Historical Mortality Dynamics on the Baja California Peninsula : Marriage, Mining Booms, Migration, and Infectious Disease.

Historical demographic research shows that the factors influencing mortality risk are labile across time and space. This is particularly true for datasets that span societal transitions. Here, we seek to understand how marriage, migration, and the local economy influenced mortality dynamics in a rapidly changing environment characterized by high in-migration and male-biased sex ratios. Mortality records were extracted from a compendium of historical vital records for the Baja California peninsula (Mexico). Our sample consists of 1,201 mortality records spanning AD 1835-1900. Findings from Cox proportional hazard models indicate that (1) marriage was associated with a protective effect for both sexes; (2) residing in a mining town was associated with higher mortality for men, but not women; (3) migration was associated with decreased mortality risk for women, but not men; and (4) the risk of mortality increased in the face of infectious disease, but decreased over time. Despite the early initiation of reproduction for women, marriage had a protective effect, likely because marriage linked women to resources. Although mining boomtowns were associated with elevated risk factors generally, only men experienced greater mortality risk, likely due to dangerous working conditions that women did not experience. Last, female, but not male, migrants experienced greater longevity, possibly because exposure to harsh labor conditions eroded the protective effect of selection bias for men. Together, these results shed light on an understudied historical population and broaden our understanding of demographic dynamics in preindustrial settings.

Comorbilidades infecciosas en la gravedad y mortalidad por Covid-19: análisis del aporte científico en The Lancet Publishing Group / Infectious comorbidities in severity and mortality from Covid-19: analysis of the scientific contribution in The Lancet Publishing Group

El número de casos totales de la enfermedad coronavirus-2019 (Covid-19) sigue aumentando rápidamente, amenazando a miles o millones de personas con condiciones crónicas preexistentes que se ven afectados de manera desproporcionada. Hasta el 2020, el centro de recursos de coronavirus de la Universidad Johns Hopkins informó que en todo el mundo más de 180 países han sido afectados con Covid-19 con más de doce millones de casos confirmados y más de 500,000 muertes. A medida que continúa la investigación relacionada con los posibles factores de riesgo de mortalidad por Covid-19, se hace evidente que las personas con comorbilidades subyacentes, como enfermedades cardiovasculares, hipertensión, diabetes, insuficiencia cardíaca congestiva, enfermedad cerebrovascular, enfermedad renal crónica, enfermedad hepática crónica, cáncer, enfermedad pulmonar obstructiva crónica, el asma y el VIH/SIDA pueden tener un mayor riesgo de muerte por Covid-19. El objetivo de este trabajo es determinar las comorbilidades infecciosas en la gravedad y mortalidad por Covid-19 especialmente asociadas con VIH/SIDA y tubercolosis, respodiendo a la siguiente pregunta: ¿La comunidad científica mundial se ha preocupado por la comorbilidad infecciosa en casos de covid-19 severos y fatales?. Un análisis hecho al grupo de referencias The Lancet Publishing Group fue realizado para dar repuesta a dicha pregunta(AU)

The number of total cases of coronavirus disease-2019 (COVID-19) continues to rise rapidly, threatening thousands or millions of people with pre-existing chronic conditions who are disproportionately affected. As of 2020, the Johns Hopkins University Coronavirus Resource Center reported that worldwide more than 180 countries have been affected with COVID-19 with more than twelve million confirmed cases and more than 500,000 deaths. As research related to potential risk factors for mortality from COVID-19 continues, it becomes clear that people with underlying comorbidities, such as cardiovascular disease, hypertension, diabetes, congestive heart failure, cerebrovascular disease, chronic kidney disease, chronic liver disease, cancer, chronic obstructive pulmonary disease, asthma, and HIV/AIDS may be at increased risk of death from COVID-19. The objective of this work is to determine the infectious comorbidities in severity and mortality from Covid-19, especially associated with HIV/AIDS and tuberculosis, answering the following question: Has the world scientific community been concerned about infectious comorbidity in covid-19 severe and fatal cases? An analysis made to the reference group The Lancet Publishing Group was carried out to answer this question(AU)

Síndrome inflamatória multissistêmica em crianças infectadas por coronavírus: uma revisão integrativa / Multisystemic inflamatory syndrome in children infected by coronavirus: an integrative review / Síndrome inflamatorio multisistémico en niños infectados por coronavirus: una revisión integradora

