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O Brasil é um país com altas taxas de violência, o que afeta, além da sociedade civil, os agentes das forças da segurança pública, cujas taxas de mortalidade por causas violentas são superiores às da população geral. Portanto, objetivou-se caracterizar o perfil da mortalidade de policiais militares por causas violentas, segundo a cor da pele, no estado da Bahia. Neste estudo, foram analisadas as mortes violentas de policiais militares da ativa ocorridas entre 2012 e 2019, considerando variáveis tanto sociodemográficas quanto relacionadas à corporação policial e às circunstâncias da ocorrência. A análise dos resultados foi realizada por meio da linguagem computacional R versão 4.2.2. Foram registradas 110 mortes de policiais militares, em sua maioria negros (83,64%). Em relação à faixa etária, os policiais militares negros morreram mais jovens, entre 30 e 39 anos (41,30%), enquanto os brancos, entre 40 e 49 anos (61,11%). Em 50% dos casos envolvendo policiais militares negros, a motivação do crime permaneceu desconhecida, enquanto 33,33% das mortes envolvendo policiais brancos foram por confronto com criminosos. Conclui-se que o perfil das mortes de policiais militares no estado da Bahia é semelhante ao da população em geral, com predomínio de homens, negros, jovens e solteiros.

Brazil is a country with high rates of violence, which affects, in addition to civil society, public security agents, whose mortality rates from violent causes are higher than those of the general population. Therefore, the objective was to characterize the profile of mortality of military police officers due to violent causes, according to skin color, in the state of Bahia. This study analyzed violent deaths of active military police officers that occurred between 2012 and 2019, considering both sociodemographic variables and those related to the police force and the circumstances of the occurrence. The analysis of the results was carried out using the computational language R version 4.2.2. A total of 110 military police deaths were recorded, most were black (83.64%). Regarding age group, black military police officers died younger, between 30 and 39 years old (41.30%), whereas white military police officers, between 40 and 49 years old (61.11%). In 50% of cases involving black military police officers, the motivation for the crime remained unknown, whereas 33.33% of deaths involving white police officers were due to confrontation with criminals. In conclusion, the profile of military police deaths in the state of Bahia is similar to that of the general population, with a predominance of male, black, young, and single people.

Brasil tiene altos índices de violencia que no solo afectan a la sociedad civil, sino también a los agentes de seguridad pública, cuyas tasas de mortalidad por causas violentas superan a las de la población general. Así, el objetivo de este estudio fue caracterizar el perfil de mortalidad por causas violentas de los policías militares según el color de la piel, en el estado de Bahía (Brasil). En este estudio se analizaron muertes violentas de policías militares en activo, ocurridas entre 2012 y 2019, considerando variables sociodemográficas relacionadas con el cuerpo policial y las circunstancias de la ocurrencia. El análisis de los resultados se realizó utilizando el lenguaje computacional R, versión 4.2.2. Se registraron 110 muertes de policías militares, la mayoría negros (83,64%). Con relación al grupo de edad, los policías militares negros murieron más jóvenes, de entre 30 y 39 años (41,30%), que los policías militares blancos, de entre 40 y 49 años (61,11%). En el 50% de los casos que involucraron a policías militares negros, la motivación del crimen seguía siendo desconocida, mientras que en el 33,33% de las muertes que involucraron a policías blancos se debieron a enfrentamientos con delincuentes. Se concluye que el perfil de las muertes de policías militares en Bahía es similar al de la población general, con predominio de hombres, negros, jóvenes y solteros.

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Background: Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information. Aim: To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya. Setting: Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. Methods: The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information. Results: More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information. Conclusion: Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya. Contribution: Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.

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Le cancer du sein constitue un véritable problème de santé publique dans le monde. L'une des principales causes de décès dû à cette affection est la métastase, laquelle est peu étudiée dans notre contexte. Ainsi, les objectifs de ce travail étaient d'estimer la fréquence des cancers du sein métastasique synchrones, de déterminer le taux de survie global et d'identifier les principaux facteurs associés au décès par cancer du sein chez les femmes au Mali. Patients et Méthodes: Nous avons réalisé une étude de cohorte rétrospective au CHU Gabriel Touré portant sur les cas du cancer du sein diagnostiqué durant la période du 1erJanvier 2018 au 31 Août 2021. Nous avons inclus toutes les patientes ayant eu un diagnostic de cancer du sein avec confirmation anatomopathologique et avec des métastases synchrones. Des statistiques descriptives ont été utilisées pour analyser les données sociodémographiques et cliniques. L'identification des facteurs associés au décès a été effectuée en utilisant des modèles de régression de Cox univariés et multivariés pour produire des Hazard ratio ajustés (HRa) avec leur intervalle de confiance à 95%. Résultats : Durant la période d'étude, 231 cas de cancer du sein ont été diagnostiqués dans notre service ; parmi lesquels, 60 cas des métastases synchrones ont été identifiés (26%). L'âge moyen de ces cas était de 45,3 ± 12,1 ans. La forme histologique la plus représentée était le carcinome infiltrant de type non spécifique, 55 cas (91,7%). Les principaux sites métastatiques étaient respectivement les poumons seuls, 26 cas(43,3%), le foie, 12 cas (20,0%) et 16 cas (26,6%) avaient plus d'un site atteint. La survie globale à 2 ans était inférieure à 20%. Le facteur associé au risque de décès était les métastases au poumon ; HRa = 4,22 [IC à 95% : 1,13 ­ 15,79]. Conclusion : Les cancers du sein métastatiques synchrones étaient fréquents dans notre contexte et le pronostic était mauvais en cas de métastase au poumon métastatiques synchrones étaient fréquents dans notre contexte et le pronostic était mauvais en cas de métastase au poumon

Breast cancer is a public health issue worldwide. One of the main causes of death due to this disease is metastasis, which is understudied in our context. Thus, the objectives of this work were to: (1) estimate the frequency of synchronous metastatic breast cancer; (2) determine the overall survival rate; and (3) identify the main factors associated with metastatic breast cancer death in Malian women. Patients and Methods: We conducted a retrospective cohort study at Gabriel Touré Teaching hospital on breast cancer cases diagnosed during the period from January 1st, 2018 to August 31st, 2021. We included all pathologically confirmed of breast cancer with synchronous metastases. Descriptive statistics were used to analyze sociodemographic and clinical data. Identification of factors associated with metastatic breast cancer death was performed using univariate and multivariate Cox regression models to produce adjusted hazard ratios (AHR) with their 95% confidence intervals. Results: During the study period, a total of 231 cases of breast cancer were diagnosed in our department; among them, 60 cases were synchronous metastatic breast cancer (26%). The mean ageof these cases was 45.3 ±12.1 years old. The most common histological form was non-specific infiltrating carcinoma, 55 cases (91.7%). The main metastatic sites were lung alone, 26 cases (43.3%), liver alone, 12 cases (20.0%) and 16 cases (26.6%) had more than one metastatic sites. The overall 2- year survival was less than 20%. Factor associated with the risk of death was lung metastases; AHR = 4.22 [95% CI: 1.13 - 15.79]. Conclusion: Synchronous metastatic breast cancer was very common in our setting and a poor prognosis was observed in patients with lung metastasis.

