Multiple Causes of Death Associated with Pediatric Cardiopulmonary Arrest from 1996 to 2019 in Brazil. / Causas Múltiplas de Morte Associadas à Parada Cardiorrespiratória Pediátrica de 1996 a 2019 no Brasil.

BACKGROUND: In pediatrics, cardiopulmonary arrest (CPA) is associated with high mortality and severe neurologic sequelae. Information on the causes and mechanisms of death below the age of 20 years could provide theoretical support for health improvement among children and adolescents. OBJECTIVES: To conduct a population analysis of mortality rates due to primary and multiple causes of death below the age of 20 years in both sexes from 1996 to 2019 in Brazil, and identify the frequency in which CPA was recorded in the death certificates (DCs) of these individuals and the locations where the deaths occurred, in order to promote strategies to improve the prevention of deaths. METHOD: Ecological time-series study of deaths below the age of 20 years from 1996 to 2019, evaluating the mortality rates (MRs) and proportional mortality (PM) by primary cause of death. We analyzed the percentages of CPA recorded in any line of the DC and the location where the deaths occurred. We calculated the MRs per 100,000 inhabitants and the PM by primary cause of death under the age of 20 years according to sex and age group, the percentages of death from primary causes by age group when CPA was described in any line of Parts I and II of the DC, and the percentage of deaths from primary causes according to their location of occurrence. We retrieved the data from DATASUS, IBGE, and SINASC. RESULTS: From 1996 to 2019, there were 2,151,716 deaths below the age of 20 years in Brazil, yielding a mortality rate of 134.38 per 100,000 inhabitants. The death rate was highest among male neonates. Of all deaths, 249,334 (11.6%) had CPA recorded in any line of the DC. Specifically, CPA was recorded in 49,178 DCs between the ages of 1 and 4 years and in 88,116 of those between the ages of 29 and 365 days, corresponding, respectively, to 26% and 22% of the deaths in these age groups. These two age groups had the highest rates of CPA recorded in any line of the DC. The main primary causes of death when CPA was recorded in the sequence of death were respiratory, hematologic, and neoplastic diseases. CONCLUSION: Perinatal and external causes were the primary causes of death, with highest MRs under the age of 20 years in Brazil from 1996 to 2019. When multiple causes of death were considered, the main primary causes associated with CPA were respiratory, hematologic, and neoplastic diseases. Most deaths occurred in the hospital environment. Better understanding of the sequence of events in these deaths and improvements in teaching strategies in pediatric cardiopulmonary resuscitation are needed.

FUNDAMENTO: Em pediatria, a parada cardiorrespiratória (PCR) está associada a alta mortalidade e graves sequelas neurológicas. Informações sobre as causas e mecanismos de morte abaixo de 20 anos poderiam fornecer subsídios teóricos para a melhoria da saúde de crianças e adolescentes. OBJETIVOS: Realizar uma análise populacional das taxas de mortalidade por causas primárias e múltiplas de morte abaixo de 20 anos, em ambos os sexos, no período de 1996 a 2019, no Brasil, e identificar a frequência com que a PCR foi registrada nas declarações de óbito (DOs) desses indivíduos e os locais de ocorrência dos óbitos, a fim de promover estratégias para melhorar a prevenção de mortes. MÉTODO: Estudo ecológico de séries temporais de óbitos em indivíduos menores de 20 anos, no período de 1996 a 2019, avaliando as taxas de mortalidade (TMs) e a mortalidade proporcional (MP) por causa básica de morte. Foram analisados os percentuais de PCR registrados em qualquer linha da DO e o local de ocorrência dos óbitos. Foram calculadas as TMs por 100 mil habitantes e a MP por causa básica de morte nos menores de 20 anos segundo sexo e faixa etária, os percentuais de óbito por causas básicas por faixa etária quando a PCR foi descrita em qualquer linha das Partes I e II da DO, e o percentual de óbitos por causas básicas segundo o local de ocorrência. Os dados foram retirados do DATASUS, IBGE e SINASC. RESULTADOS: De 1996 a 2019, ocorreram 2.151.716 óbitos de menores de 20 anos, no Brasil, gerando uma taxa de mortalidade de 134,38 por 100 mil habitantes. A taxa de óbito foi maior entre os recém-nascidos do sexo masculino. Do total de óbitos, 249.334 (11,6%) tiveram PCR registrada em qualquer linha da DO. Especificamente, a PCR foi registrada 49.178 vezes na DO na faixa etária entre 1 e 4 anos e em 88.116 vezes entre 29 e 365 dias, correspondendo, respectivamente, a 26% e 22% dos óbitos nessas faixas etárias. Essas duas faixas etárias apresentaram as maiores taxas de PCR registradas em qualquer linha da DO. As principais causas básicas de óbito quando a PCR foi registrada na sequência de óbitos foram doenças respiratórias, hematológicas e neoplásicas. CONCLUSÃO: As causas perinatais e externas foram as principais causas de morte, com maior TM nos menores de 20 anos no Brasil de 1996 a 2019. Quando consideradas as causas múltiplas de morte, as principais causas primárias associadas à PCR foram as doenças respiratórias, hematológicas e neoplásicas. A maioria dos óbitos ocorreu no ambiente hospitalar. Melhor compreensão da sequência de eventos nesses óbitos e melhorias nas estratégias de ensino em ressuscitação cardiopulmonar pediátrica são necessárias.