Durante a pandemia de COVID-19, foram observadas manifestações atípicas em pacientes pediátricos em diversas regiões do mundo, e o conjunto desses sintomas caracterizou uma nova patologia denominada Síndrome Inflamatória Multissistêmica em Crianças (MIS-C), ou Síndrome Inflamatória Multissistêmica Pediátrica Temporariamente associada ao COVID-19 (PIMS- TS). O objetivo desta revisão foi analisar as manifestações clínicas e as possíveis complicações relacionadas a tal quadro inflamatório. Foi realizada uma busca por artigos científicos nas bases de dados Embase, PubMed e Web of Science, por meio da combinação dos descritores "MIS-C", "PIMS- TS" e "COVID-19". Após a análise dos artigos encontrados, e considerando critérios de inclusão e exclusão, foram selecionados 15 estudos para compor esta revisão. A maioria dos estudos mencionaram complicações gastrointestinais, cardiovasculares, respiratórias e mucocutâneas. Ademais, foram encontrados marcadores que indicavam estado inflamatório generalizado e coagulopatia. Assim, concluiu-se que MIS-C provavelmente é uma síndrome manifestada após a infecção por SARS-CoV-2, podendo ocasionar quadros mais graves, mas com baixas taxas de mortalidade.

During the COVID-19 pandemic, atypical manifestations were observed in pediatric patients in different regions of the world, and the set of these symptoms characterized a new pathology called Multisystemic Inflammatory Syndrome in Children (MIS-C), or Pediatric Multisystemic Inflammatory Syndrome Temporarily associated with COVID-19 (PIMS-TS). The purpose of this review was to analyze the clinical manifestations and possible complications related to such an inflammatory condition. A search for scientific articles was carried out in the databases Embase, PubMed and Web of Science, by combining the descriptors "MIS-C", "PIMS-TS" and "COVID-19". After analyzing the articles found, and considering inclusion and exclusion criteria, 15 studies were selected to compose this review. Most studies mentioned gastrointestinal, cardiovascular, respiratory and mucocutaneous complications. In addition, markers were found that indicated generalized inflammatory status and coagulopathy. Thus, it was concluded that MIS-C is probably a syndrome manifested after infection by SARS-CoV-2, which can cause more severe conditions, but with low mortality rates.

Durante la pandemia de COVID-19 se observaron manifestaciones atípicas en pacientes pediátricos de diferentes regiones del mundo, y el conjunto de estos síntomas caracterizó una nueva patología denominada Síndrome Inflamatorio Multisistémico en Niños (SMI-C), o Síndrome Inflamatorio Multisistémico Pediátrico Asociado Temporalmente a COVID-19 (SIPM-TS). El propósito de esta revisión fue analizar las manifestaciones clínicas y las posibles complicaciones relacionadas con dicha condición inflamatoria. Se realizó una búsqueda de artículos científicos en las bases de datos Embase, PubMed y Web of Science, combinando los descriptores "MIS-C", "PIMS- TS" y "COVID-19". Tras analizar los artículos encontrados, y teniendo en cuenta los criterios de inclusión y exclusión, se seleccionaron 15 estudios para componer esta revisión. La mayoría de los estudios mencionaron complicaciones gastrointestinales, cardiovasculares, respiratorias y mucocutáneas. Además, se encontraron marcadores que indicaban un estado inflamatorio generalizado y coagulopatía. Así pues, se concluyó que el SMI-C es probablemente un síndrome que se manifiesta tras la infección por el SARS-CoV-2, que puede causar cuadros más graves, pero con bajas tasas de mortalidad.

All-cause and cause-specific mortality during and following incarceration in Brazil: A retrospective cohort study.

