Changes in the community structure of stony corals in the southern Mexican Caribbean.

The Mexican Caribbean coral reef ecosystem has endured the effects of global and regional stressors and, recently, the massive arrivals of the free-living, floating brown algae Sargassum spp. This study aimed to evaluate spatiotemporal changes in the stony coral community structure in the southern Mexican Caribbean by a temporal comparison of live coral cover and colony density using a data set collected in 2008-2009 and a recent survey in 2021 within a Protected Natural Area. A multivariate analysis approach was used to reveal spatiotemporal changes in coral cover and colony densities. Coral cover ranged from 6.9 to 8.9% in 2008-2009 to 6.5% in 2021, the lowest values recorded for the area. Coral colony density ranged from 0.68 to 0.78 colonies m-1 in 2008-2009 to 0.68 colonies m-1 in 2021. The present results appear to represent subtle changes during the last decade.

Validation of physician certified verbal autopsy using conventional autopsy: a large study of adult non-external causes of death in a metropolitan area in Brazil.

BACKGROUND: Reliable mortality data are essential for the development of public health policies. In Brazil, although there is a well-consolidated universal system for mortality data, the quality of information on causes of death (CoD) is not even among Brazilian regions, with a high proportion of ill-defined CoD. Verbal autopsy (VA) is an alternative to improve mortality data. This study aimed to evaluate the performance of an adapted and reduced version of VA in identifying the underlying causes of non-forensic deaths, in São Paulo, Brazil. This is the first time that a version of the questionnaire has been validated considering the autopsy as the gold standard. METHODS: The performance of a physician-certified verbal autopsy (PCVA) was evaluated considering conventional autopsy (macroscopy plus microscopy) as gold standard, based on a sample of 2060 decedents that were sent to the Post-Mortem Verification Service (SVOC-USP). All CoD, from the underlying to the immediate, were listed by both parties, and ICD-10 attributed by a senior coder. For each cause, sensitivity and chance corrected concordance (CCC) were computed considering first the underlying causes attributed by the pathologist and PCVA, and then any CoD listed in the death certificate given by PCVA. Cause specific mortality fraction accuracy (CSMF-accuracy) and chance corrected CSMF-accuracy were computed to evaluate the PCVA performance at the populational level. RESULTS: There was substantial variability of the sensitivities and CCC across the causes. Well-known chronic diseases with accurate diagnoses that had been informed by physicians to family members, such as various cancers, had sensitivities above 40% or 50%. However, PCVA was not effective in attributing Pneumonia, Cardiomyopathy and Leukemia/Lymphoma as underlying CoD. At populational level, the PCVA estimated cause specific mortality fractions (CSMF) may be considered close to the fractions pointed by the gold standard. The CSMF-accuracy was 0.81 and the chance corrected CSMF-accuracy was 0.49. CONCLUSIONS: The PCVA was efficient in attributing some causes individually and proved effective in estimating the CSMF, which indicates that the method is useful to establish public health priorities.

Public health utility of cause of death data: applying empirical algorithms to improve data quality.

BACKGROUND: Accurate, comprehensive, cause-specific mortality estimates are crucial for informing public health decision making worldwide. Incorrectly or vaguely assigned deaths, defined as garbage-coded deaths, mask the true cause distribution. The Global Burden of Disease (GBD) study has developed methods to create comparable, timely, cause-specific mortality estimates; an impactful data processing method is the reallocation of garbage-coded deaths to a plausible underlying cause of death. We identify the pattern of garbage-coded deaths in the world and present the methods used to determine their redistribution to generate more plausible cause of death assignments. METHODS: We describe the methods developed for the GBD 2019 study and subsequent iterations to redistribute garbage-coded deaths in vital registration data to plausible underlying causes. These methods include analysis of multiple cause data, negative correlation, impairment, and proportional redistribution. We classify garbage codes into classes according to the level of specificity of the reported cause of death (CoD) and capture trends in the global pattern of proportion of garbage-coded deaths, disaggregated by these classes, and the relationship between this proportion and the Socio-Demographic Index. We examine the relative importance of the top four garbage codes by age and sex and demonstrate the impact of redistribution on the annual GBD CoD rankings. RESULTS: The proportion of least-specific (class 1 and 2) garbage-coded deaths ranged from 3.7% of all vital registration deaths to 67.3% in 2015, and the age-standardized proportion had an overall negative association with the Socio-Demographic Index. When broken down by age and sex, the category for unspecified lower respiratory infections was responsible for nearly 30% of garbage-coded deaths in those under 1 year of age for both sexes, representing the largest proportion of garbage codes for that age group. We show how the cause distribution by number of deaths changes before and after redistribution for four countries: Brazil, the United States, Japan, and France, highlighting the necessity of accounting for garbage-coded deaths in the GBD. CONCLUSIONS: We provide a detailed description of redistribution methods developed for CoD data in the GBD; these methods represent an overall improvement in empiricism compared to past reliance on a priori knowledge.

