Complicaciones vasculares postrasplante hepático, una situación con alta morbimortalidad / Vascular complications after liver transplantation: A complication with high morbidity and mortality

Introducción. El trasplante hepático es el tratamiento indicado en aquellas enfermedades del hígado en las cuales ya se han agotado otras medidas terapéuticas, y es un procedimiento complejo. Las complicaciones postquirúrgicas se relacionan con alta morbimortalidad y pueden llevar a desenlaces fatales; las complicaciones vasculares son las de mayor mortalidad, por lo que es crucial la detección temprana y el tratamiento oportuno. El objetivo de este estudio fue caracterizar los pacientes que presentaron complicaciones vasculares posterior a trasplante hepático. Métodos. Estudio descriptivo, retrospectivo, con seguimiento a los pacientes sometidos a trasplante hepático en la Fundación Cardiovascular, entre los años 2013 y 2023, que presentaron complicaciones vasculares. Se evaluó el tipo de complicación, los factores de riesgo y los desenlaces postquirúrgicos. Resultados. Se incluyeron en total 82 pacientes trasplantados, con un predominio del sexo masculino 59,8 % (n=49); la principal indicación del trasplante fue el alcoholismo (21,9 %). Veinte pacientes presentaron complicaciones vasculares; la más frecuente fue trombosis de arteria hepática, en el 45 % (n=9). En tres de estos casos se requirió nuevo trasplante. Conclusión. Las complicaciones vasculares empeoran la evolución clínica postoperatoria de los pacientes y están relacionadas con alta morbimortalidad, por lo cual es crucial la valoración multidisciplinaria, el diagnóstico oportuno y la intervención temprana para disminuir los desenlaces fatales.

Introduction. Liver transplant is the treatment indicated for those liver diseases in which other therapeutic measures have already been exhausted, and it is a complex procedure. Post-surgical complications are related to high morbidity and mortality and can lead to fatal outcomes. Vascular complications are the ones with the highest mortality, so early detection and timely treatment are crucial. The objective of this study was to characterize patients who presented vascular complications after liver transplantation. Methods. Descriptive, retrospective study, with follow-up of patients undergoing liver transplant at the Fundación Cardiovascular, between 2013 and 2023, who presented vascular complications. The type of complication, risk factors and postsurgical outcomes were evaluated. Results. A total of 82 transplant patients were included, with a predominance of males with 59.8% (n=49); the main indication for transplant was alcoholism (21.9%). Twenty patients presented vascular complications; the most frequent was hepatic artery thrombosis 45% (n=9). In three of these cases a new transplant was required. Conclusion. Vascular complications worsen the postoperative clinical course of patients and are associated with high morbidity and mortality, which is why multidisciplinary assessment, diagnosis and early intervention are crucial to reduce fatal outcomes.

Recomendaciones ALAT para el uso de vacunas respiratorias. Guía de práctica clínica basada en evidencias / ALAT Recommendations for the Use of Respiratory VaccinesEvidence-Based Clinical Practice Guideline

Introducción: Las infecciones respiratorias son las enfermedades respiratorias con mayor mortalidad en el mundo. Las causadas por Streptococcus pneumoniae, virus de influenza, Bordetella pertussis, SARS-CoV-2 y el Virus Sincitial Respiratorio, cuentan hoy día con vacunas seguras y efectivas. Este documento representa una guía de práctica clínica (GPC) de la Asociación Latinoamericana de Tórax (ALAT), elaborada por iniciativa de los departamentos de enfermedades infecciosas y pediatría, con el objetivo de establecer recomendaciones sobre vacunas respiratorias, utilizando la evidencia disponible. Método: Se estableció un grupo de desarrollo de las guías conformado por cinco médicos responsables globales del proyecto, se crearon cinco subgrupos de trabajo, uno por cada vacuna, con expertos neumólogos de adulto, pediatras e infectólogos invitados, que generaron preguntas clínicas. Se trabajó con un grupo de expertos metodólogos que transformaron preguntas clínicas en preguntas PICO, seleccionándose nueve preguntas por método DELPHI. Luego, se utilizó el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation) para evaluar la evidencia disponible. Resultados: Se obtuvieron recomendaciones para población adulta y pediátrica de las vacunas de neumococo, influenza, tos ferina, COVID-19 y Virus Respiratorio Sincitial basadas en preguntas PICO. También se agregaron recomendaciones basadas en preguntas narrativas relacionadas al uso de vacunas respiratorias en población con enfermedades respiratorias crónicas como asma, EPOC y fibrosis pulmonar.

