Informação em mortalidade: o uso das regras internacionais para a seleção da causa básica

A análise da mortalidade tem sido muito usada em saúde pública, e a causa básica da morte é uma variável bastante estudada. Na maioria dos países, há obrigatoriedade de o médico preencher a declaração de óbito (DO), informando às autoridades a ocorrência do evento, características do falecido e causas da morte. Quando há dois ou mais diagnósticos na declaração das causas da morte, surge a questão da seleção da causa básica. As normas para o preenchimento das causas de morte pelos médicos nas DO e as regras para a seleção da causa básica, quando mais de uma causa é declarada, estão definidas pela OMS, visando à comparabilidade internacional. O objetivo deste trabalho é avaliar se a aplicação das Regras Internacionais de Classificação da causa básica permite a seleção da real causa básica, mesmo se declarada incorretamente pelo médico. O material pertence ao "Estudo sobre a mortalidade de mulheres em idade fértil", sendo que 1.315 casos satisfizeram os requisitos de inclusão. Para cada morte foi realizada uma investigação através de entrevistas domiciliárias, consultas aos prontuários hospitalares e assemelhados. Médicos treinados e calibrados preenchiam uma DO nova, após a leitura de toda a informação, e selecionavam a "verdadeira" causa básica da morte. Esta era comparada com a causa básica da DO original, obtida por meio das Regras Internacionais. Entre as DO, em 1.192 (90,6%) houve concordância com a verdadeira causa básica obtida após a investigação. Concluiu-se que as Regras Internacionais permitem selecionar a real causa básica, mesmo quando o médico preenche inadequadamente a DO

The Anopheles albitarsis complex with the recognition of Anopheles oryzalimnetes Wilkerson and Motoki, n. sp. and Anopheles janconnae Wilkerson and Sallum, n. sp. (Diptera: Culicidae)

The Anopheles (Nyssorhynchus) albitarsis complex includes six species: An. albitarsis, Anopheles oryzalymnetes Wilkerson and Motoki, n. sp., Anopheles marajoara, Anopheles dencorum, Anopheles janconnae Wilkerson and Sallum, n. sp., and An. albitarsis F. Except for An. deancorum, species of the complex are indistinguishable when only using morphology. The problematic distinction among species of the complex has made study of malaria transmission and ecology of An. albitarsis s.l. difficult. Consequently, involvement of species of the An. albitarsis complex in human Plasmodium transmission is not clear throughout its distribution range. With the aim of clarifying the taxonomy of the above species, with the exception of An. albitarsis F, we present comparative morphological and morphometric analyses, morphological redescriptions of three species and descriptions of two new species using individuals from populations in Brazil, Paraguay, Argentina and Venezuela. The study included characters from adult females, males, fourth-instar larvae, pupae and male genitalia of An. albitarsis, An. deaneorum and An. oryzalimnetes n. sp. For An. janconnae n. sp. only characters of the female, male and male genitalia were analysed. Fourth-instar larvae and pupae and male genitalia characteristics of all five species are illustrated. Bionomics and distribution data are given based on published literature records

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

OBJETIVO: Descrever o perfil de pacientes adultos residentes no município de São Paulo que evoluíram para óbito associado à tuberculose, segundo fatores biológicos, ambientais e institucionais. MÉTODOS: Estudo descritivo, abrangendo todos os óbitos por tuberculose (N=416) ocorridos em 2002, entre maiores de 15 anos. Os dados analisados foram obtidos do Sistema Municipal de Informações de Mortalidade, prontuários hospitalares, Serviço de Verificação de Óbitos e Sistema de Vigilância de Tuberculose. Os cálculos dos riscos relativos e intervalos de confiança de 95 por cento (IC 95 por cento) tiveram como referência o sexo feminino, grupo de 15 a 29 anos, e os naturais do Estado de São Paulo. A análise comparativa usou o teste do qui-quadrado de Pearson e o exato de Fisher para variáveis categóricas e o teste Kruskal-Wallis para variáveis contínuas. RESULTADOS: Do total de óbitos, 78 por cento apresentavam a forma pulmonar; o diagnóstico foi efetuado após a morte em 30 por cento e em unidades de atendimento primário em 14 por cento dos casos; 44 por cento não iniciaram tratamento; 49 por cento não foram notificados; 76 por cento eram homens e a mediana da idade foi de 51 anos; 52 por cento tinham até quatro anos de estudo, 4 por cento eram prováveis moradores de rua. As taxas de mortalidade aumentavam com a idade, sendo de 5,0/100.000 no município, variando de zero a 35, conforme o distrito. Para 82 de 232 pacientes com registro de tratamento, havia referência de tratamento anterior, e desses, 41 o haviam abandonado. Constatou-se presença de diabetes (16 por cento), doença pulmonar obstrutiva crônica (19 por cento), HIV (11 por cento), tabagismo (71 por cento) e alcoolismo (64 por cento) nos pacientes. CONCLUSÕES: Homens acima de 50 anos, migrantes e residentes em distritos com baixo Índice de Desenvolvimento Humano apresentam maiores riscos de óbito. )A pouca escolaridade e apresentar co-morbidades são características importante Observou-se baixa participação das unidades básicas de saúde no diagnóstico e a elevada sub-notificação