Cardiovascular Disease in Hispanic Women: JACC Review Topic of the Week.

Cardiovascular disease affects 37% of Hispanic women and is the leading cause of death among Hispanic women in the United States. Hispanic women have a higher burden of cardiovascular risk factors, are disproportionally affected by social determinants of health, and face additional barriers related to immigration, such as discrimination, language proficiency, and acculturation. Despite this, Hispanic women show lower rates of cardiovascular disease and mortality compared with non-Hispanic White women. However, this "Hispanic paradox" is challenged by recent studies that account for the diversity in culture, race, genetic background, country of origin, and social determinants of health within Hispanic subpopulations. This review provides a comprehensive overview of the cardiovascular risk factors in Hispanic women, emphasizing the role of social determinants, and proposes a multipronged approach for equitable care.

Social vulnerability and cardiovascular risk factors in adolescents.

BACKGROUND: Social vulnerability can influence in the development of cardiovascular risk factors in adolescents (CRF). For this reason, the objective of our study was to evaluate the presence of CRF in adolescents, according to social vulnerability. METHODS: This is a cross-sectional study with 517 adolescents of both sexes, from 10 to 19 years of age, classified into 2 groups by social vulnerability, according to socioeconomic characteristics collected by means of questionnaires, where adolescents who did not have access to drinking water, sewage network, and adequate per capita income were classified as vulnerable. Anthropometric, biochemical, and blood pressure data were evaluated. Level of physical activity was assessed by an adapted questionnaire, and food intake was assessed by a 3-day food record. Independent T, Mann-Whitney, and χ2 tests were used, according to the scale of measurement of the variables, on the statistical program SPSS, version 25, at a significance level of 5%. RESULTS: Adolescents had median age of 14 (11 to 15) years; 58.4% were female; 32.4% were overweight, and 52.4% were physically inactive in leisure. Mean consumption of ultra-processed food was observed to account for 45.0% of calorie intake. Adolescents classified as vulnerable had lower weight, body mass index, waist circumference, hip circumference, and neck circumference when compared to non-vulnerable adolescents. Both groups had cholesterol concentrations above the normal level. Non-vulnerable adolescents had higher triglyceride concentrations, higher alcohol consumption, and lower fiber intake compared to vulnerable adolescents. CONCLUSIONS: Adolescents with social vulnerability are less likely to have cardiovascular risk factors.

Late Mortality After Myocardial Injury in Critical Care Non-Cardiac Surgery Patients Using Machine Learning Analysis.

