Mortality in the United States - Provisional Data, 2023.

Final annual mortality data from the National Vital Statistics System for a given year are typically released 11 months after the end of the calendar year. Provisional data, which are based on preliminary death certificate data, provide an early estimate of deaths before the release of final data. In 2023, a provisional total of 3,090,582 deaths occurred in the United States. The age-adjusted death rate per 100,000 population was 884.2 among males and 632.8 among females; the overall rate, 750.4, was 6.1% lower than in 2022 (798.8). The overall rate decreased for all age groups. Overall age-adjusted death rates in 2023 were lowest among non-Hispanic multiracial (352.1) and highest among non-Hispanic Black or African American persons (924.3). The leading causes of death were heart disease, cancer, and unintentional injury. The number of deaths from COVID-19 (76,446) was 68.9% lower than in 2022 (245,614). Provisional death estimates provide an early signal about shifts in mortality trends. Timely and actionable data can guide public health policies and interventions for populations experiencing higher mortality.

Variability in Alzheimer's disease mortality from European vital statistics, 2012-2020.

OBJECTIVE: Data regarding the trends in Alzheimer's disease (AD) mortality in the modern European Union (EU-27) member states are lacking. We assess the sex- and age-specific trends in AD mortality in the EU-27 member states between years 2012 and 2020. METHODS: Data on cause-specific deaths and population numbers by sex for each country of the EU-27 were retrieved through publicly available European Statistical Office (EUROSTAT) dataset from 2012 to 2020. AD-related deaths were ascertained when the ICD-10 code G30 was listed as the primary cause of death in the medical death certificate. To calculate annual trends, we assessed the average annual percent change (AAPC) with relative 95% confidence intervals (CIs) using Joinpoint regression. RESULTS: During the study period, 751,493 deaths (1.7%, 233,271 males and 518,222 females) occurred in the EU-27 because of AD. Trends in the proportion of AD-related deaths per 1000 total deaths slightly increased from 16.8% to 17.5% (p for trend <0.001). The age-adjusted mortality rate was higher in women over the entire study period. Joinpoint regression analysis revealed a stagnation in age-adjusted AD-related mortality from 2012 to 2020 among EU-27 Member States (AAMR: -0.1% [95% CI: -1.8-1.79], p = 0.94). Stratification by Country showed relevant regional disparities, especially in the Northern and Eastern EU-27 member states. CONCLUSIONS: Over the last decade, the age-adjusted AD-related mortality rate has plateaued in EU-27. Important disparities still exist between Western and Eastern European countries.

U.S. stillbirth surveillance: The national fetal death file and other data sources.

The National Vital Statistics System is the primary source of information on fetal deaths of 20 weeks of gestation or more in the United States. Data are cooperatively produced by jurisdiction vital statistics offices and the National Center for Health Statistics. In order to promote the uniformity of data, the National Center for Health Statistics issues The Model State Vital Statistics Act and Regulations, and produces standard certificates and reports, developed in collaboration with the states, to inform the development of jurisdictional vital records laws and regulations and data collection. While there are challenges in collecting national fetal death data, there are ongoing data quality improvement efforts to address them. Improved national fetal death data and data from other sources will continue to add insights into the risks, causes and prevention of fetal death.

Under-5 mortality surveillance in low-income and middle-income countries: insights from two Health and Demographic Surveillance Systems in rural Gambia.

Without complete data on under-5 mortality, tracking progress towards achieving Sustainable Development Goal 3.2 will be challenging. Such data are also needed to ensure proper planning and prioritisation of scarce resources in low-income and middle-income countries. However, most low-income and middle-income countries have weak Civil Registration and Vital Statistics (CRVS) systems, leaving a critical gap in understanding under-5 mortality dynamics. This paper outlines a community-based approach to enhance under-5 mortality surveillance in low-income countries, using The Gambia as a case study. The methodology involves Health and Demographic Surveillance Systems (HDSSs) in Basse and Fuladu West, employing unique identification numbers, periodical household visits and collaboration with communities, village reporters and project field workers to ensure comprehensive data collection. Verbal autopsies (VAs) are conducted by trained field workers, and causes of death are determined using the physician-certified VA method. Between 1 September 2019 and 1 September 2023, 1333 deaths were detected, for which causes of death were determined for 97.1% (1294 of 1333). The most common causes of death detected were acute respiratory infections including pneumonia, sepsis, diarrhoeal diseases and birth asphyxia. Challenges include the cost of maintaining the HDSSs, poor road infrastructure, Electronic Data Capture transition challenges, and the need for national integration of HDSS data into the CRVS system. The success of this model highlights its potential for scalable and adaptable under-5 mortality surveillance in resource-limited settings.

The trend of the quality of cause-of-death data and its association with socio-economic indicators in Serbia in the period 2005-19.