Mortes maternas e mortes por causas maternas

Ao mensurar-se mortalidade materna, é necessário distinguir ' mortes por causas maternas' e 'mortes maternas' Para a Organização Mundial da Saúde-OMS-,mortes maternas são as que ocorrem na gestação, no parto e até 42 dias após o parto; e mortes por causas maternas englobam as causas classificadas no Capítulo XV da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, Décima Revisão (CID-10), incluindo as ocorridas quando passados 42 dias do parto. Apresentam-se resultados da investigação de mortes femininas em idade fértil-10 a 49 anos- nas capitais de Estados e no Distrito Federal do Brasil, em 2002. Adotou-se a metodologia RAMOS, comparando-se as causas básicas das declarações de óbito originais com as das declarações preenchidas após o resgate de informações, obtidas em entrevistas domiciliares e prontuários. Entre as mortes por causas maternas originais, 15,9 por cento não eram mortes maternas, de acordo com a definição da OMS. Houve, concomitantemente, subenumeração de mortes maternas. Sugestões são feitas para melhorar o preenchimento das declarações de óbito e inclusão de novas categorias na CID-10, visando melhorar a informação das causas maternas

Echocardiographic study of paediatric patients with mucopolysaccharidosis

Principle Mucopolysaccharidosis is an inborn error of metabolism causing glucosaminoglycans tissue storage. Cardiovascular involvement is variable but contributes significantly towards the morbidity and mortality of the patients. Objective To characterise the echocardiographic abnormalities in children and adolescents with different types of mucopolysaccharidosis. Method Echocardiograms and medical records of 28 patients aged 2–14 years, seen from 2003 to 2005, were revised. At that time, the enzymatic replacement therapy was still not available in our institution.Results Echocardiographic alterations were detected in 26 patients (93 per cent), whereas 16 (57 per cent) had abnormal auscultation, and only 6 (21 per cent) presented with cardiovascular complaint. Mitral valve thickening with dysfunction (regurgitation, stenosis, or double lesion) was diagnosed in 60.8 per cent, left ventricular hypertrophy in 43 per cent and aortic valve thickening with regurgitation in 35.8 per cent of the patients. There was no systolic dysfunction and mild left diastolic dysfunction was shown in 21.5 per cent of the patients. Pulmonary hypertension was present in 36 per cent of the patients, causing the only two deaths recorded. There was a strong association between the accumulation of dermatan sulphate and the presence of mitral valve dysfunction (p = 0.0003), aortic valve dysfunction (p = 0.006), and pulmonary hypertension (p = 0.006). Among individuals with two or more examinations, 82 per cent had a worsening evolution. Conclusions Echocardiographic alterations in children with Mucopolysaccharidosis are frequent and have a progressive character Left valve lesions, ventricular hypertrophy, and pulmonary hypertension were the most common findings and there was an association between the accumulation of dermatan sulphate and cardiovascular involvement. Unlike in adults, pulmonary hypertension was the main cause of death, not left ventricle systolic dysfunction

Impact of outdoor biomass air pollution on hypertension hospital admissions

Background This study aimed to evaluate the association between the total suspended particles (TSP) generated from burning sugar cane plantations and the incidence of hospital admissions from hypertension in the city of Araraquara. Methods The study was an ecological time-series study. Total daily records of hypertension (ICD 10th I10-15) were obtained from admitted patients of all ages in a hospital in Araraquara, Sao Paulo State, Brazil, from 23 March 2003 to 27 July 2004. The daily concentration of TSP (mu g/m(3)) was obtained using a Handi-Vol sampler placed in downtown Araraquara. The local airport provided daily measures of temperature and humidity. In generalised linear Poisson regression models, the daily number of hospital admissions for hypertension was considered to be the dependent variable and the daily TSP concentration the independent variable. Results TSP presented a lagged effect on hypertension admissions, which was first observed 1 day after a TSP increase and remained almost unchanged for the following 2 days. A 10 mu g/m(3) increase in the TSP 3 day moving average lagged in 1 day led to an increase in hypertension-related hospital admissions during the harvest period (12.5%, 95% CI 5.6% to 19.9%) that was almost 30% higher than during non-harvest periods (9.0%, 95% CI 4.0% to 14.3%). Conclusions Increases in TSP concentrations were associated with hypertension-related hospital admissions. Despite the benefits of reduced air pollution in urban cities achieved by using ethanol produced from sugar cane to power automobiles, areas where the sugar cane is produced and harvested were found to have increased public health risk.