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Background The demand of ICU care for obstetric patients is rising in low-income settings, where there is low ICU-bed capacity. Introduction of obstetric High-dependency unit (HDU) has been described as an effective strategy to bridge this gap in resource-restricted settings. Objective: To describe the clinical characteristic and maternal outcomes of obstetric patients admitted to the first obstetric HDU in Ethiopia. Study design: This was a descriptive study on clinical characteristics and maternal outcomes of obstetric patients admitted to obstetric HDU over one year (October 2021 to September 2022) at St. Paul's Hospital Millennium Medical College (Ethiopia). Data were collected retrospectively through reviewing patients' medical records using a data extraction format with KOBO collect tool. Data were analyzed using SPSS version 23 and simple descriptive statistics were employed. Proportions and percentages were used to present the results. RESULTS: After excluding 18 patients who did not meet the inclusion criteria, a total of 355 obstetric patients who were admitted to an obstetric HDU were included in the final analysis. Among these all-obstetric patients admitted to obstetric HDU, pre-eclampsia/ eclampsia (82/355, 23.1%) and postpartum hemorrhage (66/355, 18.6%) were the most frequent reasons for admission to the HDU whereas cardiac disease constituted 14.1% (50/355) of the indication for admissions to the unit. Majority (318/355, 89.6%) from the study participants were transferred to other wards with im-provement, while 37(7.9%) deteriorated with 9(2.53%) of them died. Septic shock (6/9, 66.6%) and DIC (2/9, 22.2%) were the leading causes of death in the HDU. Conclusion: Findings of our study demonstrate that opening HDU in a low-income setting is feasible and results in favorable maternal outcomes. Introduction of obstetric HDU in low-income settings is an effective intervention to reduce severe maternal morbidity and mortality associated with low ICU-bed capacity in those settings.

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Pneumonia is one of the leading causes of death in children under five and, a major cause of infant mortality in all regions of the world, most deaths occur in sub-Saharan Africa and South Asia. The main agent with the highest prevalence in severe pneumonia is, as the name suggests the bacterium Streptococcus pneumoniae. The general objective of this study is to evaluate the antibacterial activity of the decoction of the leaves of Mitragyna stipulosa on the bacterium S. pneumoniae by the antibiogram test, to determine the minimum inhibitory concentration and, to compare the antibacterial effect of the decoction compared to infusion and maceration, as well as the reference antibiotic used. This work is part of the promotion and enhancement of the African pharmacopoeia in general and the Congolese pharmacopoeia in particular, to overcome a proven and significant public health problem.

La pneumonie est l'une des principales causes de décès chez les enfants de moins de cinq ans et une cause majeure de mortalité infantile dans toutes les régions du monde, la plupart des décès survenant en Afrique subsaharienne et en Asie du Sud. L'agent principal ayant la prévalence la plus élevée dans les pneumonies graves est, comme son nom l'indique, la bactérie Streptococcus pneumoniae. L'objectif général de cette étude est d'évaluer l'activité antibactérienne de la décoction des feuilles de Mitragyna stipulosa sur la bactérie S.pneumoniae par le test de l'antibiogramme, de déterminer la concentration minimale inhibitrice et de comparer l'effet antibactérien de la décoction par rapport à l'infusion et à la macération, ainsi qu'à l'antibiotique de référence utilisé. Ce travail s'inscrit dans le cadre de la promotion et de la valorisation de la pharmacopée africaine en général et de la pharmacopée congolaise en particulier, pour venir à bout d'un problème de santé publique avéré et important.

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Context and objective. Brain trauma is the first cause of death among young people and a quarter of victims develop an intracranial hematoma. The objective was to describe the socio-demographic, radiological, clinical and post-therapeutical aspects of patients treated for post-traumatic intracranial hematomas at Kinshasa University Hospital. Methods. This was an analytical series of traumatized patients with intracranial hematomas, followed at the Kinshasa University hospital from January 1999 to December 2019. Variables of interest included clinical, therapeutic, and post-therapeutic outcomes. The Pearson Chi-square test was used to compare proportions. Results. In a total of 269 patients, Subdural Hematoma predominated at 54.3%. Road accidents accounted for 57.6% of the etiologies. The median age was 37.3 years with male predominance. Among patients admitted for Extradural Hematoma, 27 (28.4 %) consulted beyond 24 hours. Intracranial hypertension signs were present in 57.5% of cases. The operating time was less than 24h for 12.4% of patients. Mortality was 10% and full recovery represents 61.3%. The adverse factors were age >60 years, mydriasis, polytrauma, Glasgow Coma Score ≤ 8. Conclusion. Post-traumatic intracranial hematomas are common in our environment. The admission period remains relatively long but the majority of patients fully recover.

Contexte et objectif. Les traumatismes crâniens représentent la 1ère cause de mortalité chez les jeunes et le quart de ces traumatisés développe les hématomes intracrâniens. L'objectif de la présente étude était de décrire les aspects sociodémographiques et radio-cliniques ainsi que l'évolution post-thérapeutique des patients traités pour hématomes intracrâniens post-traumatiques. Méthodes. Il s'agissait d'une série analytique des traumatisés avec hématomes intracrâniens, suivis aux Cliniques Universitaires de Kinshasa de janvier 1999 à décembre 2019. Les variables d'intérêt comprenaient les données cliniques, thérapeutiques ainsi que l'évolution post-thérapeutique. Nous avons utilisé le test de Chi-carré de Pearson pour comparer les proportions. Résultats. Sur un total de 269 patients, les hématomes sous-duraux prédominaient (54,3%). Les accidents des voies publiques ont constitué 57,6% des causes. L'âge médian global était de 37,3 ans avec une prédominance masculine. Vingt-sept patients (28,4 %) admis pour hématomes extraduraux ont consulté au-delà de 24h. Les signes d'hypertension intracrânienne étaient présents dans 57,5% des cas. Le délai opératoire général a été de moins de 24h pour 12,4% des cas. La mortalité était de 10 % et la récupération complète de 61,3 %. Les facteurs d'évolution défavorable étaient l'âge >60ans, la mydriase, le polytraumatisme, le score de Glasgow ≤ 8. Conclusion. Les hématomes intracrâniens post-traumatiques sont fréquents dans notre milieu. Le délai d'admission reste relativement long et la majorité d'entre eux récuperent complétement.