Introduction: Respiratory infections are the leading cause of respiratory disease-related mortality worldwide. Infections caused by Streptococcus pneumoniae, influenza virus, Bordetella pertussis, SARS-CoV-2 and Respiratory Syncytial Virus (RSV) now have safe and effective vaccines available.This document represents a Clinical Practice Guideline (CPG) by the Latin American Thoracic Association (ALAT), developed through the initiative of the departments of in-fectious diseases and pediatrics, with the goal of establishing recommendations on respiratory vaccines using the available evidence. Method: A guideline development group was established, composed of five lead physicians responsible for the overall project. Five working subgroups were created, one for each vaccine, involving invited experts in adult pulmonology, pediatrics, and infectious diseases, who formulated clinical questions. A group of expert methodologists then transformed these clinical questions into PICO questions, with nine questions selected using the DELPHI method. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was then used to assess the available evidence. Results: Recommendations were obtained for the adult and pediatric populations for pneumococcal, influenza, pertussis, COVID-19 and Respiratory Syncytial Virus vaccines based on PICO questions. Additionally, recommendations based on narrative questions related to the use of respiratory vaccines in populations with chronic respiratory diseases such as asthma, COPD, and pulmonary fibrosis were included.

Effect of the use of potentially inappropriate medications on the mortality of Brazilian older adults: SABE cohort study.

OBJECTIVE: Investigate the association between potentially inappropriate medication (PIM) use and the risk of death among community-dwelling older Brazilian adults. METHODS: Participants from the Health, Well-Being, and Aging Cohort Study (SABE) in São Paulo, Brazil, between 2000 and 2016 were included. The dependent variable was all-cause mortality, measured as the time elapsed until death. The exposure of interest was the use of PIM according to the Beers Criteria 2019 version. All covariates, except for sex and education, were considered time-varying. RESULTS: PIM use was not associated with mortality after adjusting for covariates (HR = 0.99; 95 % CI: 0.88-1.12). There was a significant interaction between PIM use and age (HR = 0.98; 95 % CI: 0.96-0.99). CONCLUSION: The association between PIM use and the risk of death was moderated by age. Future studies should consider the impact of necessary medication omissions when assessing the mortality risk associated with PIM use.

Does the atrazine increase animal mortality: Unraveling through a meta-analytic study.

Atrazine is one of the most used herbicides in the world, although it is banned in several countries. Pollution of terrestrial and aquatic ecosystems represents a threat to non-target organisms, with various damages already reported in different species. However, there is controversy in studies on atrazine. The question of whether atrazine increases animal mortality is not yet clearly resolved. In this context, this study aimed to carry out a meta-analytic review, focusing on studies on environmental concentrations of the herbicide atrazine to evaluate its lethal effects on various animal species. We identified and analyzed 107 datasets through a selection process that used the Scopus, PubMed, and Web of Science (WoS) databases. A significant increase in the mortality rate of animals exposed to environmental concentrations of atrazine was observed. Nematodes, amphibians, molluscs, insects, and fish showed increased mortality after exposure to atrazine. Animals in the larval and juvenile stages showed greater susceptibility when exposed to different concentrations of atrazine. Furthermore, both commercial and pure formulations resulted in high mortality rates for exposed animals. Atrazine and other pesticides had a synergistic effect, increasing the risk of mortality in animals. There are still many gaps to be filled, and this study can serve as a basis for future regulations involving atrazine.

What is a migrant death? An operational definition for a more accurate enumeration of migrant mortality along the US-Mexico border.

Over the last forty years an indeterminate number of persons, ranging from thousands to tens of thousands, have died along the US-Mexico border during migration, fleeing poverty, armed conflict, situations of violence, and disasters. An accurate accounting of migrant deaths along the southern US border is the first step toward an understanding of the extent and the contributing factors of these deaths. In this article, we describe a key aspect of our collaborative work aimed at developing a more representative account of migrant mortality along the southwestern US border: the determination of criteria for inclusion of specific forensic cases as "migrant." Our intention is not to propose a definition of "what is a migrant death" applicable to all contexts and situations but rather one specific to the US-Mexico border region. Our main impetus is to build and launch a web portal to track and map migrant deaths at the US-Mexico border. The criteria we have identified are based on an examination of death data collected by various agencies in the four border states (California, Arizona, New Mexico, and Texas) and at the federal level by the National Missing and Unidentified Persons System (NamUs). They include a) context of human remains discovery; b) identification media/documentation; c) geographic setting; and d) personal effects. Taken together, these criteria will facilitate our determination, case by case, of the probability that human remains found along the United States side of the border may be from a person in the context of migration.