Multi-trait and random regression mature weight heritability and breeding value estimates in Nelore cattle

Mature weight breeding values were estimated using a multi-trait animal model (MM) and a random regression animal model (RRM). Data consisted of 82 064 weight records from 8 145 animals, recorded from birth to eight years of age. Weights at standard ages were considered in the MM. All models included contemporary groups as fixed effects, and age of dam (linear and quadratic effects) and animal age as covariates. In the RRM, mean trends were modelled through a cubic regression on orthogonal polynomials of animal age and genetic maternal and direct and maternal permanent environmental effects were also included as random. Legendre polynomials of orders 4, 3, 6 and 3 were used for animal and maternal genetic and permanent environmental effects, respectively, considering five classes of residual variances. Mature weight (five years) direct heritability estimates were 0.35 (MM) and 0.38 (RRM). Rank correlation between sires' breeding values estimated by MM and RRM was 0.82. However, selecting the top 2% (12) or 10% (62) of the young sires based on the MM predicted breeding values, respectively 71% and 80% of the same sires would be selected if RRM estimates were used instead. The RRM modelled the changes in the (co) variances with age adequately and larger breeding value accuracies can be expected using this model.

Genetic analysis of average annual productivity of Nellore breeding cows (COWPROD)

With the aim of estimating the coefficient of heritability of average annual productivity of Nellore cows (COWPROD), a data set from 24,855 animals with known pedigree was analyzed. COWPROD is defined as the amount (in kilograms) of weaned calves produced yearly by one cow during her remaining time in herd ignoring a fixed period of 365 days. COWPROD was calculated regarding three standards: a) based on the post-weaning weight from the calves ignoring any kind of adjustment (COWPROD_NAJ), b) adjusted weight for the fixed effects (COWPROD_AJFIX) and c) adjusted weight for the fixed effects and for the genetic merit of the sire (COWPROD_AJFIN). The obtained heritabilities were 0.15, 0.15 and 0.16 for COWPROD_NAJ, COWPROD_AJFIX and COWPROD_AJFIN, respectively. A complete set composed of 105,158 COWPROD records on 130,740 animals in pedigree was also analyzed for predicting the genetic merit of all animals in the data set and for the calculation of the genetic, phenotypic and residual trends. Ranking correlation was high for the adjusted and non-adjusted data, yet, for some of the animals, the difference among the genetic values was large. This would be an indication that it would be better to work always with the adjusted weaning weights. The genetic trend was positive, but was of small magnitude (0.26% of the trait average) and the residual trend was negative as a consequence of the large intensification of the production system, which has been occurring in the last years in the farms studied. The phenotypic trend was also negative and intermediate between the genetic and the residual ones.

The force, power, and energy of the 100 meter sprint

At the 2008 Summer Olympics in Beijing, Usain Bolt broke the world record for the 100 m sprint. Just one year later, at the 2009 World Championships in Athletics in Berlin he broke it again. A few months after Beijing, Eriksen [Am. J. Phys. 77, 224-228 (2009)] studied Bolt's performance and predicted that Bolt could have run about one-tenth of a second faster, which was confirmed in Berlin. In this paper we extend the analysis of Eriksen to model Bolt's velocity time dependence for the Beijing 2008 and Berlin 2009 records. We deduce the maximum force, the maximum power, and the total mechanical energy produced by Bolt in both races. Surprisingly, we conclude that all of these values were smaller in 2009 than in 2008.

Perturbative finiteness of three-dimensional supersymmetric QED to all orders

Within the superfield formalism, we study the ultraviolet properties of the three-dimensional super-symmetric quantum electrodynamics. The theory is shown to be finite at all loop orders in a particular gauge.

Hitting and returning to rare events for all alpha-mixing processes

We prove that for any a-mixing stationary process the hitting time of any n-string A(n) converges, when suitably normalized, to an exponential law. We identify the normalization constant lambda(A(n)). A similar statement holds also for the return time. To establish this result we prove two other results of independent interest. First, we show a relation between the rescaled hitting time and the rescaled return time, generalizing a theorem of Haydn, Lacroix and Vaienti. Second, we show that for positive entropy systems, the probability of observing any n-string in n consecutive observations goes to zero as n goes to infinity. (c) 2010 Elsevier B.V. All rights reserved.