This study aims to evaluate the temporal trend in the quality of cause-of-death data and garbage code profiles and to determine its association with socio-economic status in Serbia. A longitudinal study was assessed using data from mortality registers from 2005 to 2019. Computer application Analysis of Causes of National Deaths for Action (ANACONDA) calculates the distribution of garbage codes by severity and composite quality indicator: Vital Statistics Performance Index for Quality (VSPI(Q)). A relationship between VSPI(Q) and country development was estimated by analysing two socio-economic indicators: the Socio-demographic Index and the Human Development Index (HDI). Serbia indicates progress in strengthening cause-of-death statistics. The steady upward trend of the VSPI(Q) index has risen from 55.6 (medium quality) to 70.2 (high quality) over the examined years. Significant reduction of 'Insufficiently specified causes with limited impact' (Level 4) and an increase in the trend of 'High-impact garbage codes' (Levels 1 to 3) were evident. Decreased deaths of no policy value (annual percentage change of -1.41%) have manifested since 2014. A strong positive association between VSPI(Q) and socio-economic indicators was assessed, where the HDI has shown a stronger association with VSPI(Q). Improved socio-economic conditions on the national level are followed by enhanced cause-of-death data quality. Upcoming actions to improve quality should be directed at high-impact garbage codes. The study underlines the need to prioritise the education and training of physicians with a crucial role in death certification to overcome many cause-of-death quality issues identified in this assessment.

Mortality risk following end-of-life caregiving: A population-based analysis of hospice users and their families.

Experiencing the death of a family member and providing end-of-life caregiving can be stressful on families - this is well-documented in both the caregiving and bereavement literatures. Adopting a linked-lived theoretical perspective, exposure to the death and dying of one family member could be conceptualized as a significant life stressor that produces short and long-term health consequences for surviving family members. This study uses familial-linked administrative records from the Utah Population Database to assess how variations in family hospice experiences affect mortality risk for surviving spouses and children. A cohort of hospice decedents living in Utah between 1998 and 2016 linked to their spouses and adult children (n = 37,271 pairs) provides an ideal study population because 1) hospice typically involves family members in the planning and delivery of end-of-life care, and 2) hospice admission represents a conscious awareness and acknowledgment that the decedent is entering an end-of-life experience. Thus, hospice duration (measured as the time between admission and death) is a precise measure of the family's exposure to an end-of-life stressor. Linking medical records, vital statistics, and other administrative microdata to describe decedent-kin pairs, event-history models assessed how hospice duration and characteristics of the family, including familial network size and coresidence with the decedent, were associated with long-term mortality risk of surviving daughters, sons, wives (widows), and husbands (widowers). Longer hospice duration increased mortality risk for daughters and husbands, but not sons or wives. Having other family members in the state was protective, and living in the same household as the decedent prior to death was a risk factor for sons. We conclude that relationship type and sex likely modify the how of end-of-life stressors (i.e., potential caregiving demands and bereavement experiences) affect health because of normative gender roles. Furthermore, exposure to dementia deaths may be particularly stressful, especially for women.

Description of the National Mortality Register of Panama.

Introduction: The National Mortality Register (NMR) of Panama is a key element in demographic analysis and in acquiring an updated picture of population health in Panama. The main objectives of this study are to characterize the NMR and to enumerate its strengths and weaknesses. Methods: We describe the history, processes, and structure of the Vital Statistics Section of the National Institute of Statistics and Census (the curator of the NMR database). In addition, we discuss publication punctuality, underregistration of the data, the proportion of registered deaths certified by medical doctors, and the top 5 causes of death according to the 80 groups of the International Classification of Diseases, Tenth Revision. We also examine works derived from the register's data, from the first publication on its website (2002) until 2019. Results: The NMR procedures were described. The web reports of the NMR were performed with a delay of between 1 to 2 years. The underregistration of deaths in 2002-2019 was 14.7%, and the national yearly proportion of deaths certified by medical doctors was always above 90%. Hard-to-reach areas had higher underregistration proportions and fewer deaths certified by medical doctors. Information extracted from the NMR supports several national and international reports, geographic information systems, and studies. The most common causes of death between 2002 and 2019 were noncommunicable diseases. Conclusions: The NMR is a robust official information system. However, hard-to-reach areas require improvement in terms of the NMR. The NMR is used for publishing official reports, writing studies, and updating reports on the current health status of Panama in a timely fashion following international guidelines.

Feasibility of measuring comorbidity indices based on clinical breast cancer records.

Background: Comorbidities have a significant impact on the treatment and outcome of breast cancer. However, data on such comorbidities from low-income countries are limited. Aim: To evaluate the feasibility and accuracy of comorbidity data extracted from medical records for estimating the prevalence of comorbidities among patients registered in the clinical breast cancer registry of the Islamic Republic of Iran. Methods: We collected data from the medical records of 400 patients on 30 comorbidities included in the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). The sensitivity and specificity of comorbidity data extracted from medical records were calculated using data from interviews with 97 randomly selected patients. We studied the prevalence of comorbidities using the CCI and ECI. Data were analysed using SPSS version 24. Results: The mean age of patients was 51.69 SD 12.28 years. The sensitivity and specificity of medical records for detecting any comorbidity data contained in CCI versus non-comorbidity were 93.2% and 69.8%, respectively. However, for the comorbidity data included in ECI, both sensitivity (86.9%) and specificity (44.4%) were lower than in CCI. Hypertension (n = 144, 36.0%) and diabetes without chronic complications (n = 77, 19.3%) were the most prevalent comorbidities. A higher proportion of patients had no comorbidity with CCI (72.2%) than with ECI (44.8%). Conclusion: It is feasible to construct a comorbidity index using medical records with high accuracy, especially when we extract comorbidities using the CCI. Further studies are needed to understand the association between comorbidity index and breast cancer survival among Iranian patients.