Vivir con dolor crónico desde la experiencia de adultos mayores con enfermedades crónico degenerativas / Living with cronic pain from the experience of older adults with chronic degenerative diseases

INTRODUCCIÓN: Ser adulto mayor conlleva a cambios físicos, psicológicos y sociales que se ven aún más afectados por comorbilidades como las enfermedades crónicas y el dolor. El propósito es interpretar las experiencias de vivir con dolor de los adultos mayores con enfermedades crónico-degenerativas. METODOLOGÍA: Diseño cualitativo de tipo fenomenológico, recolectado mediante un muestreo intencional a través de una entrevista semi estructurada, en la cual se seleccionó a la población adulta mayor con una patología crónico-degenerativa que haya experimentado dolor crónico; se analizaron los datos con el proceso cognitivo de Janice Morse, hasta llegar a la saturación de la información. Participaron 8 personas entre los 66 y 72 años, habiendo siete mujeres y un hombre. RESULTADOS: Se encontraron cuatro categorías: 1. El desgaste de vivir con dolor; 2. Cotidianidad del vivir con dolor; 3. Alternativas para aliviar el dolor, y 4. Afectación en el entorno social. CONCLUSIÓN: Ser adulto mayor trae muchos cambios en todas las esferas de la vida, sin embargo, el padecer una enfermedad crónica acelera toda esta transición, viéndose afectados la salud mental, físico y social, adaptando esta situación a su cotidianidad, buscando a su vez medios alternos que mitiguen o disminuya el dolor.

INTRODUCTION: Being an older adult leads to physical, psychological, and social changes that are further affected by comorbidities such as chronic diseases and pain. The purpose is to interpret the experiences of living in pain of older adults with chronic-degenerative diseases. METHOD: Qualitative phenomenological research, recollected by an intentional sampling through a semi-structured interview in which was selected the adult population with a chronic-degenerative pathology that have experienced an state of chronic pain. The data was analyzed with the cognitive process of Janice Morse and reached to a saturation of 8 participants. There were 8 participants between the ages of 66 and 72, with seven women and one man. RESULTS: Four categories were found: 1. Wearing of living with pain; 2. Daily Living with Pain; 3. Alternatives for Pain Relief, and 4. Social Affectation. CONCLUSION: Being an older adult brings many changes in all spheres of life, however, suffering from a chronic disease accelerates this whole transition, being affected mental, physical and social health, adapting this situation to its daily life, seeking in turn alternate means to mitigate or decrease pain.

Severe Leptospirosis in a Mexican Woman.

OBJECTIVE: To describe a severe case of infection by Leptospira in a woman in the northwest of Mexico. CASE REPORT: A 55-yearold woman from Sonora, México arrived at the Intensive Care Unit due to severe multiple organ failure primarily affecting the respiratory, renal and hepatic systems. Diagnostic tests were performed, and they were positive for anti-Leptospira antibodies, IgM and IgG; and spirochetes were observed on dark field microscopy and confirmed by Polymerase Chain Reaction (PCR). Doxycycline and platelet apheresis transfusion were used as treatment, which led to a very slow recovery. CONCLUSION: The information presented in this study may help in the identification of pathology caused by spirochetes. This case report is the first to present a case of severe leptospirosis in Sonora, México.

Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative.

BACKGROUND: Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the medical certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification. METHODS: The three training strategies evaluated were (1) training of trainers (TOT) in the Philippines, Myanmar, and Sri Lanka; (2) direct training of physicians by the UoM D4H in Papua New Guinea (PNG); and (3) the implementation of an online and basic training strategy in Peru. The evaluation involved an assessment of MCCODs before and after training using an assessment tool developed by the University of Melbourne. RESULTS: The TOT strategy led to reductions in incorrectly completed certificates of between 28% in Sri Lanka and 40% in the Philippines. Following direct training of physicians in PNG, the reduction in incorrectly completed certificates was 30%. In Peru, the reduction in incorrect certificates was 30% after implementation and training on an online system only and 43% after training on both the online system and basic medical certification principles. CONCLUSIONS: The results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.