BACKGROUND: Mortality during and after incarceration is poorly understood in low- and middle-income countries (LMICs). The need to address this knowledge gap is especially urgent in South America, which has the fastest growing prison population in the world. In Brazil, insufficient data have precluded our understanding of all-cause and cause-specific mortality during and after incarceration. METHODS AND FINDINGS: We linked incarceration and mortality databases for the Brazilian state of Mato Grosso do Sul to obtain a retrospective cohort of 114,751 individuals with recent incarceration. Between January 1, 2009 and December 31, 2018, we identified 3,127 deaths of individuals with recent incarceration (705 in detention and 2,422 following release). We analyzed age-standardized, all-cause, and cause-specific mortality rates among individuals detained in different facility types and following release, compared to non-incarcerated residents. We additionally modeled mortality rates over time during and after incarceration for all causes of death, violence, or suicide. Deaths in custody were 2.2 times the number reported by the national prison administration (n = 317). Incarcerated men and boys experienced elevated mortality, compared with the non-incarcerated population, due to increased risk of death from violence, suicide, and communicable diseases, with the highest standardized incidence rate ratio (IRR) in semi-open prisons (2.4; 95% confidence interval [CI]: 2.0 to 2.8), police stations (3.1; 95% CI: 2.5 to 3.9), and youth detention (8.1; 95% CI: 5.9 to 10.8). Incarcerated women experienced increased mortality from suicide (IRR = 6.0, 95% CI: 1.2 to 17.7) and communicable diseases (IRR = 2.5, 95% CI: 1.1 to 5.0). Following release from prison, mortality was markedly elevated for men (IRR = 3.0; 95% CI: 2.8 to 3.1) and women (IRR = 2.4; 95% CI: 2.1 to 2.9). The risk of violent death and suicide was highest immediately post-release and declined over time; however, all-cause mortality remained elevated 8 years post-release. The limitations of this study include inability to establish causality, uncertain reliability of data during incarceration, and underestimation of mortality rates due to imperfect database linkage. CONCLUSIONS: Incarcerated individuals in Brazil experienced increased mortality from violence, suicide, and communicable diseases. Mortality was heightened following release for all leading causes of death, with particularly high risk of early violent death and elevated all-cause mortality up to 8 years post-release. These disparities may have been underrecognized in Brazil due to underreporting and insufficient data.

Caracterización clinicoepidemiológica de niños argelinos con enfermedades infecciosas / Clinical epidemiological characterization of Algerian children with infectious diseases

Introducción: Los niños representan el futuro, y su crecimiento y desarrollo saludable deben ser una de las máximas prioridades para todas las sociedades, ellos son vulnerables frente a la malnutrición y enfermedades infecciosas, que son prevenibles o tratables en su gran mayoría, por lo que la Organización Mundial de la Salud crea estrategias para minimizar las causas que conspiren en contra de la salud de los niños y adolescentes. Métodos: Se realizó un estudio descriptivo y longitudinal de los 4 109 niños mayores de 28 días de nacidos y menores de 14 años de edad con enfermedades infecciosas, atendidos en el Servicio de Pediatría del Hospital Clinicoquirúrgico Docente Mohamed Boudiaf, de la provincia del Bayadh, en la República Popular y Democrática de Argelia, en el período 2017-2018. Objetivo: Caracterizar desde el punto de vista clinicoepidemiológico a los niños argelinos entre 28 días de nacidos y menores de 14 años de edad con enfermedades infecciosas. Resultados: Se obtuvo que 88,4 % de los integrantes del estudio padecieron de enfermedades infecciosas y 11,6 % no infecciosas; igualmente, los menores de un año y del sexo masculino fueron los que más enfermaron (58,0 %), en tanto, las enfermedades diarreicas agudas y las infecciones respiratorias resultaron ser las más frecuentes (48,0 y 32,0 %, respectivamente). Del total de pacientes, 3 607 evolucionaron favorablemente (99,8 %). Conclusiones: Las enfermedades infecciosas constituyen un problema de salud en Argelia que sigue aportando niños enfermos y fallecidos por esta causa; asimismo, las enfermedades diarreicas agudas y las infecciones respiratorias agudas son las principales causas de asistencia hospitalaria en la provincia del Bayadh, ocasionado por el destete precoz y la desnutrición, factores que contribuyen a que la morbilidad tenga una alta incidencia y la mortalidad sea baja, por lo que se debe prestar especial atención a los pacientes menores de 5 años, entre ellos a los menores de un año, que son los que enferman con mayor frecuencia.

Introduction: Children represent the future, so their healthy growth and development should be a priority for all societies, that is the reason why the Health World Organization creates strategies to minimize the causes that conspire against the health of children and adolescents. Methods: A descriptive and longitudinal study of the 4 109 children over 28 days and under 14 years with infectious diseases was carried out, who were assisted in the Pediatrics Service of Mohamed Boudiaf Teaching Clinical Surgical Hospital, in the Bayadh province, Popular and Democratic Republic of Algeria, during 2017-2018. Objective: To characterize Algerian children with 28 days and under 14 years with infectious diseases from the clinical epidemiological point of view. Results: It was obtained that 88.4 % of the members in the study suffered from infectious diseases and 11.6 % suffered from non infectious diseases; equally, those under one year and from the male sex were the ones that mostly get ill (58.0 %), as long as, acute diarrheic diseases and breathing infections were the most frequent (48.0 and 32.0 %, respectively). Of the total of patients, 3 607 had a favorable clinical course (99.8 %). Conclusions: Infectious diseases constitute a health problem in Algeria that continues contributing to increase sick and dead children due to this cause; also, acute diarrheic diseases and acute breathing infections are the main causes of hospital assistance in Bayadh province, caused due to the early weaning and malnutrition, factors that contribute to the high incidence of morbidity and low mortality, reason why patients under 5 years should receive a special care, mainly those under one year who get sick with more frequency.