Myocardial injury after noncardiac surgery (MINS) increases mortality within 30 days. We aimed to evaluate the long-term impact of myocardial injury in a large cohort of patients admitted to intensive care after noncardiac surgery. All patients who stayed, at least, overnight with measurement of high-sensitive cardiac troponin were included. Clinical characteristics and occurrence of MINS were assessed between patients who died and survivors using chi-square test and Student t test. Variables with p <0.01 in the univariate model were included in the Cox regression model to identify predictor variables. Survival decision tree (SDT), a machine learning model, was also used to find the predictors and their correlations. We included 2,230 patients with mean age of 63.8±16.3 years, with most (55.6%) being women. The prevalence of MINS was 9.4% (209 patients) and there were 556 deaths (24.9%) in a median follow-up of 6.7 years. Univariate analysis showed variables associated with late mortality, namely: MINS, arterial hypertension, previous myocardial infarction, atrial fibrillation, dementia, urgent surgery, peripheral artery disease (PAD), chronic health status, and age. These variables were included in the Cox regression model and SDT. The predictor variables of all-cause death were MINS (hazard ratio [HR] 2.21; 95% confidence interval [CI] 1.77 to 2.76), previous myocardial infarction (HR 1.47; 95% CI 1.14 to 1.89); urgent surgery (HR 1.24; 95% CI 1.01 to 1.52), PAD (HR 1.83; 95% CI 1.23 to 2.73), dementia (HR 2.54; 95% CI 1.86 to 3.46) and age (HR 1.05; 95% CI 1.04 to 1.06). SDT had the same predictors, except PAD. In conclusion, increased high-sensitive troponin levels in patients who underwent noncardiac surgery raised the risk of short and late mortality.

In-hospital Outcomes of Infective Endocarditis from 1978 to 2015: Analysis Through Machine-Learning Techniques.

BACKGROUND: Early identification of patients with infective endocarditis (IE) at higher risk for in-hospital mortality is essential to guide management and improve prognosis. METHODS: A retrospective analysis was conducted of a cohort of patients followed up from 1978 to 2015, classified according to the modified Duke criteria. Clinical parameters, echocardiographic data, and blood cultures were assessed. Techniques of machine learning, such as the classification tree, were used to explain the association between clinical characteristics and in-hospital mortality. Additionally, the log-linear model and graphical random forests (GRaFo) representation were used to assess the degree of dependence among in-hospital outcomes of IE. RESULTS: This study analyzed 653 patients: 449 (69.0%) with definite IE; 204 (31.0%) with possible IE; mean age, 41.3 ± 19.2 years; 420 (64%) men. Mode of IE acquisition: community-acquired (67.6%), nosocomial (17.0%), undetermined (15.4%). Complications occurred in 547 patients (83.7%), the most frequent being heart failure (47.0%), neurologic complications (30.7%), and dialysis-dependent renal failure (6.5%). In-hospital mortality was 36.0%. The classification tree analysis identified subgroups with higher in-hospital mortality: patients with community-acquired IE and peripheral stigmata on admission; and patients with nosocomial IE. The log-linear model showed that surgical treatment was related to higher in-hospital mortality in patients with neurologic complications. CONCLUSIONS: The use of a machine-learning model allowed identification of subgroups of patients at higher risk for in-hospital mortality. Peripheral stigmata, nosocomial IE, absence of vegetation, and surgery in the presence of neurologic complications are predictors of fatal outcomes in machine learning-based analysis.

CONTEXTE: Le dépistage précoce des patients atteints d'endocardite infectieuse (EI) présentant un risque élevé de mortalité à l'hôpital est essentiel pour orienter la prise en charge et améliorer le pronostic. MÉTHODOLOGIE: Une analyse rétrospective a été réalisée sur une cohorte de patients suivis de 1978 à 2015 et classés selon les critères de Duke modifiés. Les paramètres cliniques, les données des échocardiographies et les hémocultures ont été évalués. Des techniques d'apprentissage automatique, comme l'arbre de classification, ont été utilisées pour expliquer l'association entre les caractéristiques cliniques et la mortalité hospitalière. De plus, le modèle log-linéaire et la représentation graphique en forêts aléatoires ont été utilisés pour évaluer le degré de dépendance entre les résultats hospitaliers et l'EI. RÉSULTATS: Cette étude a permis d'analyser 653 patients : 449 (69,0 %) avec une EI avérée; 204 (31,0 %) avec une EI possible; âge moyen de 41,3 ± 19,2 ans; 420 (64 %) étaient des hommes. Mode d'acquisition de l'EI : communautaire (67,6 %), nosocomial (17,0 %), indéterminé (15,4 %). Des complications sont survenues chez 547 patients (83,7 %), les plus fréquentes étant l'insuffisance cardiaque (47,0 %), les complications neurologiques (30,7 %) et l'insuffisance rénale dépendante de la dialyse (6,5 %). La mortalité hospitalière était de 36,0 %. L'analyse de l'arbre de classification a permis d'identifier des sous-groupes présentant une mortalité hospitalière plus élevée : les patients présentant une EI communautaire et des stigmates périphériques à l'admission; et les patients présentant une EI nosocomiale. Le modèle log-linéaire a montré que le traitement chirurgical était lié à une mortalité hospitalière plus élevée chez les patients présentant des complications neurologiques. CONCLUSIONS: L'utilisation d'un modèle d'apprentissage automatique a permis d'identifier des sous-groupes de patients présentant un risque plus élevé de mortalité à l'hôpital. Les stigmates périphériques, l'EI nosocomiale, l'absence de végétation et la chirurgie en présence de complications neurologiques sont des prédicteurs d'issue fatale dans l'analyse basée sur l'apprentissage automatique.

