[Suicide in the state of São Paulo, Brazil: comparing Public Safety and Health data]. / O suicídio no estado de São Paulo, Brasil: comparando dados da Segurança Pública e da Saúde.

Suicide is prevalent among people of almost all ages and has a high social and economic cost. It is widely known, however, that its true prevalence is underestimated. This article aims to study suicide in São Paulo based on Public Safety data, compared with mortality information system data (SIM/MS), in order to assess possible information gains. A database (Banco SSP) was assembled from spreadsheets for police reports, complemented with existing Forensic Medicine Institute information, which was compared with the SIM/MS data. The Banco SSP database (2,469) was 7.5% higher than SIM/MS (2,297), with results reflected in the sex and age of the victims, showing the highest rates among elderly men (rate of 12.8 per 100,000 inhabitants). In relation to the method of suicide, there was a predominance of hanging (60.2%); 92.5% of unspecified cases were clarified, with an increase in deaths from exogenous poisoning (55.7%). The police reports revealed variables considered as possible risk factors for suicide, such as the mention of mental disorders (39.4%), other pathologies (5.0%), other problems (23.2%) and earlier attempted suicides (10.0%). The source studied enabled obtaining quantitative and qualitatively enhanced data compared to the SIM/MS data.

O suicídio afeta pessoas de quase todas as idades e tem elevado custo social e econômico. Sabe-se, porém, que sua ocorrência é subestimada. O objetivo deste artigo é estudar o suicídio em São Paulo segundo dados da Segurança Pública, comparando com os do Ministério da Saúde (SIM/MS), a fim de mensurar possíveis ganhos de informação. Foi elaborado um banco (Banco SSP) a partir de planilhas de boletins de ocorrência policial, complementado com informações do Instituto Médico Legal, o qual foi comparado com os dados do SIM/MS. O Banco SSP (2.469) mostrou-se 7,5% mais elevado que o SIM/MS (2.297), resultados que se refletiram no sexo e idade das vítimas, mostrando taxas mais elevadas em homens idosos (taxa 12,8 por 100 mil habitantes). Quanto ao meio utilizado, verificou-se predomínio do enforcamento (60,2%); 92,5% de casos não especificados puderam ser esclarecidos, verificando-se aumento nas mortes por intoxicações exógenas (55,7%). O histórico policial permitiu conhecer variáveis consideradas como possíveis fatores de risco para o suicídio, como menção a transtornos mentais (39,4%), outras patologias (5,0%), outros problemas (23,2%) e tentativas anteriores (10,0%). A fonte estudada possibilitou ganho quantitativo e qualitativo em relação ao SIM/MS.

[Deaths due to infectious diseases in women: occurrences in pregnancy and puerperium]. / Mortes por doenças infecciosas em mulheres: ocorrências no ciclo gravídico-puerperal.

OBJECTIVE: To describe deaths due to infectious diseases as an underlying or multiple cause, identifying cases of pre-existent infectious diseases or ones developed during pregnancy; deaths due to an indirect obstetric cause and deaths due to Aids or other infectious diseases during pregnancy or post-partum, however difficult to classify. METHODS: RAMOS methodology was adopted (by investigation in the household and medical records of the deceased, a new death certificate was filled out with the real causes concerning deaths of women from 10 to 49 years of age, residents in Brazilian capital cities,during the first semester of 2002. RESULTS: A total of 7,332 female cases was analyzed, according to underlying and multiple causes of death, of which 917 were due to infectious diseases (mainly Aids and tuberculosis). In 37 cases, the deceased was pregnant or in an 'extended' puerperium (including) post-partum from 43 days up to one year). Of these, 10 were not indirect obstetric deaths, but the underlying cause was an infectious disease and 14 were classified as indirect obstetric deaths. Regarding multiple causes, 791 cases (neither maternal nor infectious disease as underlying cause) generated 1,016 mentions of infectious diseases (1.28 mentions/death). CONCLUSION: As the frequency of maternal deaths is low, investigations on the near miss (severe cases due to complications of pregnancy and puerperium who survived) are recommended, because they occur in larger numbers and are a relevant contribution to studies on maternal mortality.

[Treatment of injuries in emergency departments: characteristics of victims and place of injury, São Paulo State, Brazil, 2005]. / Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005.