Where there is no hospital: improving the notification of community deaths.

BACKGROUND: Globally, an estimated two-thirds of all deaths occur in the community, the majority of which are not attended by a physician and remain unregistered. Identifying and registering these deaths in civil registration and vital statistics (CRVS) systems, and ascertaining the cause of death, is thus a critical challenge to ensure that policy benefits from reliable evidence on mortality levels and patterns in populations. In contrast to traditional processes for registration, death notification can be faster and more efficient at informing responsible government agencies about the event and at triggering a verbal autopsy for ascertaining cause of death. Thus, innovative approaches to death notification, tailored to suit the setting, can improve the availability and quality of information on community deaths in CRVS systems. IMPROVING THE NOTIFICATION OF COMMUNITY DEATHS: Here, we present case studies in four countries (Bangladesh, Colombia, Myanmar and Papua New Guinea) that were part of the initial phases of the Bloomberg Data for Health Initiative at the University of Melbourne, each of which faces unique challenges to community death registration. The approaches taken promote improved notification of community deaths through a combination of interventions, including integration with the health sector, using various notifying agents and methods, and the application of information and communication technologies. One key factor for success has been the smoothing of processes linking notification, registration and initiation of a verbal autopsy interview. The processes implemented champion more active notification systems in relation to the passive systems commonly in place in these countries. CONCLUSIONS: The case studies demonstrate the significant potential for improving death reporting through the implementation of notification practices tailored to a country's specific circumstances, including geography, cultural factors, structure of the existing CRVS system, and available human, information and communication technology resources. Strategic deployment of some, or all, of these innovations can result in rapid improvements to death notification systems and should be trialled in other settings.

Florecimiento algal nocivo de Pyrodinium bahamense en diciembre 2018 en la costa del Pacífico de Guatemala / Harmful algal bloom of Pyrodinium bahamense in December 2018 in the Pacific coast of Guatemala

Los florecimientos algales nocivos (FAN) son eventos naturales que ocurren cuando una o más especies de microalgas proliferan en concentraciones que pueden causar daño a los organismos acuáticos y a seres humanos que los consuman. En las últimas décadas, se ha registrado a nivel mundial un aumento de eventos de mortalidad alarmante de organismos acuáticos e intoxicaciones en seres humanos causadas por toxinas producidas por microalgas. En Guatemala existe escasa información sobre eventos FAN, no obstante, en diciembre de 2018 ocurrió un FAN en la costa Pacífico de Guatemala. La Comisión Nacional para la Vigilancia y el Control de la Marea Roja Tóxica recolectó muestras biológicas e identificó la presencia de 3,000 cel/L del dinoflagelado Pyrodinium bahamense. El bioensayo en ratón de las muestras, indica concentraciones de saxitoxina de 8,236 UR/100 g y 6,559 UR/100 g, para los días 20 y 27 de diciembre, respectivamente. Estas concentraciones no han sido reportadas previamente en Guatemala, y pueden ser potencialmente tóxicas para la salud pública. Se recomienda mantener un monitoreo de FAN para prevenir impactos negativos en la salud pública y ambiental.

Harmful algal blooms (HABs) are natural events that occur when one or more species of microalgae proliferate at concentrations that can cause damage to aquatic organisms and to those who consume them. In Guatemala very little information exists on HAB events, although in December 2018 has occurred a HABs at the Pacific Coast of Guatemala. A biological sample were collected by the National Commission for Surveillance and Control of Toxic Red Tide. The samples showed 3,000 cel/L of the dinoflagellate Pyrodinium bahamense. During the bioassay for saxitoxin, the concentrations reached 8,236 MU/100 g and 6,559 MU/100 g, for December 20th and 27th, respectively. These concentrations has not been reported previously for Guatemala, and could be a risk in the public health. This result emphasizes the importance of maintaining the HABS monitoring program to prevent negative impact on public environmental health.

The burden of cancer in Mexico, 1990-2013.