Desigualdades regionais na enumeração dos registros de óbitos fetais nos sistemas de informações sobre estatísticas vitais no Brasil / Regional inequalities in the enumeration of stillbirth records in information systems on vital statistics in Brazil / Desigualdades regionales en la enumeración de los registros de muertes fetales en los sistemas de información sobre estadísticas vitales en Brasil

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.

Experimental study on the impact of functional training on the agility quality of young athletes

At present, there is a lack of relevant literature on functional training for young athletes aged 10-12 years old in China. This project plans to combine functional training with sports training classes. Through 40 young athletes aged 10-12 years old, the impact of functional training on 10-12-year-oldathletes is systematically studied. Effects on agility in age-old athletes and exploring its causes. This article uses expert interview methods, experimental methods, mathematical statistics and other methods to analyze the survey results. Before the experiment begins, general information about the research subjects is collected, and then they are divided into experimental groups and control groups, and then a difference analysis is performed to determine the differences between the two groups. After 12 weeks of experimental intervention, the sensitivity quality evaluation indicators of the two groups of students were compared. Results: There was a very significant difference in the experimental group's scores on the hexagonal reaction ball test before and after the experiment (P<0.01), with an improvement rate of 10.8%; the difference between the control group's scores on the hexagonal reaction ball test before and after the experiment was statistically significant (P<0.01). Significance (P<0.05), the average improvement was 4.0%. There was a very significant difference (P<0.01) in the performance of the experimental group in the 4×10m return run before and after the experiment, with an improvement rate of 11.7%; in the control group, there was a significant difference in the 4×10m return run before and after the experiment. The difference was statistically significant (P<0.05), and the average progress rate was 8.0%... (AU)

BR-EMS 2021 life table for the Brazilian insured population / Tábuas de mortalidade BR-EMS 2021 do mercado segurador brasileiro / Tabla de vida BR-EMS 2021 para la población asegurada brasileña

Abstract This article presents the Brazilian private insurance market's actuarial life tables, BR- EMS 2021. Using Bayesian inference on the parameters of the Heligman- Pollard law of mortality and data from 23 insurance groups over 15 years, totaling 3.5 billion registers, the data were corrected through a two hidden-layer neural network. The resulting tables show that the insured population exhibits lower mortality rates than the general Brazilian population, even lower than the national populations of well-developed countries such as the USA. Moreover, besides the expected gender gap in mortality rates, there is a clear distance between the death and survivorship insurance coverage groups. Likewise, the insured population characteristics mitigate well-known regional structural discrepancies in the Brazilian population, indicating that being part of the selected population of insured individuals is thus associated with a more effective protection against death than other outstanding factors such as geographic region of residence.

Resumo Este artigo apresenta as tábuas de vida do mercado de seguros privados brasileiro, BR-EMS 2021. Os dados obtidos de 23 grupos seguradores ao longo de 15 anos, totalizando 3,5 bilhões de registros, foram corrigidos por meio de rede neural com duas camadas ocultas. Usando a inferência bayesiana para estimar os parâmetros sob a lei de mortalidade Heligman-Pollard, as tábuas obtidas mostram que a população segurada apresenta probabilidades de morte mais baixas do que a população brasileira em geral e até mesmo em relação a populações nacionais de países desenvolvidos, como os EUA. Além da esperada diferença de gênero nas taxas de mortalidade, há uma clara distância entre as probabilidades de morte dos grupos de cobertura de risco e cobertura de sobrevivência. Da mesma forma, é demonstrado que as tábuas regionais da população segurada não apresentam as discrepâncias regionais conhecidas no Brasil, indicando que fazer parte da população selecionada de segurados está associado a um fator de proteção mais eficaz do que outros fatores, como a região geográfica de residência.

Resumen Este artículo presenta las tablas de vida del mercado de seguros privados brasileño, BR-EMS 2021. Los datos, obtenidos de 23 grupos de seguros a lo largo de 15 años, totalizando 3,5 mil millones de registros, fueron corregidos usando una red neuronal con dos capas ocultas. Mediante la inferencia bayesiana para estimar los parámetros bajo la ley de mortalidad de Heligman-Pollard, las tablas obtenidas muestran que la población asegurada tiene tasas de mortalidad más bajas que la población general brasileña e incluso más bajas que las poblaciones nacionales de países desarrollados, como los Estados Unidos de Norteamérica. Además de la diferencia de género esperada en las tasas de mortalidad, hay una clara distinción entre las tablas de grupos de cobertura de riesgo y cobertura de sobrevivientes. Asimismo, se demuestra que las tablas regionales de población asegurada no presentan las conocidas discrepancias estructurales regionales en Brasil, lo que indica que participar de la población de asegurados está asociado con una protección contra la muerte más efectiva que otros factores como la región geográfica de residencia.