The objective of this study was to analyze the characteristics and place of occurrence of injuries treated in emergency departments. A total of 35,107 emergency department visits for injuries were analyzed, excluding traffic injuries, in São Paulo State, Brazil, 2005. The majority of victims were male (59.1%), and from 0 to 29 years of age (62.1%). Leading causes were falls (39.3%) and accidental blows (16.5%). Most injuries occurred in the home (64.7%), followed by public places (19.9%). Assaults were more frequent in public. Women were more likely to suffer injuries at home, as compared to men (OR = 0.51; 95% CI: 0.48-0.53). Men were 1.34 times more likely to be injured in public places, 3.22 times in bars, and 2.82 times in the workplace. A higher proportion of events among children aged 0 to 9 and individuals 60 years or older occurred at home. The results highlighted the home as an important place for the occurrence of injuries, which should be considered when planning injury prevention programs.

Deaths of women hospitalized for childbirth and abortion, and of their concept, in maternity wards of Brazilian public hospitals. / Mortes de mulheres internadas para parto e por aborto e de seus conceptos em maternidades públicas.

The aim of this cross-sectional hospital-based study of 7,845 pregnancies was to analyze deaths of women hospitalized for childbirth and abortion, and fetal and neonatal deaths, in public hospitals in the cities of São Paulo, Rio de Janeiro and Niteroi (RJ), Brazil, in 2011. Outcomes of the pregnancies were: one maternal death, 498 abortions, 65 fetal deaths, 44 neonatal deaths and 7,291 infant survivors. Data were collected through interviews, medical records and the women's pregnancy records, and from the Mortality Information System (SIM). The study population was described and kappa coefficients of causes of death (from the SIM, and certified by research) and mortality health indicators were estimated. The maternal mortality ratio was 13.6 per 100,000 live births (LB), the fetal death rate was 8.8‰ births and the neonatal mortality rate was 6.0‰ LB. The drug most used to induce abortion was Misoprostol. The main causes of fetal and neonatal deaths were respiratory disorders and maternal factors. Congenital syphilis, diabetes and fetal death of unspecified cause were under-reported in the SIM. Kappa coefficients by chapter were 0.70 (neonatal deaths) and 0.54 (stillbirths). Good quality care in reproductive planning, prenatal care, during labor and at birth will result in prevention of deaths.

O objetivo deste estudo foi analisar mortes de mulheres internadas para parto e por aborto, e de seus conceptos ­ fetais e neonatais ­ em maternidades públicas nas cidades de São Paulo, Rio de Janeiro e Niterói (RJ), em 2011. Estudo seccional de base hospitalar. Participaram 7.845 mulheres resultando em um óbito materno, 498 abortos, 65 óbitos fetais, 44 óbitos neonatais e 7.291 sobreviventes infantis. Dados foram obtidos por meio de entrevista, consulta ao prontuário, cartão da gestante e no Sistema de Informações sobre Mortalidade (SIM). Foi descrita a população de estudo e estimados a concordância da causa básica (SIM e certificada pela pesquisa) e os indicadores de mortalidade. A mortalidade materna foi 13,6 por cem mil nascidos vivos (NV), fetal 8,8‰ nascimentos e neonatal 6,0‰ NV. Misoprostol foi o medicamento mais utilizado no aborto provocado. Transtornos respiratórios e fatores maternos foram as principais causas entre óbitos fetais e neonatais. Sífilis congênita, diabetes e causas de morte fetal não especificada foram subdeclaradas no SIM. Os coeficientes kappa por capítulo foram 0,70 (neonatais) e 0,54 (natimortos). A assistência de boa qualidade no planejamento reprodutivo, pré-natal, durante o parto e nascimento resultará na prevenção das mortes.

Hospitalization due to road traffic injuries in Brazil, 2013: hospital stay and costs. / Internações hospitalares por lesões decorrentes de acidente de transporte terrestre no Brasil, 2013: permanência e gastos.

Objetivo: to describe hospitalization rates and to estimate hospital costs and time spent in hospital due to road traffic accidents (RTA) in Brazil, in 2013. Methods: this is an ecological study conducted using data from the Brazilian National Hospital Information System. Results: in 2013, 170,805 hospitalizations due to RTA were funded by the Brazilian National Health System; 78.2% of the individuals were male, 48.6% were from 20 to 39 years old, and 51.9% were motorcyclists; RTA hospitalization rate was of 85.0 hospitalizations/100,000 inhabitants; total cost was BRL 231,469,333.13, with 1,072,557 hospital inpatient days and average stay of 6.3 days in hospital. Conclusion: the magnitude of hospitalization due to RTA was high; victims hospitalized were mainly men, young adults and motorcyclists; average stay in hospital was almost a week, implying significant costs.

