The objective of this study was to determine the clinical and epidemiological profile of women who died at the Caucaia Health Region from 2009 to 2014, through the epidemiological investigation of the pathway performed by these women to access, Death, and if there was an opinion of the Maternal Mortality Prevention Committee. This is a documental, descriptive and quantitative approach, with a population and a sample of 56 maternal deaths. Data were collected in the first half of 2016, using death certificates and M5 investigation forms found in the Information System on Mortality. The chosen variables were analyzed using SPSS 17.0 program and presented in absolute frequency and simple proportion. The research protocol was approved by the Ethics Committee of the Federal University of CearÃ, with opinion No. 1,403,777. It was found that the deaths occurred in women with a mean age 28.2 years (62.4%), mulattos (62.5%), single (57.1%), incomplete primary education (33.9%), housewives (48.2%). Obstetric data revealed bond to the Family Health Team (82.1%), prenatal consultations with more than 5 (51.8%), and only 25% directed to high-risk prenatal care. 80% delivery occurred in maternity, 48.2% caesarean section. The deaths occurred in hospital (76.8%), postpartum period (69.7%), the main causes of hypertension (16.1%) and infections (16.1%) and emboli (14.3 %), characterizing deaths from direct obstetric causes (58.3%) and preventable by appropriate action to prevent, control and attention to the causes of maternal death (73.2%). The Mortality Committee analyzed 87.5% of deaths. Despite the ease of access, there is poor quality of care. There is no guaranteed linking. The deaths could have been prevented through actions for the organization of the Maternal and Child Network with the expansion of resolutive and quality health services, the training of professionals for prenatal, childbirth and puerperium care, improvement of the recording of information, and strengthening the work of the municipal and regional Maternal, Child and Fetal Mortality Committees for the promotion of maternal and child health. / Este estudo teve por objetivo conhecer o perfil clÃnico-epidemiolÃgico das mulheres que foram a Ãbito materno na RegiÃo de SaÃde de Caucaia no perÃodo de 2009 a 2014, identificando por meio da investigaÃÃo epidemiolÃgica o trajeto realizado por essas mulheres, para acesso, atendimento, classificaÃÃo do Ãbito, e se houve parecer do Comità de PrevenÃÃo de Mortalidade Materna. Trata-se de um estudo do tipo epidemiolÃgico documental, descritivo e com abordagem quantitativa, com uma populaÃÃo e amostra de 56 Ãbitos maternos. Os dados foram coletados no primeiro semestre de 2016, utilizando as declaraÃÃes de Ãbito e fichas de investigaÃÃo M5 encontradas no Sistema de InformaÃÃo em Mortalidade. As variÃveis escolhidas foram analisadas pelo programa SPSS 17.0 e apresentadas em frequÃncia absoluta e proporÃÃo simples. A pesquisa foi submetida e aprovada no Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, com o parecer n 1.403.777. Identificou-se que os Ãbitos ocorreram em mulheres com idade mÃdia de 28,2 anos (62,4%), raÃa parda (62,5%), solteiras (57,1%), escolaridade baixa (33,9%) e donas de casa (48,2%). Os dados obstÃtricos revelaram vinculo à Equipe de SaÃde da FamÃlia (82,1%), prÃ-natal com mais de 5 consultas (51,8%), e apenas 25% encaminhadas ao prÃ-natal de alto risco. Em 80%; o parto ocorreu em maternidade, sendo 48,2% cesariana. As mortes ocorreram em hospital (76,8%), no perÃodo do puerpÃrio (69,7%), tendo como principais causas a hipertensÃo (16,1%), infecÃÃes (16,1%) e embolias (14,3%), caracterizando Ãbitos por causas obstÃtricas diretas (58,3%) e evitÃveis por adequada aÃÃo de prevenÃÃo, controle e atenÃÃo Ãs causas de morte materna (73,2%). O Comità de Mortalidade analisou 87,5% dos Ãbitos, apesar da facilidade no acesso, a qualidade da assistÃncia ruim. NÃo hà vinculaÃÃo garantida. As mortes poderiam ter sido evitadas mediante aÃÃes para a organizaÃÃo da Rede Materno-Infantil com ampliaÃÃo de serviÃos de saÃde resolutivos e de qualidade, capacitaÃÃo dos profissionais para os cuidados no prÃ-natal, parto e puerpÃrio, melhoria do registro das informaÃÃes, e fortalecimento do trabalho dos ComitÃs de Mortalidade Materna, Infantil e Fetal municipais e regional para a promoÃÃo da saÃde materna e infantil.