Coinfección VIH y COVID 19 en niños: teporte de casos / HIV and COVID 19 Coinfection in Children: Case Report

Honduras reportó sus dos primeros casos de COVID-19 el 11 de marzo del 2020, actualmente reporta un total de 64, 352 casos confirmados con 2,006 fallecidos que estiman una tasa letalidad de 3.1%. La presencia de comorbilidades que debiliten el sistema inmune está asociado a un incremento en la severidad y mortalidad de la enfermedad, es por esto que se ha cuestionado si la infección por virus de inmunodeficiencia humana incrementa el riesgo de contagio y severidad del cuadro de la COVID-19 debido a la presencia de bajo recuento de células CD4. En Honduras para mayo del 2020 se registraron 38,291 casos de VIH acumulados de los cuales 2,086 corresponden a menores de 14 años. En el presente reporte se incluyeron 2 pacientes pediátricos con VIH coinfectados con COVID-19 tratados en el Hospital Nacional Dr. Mario Catarino Rivas (HNMCR) desde el inicio de la pandemia en marzo hasta septiembre del 2020. Ambos pacientes fueron hospitalizados por su estado clínico crítico y la necesidad de apoyo con oxígeno. Ambos pacientes recibían terapia antirretroviral, sin embargo, el paciente numero 2 presentaba mala adherencia y se encontraba con inmunosupresión severa y falleció 2 días posteriores a su ingreso hospitalario. En conclusión, una vez más sigue siendo importante la adherencia al tratamiento antirretroviral en los niños con VIH con el fin de lograr la indetectabilidad en su carga viral mejorando su estado inmunológico, y evitando las infecciones oportunistas asociadas al VIH, así como también respondiendo adecuadamente a cualquier otra enfermedad...(AU)

Mortalidad por infecciones asociadas a la asistencia sanitaria. Hospital Abel Santa María Cuadrado, 2015 / Mortality due to Infections associated with healthcare. Abel Santa María Cuadrado Hospital, 2015

Objetivo: caracterizar la mortalidad por infecciones asociadas a la asisten-cia sanitaria (IAAS) en el Hospital Abel Santamaría Cuadrado de Pinar del Río durante el año 2015.Metodología: estudio descriptivo de corte transversal. La muestra estuvo constituida por 278 pacientes fallecidos por infecciones asociadas a la asistencia sanitaria con necropsia realizada y datos completos en la historia clínica. Resultados: el 40.6% de pacientes presentó una estadía hospitalaria de 22 días y más. El 66.2% presentó una infección de localización respiratoria, siendo la neumonía nosocomial la principal causa de muerte. El 28.8% de los organismos aislados fueron Enterobacter ssp. El antibiótico más utilizado fue la Ciprofloxacino, con un 54.3% y el procedimiento invasivo más prevalente fue el cateterismo vesical (84.2%). Conclusiones las principales variables asociadas a la mortalidad por IAAS fueron la sobrestadía hospitalaria y el uso de catéter urinario. La infección de localización respiratoria fue la más frecuente con predominio de gérmenes gram negativos. Se evidenció un elevado uso de antibióticos.

Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: A retrospective observational study

Background Clinico-pathological discrepancies are more frequent in settings in which limited diagnostic techniques are available, but there is little information on their actual impact. Aim We assessed the accuracy of the clinical diagnoses in a tertiary referral hospital in sub-Saharan Africa by comparison with post-mortem findings. We also identified potential risk factors for misdiagnoses. Methods One hundred and twelve complete autopsy procedures were performed at the Maputo Central Hospital (Mozambique), from November 2013 to March 2015. We reviewed the clinical records. Major clinico-pathological discrepancies were assessed using a modified version of the Goldman and Battle classification. Results Major diagnostic discrepancies were detected in 65/112 cases (58%) and were particularly frequent in infection-related deaths (56/80 [70%] major discrepancies). The sensitivity of the clinical diagnosis for toxoplasmosis was 0% (95% CI: 0­37), 18% (95% CI: 2­52) for invasive fungal infections, 25% (95% CI: 5­57) for bacterial sepsis, 34% (95% CI: 16­57), for tuberculosis, and 46% (95% CI: 19­75) for bacterial pneumonia. Major discrepancies were more frequent in HIV-positive than in HIV-negative patients (48/73 [66%] vs. 17/39 [44%]; p = 0.0236). Conclusions Major clinico-pathological discrepancies are still frequent in resource constrained settings. Increasing the level of suspicion for infectious diseases and expanding the availability of diagnostic tests could significantly improve the recognition of common life-threatening infections, and thereby reduce the mortality associated with these diseases. The high frequency of clinico-pathological discrepancies questions the validity of mortality reports based on clinical data or verbal autopsy.