O suicídio no estado de São Paulo, Brasil: comparando dados da Segurança Pública e da Saúde / Suicide in the state of São Paulo, Brazil: comparing Public Safety and Health data

Resumo O suicídio afeta pessoas de quase todas as idades e tem elevado custo social e econômico. Sabe-se, porém, que sua ocorrência é subestimada. O objetivo deste artigo é estudar o suicídio em São Paulo segundo dados da Segurança Pública, comparando com os do Ministério da Saúde (SIM/MS), a fim de mensurar possíveis ganhos de informação. Foi elaborado um banco (Banco SSP) a partir de planilhas de boletins de ocorrência policial, complementado com informações do Instituto Médico Legal, o qual foi comparado com os dados do SIM/MS. O Banco SSP (2.469) mostrou-se 7,5% mais elevado que o SIM/MS (2.297), resultados que se refletiram no sexo e idade das vítimas, mostrando taxas mais elevadas em homens idosos (taxa 12,8 por 100 mil habitantes). Quanto ao meio utilizado, verificou-se predomínio do enforcamento (60,2%); 92,5% de casos não especificados puderam ser esclarecidos, verificando-se aumento nas mortes por intoxicações exógenas (55,7%). O histórico policial permitiu conhecer variáveis consideradas como possíveis fatores de risco para o suicídio, como menção a transtornos mentais (39,4%), outras patologias (5,0%), outros problemas (23,2%) e tentativas anteriores (10,0%). A fonte estudada possibilitou ganho quantitativo e qualitativo em relação ao SIM/MS.

Abstract Suicide is prevalent among people of almost all ages and has a high social and economic cost. It is widely known, however, that its true prevalence is underestimated. This article aims to study suicide in São Paulo based on Public Safety data, compared with mortality information system data (SIM/MS), in order to assess possible information gains. A database (Banco SSP) was assembled from spreadsheets for police reports, complemented with existing Forensic Medicine Institute information, which was compared with the SIM/MS data. The Banco SSP database (2,469) was 7.5% higher than SIM/MS (2,297), with results reflected in the sex and age of the victims, showing the highest rates among elderly men (rate of 12.8 per 100,000 inhabitants). In relation to the method of suicide, there was a predominance of hanging (60.2%); 92.5% of unspecified cases were clarified, with an increase in deaths from exogenous poisoning (55.7%). The police reports revealed variables considered as possible risk factors for suicide, such as the mention of mental disorders (39.4%), other pathologies (5.0%), other problems (23.2%) and earlier attempted suicides (10.0%). The source studied enabled obtaining quantitative and qualitatively enhanced data compared to the SIM/MS data.

Pragmatic criteria of the definition of neonatal near miss: a comparative study.

OBJECTIVE: The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals. METHODS: A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5' Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births. RESULTS: A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0-6 to 0-27 days, and there is a decrease when it goes to 0-364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition. CONCLUSIONS: The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.

[Morbidity and mortality due to external causes among the elderly in the South of Brazil]. / Morbimortalidade por causas externas na população idosa residente em município da região sul do Brasil.

We analyzed morbidity and mortality rates due to external causes among elderly persons in a city in the South of Brazil. Data about deaths, from 1979 to 1998, and about hospital admissions, from 1995 to 1998, were obtained from the Mortality Information System and the Hospital Information System of the Brazilian Ministry of Health. Population data were based on the national demographic census. Mortality rates due to external causes decreased 16.2%, but levels increased in advanced ages, especially for women. Falls, pedestrian accidents and other road accidents were the most important external causes of death in this population. In the last three years of this study, mortality rates were higher for pedestrian accidents among men and for falls among women (64.8 and 58.3 per 100.000 inhabitants, respectively). Hospital admissions due to injuries and intoxications decreased in the period. Among the 146 admissions in 1998, 45.9% were due to falls. The community has to recognize that elderly persons are exposed to accidents and that preventive measures are needed.

Estimate of physical sequelae in victims of road traffic accidents hospitalized in the Public Health System. / Estimativa de sequelas físicas em vítimas de acidentes de transporte terrestre internadas em hospitais do Sistema Único de Saúde.