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Abstract Objectives: to analyze neonatal deaths according to avoidability and to analyze the temporal trend of neonatal mortality rate (NMR) in Niterói/RJ, 2012-2022. Methods: ecological time series study. Data from Sistema de Informação sobre Nascidos Vivos and Sistema de Informação sobre Mortalidade. NMRs were calculated according to maternal and neonatal variables and trends were estimated using the joinpoint regression. Results: the annual number of live births (LB) fell, with a decreasing trend among adolescents and those with low education level. Of the 324 deaths, most occurred early (0-6 days), by preventable causes in 68.6%, predominating those reducible by adequate care during pregnancy. The overall NMR remained stable, ranging from 4.2 to 6/1,000 LB, being higher at the extremes of maternal age (12.7 and 8.6/1,000 LB in 2022, adolescents and over 35 years old, respectively), in low education level mothers (27.6/1,000 LB in 2022), in neonates <1,500g and <32 weeks (293.1 and 250/1,000 LB in 2022, respectively). NMR trend was upward in low schooling women, white-colored, adolescents and those ≥35 years, in babies weighing <1,500g and >2,500g, and for avoidable causes. Conclusions: the high proportion of preventable causes reveals the reduction potential. There was inequality in NMR and its trend, demanding more equitable health actions.

Resumo Objetivos: analisar os óbitos neonatais segundo evitabilidade e a tendência temporal da taxa de mortalidade neonatal (TMN) em Niterói/RJ, de 2012-2022. Métodos: estudo ecológico de série temporal. Dados provenientes do Sistema de Informações sobre Nascidos Vivos e Sistema de Informação sobre Mortalidade. As TMN foram calculadas segundo variáveis maternas e neonatais e as tendências estimadas pela regressão joinpoint. Resultados: o número anual de nascidos vivos (NV) diminuiu, com tendência decrescente entre mães adolescentes e de baixa escolaridade. Dos 324 óbitos, a maioria ocorreu precocemente, por causas evitáveis (68,6%), predominando aquelas reduzíveis por adequada atenção à gestação. A TMN global mostrou estabilidade, entre 4,2 e 6,0/1000NV, mais elevada nos extremos etários maternos (12,7 e 8,6/1.000 NV em 2022, adolescentes e maiores de 35 anos, respectivamente), nas mães com baixa escolaridade (27,6/1.000 NV em 2022), nos neonatos <1.500g e <32 semanas (293,1 e 250/1.000 NV em 2022, respectivamente). A tendência da TMN foi crescente entre mulheres de baixa escolaridade, brancas, adolescentes e ≥35 anos, nas faixas de peso <1.500g e >2.500g, e por causas evitáveis. Conclusões: a elevada proporção de causas evitáveis revela o potencial de redução. Houve desigualdade da TMN e sua tendência, demandando ações de saúde mais equânimes.

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Resumo Este estudo tem por objetivo analisar a variação do número de óbitos fetais informados entre o Sistema de Estatísticas Vitais do Registro Civil (RC) e o Sistema de Informações sobre Mortalidade (SIM) e comparar a tendência da taxa de mortalidade fetal (TMF) de ambos os sistemas no Brasil, para o período 2009-2019. A variação percentual (VP) foi analisada por meio da comparação entre as fontes de dados para os óbitos fetais precoces (<28 semanas) e tardios (≥28 semanas). Os clusters de unidades da federação foram obtidos pelo método k-means. Aplicou-se a regressão linear generalizada de Prais-Winsten na análise da tendência da TMF. O SIM demonstrou percentual de captação 27,7% superior ao RC no período estudado. Houve maior número de óbitos fetais informados no SIM para o Brasil e regiões, em ambos os estratos de óbitos. As regiões Norte e Nordeste apresentaram as maiores VP em oposição às regiões mais desenvolvidas do país, Sudeste e Sul, onde verificou-se uma convergência de 95%. Apesar da redução da VP na década analisada, as estimativas de tendência da TMF permaneceram subestimadas no RC. Conclui-se que a captação dos óbitos fetais foi maior no SIM, sobretudo nas regiões Norte e Nordeste, reconhecidas como as mais vulneráveis do país.

Abstract This study aimed to analyze the variation in the number of stillbirths reported between the vital statistics system of the Civil Registry (RC) and the Mortality Information System (SIM) as well as to compare the trend in stillbirth rates (SBR) in both systems in Brazil between 2009 and 2019. Percent change (PC) was analyzed by comparing data sources for early (<28 weeks) and late (≥28 weeks) stillbirths. Clusters of Federation Units were obtained using the k-means method. Prais-Winsten generalized linear regression was applied in the analysis of the SBR trend. The SIM showed a percentage of uptake 27.7% higher than RC in the period. A higher number of fetal deaths were reported on the SIM for Brazil and its regions, in both death strata. The North and Northeast regions presented the highest PC, as opposed to the most developed regions of the country, Southeast and South, where there was a convergence of 95%. Despite the reduction in PC in the decade analyzed, the SBR trend estimates remained underestimated in the RC. The conclusion, that the capture of fetal deaths was higher in the SIM, demonstrates the need for improvements in civilian registration of stillbirths, especially in the North and Northeast regions, recognized as the most vulnerable in the country.

Resumen Este estudio tuvo como objetivo analizar la variación en el número de muertes fetales notificadas entre el sistema de estadísticas vitales del Registro Civil (RC) y el Sistema de Información de Mortalidad (SIM) y comparar la tendencia de la Tasa de Mortalidad Fetal (TMF) de ambos sistemas en Brasil entre 2009 y 2019. El cambio porcentual (CP) se analizó comparando fuentes de datos para muertes fetales tempranas (< 28 semanas) y tardías (≥ 28 semanas). Los conglomerados de unidades de la federación se obtuvieron mediante el método de k-means. Se aplicó la regresión lineal generalizada Prais-Winsten en el análisis de la tendencia TMF. El SIM mostró un porcentaje de captación 27,7 % superior al del RC en el período. Hubo mayor número de muertes fetales reportadas en el SIM para Brasil y regiones, en ambos estratos de muerte. Las regiones Norte y Noreste tuvieron el CP más alto en comparación con las regiones más desarrolladas del país, Sudeste y Sur, donde hubo convergencia del 95 %. A pesar de la reducción del CP en la década analizada, las estimaciones de tendencia de la TMF permanecieron subestimadas en el RC. Se concluye que la captura de las defunciones fetales fue mayor en el SIM, demostrando la necesidad de mejoras en el registro civil de las defunciones fetales, especialmente en las regiones Norte y Nordeste, reconocidas como las más vulnerables del país.

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ABSTRACT Objective: To analyze the temporal trend of fetal mortality and its components, of avoidable and ill-defined causes according to two avoidability classifications in Recife, Pernambuco, 2010-2021. Method: Ecological study of temporal trends of fetal mortality in Recife, 2010-2021. The Brazilian List of Avoidable Causes of Death for fetal deaths (LBE-OF) and Brazilian List of Avoidable Causes of Death for children under five years of age (LBE < 5) were used. The Joinpoint regression model was applied to analyze the temporal trends. Results: Trends in fetal mortality and its components were stationary. The group of avoidable causes presented higher mortality rates in both classifications, with an increasing trend according to the LBE-OF (Annual Percentage Change-APC: 2,1; p = 0,018) and stationary according to the LBE < 5. There was a decreasing trend in mortality from ill-defined causes only according to the LBE-OF (APC: -12,3; p < 0,001). Conclusion: The results showed the stagnation of the temporal trend in fetal mortality, the avoidability of most deaths, and the potential of LBE-OF in monitoring the quality of information on the basic causes and avoidability of fetal deaths.