Factors Associated With In-Hospital Mortality in Very Elderly Patients With Ischemic Stroke: A Cohort Study.

INTRODUCTION: The highest mortality rates associated with ischemic stroke occur in patients of advanced age. However, studies of factors that establish the increase in hospital mortality are scanty in this population. MATERIAL AND METHODS: Epidemiologic, clinical and laboratory data, etiology and ischemic stroke subtype and complications during hospitalization were analyzed in 195 patients aged 80 years or older. In attempt to associate prognostic factor with the in-hospital mortality during first 28 days from admission, the death and survivor groups were compared. RESULTS: Among the 195 patients evaluated, the age was 85.3 ± 4.6 years with a mortality of 26.1%. Following the multivariate model, the factors associated with in-hospital mortality were: age (OR = 1.07, 95% CI = 1.00-1.20), the score less than or equal to 8 on Glasgow coma scale (OR = 22.87, 95% CI = 3.55-148.76), diabetes mellitus (OR = 3.40, 95% CI = 1.30-8.87), total anterior clinical subtype (OR = 5.15, 95% CI = 1.82-14.52) and infectious complications (OR = 8.38, 95% CI = 3.28-21.43). CONCLUSIONS: The following risk factors were associated with a higher in-hospital mortality rate in patients over 79 years of age with ischemic stroke: older age, Glasgow coma score less than or equal to 8, total anterior circulation infarction, infection, and diabetes mellitus.

Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies.

BACKGROUND: With global survival increasing for children younger than 5 years of age, attention is required to reduce the approximately 1 million deaths of children aged 5-14 years occurring every year. Causes of death at these ages remain poorly documented. We aimed to explore trends in mortality by causes of death in India, China, Brazil, and Mexico, which are home to about 40% of the world's children aged 5-14 years and experience more than 200 000 deaths annually at these ages. METHODS: We examined data on 244 401 deaths in children aged 5-14 years from four nationally representative data sources that obtained direct distributions of causes of death: the Indian Million Death Study, the Chinese Disease Surveillance Points, mortality data from the Mexican Instituto Nacional de Estadística y Geografía, and mortality data from the Brazilian Institute of Geography and Statistics. We present data on 12 main disease groups in all countries, with breakdown by communicable and nutritional diseases, non-communicable diseases, injuries, and ill-defined causes. To calculate age-specific and sex-specific death rates for each cause, we applied the national cause of death distribution to the UN mortality envelopes for 2005-16 for each country. FINDINGS: Unlike Brazil, China, and Mexico, communicable diseases still account for nearly half of deaths in India in children aged 5-14 years (73 920 [46·1%] of 160 330 estimated deaths in 2016). In 2016, India had the highest death rates in nearly every category, including from communicable diseases. Fast declines among girls in communicable disease mortality narrowed the gap by 2016 with boys in India (32·6 deaths per 100 000 girls vs 26·2 per 100 000 boys) and China (1·7 vs 1·5). In China, injuries accounted for the greatest proportions of deaths (20 970 [53·2%] of 39 430 estimated deaths, in which drowning was a leading cause). The homicide death rate at ages 10-14 years was higher for boys than for girls in Brazil, increasing annually by an average of 0·7% (0·3-1·1). In India and China, the suicide death rates were higher for girls than for boys at ages 10-14 years. By contrast, in Mexico it was higher for boys than for girls, increasing annually by an average of 2·8% (2·0-3·6). Deaths from transport injuries, drowning, and cancer are common in all four countries, with transport accidents among the top three causes of death for both sexes in all countries, except for Indian girls, and cancer in the top three causes for both sexes in Mexico, Brazil, and China. INTERPRETATION: Most of the deaths that occurred between 2005 and 2016 in children aged 5-14 years in India, China, Brazil, and Mexico arose from preventable or treatable conditions. This age group is important for extending some of the global disease-specific targets developed for children younger than 5 years of age. Interventions to control non-communicable diseases and injuries and to strengthen cause of death reporting systems are also required. FUNDING: WHO and the University of Toronto Connaught Global Challenge.

Stillbirth, newborn and infant mortality: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015.