OBJECTIVES: To describe the profile of the victims of road accidents presenting physical sequelae, according to the criteria established by researchers and analyze the trends in hospitalization for this cause in Brazil, from 2000 to 2013. METHODS: An ecological time-series study was performed using the data from the Hospital Information System of the National Health System (SUS). Trends in hospitalization were estimated using Prais-Winstein regression. RESULTS: During this period, a total of 1,747,191 hospitalizations for traffic accidents were registered; 410,448 were victims with physical sequelae. About 77.7% of them were male subjects, 26.5% belonged to the age group of 20 - 29 years, 46.4% lived in Southeast Brazil, 44.0% were pedestrians, and 31.1% were motorcyclists. In total, 51,189 cases were "confirmed" sequelae (12.5%), and pedestrians accounted for 43.8% of cases. There were 359,259 hospitalizations for the diagnosis of "possible" sequelae, and motorcyclists accounted for 43.3% of these cases. There was a trend of stability for all the patients with confirmed and possible sequelae, but there was a significant rise in hospitalization rates owing to confirmed sequelae among the men in North and Central-West regions. CONCLUSION: The hospitalizations associated with physical sequelae were responsible for about one-fourth of the hospitalizations in the Hospital Information System in the studied period. Most events involved men, young adults, residents in Southeast Brazil, and pedestrians. Hospitalization rates for traffic accidents associated with physical sequelae were stable in Brazil and regions, but a significant increase was observed for confirmed sequelae among men in the North and Central-West regions.

Use of primary diagnosis during hospitalization in the Unified Health System (Sistema Único de Saúde) to qualify information regarding the underlying cause of natural deaths among the elderly. / Uso do diagnóstico principal das internações do Sistema Único de Saúde para qualificar a informação sobre causa básica de mortes naturais em idosos.

INTRODUCTION:: Ill-defined causes of death are common among the elderly owing to the high frequency of comorbidities and, consequently, to the difficulty in defining the underlying cause of death. OBJECTIVE:: To analyze the validity and reliability of the "primary diagnosis" in hospitalization to recover the information on the underlying cause of death in natural deaths among the elderly whose deaths were originally assigned to "ill-defined cause" in their Death Certificate. The hospitalizations occurred in the state of Rio de Janeiro, in 2006. METHODS:: The databases obtained in the Information Systems on Mortality and Hospitalization were probabilistically linked. The following data were calculated for hospitalizations of the elderly that evolved into deaths with a natural cause: concordance percentages, Kappa coefficient, sensitivity, specificity, and the positive predictive value of the primary diagnosis. Deaths related to "ill-defined causes" were assigned to a new cause, which was defined based on the primary diagnosis. RESULTS:: The reliability of the primary diagnosis was good, according to the total percentage of consistency (50.2%), and fair, according to the Kappa coefficient (k = 0.4; p < 0.0001). Diseases related to the circulatory system and neoplasia occurred with the highest frequency among the deaths and the hospitalizations and presented a higher consistency of positive predictive values per chapter and grouping of the International Classification of Diseases. The recovery of the information on the primary cause occurred in 22.6% of the deaths with ill-defined causes (n = 14). CONCLUSION:: The methodology developed and applied for the recovery of the information on the natural cause of death among the elderly in this study had the advantage of effectiveness and the reduction of costs compared to an investigation of the death that is recommended in situations of non-linked and low positive predictive values. Monitoring the mortality profile by the cause of death is necessary to periodically update the predictive values.

The study of the mother-child binomium: description and general results.

OBJECTIVE: The present study investigated the characteristics of women during pregnancy/immediate postpartum cycles and the product of their pregnancy. METHOD: Data collection was conducted for a period of three months in 2011, in six maternity hospitals in the State of São Paulo. The data were obtained in an interview with the women after the end of the pregnancy and collected from hospital records. The sample included 7,058 women hospitalized for abortion or childbirth in five hospitals from SUS (Unified Health System) and from only one hospital for private health insurance patients and their 6,602 conceptuses (live births and stillborns). Statistical analysis was based on χ2 tests, with a significance level of α = 5%. RESULTS: It was observed that 6,530 women gave birth and 528 showed interruption of pregnancy. Regarding age, 1,448 were teenagers (20.5%). There were no deaths during hospitalization and 99.8% of women received a medical discharge. Maternal morbidity in the current pregnancy was analyzed, showing urinary tract infection, anemia and excessive vomiting as the main problems. The rate of cesarean sections accounted for 31.1% and complications in childbirth and postpartum were shown, respectively, by 834 (12.8%) and 265 (4.1%) women. The characteristics of the conceptuses were also studied: gestation length (9.3% of preterm among live births, and 68% among the stillborn); birth weight (underweight in 8.2% among live births, and 66% among the stillborn) and morbidity, measured by congenital anomalies and other diseases; these diseases were responsible for ICU stay, transfers to better-equipped hospitals (10 cases) and 37 deaths. Thirteen live births were still hospitalized at the end of the investigation.