RESUMEN Objetivo: Analizar la tendencia temporal de la mortalidad fetal y sus componentes, causas evitables y mal definidas según dos clasificaciones de evitabilidad en Recife, Pernambuco, 2010-2021. Metodología: Estudio ecológico de tendencias temporales de la mortalidad fetal en Recife, 2010-2021. Se utilizó la Lista Brasileña de Causas Evitables de Muerte para muertes fetales (LBE-OF) y la Lista Brasileña de Causas Evitables de Muerte para niños menores de cinco años (LBE < 5). Se aplicó el modelo de regresión Joinpoint para analizar las tendencias temporales. Resultados: Las tendencias en la mortalidad fetal y sus componentes se mantuvieron estacionarias. El grupo de causas evitables presentó mayores tasas de mortalidad en ambas clasificaciones, con tendencia creciente según LBE-OF (Variación Porcentual Anual-APC: 2,1; p = 0,018) y estacionaria según LBE < 5. Hubo tendencia decreciente para la mortalidad por causas mal definidas sólo según LBE-OF (APC: -12,3; p < 0,001). Conclusión: Los resultados mostraron el estancamiento de la tendencia temporal de la mortalidad fetal, la evitabilidad de la mayoría de las muertes y el potencial del LBE-OF para monitorear la calidad de la información sobre las causas básicas y la evitabilidad de las muertes fetales.

RESUMO Objetivo: Analisar a tendência temporal da mortalidade fetal e de seus componentes, das causas evitáveis e mal definidas segundo duas classificações de evitabilidade no Recife, Pernambuco, 2010-2021. Método: Estudo ecológico de tendência temporal para a mortalidade fetal no Recife, 2010-2021. Foram utilizadas as classificações de evitabilidade Lista Brasileira de Causas de Morte Evitáveis para óbitos fetais (LBE-OF) e Lista Brasileira de Causas de Morte Evitáveis para menores de cinco anos (LBE < 5). O modelo de regressão Joinpoint foi aplicado para analisar as tendências temporais. Resultados: As tendências da mortalidade fetal e de seus componentes foram estacionárias. O grupo de causas evitáveis apresentou maiores taxas de mortalidade nas duas classificações, com tendência crescente segundo a LBE-OF (Variação Percentual Anual-APC: 2,1; p = 0,018) e estacionária segundo a LBE < 5. Houve tendência decrescente para a mortalidade por causas mal definidas apenas conforme a LBE-OF (APC: -12,3; p < 0,001). Conclusão: Os resultados evidenciaram a estagnação da tendência temporal da mortalidade fetal, a evitabilidade da maior parte dos óbitos, e a potencialidade da LBE-OF no monitoramento da qualidade das informações sobre as causas básicas e evitabilidade dos óbitos fetais.

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Introducción. Los traumatismos craneoencefálicos (TCE) son una causa frecuente de muerte y discapacidad alrededor del mundo. Objetivo. Describir la discapacidad, el funcionamiento, la depresión, la ansiedad y la calidad de vida en pacientes con TCE moderado o grave en los primeros 90 días luego de sufrir la lesión. Métodos. Estudio de corte transversal realizado con pacientes adultos que sufrieron un TCE moderado o grave en Medellín (Colombia) y su área metropolitana. Resultados. Se incluyeron 153 pacientes con TCE, 87 grave y 66 moderado. La causa más frecuente de la lesión fueron los accidentes de tránsito en motocicleta, la edad promedio de los participantes fue 48,3 (DE=19,4) años, 79,7% eran de sexo masculino y 46,4% estaban solteros. Al momento del trauma, 70,6% estaban bajo efecto de alcohol o sustancias psicoactivas y 44,4% trabajaban por su propia cuenta. En las imágenes diagnósticas tomadas en la fase aguda, la lesión observada con más frecuencia fue el hematoma subdural, en 43,79%. El funcionamiento fue peor en los pacientes con TCE grave evaluado tanto por la escala Disabilty Rating Scale (DRS) (8,79 vs. 3,82) como en todos los dominios del World Health Organization Disability Assessment Schedule (WHO-DAS II) (el más afectado fue el de Actividades fuera de la casa y el menos afectado, el de Relaciones interpersonales). En la función cognitiva, el puntaje promedio del Montreal Cognitive Assessment (MoCA) fue 16 (DE=8,9) en los pacientes con TCE grave y 20.2 (DE=6,9) en los de TCE moderado. La cali-dad de vida fue peor en los pacientes con TCE grave en todos los dominios, con peor percepción en el desempeño físico. La ansiedad de estado y la de rasgo fueron peores en los pacientes con TCE grave, aunque con diferencias no significativas. El dolor en la escala análoga visual fue mayor en quienes tuvieron TCE grave. Conclusiones. Los TCE son lesiones que pueden afectar a la población en edad productiva y generar secuelas de funcionamiento, dolor, ansiedad, depresión y cognitivas que impactan la calidad de vida, siendo estas consecuencias más graves en quienes sufren TCE graves en comparación con quienes tienen TCE moderados.

Introduction. Cranioencephalic traumatisms (CETs) are a common cause of death and disability worldwide. Objective. To describe the disability, functioning, depression, anxiety, and quality of life in patients with moderate or severe CET in the first 90 days after suffering the injury. Methods. Cross-sectional study conducted with adult patients who suffered a moderate or severe CET in Medellín (Colombia) and its metropolitan area. Results. 153 patients with CET, 87 severe and 66 moderate, were included. The most frequent cause of the injury was motorcycle traffic accidents, the mean age of the participants was 48.3 (SD=19.4) years, 79.7% were men and 46.4% were single. At the time of the trauma, 70.6% were under the influence of alcohol or psychoactive substances and 44.4% were working on their own. In the diagnostic images taken in the acute phase, the most frequently observed lesion was subdural hematoma, in 43.79%. Functioning was worse in patients with severe CET as assessed by both the Disability Rating Scale (DRS) (8.79 vs. 3.82) and in all domains of the World Health Organization Disability Assessment Schedule (WHO-DAS II) (the most affected domain was the one of Activities outside home and the least affected was Interperson-al relations). In the cognitive function, the average score in the Montreal Cognitive Assessment (MoCA) was 16 (SD=8.9) in patients with severe CET and 20.2 (SD=6.9) in those with moderate CET. The quality of life was worse in patients with severe CET in all domains, with a worse perception in physical performance. State and trait anxiety were worse in patients with severe CET, although with non-significant differences. Pain on the visual analogue scale was worse in those who had severe CET. Conclusions. CETs are injuries that can affect the population of productive age and generate pain, anxiety, depression, functioning and cognitive sequelae that impact quality of life, being these consequences more serious in those who suffer severe CETs compared with those with moderate CETs.

