Feasibility of using death certificates for studying place of death in Latin America.

OBJECTIVE: This paper assesses the availability and quality of death certificate data in Latin America and the feasibility of using these data to study place of death and associated factors. METHODS: In this comparative study, we collected examples of current official death certificates and digital data files containing information about all deaths that occurred during 1 year in 19 Latin American countries. Data were collected from June 2019 to May 2020. The records for place of death and associated variables were studied. The criteria for data quality were completeness, number of ill-defined causes of death and timeliness. RESULTS: All 19 countries provided copies of current official death certificates and 18 of these registered the place of death. Distinguishing among hospital or other health care institution, home and other was possible for all countries. Digital data files with death certificate data were available from 12 countries and 1 region. Three countries had data considered to be of high quality and seven had data considered to be of medium quality. Categories for place of death and most of the predetermined factors possibly associated with place of death were included in the data files. CONCLUSIONS: The quality of data sets was rated medium to high in 10 countries. Hence, death certificate data make it feasible to conduct an international comparative study on place of death and the associated factors in Latin America.

Place of death and associated factors in 12 Latin American countries: A total population study using death certificate data.

Background: Little is known about place of death in Latin America, although this data are crucial for health system planning. This study aims to describe place of death and associated factors in Latin America and to identify factors that contribute to inter-country differences in place of death. Methods: We conducted a total population observational study using death certificates of the total annual decedent populations in 12 countries (Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Ecuador, Mexico, Paraguay, Peru, and Uruguay) for the most recent available year (2016, 2017, or 2018). Data were analysed regarding place of death and multivariable logistic regression with place of death as the dependent variable was used to examine associated clinical and sociodemographic factors (independent variables) in each of the countries. Results: The total study sample was 2 994 685 deaths; 31.3% of deaths occurred at home, and 57.6% in hospitals. A strong variation was found among the countries with home deaths ranging from 20% (Brazil) to 67.9% (Guatemala) and hospital deaths from 22.3% (Guatemala) to 69.5% (Argentina). These differences between countries remained largely unchanged after controlling for sociodemographic factors and causes of death. The likelihood of dying at home was consistently higher with increasing age, for those living in a rural area, and for those with a lower educational level (except in Argentina). Conclusions: Most deaths in Latin America occur in hospitals, with a strong variation between countries. As clinical and sociodemographic factors included in this study did not explain country differences, other factors such as policy and health care system seem to have a crucial impact on where people die in Latin America.

Evaluating Pain Management Practices for Cancer Patients among Health Professionals: A Global Survey.

Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large.

Feasibility of using death certificates for studying place of death in Latin America

Objective: this paper assesses the availability and quality of death certificate data in Latin America and the feasibility of using these data to study place of death and associated factors. Methods: in this comparative study, we collected examples of current official death certificates and digital data files containing information about all deaths that occurred during 1 year in 19 Latin American countries. Data were collected from June 2019 to May 2020. The records for place of death and associated variables were studied. The criteria for data quality were completeness, number of ill-defined causes of death and timeliness. Results: all 19 countries provided copies of current official death certificates and 18 of these registered the place of death. Distinguishing among hospital or other health care institution, home and other was possible for all countries. Digital data files with death certificate data were available from 12 countries and 1 region. Three countries had data considered to be of high quality and seven had data considered to be of medium quality. Categories for place of death and most of the predetermined factors possibly associated with place of death were included in the data files. Conclusions: the quality of data sets was rated medium to high in 10 countries. Hence, death certificate data make it feasible to conduct an international comparative study on place of death and the associated factors in Latin America.

Estructura familiar y redes de apoyo en los adultos mayores que acuden al centro de experiencia del adulto mayor CEAM - Quito / Family structure and support networks in older adults who come to the experience center for older adults CEAM - Quito

Objetivo: Describir las características de la estructura familiar y de las redes de apoyo social de las y los ancianos que acuden al centro de Experiencias del Adulto Mayor en Quito. Métodos: Realizamos un estudio cuantitativo, de corte transversal, con muestreo intencionado y al azar, en 42 adultos mayores usuarios del CEAM, en diciembre del 2004. La información se recolectó mediante familiogramas y la aplicación del cuestionario MOS de apoyo social. Resultados: En las 42 encuastas válidas la edad promedio fue 71.88 años; el 69% fueron ancianos jóvenes, el 22.2% ancianos medios, 4.8% ancianos frágiles. El 40.5% tienen familias extensas, 7.1% monoparentales 4.8% nucleares íntegras, 9.5% nucleares ampliadas y 38.1% son no clasificadas que se caracterizan por vivir solos. El promedio de amigos íntimos y familiares cercanos fue de 4.83 personas, moda de 3, desviación estándar de 6.99 y un rango entre 0 y 37. Los porcentajes encontrados en la escala máxima, media y mínima para el índice global de MOS fueron del 19%, 71,4% Y 9,5% respectivamente al diferenciar por tipos de familias el 100% de personas que reciben apoyo instrumental mínimo viven solas, el 100% que reciben apoyo instrumental máximo son familiares monoparentales. En las familias extensas, monoparentales y nucleares ampliadas no se encontraron categorías mínimas en el componente afectivo.

Objective: Describe the characteristics of the family structure and social support networks of people and the elderly who come to the Experiences Center for the Elderly in Quito. Methods: We carried out a quantitative cross-sectional study, with intentional and random sampling, in 42 elderly CEAM users, in December 2004. The information was collected using familiograms and the application of the MOS questionnaire on social support. Results: In the 42 valid surveys, the average age was 71.88 years; 69% were young elderly, 22.2% middle aged, 4.8% frail elderly. 40.5% have extended families, 7.1% single-parent 4.8% whole nuclear, 9.5% extended nuclear and 38.1% are unclassified, characterized by living alone. The average of close friends and close family members was 4.83 people, mode of 3, standard deviation of 6.99 and a range between 0 and 37. The percentages found on the maximum, mean and minimum scale for the global MOS index were 19% , 71.4% and 9.5% respectively, when differentiating by type of family, 100% of people who receive minimum instrumental support live alone, 100% who receive maximum instrumental support are single-parent family members. In the extended, single-parent and extended nuclear families, no minimum categories are found in the affective component.

Cuidado paliativo Domiciliario: Dos años de experiencia en Quito / Home palliative care: Two years of experience in Quito

Este artículo describe los dos primeros año de trabajo de un pequeño equipo de cuidado paliativo, trabajando en los domicilios, en la ciudad de Quito y la filosofía de este cuidado. De los 66 pacientes atendidos, el 77% conocía su diagnóstico. El 81% de pacientes fallecieron en su domicilio, esto en comparación con otros países es un porcentaje muy alto, por lo que explicamos las posibles causas.

This article describes the first two years of work of a small palliative care team, working at home in the city of Quito and the philosophy of this care. Of the 66 patients attended, 77% knew their diagnosis. 81% of patients died at home, this compared to other countries is a very high percentage, so we explain the possible causes.