Cardiovascular diseases in the elderly: analysis of the behavior of mortality in a municipality in the Southern Region of Brazil from 1979 to 1998.

OBJECTIVE: To know the behavior of mortality due to cardiovascular diseases in the elderly living in the municipality of Maringá, in the Brazilian state of Paraná. METHODS: The causes of death over 20 years were studied according to sex, age, and groupings of the International Classification of Diseases, 9th and 10th Revisions, using the mortality database of the Ministry of Health. RESULTS: In regard to total deaths in the elderly, the proportional mortality due to cerebrovascular disease and ischemic heart disease decreased 42.5% and 34.4%, respectively, while that due to hypertension increased 119%, increasing from 2.1% to 4.6%. A 51.2%, 44.6%, and 12.5% decrease occurred, respectively, in the risk of death due to cerebrovascular disease, ischemic heart disease, and other forms of heart disease. For cerebrovascular disease and ischemic heart disease, the decrease in the estimate of the risk of death was greater among women, while for the other forms of heart disease, the decrease was greater among men. In regard to age groups, the risk of death increases as age advances for each cardiovascular disease in both sexes. CONCLUSION: Cardiovascular diseases continue to play an important role in morbidity and mortality in the elderly population, requiring even greater effort from health care providers for their prevention and treatment.

Deaths from external causes in Cuiabá, 0 a 24 years: Profile of victims and families according to intentionality.

In view of the importance of knowing the circumstances associated with external causes (accidents and violence), this study analyzes the profile of the victims and their families as to the intentionality of the event (intentional or accidental). Cross-sectional study, which population comprise children, adolescents, and young people (age 0 to 24) who lived in Cuiabá, MT, and died from external causes in 2009. The data, processed by the Epi-Info software, were taken from the Declarations of Death and interviews with the families of the victims. The nonparametric chi-square test showed statistically significant differences between accidental and intentional deaths by sex and the type of accident or violence, the occurrence of the previous event external cause, parental education, family type, income, responsible for supporting the house, mother's age and caregiver. Among the victims, male participation (88.7 %) stands out compared to female (11.3 %). 50.0% of the deaths of females were accidental and 50.0% intentional; 68.2% of the deaths of males were intentional, 29.1% accidental and 2.7% from undetermined intent. Among the intentional deaths, 72.5% of the victims had already suffered violence. As the degree of instruction of the parents increases, intentional deaths decrease. The proportion of reconstituted/fragmented families is higher for fatal accidents. Intentional causes increase as family income decreases and the age of the parents increases. The agglomeration of people in the homes is higher for intentional deaths. Analizing the profiles of families and victims as to the intentionality of the event allows directing local prevention and control policies.

Mortes de mulheres internadas para parto e por aborto e de seus conceptos em maternidades públicas / Deaths of women hospitalized for childbirth and abortion, and of their concept, in maternity wards of Brazilian public hospitals

Resumo O objetivo deste estudo foi analisar mortes de mulheres internadas para parto e por aborto, e de seus conceptos - fetais e neonatais - em maternidades públicas nas cidades de São Paulo, Rio de Janeiro e Niterói (RJ), em 2011. Estudo seccional de base hospitalar. Participaram 7.845 mulheres resultando em um óbito materno, 498 abortos, 65 óbitos fetais, 44 óbitos neonatais e 7.291 sobreviventes infantis. Dados foram obtidos por meio de entrevista, consulta ao prontuário, cartão da gestante e no Sistema de Informações sobre Mortalidade (SIM). Foi descrita a população de estudo e estimados a concordância da causa básica (SIM e certificada pela pesquisa) e os indicadores de mortalidade. A mortalidade materna foi 13,6 por cem mil nascidos vivos (NV), fetal 8,8‰ nascimentos e neonatal 6,0‰ NV. Misoprostol foi o medicamento mais utilizado no aborto provocado. Transtornos respiratórios e fatores maternos foram as principais causas entre óbitos fetais e neonatais. Sífilis congênita, diabetes e causas de morte fetal não especificada foram subdeclaradas no SIM. Os coeficientes kappa por capítulo foram 0,70 (neonatais) e 0,54 (natimortos). A assistência de boa qualidade no planejamento reprodutivo, pré-natal, durante o parto e nascimento resultará na prevenção das mortes.