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Resumo Introdução: O câncer do colo uterino (CCU) permanece uma importante causa de morte nas regiões mais pobres do mundo. Objetivo: Analisar tendências da distribuição relativa de óbitos por CCU ocorridos nos municípios de extrema pobreza (EP) do Brasil, de 2000 a 2018. Método: A distribuição relativa de óbitos por CCU nos municípios de EP foi avaliada em relação ao total de óbitos observados em cada Unidade Federativa (UF). Uma modelagem autorregressiva foi usada para avaliar as tendências temporais da distribuição relativa de óbitos de 2000 a 2018. Resultados: De 2000 a 2018, houve 94.065 óbitos por CCU no Brasil, e 10,7% deles ocorreram nos municípios de EP. Seis estados (Amazonas, Roraima, Pará, Amapá, Tocantins e Mato Grosso do Sul) tiveram 100% dos seus municípios de EP reportando a ocorrência desses óbitos. As tendências na distribuição de óbitos nos municípios de EP em relação ao total de óbitos de cada UF seguiram em elevação em onze estados brasileiros. Conclusões: O CCU é doença prioritária das políticas públicas do Brasil, e as tendências desses óbitos observadas nos municípios mais pobres apontam que mais atenção deve ser dada a estas unidades de análise, a fim de melhorar a saúde das pessoas mais pobres.

Abstract Background: Cervical cancer (CC) remains a major cause of death in the poorest regions of the world. Objective: To analyze trends in relative distribution of CC deaths occurred in extreme poverty municipalities, Brazil, from 2000 to 2018. Method: The relative distribution of CC deaths occurred in extreme poverty municipalities was evaluated in relation to total number of CC deaths observed in each Federative Unit (FU). An autoregressive modeling was used to assess the temporal trends in the death distribution, 2000-2018. Results: From 2000 to 2018, there were 94,065 CC deaths, and 10.7% of them were recorded in extreme poverty municipalities. There were six states (Amazonas, Roraima, Pará, Amapá, Tocantins, and Mato Grosso do Sul) with 100.0% of extreme poverty municipalities reporting the occurrence of these deaths. The trends of death distribution in extreme poverty municipalities in relation to the total of deaths in each FU followed in increasing trends in eleven Brazilian FU. Conclusions: CC is a disease prioritized by public policies in Brazil, and the trends of these deaths observed in the poorest municipalities point out that more attention should be given to these units of analysis, in order to improve the health of the poorest people.

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ABSTRACT OBJECTIVE To assess regional and national mortality and years of life lost (YLL) related to adverse drug events in Brazil. METHODS This is an ecological study in which death records from 2009 to 2018 from the Mortality Information System were analyzed. Codes from the International Classification of Diseases 10th revision (ICD-10) that indicated drugs as the cause of death were identified. The number of deaths and the YLL due to adverse drug events were obtained. Crude, age- and gender-specific, and age-adjusted mortality rates and YLL rates per 100,000 inhabitants were formed by year, age group, gender, and Brazilian Federative Unit. Rate ratios were calculated by comparing rates from 2009 to 2018. A joinpoint regression model was applied for temporal analysis. RESULTS For the selected ICD-10 codes, a total of 95,231 deaths and 2,843,413 YLL were recorded. Mortality rates from adverse drug events increased by a mean of 2.5% per year, and YLL rates increased by 3.7%. Increases in rates were observed in almost all age groups for both genders. Variations in rates were found between Federative Units, with the highest age-adjusted mortality and YLL rates occurring in the Distrito Federal. CONCLUSIONS The numbers and rates of deaths and YLL increased during the study period, and variations in rates of deaths and YLL were observed between Brazilian Federative Units. Information on multiple causes of death from death certificates can be useful for quantifying adverse drug events and analyzing them geographically, by age and by gender.

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Introducción: El accidente cerebrovascular es la segunda causa de muerte a nivel mundial y una de las principales causas de discapacidad. La rehabilitación constituye un componente vital para la recuperación. Frecuentemente, hay dificultades para cumplir con las horas de terapia recomendadas. Ante este problema, recientemente se han sugerido las aplicaciones móviles. Objetivo: Identificar la eficacia de las aplicaciones móviles como adyuvantes en la rehabilitación de los pacientes que han sufrido un accidente cerebrovascular. Métodos: Se realizó una revisión siguiendo la normativa PRISMA. Se consultaron las bases de datos PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO y WOS. Se utilizó la herramienta Cochrane para valorar el riesgo de sesgo y para la calidad de la evidencia se evaluó GRADE. Resultados: Del total de bases de datos se obtuvieron 115 estudios. Tras la eliminación de los duplicados y aplicación de criterios de inclusión, quedaron seis ensayos clínicos. La muestra total fue de 181 pacientes que habían sufrido un accidente cerebrovascular. La duración del tratamiento osciló entre los ensayos clínicos alrededor de 2 y 12 semanas. Todos los estudios mostraron seguridad, tolerabilidad y no se produjeron importantes efectos secundarios. Conclusiones: Las aplicaciones móviles son eficaces para la rehabilitación de pacientes que han sufrido un accidente cerebrovascular. Estas aplicaciones basadas en juegos resultan factibles y eficaces para promover la recuperación de las extremidades, el control postural, la calidad de vida, la recuperación del habla y la actividad diaria después de un accidente cerebrovascular(AU)

Introduction: Stroke is the second leading cause of death worldwide and a major cause of disability. Rehabilitation constitutes a vital component for recovery. Frequently, there are difficulties in meeting the recommended hours of therapy. Faced with this problem, mobile applications have recently been suggested. Objective: To identify the efficacy of mobile applications as adjuvants in the rehabilitation of stroke patients. Methods: A review was performed following the PRISMA guidelines. The databases PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO and WOS were consulted. The Cochrane tool was used to assess the risk of bias and GRADE was used to evaluate the quality of evidence. Results: 115 studies were obtained from the total number of databases. After elimination of duplicates and application of inclusion criteria, six clinical trials remained. The total sample was 181 patients who had suffered a stroke. The duration of treatment ranged between the clinical trials between 2 and 12 weeks. All studies showed safety, tolerability and no major side effects. Conclusions: Mobile applications are effective for the rehabilitation of post-stroke patients. These game-based applications are feasible and effective in promoting limb recovery, postural control, quality of life, speech recovery, and daily activity after stroke(AU)