NHANES 2011-2014: Objective Physical Activity Is the Strongest Predictor of All-Cause Mortality.

INTRODUCTION: Objectively measured physical activity (PA) is a modifiable risk factor for mortality. Understanding the predictive performance of PA is essential to establish potential targets for early intervention to reduce mortality among older adults. METHODS: The study used a subset of the National Health and Nutrition Examination Survey (NHANES) 2011-2014 data consisting of participants 50 to 80 yr old ( n = 3653, 24297.5 person-years of follow-up, 416 deaths). Eight accelerometry-derived features and 14 traditional predictors of all-cause mortality were compared and ranked in terms of their individual and combined predictive performance using the 10-fold cross-validated concordance (C) from Cox regression. RESULTS: The top 3 predictors of mortality in univariate analysis were PA related: average Monitor-Independent Movement Summary (MIMS) in the 10 most active hours (C = 0.697), total MIMS per day (C = 0.686), and average log-transformed MIMS in the most 10 active hours of the day (C = 0.684), outperforming age (C = 0.676) and other traditional predictors of mortality. In multivariate regression, adding objectively measured PA to the top performing model without PA variables increased concordance from C = 0.776 to C = 0.790 ( P < 0.001). CONCLUSIONS: These findings highlight the importance of PA as a risk marker of mortality and are consistent with prior studies, confirming the importance of accelerometer-derived activity measures beyond total volume.

Excess mortality during the COVID-19 pandemic and its spatial distribution in the state of Pernambuco, Brazil: an ecological study.

OBJECTIVE: To investigate excess mortality during the COVID-19 pandemic and its spatial distribution in Pernambuco, Brazil. METHODS: This was an ecological, descriptive and analytical study of deaths, by municipality, recorded on the Mortality Information System, in 2020 and 2021. Excess mortality was measured by comparing observed and expected deaths, the latter estimated by calculating standardized mortality ratio (SMR). SMR and respective confidence intervals (95%CI) were calculated. Spatial analysis was performed by calculating the Global and Local Moran Index. RESULTS: Excess mortality was 20.6% and 27.5%, respectively, in 2020 and 2021, with positive spatial correlation (p-value < 0.05). More populous municipalities (2020: SMR = 1.26; 95%CI 1.24;1.27 and 2021: SMR = 1.34; 95%CI 1.32;1.34), more developed municipalities (2020: SMR = 1.43; 95%CI 1.41;1.44 and 2021: SMR = 1.51;95%CI 1.50;1.53) and municipalities in the Sertão region (2020:SMR = 1.31;95%CI 1.30;1.33 and 2021: SMR = 1.44; 95%CI 1.42;1.46) showed greater excess deaths. CONCLUSION: Excess mortality coincided with peak periods of COVID-19 transmission.

[Frailty as a predictor of 3-year mortality in older adult patients in long-term care in Mexico]. / Fragilidad como predictor de mortalidad a 3 años en los pacientes adultos mayores en cuidados de largo plazo en México.

INTRODUCTION: The objective of our study was to evaluate the long-term association between mortality and frailty in institutionalized patients in Mexico. Worldwide, there are limited lines of research in this population of geriatric patients and this entity generates a significant impact on the quality of life and prognosis of our patients. MATERIAL AND METHODS: It is a prospective cohort study of 81 patients in long-term care who met the selection criteria. Frailty was determined using the FRAIL scale. Data on mortality were collected during the follow-up period, and diagnosis was monitored. The risk of presenting this event was determined by logistic regression, Kaplan-Meier, and Cox proportional hazards analysis, adjusted for age and sex. RESULTS: The mean follow-up time of the patients was 36 months (1094 days), during which 33 subjects died (40.7%). In our population, at the beginning of the study the vast majority of frail patients had pathologies that independently generate risk of adverse events, disability (Barthel=30.9; SD 28.8), sarcopenia (n=40; 71.4%), one to 3 falls in the last year (n=17; 63%), ≥4 falls (n=4; 57.1%). Frail participants had a higher adjusted risk of mortality (HR 2.93; 95% CI 1.33-6.43; p=0.007). CONCLUSIONS: The frailty entity is associated in the long term with mortality in institutionalized patients in Mexico. Timely treatment and approach may allow a good prognosis and quality of life.