OBJECTIVE: To analyze mortality and incidence for 28 cancers by deprivation status, age and sex from 1990 to 2013. MATERIALS AND METHODS: The data and methodological approaches provided by the Global Burden of Disease (GBD 2013) were used. RESULTS: Trends from 1990 to 2013 show important changes in cancer epidemiology in Mexico. While some cancers show a decreasing trend in incidence and mortality (lung, cervical) others emerge as relevant health priorities (prostate, breast, stomach, colorectal and liver cancer). Age standardized incidence and mortality rates for all cancers are higher in the northern states while the central states show a decreasing trend in the mortality rate. The analysis show that infection related cancers like cervical or liver cancer play a bigger role in more deprived states and that cancers with risk factors related to lifestyle like colorectal cancer are more common in less marginalized states. CONCLUSIONS: The burden of cancer in Mexico shows complex regional patterns by age, sex, types of cancer and deprivation status. Creation of a national cancer registry is crucial.

The burden of cancer in Mexico, 1990-2013 / La carga del cáncer en México, 1990-2013

Abstract: Objective: To analyze mortality and incidence for 28 cancers by deprivation status, age and sex from 1990 to 2013. Materials and methods: The data and methodological approaches provided by the Global Burden of Disease (GBD 2013) were used. Results: Trends from 1990 to 2013 show important changes in cancer epidemiology in Mexico. While some cancers show a decreasing trend in incidence and mortality (lung, cervical) others emerge as relevant health priorities (prostate, breast, stomach, colorectal and liver cancer). Age standardized incidence and mortality rates for all cancers are higher in the northern states while the central states show a decreasing trend in the mortality rate. The analysis show that infection related cancers like cervical or liver cancer play a bigger role in more deprived states and that cancers with risk factors related to lifestyle like colorectal cancer are more common in less marginalized states. Conclusions: The burden of cancer in Mexico shows complex regional patterns by age, sex, types of cancer and deprivation status. Creation of a national cancer registry is crucial.

Resumen: Objetivo: Analizar la incidencia y la mortalidad de 28 tipos de cáncer por nivel de marginación, grupos de edad y sexo, de 1990 a 2013. Material y métodos: Los datos utilizados provienen del estudio de la Carga Global de Enfermedades (2013). Las entidades federativas se clasificaron de acuerdo con el índice de marginación del Consejo Nacional de Población. Resultados: Los datos muestran una tendencia decreciente para algunos cánceres (pulmón y cervical), mientras otros aparecen como prioritarios y relevantes (próstata, mama, estómago, colon e hígado). En el norte se observan incrementos regionales mayores en las tasas de incidencia y mortalidad estandarizadas por edad, mientras que en los estados del centro se observa una tendencia decreciente de la tasa de mortalidad. Conclusiones: La epidemiología del cáncer en México (en su mayoría basada en datos de mortalidad) presentan patrones regionales complejos por edad, sexo, tipo de cáncer e índice de marginación. Es vital la creación de un registro nacional para mejorar el seguimiento y evaluación de intervenciones preventivas y curativas.

Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis.

BACKGROUND: Liver cirrhosis is a major yet largely preventable and underappreciated cause of global health loss. Variations in cirrhosis mortality at the country level reflect differences in prevalence of risk factors such as alcohol use and hepatitis B and C infection. We estimated annual age-specific mortality from liver cirrhosis in 187 countries between 1980 and 2010. METHODS: We systematically collected vital registration and verbal autopsy data on liver cirrhosis mortality for the period 1980 to 2010. We corrected for misclassification of deaths, which included deaths attributed to improbable or nonfatal causes. We used ensemble models to estimate liver cirrhosis mortality with uncertainty by age, sex, country and year. We used out-of-sample predictive validity to select the optimal model. RESULTS: Global liver cirrhosis deaths increased from around 676,000 (95% uncertainty interval: 452,863 to 1,004,530) in 1980 to over 1 million (1,029,042; 670,216 to 1,554,530) in 2010 (about 2% of the global total). Over the same period, the age-standardized cirrhosis mortality rate decreased by 22%. This was largely driven by decreasing cirrhosis mortality rates in China, the US and countries in Western Europe. In 2010, Egypt, followed by Moldova, had the highest age-standardized cirrhosis mortality rates, 72.7 and 71.2 deaths per 100,000, respectively, while Iceland had the lowest. In Egypt, almost one-fifth (18.1%) of all deaths in males 45- to 54-years old were due to liver cirrhosis. Liver cirrhosis mortality in Mexico is the highest in Latin America. In France and Italy, liver cirrhosis mortality fell by 50% to 60%; conversely, in the United Kingdom, mortality increased by about one-third. Mortality from liver cirrhosis was also comparatively high in Central Asia countries, particularly Mongolia, Uzbekistan and Kyrgyzstan, and in parts of sub-Saharan Africa, notably Gabon. CONCLUSIONS: Liver cirrhosis is a significant cause of global health burden, with more than one million deaths in 2010. Our study identifies areas with high and/or rapidly increasing mortality where preventive measures to control and reduce liver cirrhosis risk factors should be urgently strengthened.