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Introducción: El cáncer se caracteriza por la multiplicación de células anormales que se extienden fuera de sus límites habituales. El cáncer de mama constituye la neoplasia maligna más frecuente en la mujer y el segundo en causar la muerte en este sexo. La metástasis es la diseminación de las células malignas, originadas en un órgano, hacia otro sitio del organismo. Ocurre por contigüidad, vía hemática o linfática. Las metástasis óseas pueden resultar una complicación en cualquier tipo de cáncer. Objetivo: Caracterizar las metástasis óseas por cáncer de mama en casos atendidos en el Hospital Universitario General Calixto García entre 2017 y 2022. Métodos: Se realizó un estudio descriptivo y retrospectivo en el Hospital Universitario General Calixto García (enero de 2017-diciembre de 2022). La muestra quedó conformada por 815 pacientes con cáncer de mama, de ellos 55 con metástasis óseas. Se emplearon métodos teóricos y empíricos, acompañados por un conjunto de procesos lógicos del pensamiento: análisis, síntesis, abstracción, generalización, entre otros. Resultados: De las pacientes vistas durante el período de estudio, 26 presentaron metástasis óseas desde el inicio (etapa IV) y 29 durante el seguimiento. El sitio más frecuente fue la columna vertebral. Conclusiones: Presentaron metástasis óseas 55 pacientes de ellas 25 con mastectomía radical modificada y cuatro con cirugía conservadora previa. Se trataron con ácido zoledrónico(AU)

Introduction: Cancer is characterized by the multiplication of abnormal cells that extend outside their usual limits. Breast cancer is the most common malignant neoplasm in women and the second most common cause of death in this sex. Metastasis is the spread of malignant cells, originating in one organ, to another site in the body. It occurs by contiguity, blood or lymphatic route. Bone metastases can be a complication in any type of cancer. Objective: To characterize bone metastases due to breast cancer in cases treated at General Calixto García University Hospital from 2017 to 2022. Methods: A descriptive and retrospective study was carried out at General Calixto García University Hospital (from January 2017-December 2022). The sample was made up of 815 patients with breast cancer, fifty-five of them with bone metastases. Theoretical and empirical methods were used, accompanied by a set of logical thought processes: analysis, synthesis, abstraction, generalization, among others. Results: Twenty-six patients of those seen during the study period, presented with bone metastases from the beginning (stage IV) and 29 during follow-up. The most frequent site was the spine. Conclusions: Fifty-five patients presented bone metastases, 25 of them had modified radical mastectomy and four with previous conservative surgery. They were treated with zoledronic acid(AU)

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Los accidentes de tránsito son un problema de salud pública de gran magnitud y gravedad, en las Américas; Venezuela ocupa un lugar destacado por su alta incidencia. El objetivo de la investigación es establecer la relación entre las políticas públicas para la prevención de los accidentes de motocicletas, y las tasas de mortalidad. Metodología: Estudio documental retrospectivo de las políticas viales y las tasas de mortalidad específicas de lesionados por accidentes de motocicletas en Venezuela durante el período 1996-2018. Resultados: como causa de muerte en Venezuela (2000-2018), representa casi 7% del total, entre 6 a 50% del total de las muertes por accidentes de tránsito terrestre y se mantiene muy alta al final del período, con fallecidos por motocicletas sobre 25%. La elevación de la curva endémica de mortalidad ocurrió simultáneamente al aumento en la producción e importación de motocicletas, y cayó durante la crisis económica, en el año 2014. La legislación actualizada mas no acatada en esta materia, es notoria Conclusiones: Los accidentes de motocicleta son un problema de salud pública de primer orden en Venezuela asociadas al clima económico y social, las tasas de mortalidad tuvieron su máxima meseta de elevación durante la bonanza petrolera 2005-2013. Las políticas asociadas a la prevención de accidentes viales en moto están fragmentadas, son ineficientes y reactivas a situaciones complejas, deficientemente aplicadas por los organismos de tránsito responsables a escala nacional, regional y municipal.

Introduction. Traffic accidents are a public health problem of great magnitude and gravity in the Americas; Venezuela occupies a prominent place for its high incidence. The objective of the research is to establish the relationship between public policies for the prevention of motorcycle accidents, and mortality rates. Methodology: Retrospective documentary study of road policies and specific mortality rates of those injured by motorcycle accidents in Venezuela during the period 1996-2018. Descriptive statistical analysis with trend lines, frequency distributions and annual average rates. Results: cause of death in Venezuela (2000-2018), represents almost 7% of the total. The burden of motorcycle injury deaths represents between 6 to 50% of total road traffic fatalities and remains very high at the end of the period, with motorcycle fatalities over 25%. The elevation of the endemic mortality curve occurred simultaneously with the increase in the production and import of motorcycles, and fell concomitantly with the economic crisis in 2014. Conclusions: Motorcycle accidents are a public health problem of the first order in Venezuela associated with the economic and social climate, mortality rates had their maximum plateau of elevation during the oil economic boom 2005-2013. The policies associated with the prevention of road accidents by motorcycle are fragmented, inefficient and reactive to complex situations and poorly applied by the responsible traffic agencies at national, regional and municipal level.

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Objetivo: analizar el patrón temporal y estimar las tasas de mortalidad en las primeras 24 horas de vida y por causas evitables en el estado de Pernambuco en el período de 2000 a 2021. Método: estudio ecológico, teniendo como unidad de análisis el trimestre. La fuente de datos se constituyó por el Sistema de Informaciones sobre Mortalidad y el Sistema de Informaciones sobre Nacidos Vivos. El modelado de series temporales se realizó según el Modelo Autorregresivo Integrado de Promedio Móvil. Resultados: se registraron 14.462 óbitos en las primeras 24 horas de vida, siendo 11.110 (el 76,8%) evitables. Se observa para los pronósticos ( forecasts) que la tasa de mortalidad en las primeras 24 horas de vida registro una variación de 3,3 a 2,4 por 1.000 nacidos vivos, y la tasa de mortalidad por causas evitables de 2,3 a 1,8 por 1.000 nacidos vivos. Conclusión: la predicción sugirió avances en la reducción de la mortalidad en las primeras 24 horas de vida en el estado y por causas evitables. Los modelos ARIMA presentaron estimaciones satisfactorias para las tasas de mortalidad y por causas evitables en las primeras 24 horas de vida.

Objective: to analyze the temporal pattern and estimate mortality rates in the first 24 hours of life and from preventable causes in the state of Pernambuco from 2000 to 2021. Method: an ecological study, using the quarter as the unit of analysis. The data source was made up of the Mortality Information System and the Live Birth Information System. The time series modeling was conducted according to the Autoregressive Integrated Moving Average Model. Results: 14,462 deaths were recorded in the first 24 hours of life, 11,110 (76.8%) of which being preventable. It is observed from the forecasts that the mortality rate in the first 24 hours of life ranged from 3.3 to 2.4 per 1,000 live births, and the mortality rate from preventable causes ranged from 2.3 to 1.8 per 1,000 live births. Conclusion: the prediction suggested progress in reducing mortality in the first 24 hours of life in the state and from preventable causes. The ARIMA models presented satisfactory estimates for mortality rates and preventable causes in the first 24 hours of life.