BACKGROUND: Infant-mortality rates have been declining in many low- and middle-income countries, including Brazil. Information on causes of death and on socio-economic inequalities is scarce. METHODS: Four birth cohorts were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. Surveillance in hospitals and vital registries, accompanied by interviews with doctors and families, detected fetal and infant deaths and ascertained their causes. Late-fetal (stillbirth)-, neonatal- and post-neonatal-death rates were calculated. RESULTS: All-cause and cause-specific death rates were reduced. During the study period, stillbirths fell by 47.8% (from 16.1 to 8.4 per 1000), neonatal mortality by 57.0% (from 20.1 to 8.7) and infant mortality by 62.0% (from 36.4 to 13.8). Perinatal causes were the leading causes of death in the four cohorts; deaths due to infectious diseases showed the largest reductions, with diarrhoea causing 25 deaths in 1982 and none in 2015. Late-fetal-, neonatal- and infant-mortality rates were higher for children born to Brown or Black women and to low-income women. Absolute socio-economic inequalities based on income-expressed in deaths per 1000 births-were reduced over time but relative inequalities-expressed as ratios of mortality rates-tended to remain stable. CONCLUSION: The observed improvements are likely due to progress in social determinants of health and expansion of health care. In spite of progress, current levels remain substantially greater than those observed in high-income countries, and social and ethnic inequalities persist.

Risk factors of long-term mortality in middle-aged women: a 27-year follow-up cohort.

OBJECTIVE: This study aimed to evaluate the impact of different risk factors on long-term mortality in middle-aged women. METHODS: Women who received preventive health care control between 1990 and 1993 were recruited. Anamnesis and physical examination were recorded. Blood samples for the measurement of glycemia and lipids were taken. Data are reported as of December 2017. RESULTS: We studied 1197 women aged between 40 and 60 years. We observed 183 deaths (survival 84.0%; 95% confidence interval [CI], 81.7-86.1, Kaplan-Meier survival analysis). The main causes of death were cancer (39.9%; 95% CI, 32.7-47.1), cardiovascular disease (22.9%; 95% CI, 16.8-29.1), infectious disease (13.7%; 95% CI, 8.6-18.7), other causes (7.1%, 95% CI, 3.4-10.9), and unspecified cause (6.6%; 95% CI, 2.9-10.2). The final Cox regression model showed the following hazard ratios for mortality: diabetes mellitus 2.51 (95% CI, 1.40-4.51), history of fracture 2.47 (95% CI, 1.15-5.30), history of heart illness 2.06 (95% CI, 1.15-3.72), arterial hypertension 1.51 (95% CI, 1.08-2.11), age 1.07 (95% CI, 1.04-1.10), body mass index 1.06 (95% CI, 1.02-1.09), and sexual intercourse 0.94 (95% CI, 0.89-0.98). Lipid disorders did not reach statistical significance as a risk factor. CONCLUSION: Diabetes, a history of fractures, and cardiovascular risk factors, except lipids, are markers of long-term mortality in middle-aged women. Physicians should pay special attention to these risk factors.

Long-term impact of competitive biddings and an antimicrobial stewardship program in a general hospital in Chile / Impacto de un programa de control de antimicrobianos (PCA) y licitaciones públicas sobre el consumo de estos medicamentos

ABSTRACT Background: The long-term effect of an antimicrobial stewardship program (ASP) and its integrated impact with competitive biddings have been seldom reported. Aim: To evaluate the long-term effect of an ASP on antimicrobial consumption, expenditure, antimicrobial resistance and hospital mortality. To estimate the contribution of competitive biddings on cost-savings. Material and Methods: A comparison of periods prior (2005-2008) and posterior to ASP initiation (2009 and 2015) was done. An estimation of cost savings attributable to ASP and to competitive biddings was also performed. Results: Basal median antimicrobial consumption decreased from 221.3 to 170 daily defined doses/100 beds after the start of the ASP. At the last year, global antimicrobial consumption declined by 28%. Median antimicrobial expenditure per bed (initially US$ 13) declined to US$ 10 at the first year (-28%) and to US$ 6 the last year (-57%). As the reduction in consumption was lower than the reduction in expenditure during the last year, we assumed that only 48.4% of savings were attributable to the ASP. According to antimicrobial charges per bed from prior and after ASP implementation, we estimated global savings of US$ 393072 and US$ 190000 directly attributable to the ASP, difference explained by parallel competitive biddings. Drug resistance among nosocomial bacterial isolates did not show significant changes. Global and infectious disease-associated mortality per 1000 discharges significantly decreased during the study period (p < 0.05). Conclusions: The ASP had a favorable impact on antimicrobial consumption, savings and mortality rates but did not have effect on antimicrobial resistance in selected bacterial strains.