La carga de enfermedad, lesiones, factores de riesgo y desafíos para el sistema de salud en México / Burden of disease, injuries, risk factors and challenges for the health system in Mexico

Objetivo. Presentar los resultados de la carga de enfermedad en México de 1990 a 2010 para las principales enfermedades, lesiones y factores de riesgo, por sexo. Materiales y métodos. Se realizó un análisis secundario del estudio de la carga mundial de la enfermedad 2010. Resultados. En 2010 se perdieron 26.2 millones de años de vida saludable (AVISA), 56% en hombres y 44% en mujeres. Las principales causas de AVISA en hombres fueron violencia, cardiopatía isquémica y los accidentes de tránsito. En las mujeres fueron la diabetes, la enfermedad renal crónica y la cardiopatía isquémica. Los trastornos mentales y musculoesqueléticos concentran 18% de la carga. Los factores de riesgo que más afectan a los hombres son sobrepeso/obesidad; niveles de glucosa en sangre y de presión arterial elevados; y el consumo de alcohol y tabaco (35.6% de AVISA perdidos). En las mujeres, el sobrepeso y la obesidad; glucosa elevada; hipertensión arterial; baja actividad física; y el consumo de alcohol y tabaco fueron responsables de 40% de los AVISA perdidos; en ambos sexos, la dieta contribuye con 12% de la carga. Conclusiones. El panorama epidemiológico en México demanda una urgente adecuación y modernización del sistema de salud.

Objective. To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. Materials and methods. A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. Results. In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. Conclusions. The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.

[Burden of disease, injuries, risk factors and challenges for the health system in Mexico]. / La carga de enfermedad, lesiones, factores de riesgo y desafíos para el sistema de salud en México.

OBJECTIVE: To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. MATERIALS AND METHODS: A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. RESULTS: In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. CONCLUSIONS: The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.

Comparison of crude and adjusted mortality rates from leading causes of death in northeastern Brazil.

OBJECTIVE: To present how the adjustment of incompleteness and misclassification of causes of death in the vital registration (VR) system can contribute to more accurate estimates of the risk of mortality from leading causes of death in northeastern Brazil. METHODS: After estimating the total numbers of deaths by age and sex in Brazil's Northeast region in 2002-2004 by correcting for undercount in the VR data, adjustment algorithms were applied to the reported cause-of-death structure. Average annual age-standardized mortality rates were computed by cause, with and without the corrections, and compared to death rates for Brazil's South region after adjustments for potential misdiagnosis. RESULTS: Death rates from ischemic heart disease, lower respiratory infections, chronic obstructive pulmonary disease, and perinatal conditions were more than 100% higher for both sexes than what was suggested by the routine VR data. Corrected cause-specific mortality rates were higher in the Northeast region versus the South region for the majority of causes of death, including several noncommunicable conditions. CONCLUSIONS: Failure to adjust VR data for undercount of cases reported and misdiagnoses will cause underestimation of mortality risks for the populations of the Northeast region, which are more vulnerable than those in other regions of the country. In order to more reliably understand the pattern of disease, all cause-specific mortality rates in poor populations should be adjusted.

Comparison of crude and adjusted mortality rates from leading causes of death in northeastern Brazil / Comparación de las tasas de mortalidad bruta y ajustada debida a las principales causas de muerte en el nordeste del Brasil

Objetivo. Presentar de qué manera el ajuste de los datos incompletos y de laclasificación errónea de las causas de muerte registradas en el sistema del registro civil puede ayudar a estimar los riesgos de mortalidad debida a las principales causas de muerte en el nordeste del Brasil. Métodos. Después de calcular el número total de defunciones por edad y sexo en el nordeste del Brasil entre 2002 y 2004 mediante la corrección del subregistro de los datos del registro civil, se aplicaron algoritmos de ajuste a la estructura de las causas de defunción notificadas. Las tasas de mortalidad promedio anuales estandarizadaspor edades se calcularon según la causa, con y sin las correcciones, y se compararon con las tasas de mortalidad de la región meridional del Brasil después de efectuar un ajuste de los posibles diagnósticos erróneos.Resultados. Las tasas de mortalidad debidas a cardiopatía isquémica, infecciones de las vías respiratorias inferiores, enfermedad pulmonar obstructiva crónica y enfermedades perinatales fueron más de 100% mayores para ambos sexos quelas sugeridas por los datos habituales del registro civil. Las tasas de mortalidad corregidas por causa específica fueron mayores en la región del nordeste que en la región meridional para la mayoría de las causas de muerte, incluso para varias enfermedades no transmisibles.Conclusiones. La falta de ajuste de los datos del registro civil para compensarel subregistro de los casos notificados y los diagnósticos erróneos ocasionará una subestimación del riesgo de mortalidad para las poblaciones de la región del nordeste, más vulnerables que las de otras regiones del país. Para comprender de manera más fiable el patrón de las enfermedades, en las poblaciones pobres deben ajustarse todas las tasas de mortalidad por causa específica.