Objetivo: analisar o padrão temporal e estimar as taxas de mortalidade nas primeiras 24 horas de vida e por causas evitáveis no estado de Pernambuco no período de 2000 a 2021. Método: estudo ecológico, tendo como unidade de análise o trimestre. A fonte de dados foi constituída pelo Sistema de Informações sobre Mortalidade e pelo Sistema de Informações sobre Nascidos Vivos. A modelagem da série temporal foi conduzida segundo o Modelo Autorregressivo Integrado de Médias Móveis. Resultados: foram registrados 14.462 óbitos nas primeiras 24 horas de vida, sendo 11.110 (76,8%) evitáveis. Observa-se para os forecasts que a taxa de mortalidade nas primeiras 24 horas de vida variou de 3,3 a 2,4 por 1.000 nascidos vivos, e a taxa de mortalidade por causas evitáveis variou de 2,3 a 1,8 por 1.000 nascidos vivos. Conclusão: a previsão sugeriu avanços na redução da mortalidade nas primeiras 24 horas de vida no estado e por causas evitáveis. Os modelos ARIMA apresentaram estimativas satisfatórias para as taxas de mortalidade e por causas evitáveis nas primeiras 24 horas de vida.

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Introducción: Las enfermedades crónicas repercuten en gran medida en la calidad de vida de los pacientes, ya sea por sus características inherentes o por las complicaciones derivadas que ocasionan emergencias recurrentes. Objetivo: Pronosticar los días de hospitalización hasta el desenlace de pacientes con enfermedad crónica ingresados en un hospital público peruano. Métodos: Se realizó una investigación descriptiva, retrospectiva y transversal, entre julio y agosto del 2022, con 488 pacientes con enfermedad crónica ingresados en el Hospital Regional Docente de Cajamarca. Los datos demográficos de ingreso y el tipo de diagnóstico de los pacientes fueron proporcionados por la oficina de estadística del hospital. El análisis univariado se realizó con distribuciones absolutas y relativas, junto a sus intervalos de confianza al 95 por ciento y la relación pronóstica con Log Rank (Mantel-Cox) - ji al cuadrado, análisis de supervivencia de Kaplan-Meier (p < 0,05) y tablas de mortalidad. Resultados: El 53,1 por ciento de pacientes fueron mujeres, con 67,1 años de edad promedio, ingresaron al hospital por el servicio de emergencia (66,0 por ciento) y la enfermedad crónica fue la causa principal (79,1 por ciento). El promedio de hospitalización fue de 67,5 días, con mayor número en la hipertensión arterial (63 días), las diferencias numéricas en el tiempo de hospitalización según enfermedad crónica no se reflejan a nivel estadístico (p = 0,130). Las defunciones ocurrieron dentro del primer mes de hospitalización. Conclusión: Los días de hospitalización hasta el desenlace no son independientes de la enfermedad crónica de los pacientes, pues en ambos casos pueden ocurrir defunciones si sus características clínicas son irrecuperables(AU)

Introduction: Chronic diseases greatly impact the quality of life of patients, either due to their inherent characteristics or due to the derived complications that cause recurrent emergencies. Objective: To predict the days of hospitalization until the outcome of patients with chronic disease admitted to a Peruvian public hospital. Methods: A descriptive, retrospective and cross-sectional investigation was carried out from July to August 2022, with 488 patients with chronic disease admitted to Cajamarca Regional Teaching Hospital. Admission demographic data and type of patient diagnosis were provided by the hospital statistics office. The univariate analysis was performed with absolute and relative distributions, along with their 95percent confidence intervals and the prognostic relationship with Log Rank (Mantel-Cox) - chi square, Kaplan-Meier survival analysis (p < 0.05) and mortality tables. Results: 53.1percent of patients were women, with average age of 67.1 years, who were admitted to the hospital through the Emergency Service (66.0percent) and chronic disease was the main cause (79.1percent). The average hospitalization time was 67.5 days, with greater number in high blood pressure (63 days). The numerical differences in hospitalization time, according to chronic disease, are not reflected at a statistical level (p = 0.130). Deaths occurred within the first month of hospitalization. Conclusion: The days of hospitalization until the outcome are not independent of the patients' chronic illness, since in both cases deaths can occur if their clinical characteristics are irrecoverable(AU)

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La autopsia médico legal en Costa Rica, en casos sospechosos de intoxicación por cocaetileno se debe realizar bajo las normas establecidas en la Guía de estándares de trabajo para la Sección de Patología Forense del Departamento de Medicina Legal. El análisis del mecanismo fisiopatológico de cómo estas sustancias provocan alteraciones en el organismo que pueden conllevar a un eventual fallecimiento corresponde a parte del análisis requerido en la investigación ante la sospecha de esta causa de muerte. Por lo anterior, el objetivo de este artículo es describir los mecanismos fisiopatológicos que ocurren durante el consumo combinado de cocaína y etanol, los mecanismos que conllevan a la muerte de personas consumidoras de estas sustancias y las consideraciones médico legales a tomar en cuenta para el diagnóstico de esta causa de muerte. Se realizó revisión de artículos científicos, sobre los efectos del uso combinado de la cocaína y el etanol. La literatura describe que el uso combinado de cocaína y etanol potencia los efectos farmacocinéticos y bioquímicos de cada una de estas sustancias, que su derivado, el cocaetileno, es capaz de generar por sí mismo los mecanismos causantes de la muerte. Que los principales mecanismos fisiopatológicos que conllevan la muerte ante el uso combinado de estas sustancias son de origen cardiovascular y hepático. Como consideraciones médico legales a tomar en cuenta para el diagnóstico de esta manera de muerte accidental, en la Sección de Toxicología del Departamento de Ciencias Forenses de Costa Rica, la cuantificación del cocaetileno y las sustancias relacionadas no se realiza, aunque se encuentra actualmente en el desarrollo de un proyecto para la determinación de la estabilidad de las drogas en sangre bajo las condiciones de almacenamiento, con el fin de ofrecer la posibilidad de cuantificar ciertas drogas (en donde se podría incluir el cocaetileno) en un futuro próximo.

Medical-legal autopsy in Costa Rica, in suspected cases of cocaethylene poisoning must be performed under the regulations established in the Work Standards Guide for the Forensic Pathology Section of the Department of Legal Medicine. The analysis of the pathophysiological mechanism of how these substances cause alterations in the organism that can lead to eventual death corresponds to part of the analysis required in the investigation when this cause of death is suspected. Therefore, the objective of this article is to describe the pathophysiological mechanisms that occur during the combined consumption of cocaine and ethanol, the mechanisms that lead to the death of people who consume these substances, and the medico-legal considerations to be considered for the diagnosis. of this cause of death. A review of scientific articles was carried out on the effects of the combined use of cocaine and ethanol. The literature describes that the combined use of cocaine and ethanol enhances the pharmacokinetic and biochemical effects of each one of these substances, that its derivative, cocaethylene, can generate the mechanisms that cause death by itself. That the main pathophysiological mechanisms that lead to death in the combined use of these substances are of cardiovascular and hepatic origin. As legal medical considerations to take into account for the diagnosis of this type of accidental death, in the Toxicology Section of the Department of Forensic Sciences of Costa Rica, the quantification of cocaethylene and related substances is not carried out, although it is currently in the development of a project for the determination of the stability of drugs in blood under storage conditions, in order to offer the possibility of quantifying certain drugs (which could include cocaethylene) in the near future.