Evolução da completude das informações sobre suicídios no estado de Pernambuco, Brasil, 1996 a 2015 / Evolution of the information completeness on suicides in the state of Pernambuco, Brazil, from 1996 to 2015

Resumo Introdução O suicídio representa um importante problema de saúde pública no mundo. Considerado um fenômeno complexo, está associado a fatores sociais, biológicos e demográficos. A qualidade dos dados registrados na declaração de óbito é fundamental para conhecer a magnitude deste problema e subsidiar a construção de indicadores epidemiológicos que contribuem para a eficiência da gestão em saúde. Objetivo Analisar a evolução da completude dos registros de suicídio do Sistema de Informações sobre Mortalidade (SIM) no estado de Pernambuco, entre 1996 e 2015. Métodos Calculou-se a proporção de completude das variáveis da Declaração de Óbito. Para análise da tendência da completude, empregou-se o modelo de regressão Joinpoint. Resultados Houve tendência de aumento de completude das variáveis analisadas, com destaque para "raça/cor", "estado civil" e "escolaridade", com aumento superior a 60,0%. Conclusão A análise de tendência temporal mostrou melhoria no preenchimento dos dados sobre suicídio no SIM, porém, ainda figura o desafio de alcançar menos de 5,0% de incompletude para todas as variáveis. A avaliação da completude dos registros de suicídio contribui com o sistema de vigilância e com o aprimoramento das estatísticas vitais relacionadas às causas externas.

Abstract Background Suicide represents an important public health problem in the world. Considered a complex phenomenon it is associated with social, biological and demographic factors. The quality of the data registered in the Death Certificate is fundamental to know the magnitude of this problem and subsidizes the construction of epidemiological indicators that contribute to the efficiency of health management. Objective To analyze the evolution of the completeness of suicide records in the mortality information system (SIM) of the state of Pernambuco, between 1996 and 2015. Method The proportion of completeness of the death certificate variables was calculated. For the analysis of the completeness trend, the Joinpoint Regression model was used. Results There was a tendency to increase the completeness of the variables analyzed, with an emphasis on "race/color", "marital status", and "education level", with an increase of more than 60%. Conclusion Analysis of temporal trends showed an improvement in the filling of suicide data into the SIM. However, the challenge remains to reach less than 5% incompleteness across all variables. The assessment of the completeness of suicide records in the SIM is relevant for contributing to the suicide surveillance system and for the improvement of vital statistics related to external causes.

Maternal mortality committee and death surveillance in Recife in improving information: ex-ante and ex-post evaluation / Comitê de mortalidade materna e a vigilância do óbito em Recife no aprimoramento das informações: avaliação ex-ante e ex-post

Abstract Objectives: to evaluate the contribution of the Maternal Mortality and Death Surveillance Committee for women of childbearing age (WCA) and maternal mortality in the magnitude of maternal mortality and in the qualification of the causes of death in Recife, Brazil. Methods: ex ante/ex post evaluation, ecological, of the annual indicators of mortality of WCA, maternal and case study of declared maternal deaths according to causes of death before and after surveillance. Deaths of WCA (2010 and 2017) were analyzed. The percentage of investigation of deaths of WCA was calculated; their rates and maternal mortality ratio (MMR) were estimated; the groups of causes of death, classification of death, the moment of death, the proportional variation before and after surveillance, and the relocation of the causes after this process were described. Results: 4.327 (97.0%) of deaths of WCA were investigated (increase of 40.7% of maternal deaths) and MMR of 62.9/100 thousand live births. Improved notifications of immediate/late (75.0%) and remote (300.0%) postpartum; there was a difference in direct obstetric causes, total maternal deaths and late maternal death (p<0.001). Conclusion: the surveillance and the Maternal Mortality Committee showed potential in identifying the magnitude and qualification of causes of maternal death in order to propose the interventions directed to obstetric care.

Resumo Objetivos: avaliar a contribuição do Comitê de Mortalidade Materna e da Vigilância do Óbito de mulheres em idade fértil (MIF) e materno na magnitude da mortalidade materna e na qualificação das causas dos óbitos no Recife, Brasil. Métodos: avaliação ex ante/ex post, ecológico, dos indicadores anuais de mortalidade de MIF, materna e estudo de caso de óbitos maternos declarados segundo causas de morte antes e após a vigilância. Analisaram-se óbitos de MIF (2010-2017) e calculou-se o percentual de investigação; estimaram-se suas taxas e a razão de mortalidade materna (RMM); descreveram-se: grupos de causa, classificação e momento do óbito, variação proporcional antes e após a vigilância/análise do comitê e a realocação das causas após esse processo. Resultados: investigou-se 4.327 (97,0%) dos óbitos de MIF (incremento de 40,7% das mortes maternas), e RMM de 62,9/100 mil nascidos vivos; melhoraram as notificações do puerpério imediato/ tardio (75,0%) e remoto (300,0%); houve diferença nas causas obstétricas diretas, total de óbitos maternos e morte materna tardia (p<0,001). Conclusão: mostrou-se o potencial da vigilância e do Comitê de Mortalidade Materna na identificação da magnitude e qualificação das causas de morte materna para proposição de medidas direcionadas aos cuidados obstétricos.