Abstract The aim of this cross-sectional hospital-based study of 7,845 pregnancies was to analyze deaths of women hospitalized for childbirth and abortion, and fetal and neonatal deaths, in public hospitals in the cities of São Paulo, Rio de Janeiro and Niteroi (RJ), Brazil, in 2011. Outcomes of the pregnancies were: one maternal death, 498 abortions, 65 fetal deaths, 44 neonatal deaths and 7,291 infant survivors. Data were collected through interviews, medical records and the women's pregnancy records, and from the Mortality Information System (SIM). The study population was described and kappa coefficients of causes of death (from the SIM, and certified by research) and mortality health indicators were estimated. The maternal mortality ratio was 13.6 per 100,000 live births (LB), the fetal death rate was 8.8‰ births and the neonatal mortality rate was 6.0‰ LB. The drug most used to induce abortion was Misoprostol. The main causes of fetal and neonatal deaths were respiratory disorders and maternal factors. Congenital syphilis, diabetes and fetal death of unspecified cause were under-reported in the SIM. Kappa coefficients by chapter were 0.70 (neonatal deaths) and 0.54 (stillbirths). Good quality care in reproductive planning, prenatal care, during labor and at birth will result in prevention of deaths.

Pragmatic criteria of the definition of neonatal near miss: a comparative study / Critérios pragmáticos da definição de near miss neonatal: um estudo comparativo

ABSTRACT OBJECTIVE The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals. METHODS A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5' Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births. RESULTS A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0-6 to 0-27 days, and there is a decrease when it goes to 0-364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition. CONCLUSIONS The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.

RESUMO OBJETIVO Testar a validade dos critérios pragmáticos de definições de near miss neonatal, estendendo-as para todo o período infantil, e estimar indicadores de assistência perinatal em maternidades públicas. MÉTODOS Constituiu-se uma coorte de nascidos vivos de seis maternidades dos municípios de São Paulo, Niterói e Rio de Janeiro em 2011. Foram realizadas entrevistas e consultas aos cartões de pré-natal e prontuários. Critérios pragmáticos (peso ao nascer, idade gestacional e escore de Apgar 5') das definições de near miss de Pileggi et al., Pileggi-Castro et al., Souza et al. e Silva et al. foram comparados. Foram calculados sensibilidade, especificidade (padrão-ouro: óbito infantil), percentual de óbitos entre recém-nascidos com ameaça à vida e taxas de near miss, mortalidade e desfechos graves por 1.000 nascidos vivos. RESULTADOS Foram analisados 7.315 recém-nascidos (completude das informações > 99%). A sensibilidade da definição de Pileggi-Castro et al. foi maior, resultando em um maior número de casos de near miss; a de Souza et al. apresentou menor valor, e as de Pileggi et al. e de Silva et al. apresentaram valores intermediários. Há um aumento da sensibilidade quando se estende o período de 0-6 para 0-27 dias, e um declínio quando se amplia para 0-364 dias. Especificidades foram elevadas (≥ 97%) e superiores às sensibilidades (54% a 77%). Uma maternidade de São Paulo e outra de Niterói apresentaram, respectivamente, as menores e as maiores: taxas de mortalidade infantil, near miss, e frequência de nascimentos em situação de ameaça à vida, independentemente da definição. CONCLUSÕES As definições de near miss baseadas exclusivamente em critérios pragmáticos são válidas e podem ser utilizadas para fins de monitoramento. Com base na literatura perinatal, os pontos de corte adotados por Silva et al. foram mais adequados. Estudos periódicos poderiam aplicar uma definição mais completa, com incorporação de critérios clínicos, laboratoriais e de manejo, incluindo as anomalias congênitas preditoras do óbito infantil.