Structure, stability, depolarized light scattering, and vibrational spectra of fullerenols from all-electron density-functional-theory calculations

We have investigated the stability, electronic properties, Rayleigh (elastic), and Raman (inelastic) depolarization ratios, infrared and Raman absorption vibrational spectra of fullerenols [C(60)(OH)(n)] with different degrees of hydroxylation by using all-electron density-functional-theory (DFT) methods. Stable arrangements of these molecules were found by means of full geometry optimizations using Becke's three-parameter exchange functional with the Lee, Yang, and Parr correlation functional. This DFT level has been combined with the 6-31G(d,p) Gaussian-type basis set, as a compromise between accuracy and capability to treat highly hydroxylated fullerenes, e.g., C(60)(OH)(36). Thus, the molecular properties of fullerenols were systematically analyzed for structures with n=1, 2, 3, 4, 8, 10, 16, 18, 24, 32, and 36. From the electronic structure analysis of these molecules, we have evidenced an important effect related to the weak chemical reactivity of a possible C(60)(OH)(24) isomer. To investigate Raman scattering and the vibrational spectra of the different fullerenols, frequency calculations are carried out within the harmonic approximation. In this case a systematic study is only performed for n=1-4, 8, 10, 16, 18, and 24. Our results give good agreements with the expected changes in the spectral absorptions due to the hydroxylation of fullerenes.

Quaternary paleoenvironments and relative sea-level changes in Marajo Island (Northern Brazil): Facies, delta(13)C, delta(15)N and C/N

The reconstruction of physical environments of Amazonian areas is of great interest to determine the dynamic evolution of the Amazon drainage basin. However. few studies have emphasized the Quaternary deposits in this region. which is mostly due to the lack of natural exposures imposed by the low topography. This work integrates facies analysis. radiocarbon dating, delta(13)C, delta(15)N, and C/N of an 124 m-thick core from an area located at the mouth of the Amazon River. northeastern Amazonia. The study records deposits up to 50.795 (14)C yr B P. in age. which formed in a variety of depositional environments including fluvial channel, tidal flat, outer estuarine basin to shallow marine. inner estuarine basin, estuarine channel and lagoon. Facies interpretation was significantly improved with the inclusion of delta(13)C, delta(15)N, and C/N analyses of organic matter extracted from the sediments The obtained values conform to a transitional. mostly estuarine paleosetting evolved during successive relative sea-level fluctuations. The results suggest fluvial deposition between 40,950 (+/- 590) and 50.795 (14)C yr B P, with a rise in relative sea level that commenced between 35,567 (+/- 649) and 39,079 (+/- 1114) (14)C yr B P. An overall transgression took place until 29,340 (+/- 340) (14)C yr B P., after which the relative sea level dropped, favoring valley rejuvenation and incision. Following this time up to 10,479 (+/- 34) (14)C yr B.P. a rise in relative sea level filled up the valley with estuarine deposits After 10.479(+/- 34) (14)C yr B.P., the estuary was replaced by a lagoon At the end of the Holocene, the coastline prograided approximately 45 km northward, replaci ng the lagoon by a lake system Despite the influence of eustatic fluctuations. regional tectonics played a significant role to create new space where these Late Pleistocene and Holocene sediments accumulated. (C) 2009 Elsevier B V All rights reserved.

Stratigraphy of near-valley head quaternary deposits and evidence of climate-driven slope-channel processes in southern Brazilian highlands

During the past 40 years colluvial and alluvial deposits have been used in Brazil as good indicators of regional landscape sensitivity to Quaternary environmental changes. In spite of the low resolution of most of the continental sedimentary record, geomorphology and sedimentology may favor palaeoenvironmental interpretation when supported by independent proxy data. This paper presents results obtained from pedostratigraphic sequences, in near-valley head sites of southern Brazilian highlands, based on geomorphologic. sedimentologic, micromorphologic, isotopic and palynologic data. Results point to environmental changes, with ages that coincide with Marine Isotopic Stages (MIS) 5b; 3; 2 and 1. During the late Pleistocene, although under temperatures and precipitation lower than today, the local record points to relatively wet local environments, where shallow soil-water saturated zones contributed to erosion and sedimentation during periods of climatic change, as during the transition between MIS 2 and MIS 1. Late Pleistocene events with ages that coincide with the Northern Hemisphere Younger Dryas are also depicted. During the mid Holocene, slope-wash deposits suggest a climate drier than today, probably under the influence of seasonally contrasted precipitation regimes. The predominance of overland flow-related sedimentary deposits suggests an excess of precipitation over evaporation that influenced local palaeohydrology. This environmental condition seems to be recurrent and explains how slope morphology had influenced pedogenesis and sedimentation in the study area. Due to relative sensitiveness, resilience and short source-to-sink sedimentary pathways, near-valley head sites deserve further attention in Quaternary studies in the humid tropics. (c) 2008 Elsevier B.A. All rights reserved.