Foram estudados 375 óbitos ocorridos no município de São Paulo, de pessoas de 15 anos ou mais residentes nessa cidade e em cujo atestado de óbito constava a tuberculose como causa básica ou associada. Desses 375 óbitos, foram localizadas 245 famílias dos falecidos e realizadas entrevistas domiciliárias. Houve 287 pacientes que faleceram em hospitais, e em dois desses casos não foi conseguido realizar a entrevista institucional. Dessas entrevistas, pôde ser concluído que os possíveis fatores que influíram nesses óbitos foram o baixo nível sócio-econômico e o alcoolismo; não influíram nestes óbitos a migração e o tabagismo. Foi observado que estes doentes entraram tardiamente no sistema de saúde e a maioria dos que chegaram a ser internados faleceram nos primeiros dias de internação. Foi observado também, que a maioria dos casos não estava notificada, nem como caso nem como óbito, e a Secretaria da Saúde tinha conhecimento de apenas 119 casos. Analisando esses atestados, notou-se que a tuberculose foi causa básica em 88,4 por cento deles e, após a revisão dos mesmos com base nas entrevistas domiciliárias e institucionais, a tuberculose passou a ser causa básica em 92,8 por cento , havendo uma concordância de 95,6 por cento entre o atestado original e o revisto. / Three-hundred and seventy-five deaths of persons aged 15 years or more, which ocurred in São Paulo city, have been studied taking into account the death certificates in which tuberculosis had been appointed as the basic or associate cause of death. From these 375 deaths, 245 families of the deceased have been located and then submitted to domiciliary interviews: it was found out that two-hundred and eighty-seven patients had died in hospitals; in two of the cases it was not possible to make an institutional interview. From these data, some factors which could possibly have influenced the deaths were the low-socioeconomic status and alcoholism; it was found out that neither migration nor tabaccoism had influenced the deaths. It was also noticed that these patients had entered the health system very late and the majority of those who had been duly hospitalized died within the first days of hospitalization. It was also observed that most of the cases had not been reported either, neither as a case nor as a death, being that the State Health Department only had knowledge of 119 cases. Analysing these certificates, it was observed that tuberculosis was the basic cause of death in 88.4 per cent of them, and that after reviewing them on the basis of domiciliary and institutionas interviews, tuberculosis came out to be the basic cause of death in 92.8 per cent 06 the causes, having been reached an agreement of 95.6 per cent between the original certificates and the reviewed ones.

Através de levantamento amostral do peso ao nascer dos nascimentos ocorridos nas maternidades do município em 1976, estimou-se em 9,7 por cento a incidência de recém-nascidos de baixo peso em são Paulo. O ajuste dos coeficientes de mortalidade infantil de São Paulo segundo a distribuição do peso ao nascer da população branca americana determinou que em 1976 apenas 31 por cento do excesso de óbitos infantis de São Paulo poderia ser atribuído à performance do peso ao nascer verificada no município. O mesmo ajuste segundo a distribuição do peso ao nascer da Califórnia atribuiu ao peso ao nascer no período 1968-70, 15 por cento do excesso de mortalidade e revelou excesso de mortalidade particularmente notável não para os recém-nascidos de baixo peso, mas para os recém-nascidos com mais de 3.000 gramas. O ajuste simultâneo dos coeficientes de mortalidade infantil das áreas central, intermediária e periférica do município a uma idêntica distribuição de pesos de nascimento revelou uma participação decisiva do peso ao nascer no pequeno gradiente de mortalidade existente entre a área intermediária e a área central, porém descartou totalmente a possibilidade do peso ao nascer explicar o grande excesso de mortalidade infantil da área periférica em relação às duas outras. A consideração dos demais fatores que determinam no seu conjunto a probabilidade de sobrevida do recém-nascido no primeiro ano de vida, demonstrou ser capaz de complementar os achados relativos à participação do peso ao nascer no excesso de mortalidade infantil verificado no município. Assim foi para a disponibilidade de serviços públicos de pré-natal, insuficiente para o município como um todo, progressivamente menor na periferia. Assim foi para a disponibilidade de assistência médico-hospitalar ao parto e ao recém-nascido, suficiente em termos quantitativos para o município, porém insuficiente e precária para a população da periferia. Assim foi para a disponibilidade do saneamento do meio, razoável apenas na área central, praticamente inexistente na periferia. Associadamente, a verificação da distribuição de renda em São Paulo demonstrou que a distribuição desigual da disponibilidade de serviços públicos fundamentais à manutenção da saúde infantil superpõe-se exatamente à desigual distribuição de riquezas. A conclusão final deste estudo foi a de que são principalmente as precárias condições de vida que recepcionam o recém-nascido sobretudo na periferia, e não a vitalidade daquele, medida pelo seu peso ao nascer, que explicam o excesso de mortalidade infantil verificado em são Paulo. / By means of the sample research survey of the birth-weight of births which took place in the Maternity Hospitals of the city in 1976, it was calculated that the incidence of low birth-weight in São Paulo was of the order of 9,7 per cent . The adjustment of the infant mortality rates of São Paulo according to the birth-weight distribution of the white American population led to the conclusion that in 1976 only 31 per cent of the excess of infant mortality of São Paulo could be attributed to the birth-weight distribution found to exist in the city. The same adjustment according to the birth-weight distribution in California attributed 15 per cent of mortality excess to birth-weight in the period 1968-70 and a particularly clear mortality excess not for the infants of low birth-weight, but for those with a birth-weight of more than 3000 grams. The infant mortality coefficients of the central, intermediate and outlying areas of the city when seen against a hypothetical distribution of birth-weights for all areas revealed a decisive effect of the birth weight only in the small difference between the mortality rates of the intermediate and the central areas, but eliminated altogether the possibility of the birth-weight explaining the excess of infant mortality in the outlying areas in relation to the other two Cintermediate and central) areas. The study of the other factors wich determine, together, the probability of an infantis survival in the first year of life, was seen to corroborate the conclusions relative to the part played by birth-weight in the infant mortality excess of the city. This was true in relation to public pre-natal services, insufficient for the city as a whole, and becoming progressively still less numerically adequate in the outlying areas. It was also true in relation to the medical and hospital attendance at the birth and to the new-born infant, wich were adequate in quantitative terms for the city as a whole, but inadequate and unreliable for the population of the outlying areas. It was true for the availability of water supply and sanitation systems, which are reasonable only for the central area but practically non-existent in the outlying areas. At the same time, research on income distribution in são Paulo showed that the unequal distribution of the availability of those public services essential to the maintenance of infant coincides exactly with the unequal distribution of wealth. The final conclusion of this study was that it is mainly the inadequate living conditions wich await the new-born infant, especially in the outlying areas, and not his/her vitality as measured by birth-weight, which explain the infant mortality excess found in são Paulo.

