidents). This study uses correlation, factor, and cluster analysis. Because of the low numbers of deaths in the case of women (in all dependent variables), the study analyzes mortality from both sexes together. Based on created factors clusters of regions are developed. Results show the difference between regions in CZ in mortality external causes. Regions also vary in suicide mortality rates and traffic accident mortality rates. Independent variables that correlate with mortality from external causes vary for external causes as a group, for suicides, and for mortality from traffic accidents. Keywords: external causes of death, suicides, traffic accidents, factor analysis, cluster analysis

Analysis of mortality development in Russia using various decomposition methods Abstract The aim of this thesis is to analyze and evaluate mortality development in Russia in last 50 years by using various decomposition methods. The first part presents the method of decomposition of the difference between two demographic indicators (E. Kitagawa's method or methods from E. Arriaga, R. Pressat and J. Pollard). In the second part mortality development in Russia is analyzed by using methods that decomposed the value of demographic indicators in a given year. Mortality is divided into senescent and background component by using the Gompertz-Makeham formula and by using the logistic model. Afterwards, avoidable and unavoidable mortality and mortality due to endogenous and exogenous causes of death is analyzed. Hypotheses, set out in the introductory chapter, are verified by using different decomposition methods. Using multiple methods of decomposition enable to obtain a more complex view of the evolution of mortality in the observed period so that could be viewed from multiple perspectives and identify specific population trends in Russia. Keywords: mortality, Russia, decomposition, senescent and background mortality, avoidable mortality, endogenous, exogenous, causes of death, mortality crisis

O Serviço de Verificação de Óbitos (SVO) foi criado para elucidar causas de óbitos naturais mal definidas por meio de exames necroscópicos e registrar informações mais completas sobre as causas de morte no Sistema de Informação de Mortalidade (SIM). Desde a criação da rede nacional de SVO, poucos estudos avaliaram a qualidade dos registros de óbitos dos SVO no SIM. Foram estudados 19780 registros de óbitos não fetais de residentes no Estado do Tocantins entre os anos de 2012, 2011 e 2012, obtidos por download do site do DATASUS do Ministério da Saúde. Além de estabelecer o perfil social demográfico dos óbitos, foram estudadas a completude das informações, as cinco principais causas de morte e as causas básicas registradas pelo SVO e demais atestantes dentro do SIM. Óbitos do sexo masculino, cor parda, casados, sem escolaridade, hospitalares de aposentados e maiores de 75 anos predominaram. A incompletude de dados registrados no SIM para o Estado do Tocantins foi superior a 10% e não houve diferença estatística significativa entre a completude de dados registrados pelo SVO e pelos demais atestantes. As doenças do aparelho circulatório foram as principais causas de morte registradas pelos atestantes, exceto pelo IML, onde as causas externas predominaram. 15% dos registros de causas básicas externas não pertenciam ao IML e o SVO apresentou uma grande proporção de registros de causas básicas mal definidas. A qualificação das informações sobre mortalidade, imprescindível à elaboração de políticas públicas sanitárias, persiste desafiadora no Estado do Tocantins. A criação de uma cultura da informação epidemiológica passa pela inserção curricular, educação e sensibilização médica continuada. / The Death Verification Service (SVO) was created to elucidate causes of natural deaths poorly defined by postmortem examinations and record more complete information on the causes of death in the Mortality Information System (SIM). Since the establishment of the national network of SVO, few studies have evaluated the quality of death records of SVO SIM. We studied 19780 no fetal death records of residents in the State of Tocantins between the years 2012, 2011 and 2012, downloaded the DATASUS website of the Ministry of Health. In addition to establishing the demographic social profile of the deaths were studied completeness information, the five leading causes of death and root causes recorded by the SVO and other informers within the SIM. Deaths male, mulatto, married, uneducated, retired hospital and over 75 years predominated. The incompleteness of data in SIM for the State of Tocantins was higher than 10% and there was no statistically significant difference between the completeness of data recorded by the SVO and the other informers. The circulatory diseases were the main causes of death recorded by informers except for IML, where external causes predominated. 15% of the records of external root causes did not belong to the IML and the SVO had a large proportion of ill-defined basic causes records. The qualification of information on mortality, essential to the development of health policies, remains defiant in the State of Tocantins. Creating a culture of epidemiological information passes through curriculum integration, education and continuing medical awareness.