Violência sexual e aborto legal: possibilidades e desafios da atuação psicológica / Sexual offence and legal abortion: opportunities and challenges from psychological working / Violencia sexual y aborto legal: posibilidades y desafíos de la atención psicológica

A violência sexual e o aborto legal são temas tabus em nossa sociedade. No campo da saúde, a(o) psicóloga(o) atua em fases distintas, seja na avaliação psicológica do pedido pelo aborto legal, que culminará ou não em sua aquiescência; seja no momento posterior à solicitação, no atendimento em enfermarias ou ambulatorial. Partindo de relato de experiência, este artigo tem como objetivo refletir sobre as possibilidades e desafios da atuação psicológica no atendimento em saúde para pessoas em situação de gestação decorrente de violência sexual e que buscam pelo aborto legal. Para tanto, dividimos o artigo em três momentos. No primeiro deles, será possível encontrar dados conceituais, estatísticos e históricos sobre ambos os temas, trazendo recortes nacionais e internacionais. No segundo, trazemos apontamentos sobre o que chamamos de "eixos norteadores", ou seja, dialogamos com aspectos fundamentais para o trabalho nesta seara, sendo eles gênero, família, sexualidade e trauma. Por fim, no terceiro, aprofundamos a reflexão sobre o atendimento psicológico atrelado aos conceitos já discutidos, analisando de forma crítica principalmente um dos pontos mais espinhosos da atuação: a avaliação para aprovação (ou recusa) do pedido pelo aborto. Apoiamo-nos no referencial psicanalítico e defendemos que esta atuação psicológica é primordialmente uma oferta de cuidado, comprometido com as demandas das pessoas atendidas e com a promoção de saúde mental, e consideramos que o papel da psicologia é essencial para o reconhecimento do sofrimento e dos efeitos do abandono socioinstitucional na vida do público atendido.(AU)

Sexual abuse and legal abortion are taboo subjects in our society. On the health area, the psychologist works on different fields, such as psychological evaluation from the request of legal abortion, that will end or not on its approval, and also in a further moment, either the care on wards or ambulatorial treatment. Relying on a case report, this article aims to contemplate the possibilities and challenges from psychological work on healthcare to pregnant women from sexual violence and seek legal abortion. For this purpose, we divide this article in three moments. On the first, it will find definitions, statistics, and historical data about both issues, including national and international information. On the second, we bring notes called 'guiding pillar,' that is, we interact with fundamental aspects from this area, such as gender, family, sexuality, and trauma. On the third one, in-depth discussions we dwell on psychological care tied to the concepts previously addressed, critically analyzing one of the hardest moments of working in this area: the evaluation to approve (or refuse) the request for abortion. We lean over psychoanalytic thoughts and argue that this psychological work is primarily an offer of care, committed to the needs from those who seek us and to promoting good mental health and, also, we consider that psychology is essential to acknowledge the suffering and the effects of social and institutional neglect on the lives of the people seen.(AU)

La violencia sexual y el aborto son temas tabús en nuestra sociedad. En el campo de la salud, el(la) psicólogo(a) actúa en diferentes fases: en la evaluación psicológica de la solicitud del aborto legal, que culminará o no en su obtención, y/o en el momento posterior a la solicitud en la atención en enfermería o ambulatorio. Desde un reporte de experiencia, este artículo pretende reflexionar sobre las posibilidades y los desafíos de la Psicología en la atención en salud para personas en estado de embarazo producto de violencia sexual y que buscan un aborto legal. Para ello, este artículo está dividido en tres momentos. En el primer, presenta datos conceptuales, estadísticos e históricos sobre los dos temas, trayendo recortes nacionales e internacionales. En el segundo, comenta los llamados "ejes temáticos", es decir, se establece un diálogo con aspectos fundamentales para el trabajo en este ámbito, como género, familia, sexualidad y trauma. Por último, en el tercer, profundiza en la reflexión sobre la atención psicológica asociada a los conceptos discutidos, analizando de forma crítica uno de los puntos más espinosos de la actuación: la evaluación para la aprobación (o negativa) de la solicitud de aborto. Se utilizó el referencial psicoanalítico y se argumenta que esta atención psicológica es sobre todo una forma de cuidado, comprometida con las demandas de las personas atendidas y la promoción de la salud mental, y el papel de la Psicología es esencial para reconocer el sufrimiento y los efectos del abandono socioinstitucional en la vida del público atendido.(AU)

Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)

Feasibility of measuring comorbidity indices based on clinical breast cancer records

Background:Comorbidities have a significant impact on the treatment and outcome of breast cancer. However, data on such comorbidities from low-income countries are limited.Aim:To evaluate the feasibility and accuracy of comorbidity data extracted from medical records for estimating the prevalence of comorbidities among patients registered in the clinical breast cancer registry of the Islamic Republic of Iran.Methods:We collected data from the medical records of 400 patients on 30 comorbidities included in the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). The sensitivity and specificity of comorbidity data extracted from medical records were calculated using data from interviews with 97 randomly selected patients. We studied the prevalence of comorbidities using the CCI and ECI. Data were analysed using SPSS version 24.Results:The mean age of patients was 51.69 SD 12.28 years. The sensitivity and specificity of medical records for detecting any comorbidity data contained in CCI versus non-comorbidity were 93.2% and 69.8%, respectively. However, for the comorbidity data included in ECI, both sensitivity (86.9%) and specificity (44.4%) were lower than in CCI. Hypertension (n = 144, 36.0%) and diabetes without chronic complications (n = 77, 19.3%) were the most prevalent comorbidities. A higher proportion of patients had no comorbidity with CCI (72.2%) than with ECI (44.8%).Conclusion:It is feasible to construct a comorbidity index using medical records with high accuracy, especially when we extract comorbidities using the CCI. Further studies are needed to understand the association between comorbidity index and breast cancer survival among Iranian patients.