Estimativa de sequelas físicas em vítimas de acidentes de transporte terrestre internadas em hospitais do Sistema Único de Saúde / Estimate of physical sequelae in victims of road traffic accidents hospitalized in the Public Health System

Resumo: Objetivos: Descrever o perfil das vítimas que foram internadas por lesões decorrentes de acidentes de transporte terrestre (ATT) e com diagnóstico sugestivo de sequelas físicas, no Brasil, de 2000 a 2013, e analisar sua tendência temporal neste período. Métodos: Estudo ecológico com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Foi utilizada regressão de Prais-Winstein para estudo das tendências. Resultados: No período estudado, ocorreram 1.747.191 internações por ATT. O estudo destas identificou 410.448 pessoas (23,5%) com diagnóstico sugestivo de sequelas físicas. Destas, 77,7% eram do sexo masculino, 26,5% na faixa etária de 20 a 29 anos, 46,4% residentes na Região Sudeste, 32,5% pedestres e 31,1% motociclistas. Para sequela "certeza" foram observadas 51.189 casos (12,5%), 43,8% eram pedestres. Houve 359.259 internações cujo diagnóstico sugeria sequela física "provável", destes 43,3% eram motociclistas. A tendência foi de estabilidade para as internações por ATT relacionadas ao total de pacientes com sequelas físicas e com sequela "provável". Todavia, foi observado aumento nas internações por ATT com diagnóstico sugestivo de sequela "certeza" no sexo masculino e nas regiões Norte e Centro-Oeste. Conclusão: As internações com diagnóstico sugestivo de sequelas físicas representaram cerca de 1/4 das internações por ATT registradas. As maiores proporções foram no sexo masculino, entre os adultos jovens, residentes na região Sudeste e entre os pedestres. Houve estabilidade na tendência das taxas de internação por ATT com diagnóstico sugestivo de sequelas físicas para o Brasil e regiões, mas tendência ascendente para sequela "certeza" para a região Centro-Oeste e Norte e para o sexo masculino.

Abstract: Objectives: To describe the profile of the victims of road accidents presenting physical sequelae, according to the criteria established by researchers and analyze the trends in hospitalization for this cause in Brazil, from 2000 to 2013. Methods: An ecological time-series study was performed using the data from the Hospital Information System of the National Health System (SUS). Trends in hospitalization were estimated using Prais-Winstein regression. Results: During this period, a total of 1,747,191 hospitalizations for traffic accidents were registered; 410,448 were victims with physical sequelae. About 77.7% of them were male subjects, 26.5% belonged to the age group of 20 - 29 years, 46.4% lived in Southeast Brazil, 44.0% were pedestrians, and 31.1% were motorcyclists. In total, 51,189 cases were "confirmed" sequelae (12.5%), and pedestrians accounted for 43.8% of cases. There were 359,259 hospitalizations for the diagnosis of "possible" sequelae, and motorcyclists accounted for 43.3% of these cases. There was a trend of stability for all the patients with confirmed and possible sequelae, but there was a significant rise in hospitalization rates owing to confirmed sequelae among the men in North and Central-West regions. Conclusion: The hospitalizations associated with physical sequelae were responsible for about one-fourth of the hospitalizations in the Hospital Information System in the studied period. Most events involved men, young adults, residents in Southeast Brazil, and pedestrians. Hospitalization rates for traffic accidents associated with physical sequelae were stable in Brazil and regions, but a significant increase was observed for confirmed sequelae among men in the North and Central-West regions.

Uso do diagnóstico principal das internações do Sistema Único de Saúde para qualificar a informação sobre causa básica de mortes naturais em idosos / Use of primary diagnosis during hospitalization in the Unified Health System (Sistema Único de Saúde) to qualify information regarding the underlying cause of natural deaths among the elderly