Objective. To present how the adjustment of incompleteness and misclassification of causesof death in the vital registration (VR) system can contribute to more accurate estimates of the risk of mortality from leading causes of death in northeastern Brazil. Methods. After estimating the total numbers of deaths by age and sex in Brazil’s Northeast region in 2002–2004 by correcting for undercount in the VR data, adjustment algorithms were applied to the reported cause-of-death structure. Average anual age-standardized mortality rates were computed by cause, with and without the corrections, and compared to deathrates for Brazil’s South region after adjustments for potential misdiagnosis.Results. Death rates from ischemic heart disease, lower respiratory infections, chronic obstructivepulmonary disease, and perinatal conditions were more than 100% higher for both sexes than what was suggested by the routine VR data. Corrected cause-specific mortalityrates were higher in the Northeast region versus the South region for the majority of causes of death, including several noncommunicable conditions.Conclusions. Failure to adjust VR data for undercount of cases reported and misdiagnoses will cause underestimation of mortality risks for the populations of the Northeast region,which are more vulnerable than those in other regions of the country. In order to more reliably understand the pattern of disease, all cause-specific mortality rates in poor populations should be adjusted.

Evaluation of cause-of-death statistics for Brazil, 2002-2004.

BACKGROUND: Mortality statistics systems with reliable cause-of-death data constitute a major resource for effective health planning; however, many developing countries lack such information systems. Brazil has a long history of registering deaths, and a critical assessment of the quality of current cause-of-death statistics in its five different regions is crucial to identify strengths and weaknesses in the data, and present options for improvement. METHODS: Quality of cause-of-death data from 2002 to 2004 was evaluated using an assessment framework based on four main attributes: generalizability, reliability, validity and policy relevance. A set of nine criteria: coverage, completeness, consistency of cause patterns with general mortality levels, consistency of cause specific mortality proportions over time, content validity, proportion of ill-defined causes and non-specific codes, incorrect or improbable age or sex patterns, timeliness, and geographical disaggregation were used to assess the four attributes of data quality. RESULTS: Completeness of death registration varies from 72 to 80% in the northeast regions, compared with 85-90% in the Southeast and Centre-West regions, and 94-97% in the wealthier South region. The proportion of ill-defined deaths is an important problem in reported causes of death from almost all regions. Lack of adequate evidence limits the assessment of content validity of registered causes of death. Coverage, consistency of causes with general level of mortality, consistency over time, age and sex patterns, timeliness and usability of statistics for subnational purposes were judged to be reasonable and increase confidence in using the statistics. CONCLUSIONS: There is considerable heterogeneity in the quality of cause-of-death statistics across Brazilian regions, especially for criteria such as completeness and ill-defined causes. These factors can influence generalizability and validity of reported causes of death, and must be considered in the interpretation and use of data for secondary descriptive analyses such as burden of disease estimation at regional level, with suitable adjustments to account for bias. The differences identified in this study could be a useful guide for defining measures and investments needed to improve data quality in Brazil.

Injerto autólogo de calota craneana para reconstrucción de piso de órbita en trauma facial: reporte de caso / Graft autologo of calota cranial for reconstruction of floor of orbit in facial trauma: report of case

Las fracturas de órbita concomitantes con otras fracturas faciales tienen una prevalencia de entre 30-55 por ciento de todos los traumas faciales. Las indicaciones para el manejo abierto son: distopía, enoftalmos clínicamente evidente, limitación de movimientos oculares por interrupción mecánica y diplopía por más de 15 días. Se presenta un caso de reconstrucción de piso de órbita con injerto de calota craneana asociado con fracturas faciales múltiples y se realiza una revisión de la literatura.