Antecedentes: Existe poca información sobre el impacto a largo plazo de un programa de control de antimicrobianos (PCA) y su efecto combinado con licitaciones públicas de fármacos. Objetivo: Evaluar el impacto de un PCA sobre el consumo, gasto, mortalidad y estimar la contribución de las licitaciones. Material y Métodos: Comparación antes (2005-2008) - después (2009-2015) del PCA y estimación porcentual del ahorro atribuible al PCA y licitaciones. Resultados: El consumo bajó de 221,3 a 170 dosis diarias definidas por 100 días camas (medianas) al primer año. En el último año el consumo declinó un 27,6%. La mediana del gasto por cama ocupada se redujo de 13 a 10 US$ el primer año y a 6 US$ el último año (-57%). Debido a que el gasto bajó más que el consumo, estimamos que solo el 48,4% del ahorro fue debido al PCA (cuociente de ambas reducciones: −27,6%/-57%). De acuerdo con el gasto en antimicrobianos por cama entre ambos períodos, se calculó un ahorro global de 393.000 US$ y de 190.000 US$ directamente atribuible al PCA, siendo la diferencia explicada por licitaciones. Los porcentajes de resistencia en cepas de infecciones nosocomiales no mostraron incrementos o reducciones significativas en el tiempo y la mortalidad por egresos asociada a enfermedades infecciosas (Códigos CIE 10) se redujo significativamente (p < 0,05). Conclusiones: El PCA se asoció a largo plazo a un impacto favorable sobre el consumo de antimicrobianos, gasto por antimicrobianos y egresos por enfermedades infecciosas sin un impacto en la resistencia antimicrobiana. Las licitaciones tuvieron un efecto aditivo en el ahorro.

The achievements of the SUS in tackling the communicable diseases. / Conquistas do SUS no enfrentamento das doenças transmissíveis.

This article presents the development of the epidemiological situation of some of the major communicable diseases (CD) in Brazil, with emphasis on the interventions by the SUS and other social policies. The data and information were collected from Datasus, epidemiological newsletters from the Brazilian Ministry of Health, and scientific articles on the issue. The universalization, decentralization and expansion of the surveillance, control and prevention of CD has produced an impact on the morbidity and mortality of these diseases, mainly those which are vaccine-preventable. The emergence and re-emergence of three arboviruses, for which there are no effective control instruments, interrupted the downward trend in the morbidity profile of CD in Brazil. Other social and economic programs, which are geared to the needier sectors of the Brazilian population, have also contributed to the improvement of the analyzed health indicators. However, the universalization of access to healthcare services, as well as improvements in the scope of the surveillance of diseases and health risks, has played a key role in improving the health and quality of life of the population, as well as contributing to the process of the democratization of Brazil.

Apresenta-se a evolução da situação epidemiológica de algumas das principais Doenças transmissíveis (DT) no Brasil, assinalando as intervenções proporcionadas pelo SUS e outras políticas sociais. Dados e informações foram levantados do Datasus e Boletins epidemiológicos do Ministério da Saúde e de artigos científicos sobre o tema. A universalização, a descentralização e a ampliação das ações de vigilância, controle e prevenção de DT produziram impacto sobre a morbimortalidade dessas doenças, principalmente das imunopreveníveis. A emergência e reemergência de três arboviroses, para as quais não se dispõe de instrumentos de controle efetivos, interromperam a evolução decrescente no perfil de morbidade das DT no Brasil. Outros programas sociais e econômicos, voltados para a população brasileira mais carente, também contribuíram para a melhoria dos indicadores de saúde analisados. Contudo, a universalização do acesso aos serviços de atenção à saúde, ao lado do aperfeiçoamento do escopo de atuação da vigilância sobre doenças e riscos à saúde, vem desempenhando papel fundamental na melhoria das condições de saúde e qualidade de vida da população, bem como contribuindo para o processo de democratização do país.