RESUMO: Introdução: Causas mal definidas de morte destacam-se entre idosos devido à alta frequência de comorbidades e consequente dificuldade de definir a causa básica. Objetivo: Analisar a validade e a confiabilidade da informação “diagnóstico principal” da internação hospitalar para recuperação da causa de morte natural de idosos que tiveram originalmente “causas mal definidas” como causa básica nas Declarações de Óbito, ocorridas no estado do Rio de Janeiro, em 2006. Métodos: As bases de dados obtidas dos Sistemas de Informações sobre Mortalidade e de Internação Hospitalar foram relacionadas probabilisticamente. Foram calculados percentuais de concordância, coeficiente Kappa, sensibilidade, especificidade e valor preditivo positivo do diagnóstico principal da internação de idosos que evoluíram para óbito por causas naturais. Óbitos por “causas mal definidas” tiveram uma nova causa definida a partir do diagnóstico principal. Resultados: A confiabilidade do diagnóstico principal foi boa, segundo a concordância percentual total (50,2%), e razoável, conforme o coeficiente Kappa (k = 0,4; p < 0,0001). Doenças do aparelho circulatório e neoplasias ocorreram com maior frequência entre os óbitos e as internações e apresentaram maior concordância e valores preditivos positivos por capítulo e agrupamento da Classificação Internacional de Doenças. A recuperação da causa básica ocorreu em 22,6% dos óbitos por causas mal definidas (n = 14). Conclusão: A metodologia desenvolvida e aplicada para recuperação da causa natural de óbito entre idosos neste estudo tem como vantagens a efetividade e a redução dos custos provenientes de uma investigação do óbito. Esta é recomendada nas situações de registros não relacionados e de baixo valor preditivo positivo. O monitoramento do perfil de mortalidade por causas é necessário para atualização periódica dos valores preditivos.

ABSTRACT: Introduction: Ill-defined causes of death are common among the elderly owing to the high frequency of comorbidities and, consequently, to the difficulty in defining the underlying cause of death. Objective: To analyze the validity and reliability of the “primary diagnosis” in hospitalization to recover the information on the underlying cause of death in natural deaths among the elderly whose deaths were originally assigned to “ill-defined cause” in their Death Certificate. The hospitalizations occurred in the state of Rio de Janeiro, in 2006. Methods: The databases obtained in the Information Systems on Mortality and Hospitalization were probabilistically linked. The following data were calculated for hospitalizations of the elderly that evolved into deaths with a natural cause: concordance percentages, Kappa coefficient, sensitivity, specificity, and the positive predictive value of the primary diagnosis. Deaths related to “ill-defined causes” were assigned to a new cause, which was defined based on the primary diagnosis. Results: The reliability of the primary diagnosis was good, according to the total percentage of consistency (50.2%), and fair, according to the Kappa coefficient (k = 0.4; p < 0.0001). Diseases related to the circulatory system and neoplasia occurred with the highest frequency among the deaths and the hospitalizations and presented a higher consistency of positive predictive values per chapter and grouping of the International Classification of Diseases. The recovery of the information on the primary cause occurred in 22.6% of the deaths with ill-defined causes (n = 14). Conclusion: The methodology developed and applied for the recovery of the information on the natural cause of death among the elderly in this study had the advantage of effectiveness and the reduction of costs compared to an investigation of the death that is recommended in situations of non-linked and low positive predictive values. Monitoring the mortality profile by the cause of death is necessary to periodically update the predictive values.

The study of the mother-child binomium: description and general results / O estudo do binômio mãe-filho: descrição e resultados gerais

The present study investigated the characteristics of women during pregnancy/immediate postpartum cycles and the product of their pregnancy.

A pesquisa estudou as características de mulheres no ciclo gravídico/puerperal imediato e do produto de sua gestação.

Análise do atendimento a vítimas fatais por causa externa: inquérito domiciliar / Analysis of service to fatal victims by external causes: domiciliary survey

Objetivo: analisar, segundo a opinião da família, o atendimento a vítimas fataispor causa externa em Cuiabá.Método: estudo descritivo, transversal, com população composta por crianças, adolescentes e jovens,residentes do município de Cuiabá/MT, que foram a óbito por acidente ou agressão. Os dados foram coletadospor meio da Declaração de óbito e de inquérito domiciliar, utilizando-se um formulário. Para análise utilizouseo software EpiInfo com análises simples e bivariadas (p<0,05). O estudo foi aprovado pelo Comitê de Éticaem Pesquisa, Protocolo 929/CEP-HUJM/2010. Resultados: grande parte das famílias (89,5% dos acidentes e67,6% das agressões) considera ótima a qualidade do socorro no momento do evento; para 90% das famíliasnão houve demora no atendimento nem dificuldade de acesso ou indisponibilidade do serviço de saúde, commuita confiança no serviço. Conclusão: a análise revelou a importância de estruturar o serviço de saúde parao atendimento das vítimas de causas externas.