Representatividad del Registro de Tumores Torácicos de España. Comparación de datos sociodemográficos con otros registros nacionales / Representativeness of the Spanish Thoracic Tumour Registry. Comparison of sociodemographic data with other national registries

Objetivo: En España, debido a la falta de datos, se creó un registro de cáncer de pulmón, el Registro de Tumores Torácicos (RTT), el cual debería demostrar su comparabilidad con los datos poblacionales para tener una representatividad adecuada. Con esta finalidad, se comparan las características sociodemográficas del RTT con los datos de incidencia de la Red de Registros de Cáncer (REDECAN) y de mortalidad del Instituto Nacional de Estadística (INE). Método: Se utilizaron las fuentes de datos de cáncer de pulmón disponibles hasta el momento: REDECAN e INE. De cada fuente se recogieron los casos de cáncer de pulmón globales y desagregados por sexo y por grupos de edad, y se compararon los datos para el periodo 2017-2020. Se calcularon las proporciones por sexo y grupo de edad del RTT respecto a ambas bases de datos (que recogen incidencia y mortalidad), para el periodo completo de estudio y desglosado por año. Resultados: Se incluyeron 17.109 casos incidentes de cáncer de pulmón incluidos en el RTT, 58.668 casos incidentes estimados de REDECAN y 88.083 muertes entre 2017 y 2020 del INE. En cuanto al sexo, las proporciones son muy similares entre las tres fuentes y las diferencias no superan el 4%. En cuanto a la edad, las diferencias no son elevadas, siendo mayores para los datos de mortalidad en el grupo de mayor edad del INE frente al RTT. Conclusiones: El RTT parece ser representativo de los casos de cáncer de pulmón diagnosticados en España para los años 2019 y 2020, tanto por sexo como por edad. Esto permite poder caracterizar con exactitud el estado de esta enfermedad, primera causa de muerte por cáncer en España, y que el análisis de resultados que se vayan a obtener del RTT pueda ser aplicado a los casos de cáncer de pulmón diagnosticados en nuestro país. (AU)

Objective: In Spain, due to the lack of data at national level a lung cancer registry, the Thoracic Tumour Registry (TTR), was created. Such registry should demonstrate comparability with population-based data to ensure representativeness at population level. The aim is to compare the socio-demographic characteristics of the TTR with incidence data from the Red de Registros de Cáncer (REDECAN) and mortality data from the Instituto Nacional de Estadística (INE). Method: Lung cancer data sources available to date, REDECAN and INE, were used. Lung cancer cases overall and disaggregated by sex and age groups were collected from each source of information and data were compared for the period 2017-2020. Sex and age group proportions of TTR were calculated for both databases (which collect incidence and mortality data), for the entire study period and broken down by year. Results: A total of 17,109 incident lung cancer cases from the TTR, 58,668 estimated incident cases from REDECAN and 88,083 deaths registered from INE between 2017 and 2020 were included. In terms of sex, the proportions are very similar between the three sources and the differences do not exceed 4%. In terms of age, the differences are not large, being larger for mortality data in the older age group from the INE versus the TTR. Conclusions: The TTR seems to be representative of lung cancer cases diagnosed in Spain between 2019 and 2020, both by sex and age. This allows us to accurately characterise the status of this disease, which is the leading cause of cancer death in Spain, and that the analysis of results obtained from the RTT can be applied to cases of lung cancer diagnosed in our country. (AU)

Tendencias en la mortalidad por neumonía en adultos en Chile, 2000-2016 / Trends in adult pneumonia mortality in Chile, 2000-2016

Objetivo: Analizar y modelar los cambios en la tendencia de la mortalidad por neumonía en la población mayor de 15 años de Chile, entre los años 2000 y 2016. Métodos: Estudio epidemiológico basado en información de bases de datos públicas de estadísticas vitales del Departamento de Estadística e Información en Salud (DEIS) y del Instituto Nacional de Estadística (INE) del Ministerio de Salud (MINSAL) de Chile. Los casos fueron identificados por los códigos CIE-10 J12-J18. Se calculó la tasa de mortalidad estandarizada por edad, según sexo y grupo etario. Se utilizó el análisis de regresión Joinpoint para modelar la mortalidad y estimar el porcentaje de cambio anual (CPA) en las tasas e identificar cambios significativos en las tendencias. Se utilizó el cambio del CPA como medida de resumen. Resultados: Durante el período de estudio, la tasa de mortalidad por neumonía en Chile disminuyó significativamente en un 61,9%, desde 56,3 muertes por 100.000 habitantes el año 2000 a 21,7 muertes por 100.000 habitantes en el año 2016, con un CPA de −4,2%, (p < 0,05). El 90% de los fallecidos tenían más de 65 años. Conclusiones: Las tasas de mortalidad por neumonía en Chile en mayores de 15 años muestran una tendencia a la disminución sostenida significativa en el período comprendido entre los años 2000 y 2016.