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Background: Sepsis currently represents a challenge for health systems, this fact may be related to the spread of bacterial resistance, the increase in the population of elderly, immunosuppressed individuals, and the improvement of emergency care, favoring the survival of critically ill patients. This article aimed to evaluate the accuracy of mortality indicators due to sepsis in 2018. Method: Validation study of death certificates that occurred in the Federal District in 2018. Declarations whose basic causes of death identified were classified as garbage codes were identified, which were investigated by a multidisciplinary team, capable of reclassifying them with codes that allow for the improvement of health data. In order to assess accuracy, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios of death certificates from sepsis were calculated, with 95% confidence intervals. Results: A total of 6.244 statements were evaluated, of which 233 (3.74%) presented sepsis as the underlying cause before being investigated and only 35 (0.56%) maintained it after the investigation. The filling of statements with sepsis as the underlying cause by physicians showed a sensitivity of 0.9% (95%CI: 0.6 to 1.3) and a specificity of 92.0% (95%CI: 90.9 to 93.1). Conclusion: The low accuracy of the declarations demonstrates the non-reliability of the underlying cause of death from sepsis, especially the completion of death certificates that occurred in the Federal District in 2018.(AU)

Justificativa: A sepse, atualmente, representa um desafio para os sistemas de saúde, tal fato pode estar relacionado com a disseminação da resistência bacteriana, o aumento da população de idosos, os indivíduos imunossuprimidos, e a melhoria do atendimento de emergência, favorecendo a sobrevivência de pacientes críticos. Este artigo teve por objetivo avaliar a acurácia dos indicadores de mortalidade devido à sepse em 2018. Método: Estudo de validação da causa básica dos óbitos ocorridos no Distrito Federal em 2018. Foram identificadas as declarações de óbito cujas causas básicas de morte apontadas foram classificadas como garbage code sepse, as quais foram investigadas por uma equipe multidisciplinar, capacitada para reclassificá-las com códigos que permitem o aprimoramento dos dados em saúde. A fim de avaliar a acurácia, foram calculados os valores de sensibilidade, especificidade, valores preditivos positivo e negativo, razões de verossimilhança positiva e negativa das declarações dos óbitos por sepse, com intervalos de confiança de 95%. Resultados: Um total de 6.244 declarações foram avaliadas, das quais 233 (3,74%) apresentavam a sepse como causa básica antes de serem investigadas e apenas 35 (0,56%) mantiveram-na após a investigação. O preenchimento das declarações com a sepse enquanto causa básica pelos médicos apresentou sensibilidade de 0,9% (IC95%: 0,6 a 1,3) e especificidade de 92,0% (IC95%: 90,9 a 93,1). Conclusão: A baixa acurácia das declarações demonstra a não fidedignidade da causa básica de óbito por sepse, sobretudo, do preenchimento das declarações dos óbitos ocorridos no Distrito Federal em 2018.(AU)

Justificación: Sepsis representa en la actualidad un desafío para los sistemas de salud, este hecho puede estar relacionado con propagación de resistencias bacterianas, aumento de la población de ancianos, inmunodeprimidos, y mejora de la atención de urgencias, favoreciendo la supervivencia de los pacientes críticos. Este artículo tuvo como objetivo evaluar la precisión de los indicadores de mortalidad por sepsis en 2018. Método: Estudio de validación de causa básica de muertes ocurridas en Distrito Federal en 2018. Se identificaron actas de defunción cuyas causas básicas de muerte fueron clasificadas como sepsis código basura y fueron investigadas por un equipo multidisciplinario capacitado para reclasificarlas con códigos que permitan la mejora de datos de salud. Para evaluar la precisión, se calcularon sensibilidad, especificidad, valores predictivos positivo y negativo y razones de verosimilitud positiva y negativa de certificados de defunción por sepsis, con intervalos de confianza del 95%. Resultados: se evaluaron 6.244 declaraciones, de las cuales 233 (3,74%) tenían como causa básica la sepsis antes de ser investigadas y solo 35 (0,56%) mantuvieron después de investigación. Realización de declaraciones con sepsis como causa subyacente por parte de los médicos mostró sensibilidad del 0,9% (95%IC: 0,6 a 1,3) y especificidad del 92,0% (95%IC: 90,9 a 93,1). Conclusión: Baja precisión de las declaraciones demuestra la poca confiabilidad de la causa subyacente de muerte por sepsis, especialmente la finalización de los certificados de defunción ocurridos en Distrito Federal en 2018.(AU)

ABSTRACT

To study of premature/early death of autistic patients from the perspective of life course can help families, medical institutions and policy makers better deal with the adverse effects of autism. Several studies have shown that autistic patients have a high risk of death, however, the results are still inconsistent. To assess the risk of mortality among the autistic patients, we undertook a comprehensive search of MEDLINE, Web of Science and EMBASE databases. This paper reviewed the studies on the negative disease outcomes of autism spectrum disorders, including the risk of death, causes of death and several research hotspots in this field. Strict inclusion/exclusion criteria were used. Information was extracted from selected papers, tabulated and synthesized. In the study, 15 studies were included, with a total of 216 045 individuals. The main outcome was all-cause mortality in association with autism and the secondary outcome was cause-specific mortality. The results showed that all-cause mortality was higher for the autistic patients (RR=2.32, 95%CI: 1.98-2.72, I2=87.1%, P < 0.001). Risk ratio showed a greater inequality for female than male (male: RR=2.00, 95%CI: 1.57-2.55, I2=93.2%, P < 0.001; female: RR=4.66, 95%CI: 3.30-6.58, I2=92.0%, P < 0.001). Compared with the unnatural death, the risk of natural death was higher (RR=3.44, 95%CI: 1.27-9.26, I2=80.2%, P=0.025). As autism had many comorbidities, which would bring more health risks and natural deaths possibilities. There were some structural differences in unnatural death. Accidental injury death and suicide were two kinds of causes. Lacking social skills would weaken the ability to ask for help when encountering injuries. This paper put forward some suggestions for futures. First, to well study the comorbidity can reduce the risk of death from a medical point of view. Second, the scientists and policymakers should pay attention to the social environment and provide a safer environment for the autistic patients. Third, for women and for adolescents without cognitive impairment, due to their high risk of suicide, the society should provide them with more supportive social networks and improve their life satisfaction. Fourth, it is necessary to balance the rehabilitation resources in various regions in China and provide more high-quality lifelong rehabilitation monitoring and care services.