Conquistas do SUS no enfrentamento das doenças transmissíveis / The achievements of the SUS in tackling the communicable diseases

Resumo Apresenta-se a evolução da situação epidemiológica de algumas das principais Doenças transmissíveis (DT) no Brasil, assinalando as intervenções proporcionadas pelo SUS e outras políticas sociais. Dados e informações foram levantados do Datasus e Boletins epidemiológicos do Ministério da Saúde e de artigos científicos sobre o tema. A universalização, a descentralização e a ampliação das ações de vigilância, controle e prevenção de DT produziram impacto sobre a morbimortalidade dessas doenças, principalmente das imunopreveníveis. A emergência e reemergência de três arboviroses, para as quais não se dispõe de instrumentos de controle efetivos, interromperam a evolução decrescente no perfil de morbidade das DT no Brasil. Outros programas sociais e econômicos, voltados para a população brasileira mais carente, também contribuíram para a melhoria dos indicadores de saúde analisados. Contudo, a universalização do acesso aos serviços de atenção à saúde, ao lado do aperfeiçoamento do escopo de atuação da vigilância sobre doenças e riscos à saúde, vem desempenhando papel fundamental na melhoria das condições de saúde e qualidade de vida da população, bem como contribuindo para o processo de democratização do país.

Abstract This article presents the development of the epidemiological situation of some of the major communicable diseases (CD) in Brazil, with emphasis on the interventions by the SUS and other social policies. The data and information were collected from Datasus, epidemiological newsletters from the Brazilian Ministry of Health, and scientific articles on the issue. The universalization, decentralization and expansion of the surveillance, control and prevention of CD has produced an impact on the morbidity and mortality of these diseases, mainly those which are vaccine-preventable. The emergence and re-emergence of three arboviruses, for which there are no effective control instruments, interrupted the downward trend in the morbidity profile of CD in Brazil. Other social and economic programs, which are geared to the needier sectors of the Brazilian population, have also contributed to the improvement of the analyzed health indicators. However, the universalization of access to healthcare services, as well as improvements in the scope of the surveillance of diseases and health risks, has played a key role in improving the health and quality of life of the population, as well as contributing to the process of the democratization of Brazil.

Estrategias de participación en la prevención comunitaria para el control de la Leptospirosis humana / Participation strategies in community prevention for human leptospirosis control

Introducción: Las estrategias de prevención comunitaria resultan básicas para alcanzar logros en salud y en especial en las tasas de mortalidad infantil, así como en las de morbilidad y mortalidad por enfermedades transmisibles. Objetivo: Sistematizar los resultados de investigaciones sobre estrategias de prevención de la leptospirosis a través de la participación comunitaria. Métodos: Se realizó una revisión documental, investigación cualitativa y descriptiva, se emplearon métodos teóricos: el histórico-lógico, analítico-sintético, inductivo-deductivo. Conclusiones: La sistematización de la bibliografía especializada y las investigaciones realizadas sobre la temática de las estrategias de prevención para la leptospirosis humana con carácter integral participativo ha puesto de manifiesto suficientes elementos de juicio para efectuar apreciaciones en función de planear una estrategia educativa con fines preventivos fundamentada en las mejores experiencias de Cuba y del resto del mundo(AU)

Introduction: Community prevention strategies are basic to achieve positive health outcome, especially in infant mortality rates, as well as regarding morbidity and mortality for due to communicable diseases. Objective: To systematize research outcome on leptospirosis prevention strategies through community involvement. Methods: A documentary review was carried out, for a qualitative and descriptive research, theoretical methods were used: the historical-logical, the analytical-synthetic, and the inductive-deductive. Conclusions: The systematization of the specialized bibliography and the research carried out on the topic of human leptospirosis prevention strategies with a participatory holistic character has revealed enough elements of judgment to make appraisals in order to plan an educational strategy with preventive purposes based on the best experiences of Cuba and the rest of the world(AU)

Pathology and causes of death in stranded humpback whales (Megaptera novaeangliae) from Brazil.

This study describes the pathologic findings of 24 humpback whales (Megaptera novaeangliae) found stranded along the Brazilian coast from 2004 to 2016. Eighteen (75%) animals evaluated were found stranded alive. From these, 13 died naturally on shore and five were euthanized. Six died at sea and were washed ashore. Of the 24, 19 (79.2%) were calves, four (16.7%) were juveniles, and one (4.2%) was an adult. The most probable cause of stranding and/or death (CSD) was determined in 23/24 (95.8%) individuals. In calves, CSD included neonatal respiratory distress (13/19; 68.4%), infectious disease (septicemia, omphaloarteritis and urachocystitis; 3/19; 15.8%), trauma of unknown origin (2/19; 10.5%), and vehicular trauma (vessel strike; 1/19; 5.3%). In juveniles and adult individuals, CSD was: emaciation (2/5; 40%), sunlight-thermal burn shock (1/5; 20%); and discospondylitis (1/5; 20%). In one juvenile, the CSD was undetermined (1/5; 20%). This study integrates novel findings and published case reports to delineate the pathology of a South-western Atlantic population of humpback whales. This foundation will aid in the assessment of the population health and establish a baseline for development of conservation policies.