Objective: To analyze and model changes in the pneumonia mortality trend in the population over 15 years old of Chile, between 2000 and 2016. Methods: Epidemiological study based on information from public databases of vital statistics of the Department of Health Statistics and Information (DEIS) and the National Institute of Statistics (INE) of the Ministry of Health (MINSAL) of Chile. The cases were identified by the codes ICD-10 J12-J18. We calculated age-standardized overall mortality, according to sex and age group. Joinpoint regression analysis was used to model mortality and estimate the annual percentage of change (APC) in rates and identify significant changes in trends. APC was used as a summary measure. Results: During the period studied, the pneumonia mortality rate in Chile decreased significantly by 61.9%. Mortality rate diminished from 56.3 deaths per 100,000 inhabitants in 2000 to 21.7 deaths per 100,000 inhabitants in 2016 with an APC of −4.2%, (p < 0.05). Almost 90% of the deceased were over 65 years old. Conclusions: Mortality rates for pneumonia in Chile in people over 15 years of age show a significant sustained decreasing trend in the period between 2000 and 2016.

Análise espaçotemporal da mortalidade nas primeiras 24 horas de vida e sua evitabilidade no estado de Pernambuco, 2000-2019 / Spatio-temporal analysis of mortality in the first 24 hours of life and its preventability in the state of Pernambuco, 2000-2019 / Análisis espaciotemporal sobre la mortalidad en las primeras 24 horas de vida y su prevención en el estado de Pernambuco entre 2000 y 2019

O objetivo deste estudo é analisar os padrões espaçotemporais da mortalidade nas primeiras 24 horas de vida e sua evitabilidade no estado de Pernambuco no período de 2000 a 2019. Trata-se de estudo ecológico misto, tendo os trimestres e os municípios como unidades de análise. Constituíram-se como fontes de dados os sistemas de Informações sobre Mortalidade e Nascidos Vivos. Foram incluídos todos os óbitos no estado nas primeiras 24 horas de vida e por causas evitáveis, caracterizados conforme fatores de riscos proximais, intermediários e distais. A análise de evitabilidade dos óbitos utilizou a Lista Brasileira de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde. Foram calculadas as taxas de mortalidade e de evitabilidade nas primeiras 24 horas de vida. A análise espacial foi conduzida por meio da estatística scan, e a temporal, segundo o Modelo Autorregressivo Integrado de Médias Móveis. No período de 2000 a 2019, foram registrados 13.601 óbitos nas primeiras 24 horas de vida, sendo 10.497 (77,19%) por causas evitáveis. Destes, 5.513 (40,53%) foram classificados como reduzíveis por adequada atenção à mulher na gestação. As variáveis do nível proximal idade gestacional < 22 semanas (RA = 855,01) e peso ao nascer < 1.500 gramas (RA = 204,03) representam uma parcela importante dos óbitos ocorridos nas primeiras 24 horas de vida. As variáveis idade gestacional, sexo, peso ao nascer, tipo de gravidez, tipo de parto, idade da mãe e escolaridade materna foram estatisticamente significantes (p < 0,01). A varredura espacial identificou o aumento de clusters para ambas as taxas. A análise temporal evidenciou que a taxa de mortalidade e a taxa de mortalidade por causas evitáveis apresentaram padrão estacionário no período e a previsão revelou tendência crescente. Os resultados mostraram que a mortalidade nas primeiras 24 horas de vida e por causas evitáveis se configura como um problema de saúde pública no estado. Áreas de maior risco de óbito foram apontadas e a previsão revelou um aumento nas taxas.

This study aims to analyze the spatio-temporal patterns of mortality in the first 24 hours of life and its preventability in the state of Pernambuco from 2000 to 2019. This is a mixed ecological study with the quarters and the municipalities as units of analysis. The information systems on Mortality and Live Births constituted the data sources. All deaths in the state in the first 24 hours of life and from preventable causes were included, characterized according to proximal, intermediate, and distal risk factors. The analysis of preventability of deaths used the Brazilian List of Preventable Causes of Death by Interventions of the Brazilian National Health System. Mortality and preventability rates in the first 24 hours of life were calculated. Spatial analysis was conducted using scan and temporal statistics according to the Autoregressive Integrated Moving Averages Model. In the period from 2000 to 2019, 13,601 deaths were recorded in the first 24 of life, of which 10,497 (77.19%) were due to preventable causes. Of these, 5,513 (40.53%) were classified as reducible due to adequate care for women during pregnancy. The variables at the proximal level: gestational age < 22 weeks (AR = 855.01) and birth weight < 1,500 grams (AR = 204.03) represent an important part of the deaths that occurred in the first 24 hours of life. The variables gestational age, sex, birth weight, type of pregnancy, type of delivery, mother's age and maternal education were statistically significant (p < 0.01). Spatial scanning identified the increase in clusters for both rates. The temporal analysis showed that the mortality rate and the mortality rate from preventable causes presented a stationary pattern in the period and the forecast reveals a growing trend. The results show that mortality in the first 24 hours of life and from preventable causes is configured as a public health problem in the state. Areas of greater risk of death were identified and the forecast reveals an increase in the rates.