MSc (Med), Population-Based Field Epidemiology, School of Public Health, University of the Witwatersrand, 2009 / Background: MDG 4 commits the international community to reducing mortality in children younger than 5 years by two-thirds by 2015.The biggest burden of child mortality lies in Saharan Africa. Objective: To investigate how distance from home to the nearest health facility is associated with infant and child (1-4 years) mortality in a typical rural setting of sub Saharan Africa. Methods: A secondary analysis of 28,823 under five children in Ifakara Health and Demographic surveillance system between 2005 and 2007 was carried out. Both Euclidean and networked distance from the household to the nearest health facility was estimated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on infant and child mortality. Results: Children who lived in homes with networked distance >5KM experienced about 18% increased mortality risk [HR=1.18;95%CI 1.02-1.38 p-value 0.05] compared to those who lived less than 5KM networked distance to the nearest health facility. Death of mother, death of preceding sibling and multiple births were the strongest independent predictors of child mortality. Malaria/AFI and pneumonia/ARI were the leading causes of death in children although there was no evidence to show association of cause specific mortality with networked distance in the study. vi Conclusions: Staying closer to the health facility improved the survival probability of the children. This effect was similar to that reported elsewhere in other studies which re-emphasize the usefulness of having fully functional health facilities closer to the populations that need them. The inconsistency of the Euclidean distance in the study further suggests that the networked distance is a better estimator of geographical accessibility and should be the preferred proxy distance measurement option in public health research. 1 Faculty of Health Sciences, University of the Witwatersrand; South Africa. 2 Ifakara Health & Demographic Surveillance System; Tanzania. 3 Iganga/Mayuge Health & Demographic Surveillance System; Uganda

Thesis (M.S.)--University of Delaware, 2007. / Principal faculty advisor: Thomas Ilvento, Dept. of Food & Resource Economics. Includes bibliographical references.

Parkinson's disease (PD) is the 14th leading cause of the death in the United States. There is a strong relationship between cognitive decline, subsequent dementia, and mortality in PD. Cognitive reserve contributes to the maintenance of cognitive functioning in old age. However, the importance of cognitive reserve in the clinical course of PD is largely unknown. The current study examined cognitive and psychosocial parameters and their effect on survival in PD. It was proposed that cognitive factors (most specifically, higher semantic fluency) and psychosocial factors (i.e., higher educational/occupational attainment, absence of threshold level depressive symptomatology, absence of a personal/familial psychiatric history, and having a spouse/life partner) will predict increased post-onset survival in PD. After obtaining informed consent, 192 PD participants underwent a 3-hour comprehensive neuropsychological evaluation, neurological examination, and interview. Results from a multivariate Cox proportional hazards model indicated that semantic fluency is predictive of post-onset survival in PD, independent of age of onset, disease duration at examination, gender, years of education, and disease stage. The present study did not find a relationship between psychosocial factors and post-onset survival in PD. These findings indicate that a brief assessment of semantic fluency, able to be obtained in a clinic in less than five minutes, may be a useful prognostic indicator of post-onset survival in PD.