Heart failure quantified by underlying cause and multiple cause of death in Brazil between 2006 and 2016.

BACKGROUND: The Global Burden of Disease (GBD) does not produce estimates of heart failure (HF) since this condition is considered the common end to several diseases (i.e., garbage code). This study aims to analyze the interactions between underlying and multiple causes of death related to HF in Brazil and its geographic regions, by sex, from 2006 to 2016. METHODS: Descriptive study of a historical series of death certificates (DCs) related to deaths that occurred in Brazil between 2006 and 2016, including both sexes and all age groups. To identify HF as the underlying cause of death or as a multiple cause of death, we considered the International Classification of Diseases (ICD) code I50 followed by any digit. We evaluated the deaths and constructed graphs by geographic region to compare with national data. RESULTS: We included 1,074,038 DCs issued between 2006 and 2016 that included code I50 in Parts I or II of the certificate. The frequency of HF as the multiple cause of death in both sexes was nearly three times higher than the frequency of HF as an underlying cause of death; this observation remained consistent over the years. The Southeast region had the highest number of deaths in all years (about 40,000 records) and approximately double the number in the Northeast region and more than four times the number in the North region. Codes of diseases clinically unrelated to HF, such as diabetes mellitus, chronic obstructive pulmonary disease, and stroke, were mentioned in 3.11, 2.62, and 1.49% of the DCs, respectively. CONCLUSIONS: When we consider HF as the underlying cause of death, we observed an important underestimation of its impact on mortality, since when analyzed as a multiple cause of death, HF is present in almost three times more deaths recorded in Brazil from 2006 to 2016. The mentioning of conditions with little association with HF at the time of the death highlights the importance of HF as a complex syndrome with multiple components that must be considered in the analysis of mortality trends for implementation of public health management programs.

Vegetarian Diets and Cardiovascular Risk in Women

Abstract Introduction: Vegetarian diets have favorable effects on cardiovascular risk, provided that they do not contain ultra-processed foods (UPF). Objective: To compare the metabolic profile, cardiovascular risk, body composition, and food consumption in vegan (VEG), lacto-ovo vegetarian (LOV), and omnivorous (OMNI) women. To verify the association between UPF consumption and cardiovascular risk. Methods: Cross-sectional study with 119 VEG (n = 43), LOV (n = 38), and OMNI (n = 38) women. Anthropometric and biochemical parameters and the Framingham risk score were assessed. Food consumption was assessed by means of a 3-day food register, and intake of macronutrients, micronutrients, and UPF was estimated. The correlation between UPF consumption and cardiovascular risk was assessed using Spearman's coefficient, with a significance level of 5%. Results: The groups showed low cardiovascular risk, without significant difference between them. The VEG and LOV groups had lower body mass index, neck circumference, body shape index, and systolic blood pressure (p < 0.05) than the OMNI group; greater consumption of carbohydrates, sugars, dietary fibers, micronutrients, beta-carotene, and carotenoids; and lower consumption of total fat, saturated fatty acids, and cholesterol (p < 0.05). Consumption of UPF was lower in the LOV group (5.7 [0.0- 19.8]) than in the OMNI group (14.9 [5.1 - 22.3]; p < 0.05). UPF consumption was associated with SBP (ρ = 0.439; p = 0.007) and blood sugar (ρ = 0.422; p = 0.010) in the VEG group, and in the LOV group it was inversely associated with LDL-c (ρ = −0.456; p = 0.010). Conclusion: Vegetarian women showed better body composition and dietary quality than OMNI women. It is important to take consumption of UPF in vegetarians into consideration, in order to improve cardiovascular risk in women.

Socioeconomic factors and mortality due to cerebrovascular and hypertensive disease in Brazil.