El objetivo de este estudio es analizar los patrones espaciotemporales de mortalidad en las primeras 24 horas de vida y su prevención en el estado de Pernambuco (Brasil) en el periodo de 2000 a 2019. Se trata de un estudio ecológico mixto, con los trimestres y los municipios como unidades de análisis. Los sistemas de información sobre Mortalidad y Nacidos Vivos fueron las fuentes de datos. Se incluyeron todas las muertes en las primeras 24 horas de vida y por causas prevenibles en el estado y se caracterizaron según factores de riesgo proximal, intermedio y distal. El análisis de la prevención de las muertes utilizó la Lista Brasileña de Causas de Muerte Prevenibles por Intervenciones del Sistema Único de Salud. Se calcularon las tasas de mortalidad y de prevención en las primeras 24 horas de vida. El análisis espacial se llevó a cabo usando estadísticas de escaneo y análisis temporal de acuerdo con el modelo de promedios móviles integrados autorregresivos. En el período de 2000 a 2019 se registraron 13.601 muertes en las primeras 24 de vida, de las cuales 10.497 (77,19%) se debieron a causas evitables. De estas, 5.513 (40,53%) fueron clasificadas como reducibles por atención adecuada a la mujer durante el embarazo. Las variables a nivel proximal edad gestacional < 22 semanas (RA = 855,01) y peso al nacer < 1.500 gramos (RA = 204,03) representan parte importante de las muertes ocurridas en las primeras 24 horas de vida. Las variables edad gestacional, sexo, peso al nacer, tipo de embarazo, tipo de parto, edad de la madre y escolaridad materna fueron estadísticamente significativas (p < 0,01). El escaneo espacial identificó un aumento de conglomerados para ambas tasas. El análisis temporal mostró que la tasa de mortalidad y la tasa de mortalidad por causas evitables presentaron un patrón estacionario en el periodo, y el pronóstico revela una tendencia creciente. Los resultados muestran que la mortalidad en las primeras 24 horas de vida y por causas prevenibles se configura como un problema de salud pública en el estado. Se identificaron áreas de mayor riesgo de muerte, y el pronóstico revela un aumento en las tasas.

Análise espacial dos homicídios intencionais de mulheres / Análisis espacial de los homicidios intencionales de mujeres / Spatial analysis of female intentional homicides

RESUMO Objetivo Analisar as características e a distribuição espacial dos homicídios intencionais de mulheres, de acordo com as regionais de saúde, em um estado da Região Nordeste do Brasil. Método Estudo ecológico que teve o município e as regiões de saúde como unidades de análise e usou dados do Sistema de Informações sobre Mortalidade. Calcularam-se as taxas de mortalidade, que foram suavizadas pelo método bayesiano empírico local. Para identificação da existência de autocorrelação espacial, utilizou-se o índice de Moran. Resultados Registraram-se 1.144 homicídios, com taxa média de 6,2/100.000 mulheres. Para todas as regiões de saúde prevaleceram a faixa etária de 10 a 39 anos, a raça/cor negra e a situação conjugal solteira. Os homicídios ocorreram em via pública. Os dias da semana com maiores registros foram sábado e domingo e os meses do ano dezembro, janeiro, fevereiro e junho. O índice de Moran global foi de 0,6 (p = 0,01). Identificaram-se clusters de municípios com altas taxas de homicídios nas III e IV regiões de saúde. Conclusões As vítimas de homicídios eram jovens, negras e solteiras. A análise espacial localizou áreas críticas de ocorrência de homicídios, que são prioritárias para as ações de prevenção da violência contra as mulheres.

RESUMEN Objetivo Analizar las características y la distribución espacial de los homicidios intencionales de mujeres, de acuerdo con las regionales de salud, en una provincia de la Región Noreste de Brasil. Método Estudio ecológico que utilizó el municipio y las regiones de salud como unidades de análisis y empleó datos del Sistema de Informaciones sobre Mortalidad. Se calcularon las tasas de mortalidad que fueron mitigadas por el método bayesiano empírico local. Se utilizó el índice de Moran para identificación de la existencia de autocorrelación espacial. Resultados Fueron registrados 1.144 homicidios con un promedio de 6,2/100.000 mujeres. En todas las regiones de salud predominaron mujeres con edades entre 10 y 39 años, de raza/color negro y solteras. Los homicidios ocurrieran en vía pública. Los días en los que más ocurrieron fueron sábado y domingo y los meses diciembre, enero, febrero y junio. El índice de Moran global fue 0,6 (p = 0,01). Se identificaron clusters de municipios con altas tasas de homicidios en las III y IV regiones de salud. Consideraciones Finales Las victimas de homicidios eran jóvenes, negras y solteras. El análisis espacial localizó áreas críticas de ocurrencia de homicidios, que son prioritarias para las acciones preventivas de la violencia contra las mujeres.

ABSTRACT Objective To analyze the characteristics and spatial distribution of female intentional homicides, according to the regional health offices, in a state in the Northeast Region of Brazil. Method This is an ecological study that had the municipality and regional health offices as units of analysis and used data from the Brazilian Mortality Information System. Mortality rates were calculated and smoothed by the local empirical Bayesian method. To identify the existence of spatial autocorrelation, the Moran's index was used. Results A total of 1,144 homicides were reported, with an average rate of 6.2/100,000 women. For all regional health offices, the 10-39 age group, black race/skin color, and single marital status prevailed. The homicides took place in public spaces. The days of the week with the highest records were Saturday and Sunday and the months of the year December, January, February, and June. The global Moran's index was 0.6 (p = 0.01). Clusters of municipalities with high homicide rates were identified in regional health offices III and IV. Conclusions The homicide victims were young, black, and single. The spatial analysis found critical areas of homicide occurrence, which are a priority for actions to prevent violence against women.