The economic literature has found difficulty linking fertility and mortality rates. Previous versions of the dynastic (parental altruism) model have failed to predict the negative relationship between fertility and infant survival, since it was postulated that parents view children as normal goods and increases in childhood survival would result in a decrease in unit-child costs. In this work, I find that a simple reformulation of the Becker-Barro altruism hypothesis successfully predicts the observed demographic transition in the past century, as well as explaining fertility differences across countries. I contest that fertility decision is dependent on the number of surviving children and not the number of children born. Child bearing is therefore perceived as risk-taking behavior given the stochastic nature of childhood survival. Essentially, higher childhood survival requires fewer children (i.e., less "hoarding") in order to ensure the desired family size. The model predicts that higher childhood survival rates will lead to a decrease in fertility. I calibrate an infinitely-lived overlapping-generations dynastic utility model and compare the fertility predictions of the baseline model with the data for the year 2000. In doing so, I have relaxed the dual normalization of the utility of death and the overall level of utility. This is necessary given that the value of children's lives are important in the parent's fertility decision. Parents jointly care for the number and utility levels of their children. I will calibrate this number and estimate this implied value of life. I find that the consumption level an agent is indifferent between life and death to be less than 1% of current consumption. I also find that parents care for their children future 47% more than that of their own. All in all, this experiment finds that fertility differences cannot be explain by differences in mortality rates alone and that incorporating human capital investment in the household production function will yield desirable results. Simply stated, lower income countries have lower opportunity costs of birthing children and will choose quantity over quality. I find that the steady state analysis of this model can explain over 62% of the cross-country variation, while mortality rates alone can explain 10%-25%. The model generally performs better for low survival, high fertility countries and vice versa. While the model tends to perform well for these economies, more needs to be done to explain fertility in the transition economies.

Thesis (M. Phil.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.

This study utilized a multi-level model to examine the impact of religion as an occupation on mortality. Death certificate data were used to examine clergy mortality and compares them to census categorized professionals, counseling professionals and unmarried clergy. Individuals mortality exist in, and is influenced by the state they resided and died in. Because of this, they are not only examined on the individual level, they are also nested in their respective state of death. A series of hierarchical linear models were estimated in order to determine the effects of the different influence levels (individual and state). Findings suggest that clergy have a significant life advantage over professionals and counseling professionals. Married clergy have significant years of life disadvantage when compared to unmarried clergy. Implications of this research are discussed and considerations for future research are presented.

Background: Fibroblast growth factor 23 (FGF23) is the earliest marker of disturbed mineral metabolism as renal function decreases. Its serum levels are associated with mortality in dialysis patients, persons with chronic kidney disease (CKD) and prevalent cardiovascular disease (CVD), and it is associated with atherosclerosis, endothelial dysfunction and left ventricular hypertrophy in the general population. The primary aim of this study is to examine the association between FGF23 and mortality, in relation to renal function in the community. A secondary aim is to examine the association between FGF23 and CVD related death. Methods: The population-based cohort of MrOS Sweden included 3014 men (age 69-81 years). At inclusion intact FGF23, intact parathyroid hormone (PTH), 25 hydroxyl vitamin D (25D), calcium and phosphate were measured. Mortality data were collected after an average of 4.5 years follow-up. 352 deaths occurred, 132 of CVD. Association between FGF23 and mortality was analyzed in quartiles of FGF23. Kaplan-Meier curves and Log-rank test were used to examine time to events. Cox proportional hazards regression was used to examine the association between FGF23, in quartiles and as a continuous variable, with mortality. The associations were also analyzed in the sub-cohort with estimated glomerular filtration rate (eGFR) above 60 ml/min/1.73 m(2). Results: There was no association between FGF23 and all-cause mortality, Hazard ratio (HR) 95% confidence interval (CI): 1.02 (0.89-1.17). For CVD death the HR (95% CI) was 1.26 (0.99 - 1.59)/(1-SD) increase in log(10) FGF23 after adjustment for eGFR, and other confounders. In the sub-cohort with eGFR > 60 ml/min/1.73 m(2) the HR (95% CI) for CVD death was 55% (13-111)/(1-SD) increase in log(10) FGF23. Conclusions: FGF23 is not associated with mortality of all-cause in elderly community living men, but there is a weak association with CVD death, even after adjustment for eGFR and the other confounders. The association with CVD death is noticeable only in the sub-cohort with preserved renal function.