INTRODUCTION AND OBJECTIVE: Socioeconomic factors may affect mortality due to cerebrovascular diseases (CBVDs), hypertensive diseases (HYPDs), and circulatory system diseases (CSDs). This study aimed to assess the association between the Human Development Index (HDI) and the extent of supplementary health coverage and mortality due to these diseases in the Brazilian Federative Units (FUs) between 2004 and 2013. METHODS: The Municipal HDI (MHDI) scores of each FU for 2000 and 2010 were retrieved from the Atlas Brasil website, and supplementary health coverage data for the period 2004-2013 were obtained from the national regulatory agency for private health insurance. Population and mortality data were obtained from the website of the Department of Information Technology of the Unified Health System (DATASUS). Mortality rates were weighted by ill-defined causes of death and standardized by age. RESULTS: The MHDI increased between 2000 and 2010 in all FUs, in half of which it was 0.7 or higher. Supplementary health coverage increased in the country during the study period and was inversely associated with mortality due to CSDs and CBVDs between 2004 and 2013. Mortality due to CBVDs and HYPD in 2013 showed an inverse linear association with the MHDI in 2000. CONCLUSION: Mortality due to CSDs, CBVDs, and HYPDs was influenced by socioeconomic factors. There was a significant inverse association between socioeconomic factors and mortality due to CSDs, CBVDs, and HYPDs. Plans to reduce mortality due to these diseases should include measures to foster economic development and reduce inequality.

Effects of the Intake of Sesame Seeds (Sesamum indicum L.) and Derivatives on Oxidative Stress: A Systematic Review.

This study is aimed at assessing the scientific evidence on the effect of the intake of sesame seeds and derivatives on oxidative stress of individuals with systemic hypertension, dyslipidemia, and type 2 diabetes mellitus. A systematic review was conducted in seven databases (Lilacs, PubMed, ISI Web of Knowledge, Cochrane Library, Scopus, Trip Database, and Scielo) from September 2013 to January 2014. Clinical trials on the intake of sesame seeds and derivatives assessing the outcomes related to oxidative stress were retrieved. The risk of bias in the results of the studies selected was assessed according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. This review included seven clinical trials showing that the intake of sesame resulted in the increase in enzymatic and nonenzymatic antioxidants, as well as in a reduction in oxidative stress markers. This was mainly observed with the use of sesame oil for hypertensive individuals during 2 months and black sesame meal capsules for prehypertensive individuals during four weeks. Most studies involved a small number of participants, sample size being considered a limiting factor for this review. In addition, a significant heterogeneity was observed in the type of population studied and the type of sesame and derivatives used, as well as their amount. The follow-up time was considered a limiting factor, because it varied in the different studies. The high risk of randomization and blinding biases found in the studies assessed determines lower scientific evidence of the results. Despite the limitations and biases identified in this systematic review, sesame showed relevant effects on oxidative stress, suggesting it could increase the antioxidant capacity.

Characterization of metabolically healthy obese Brazilians and cardiovascular risk prediction.

OBJECTIVE: The aim of this study was to identify metabolically healthy obese individuals (MHOs) and their characteristics, as well as to estimate cardiovascular risk using the Framingham score. METHOD: In all, 258 adult individuals, with body mass index ≥30 kg/m(2), and no report of diabetes mellitus or cardiovascular disease, were classified according to their metabolic state considering two criteria: rhe National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and the homeostasis model assessment (HOMA). Biochemical, anthropometric, and body composition characteristics were compared between MHOs and metabolically unhealthy obese (MUO) individuals according to each criterion. Cardiovascular risk was estimated using the Framingham score. RESULTS: MHOs exhibited smaller waist circumference and lower body fat percentage, as well as lower blood glucose, triacylglycerols, and insulin levels, in addition to higher high-density lipoprotein cholesterol concentration, when HOMA criterion (P < 0.05) and associated criteria were adopted. The estimated cardiovascular risk was similar between the two groups according to the HOMA index; however, the risk was significantly lower according to the ATP III guidelines. Obese individuals at intermediate and high risk showed higher body fat percentage compared with those individuals at low risk. CONCLUSIONS: MHOs had biochemical and anthropometric characteristics, such as lower body mass index, waist circumference, percent fat mass, glucose, triacylglycerols, and increased high-density lipoprotein, that made them different from those individuals classified as MUO. The latter exhibited increased risk for cardiovascular disease according to the Framingham score, when using the ATP III criterion alone or in conjunction with the HOMA index.