Presidential election results in 2018-2022 and its association with excess mortality during the 2020-2021 COVID-19 pandemic in Brazilian municipalities.

We evaluated the hypothesis of an association between excess mortality and political partisanship in Brazil using municipal death certificates registered in the Brazilian Ministry of Health database and first-round electoral results of Presidential elections in 2018 and 2022. Considering the former Brazilian President's stance of discrediting and neglecting the severity of the pandemic, we expect a possible relationship between excessive mortality rates during the COVID-19 health crisis and the number of municipal votes for Bolsonaro. Our results showed that, in both elections, the first-round percentage of municipal votes for Bolsonaro was positively associated with the peaks of excess deaths across Brazilian municipalities in 2020 and 2021. Despite the excess mortality during the pandemic, the political loyalty to Bolsonaro remained the same during the electoral period of 2022. A possible explanation for this is linked to the Brazilian political scenario, which presents an environment of tribal politics and affective polarization.

A systematic evaluation of seven different scores representing the EAT-Lancet reference diet and mortality, stroke, and greenhouse gas emissions in three cohorts.

Different approaches have been used for translation of the EAT-Lancet reference diet into dietary scores that can be used to assess health and environmental impact. Our aim was to compare the different EAT-Lancet diet scores, and to estimate their associations with all-cause mortality, stroke incidence, and greenhouse gas emissions. We did a systematic review (PROSPERO, CRD42021286597) to identify different scores representing adherence to the EAT-Lancet reference diet. We then qualitatively compared the diet adherence scores, including their ability to group individuals according the EAT-Lancet reference diet recommendations, and quantitatively assessed the associations of the diet scores with health and environmental outcome data in three diverse cohorts: the Danish Diet, Cancer and Health Cohort (DCH; n=52 452), the Swedish Malmö Diet and Cancer Cohort (MDC; n=20 973), and the Mexican Teachers' Cohort (MTC; n=30 151). The DCH and MTC used food frequency questionnaires and the MDC used a modified diet history method to assess dietary intake, which we used to compute EAT-Lancet diet scores and evaluate the associations of scores with hazard of all-cause mortality and stroke. In the MDC, dietary greenhouse gas emission values were summarised for every participant, which we used to predict greenhouse gas emissions associated with varying diet adherence scores on each scoring system. In our review, seven diet scores were identified (Knuppel et al, 2019; Trijsburg et al, 2020; Cacau et al, 2021; Hanley-Cook et al, 2021; Kesse-Guyot et al, 2021; Stubbendorff et al, 2022; and Colizzi et al, 2023). Two of the seven scores (Stubbendorff and Colizzi) were among the most consistent in grouping participants according to the EAT-Lancet reference diet recommendations across cohorts, and higher scores (greater diet adherence) were associated with decreased risk of mortality (in the DCH and MDC), decreased risk of incident stroke (in the DCH and MDC for the Stubbendorff score; and in the DCH for the Colizzi score), and decreased predicted greenhouse gas emissions in the MDC. We conclude that the seven different scores representing the EAT-Lancet reference diet had differences in construction, interpretation, and relation to disease and climate-related outcomes. Two scores generally performed well in our evaluation. Future studies should carefully consider which diet score to use and preferably use multiple scores to assess the robustness of estimations, given that public health and environmental policy rely on these estimates.

The impact of social cohesion and risk communication on excess mortality due to COVID-19 in 213 countries: a retrospective analysis.

BACKGROUND: Tools for assessing a country's capacity in the face of public health emergencies must be reviewed, as they were not predictive of the COVID-19 pandemic. Social cohesion and risk communication, which are related to trust in government and trust in others, may have influenced adherence to government measures and mortality rates due to COVID-19. OBJECTIVE: To analyse the association between indicators of social cohesion and risk communication and COVID-19 outcomes in 213 countries. RESULTS: Social cohesion and risk communication, in their dimensions (public trust in politicians, trust in others, social safety nets, and equal distribution of resources index), were associated with lower excess mortality due to COVID-19. The number of COVID-19-related disorder events and government transparency were associated with higher excess mortality due to COVID-19. The lower the percentage of unemployed people, the higher the excess mortality due to COVID-19. Most of the social cohesion and risk communication variables were associated with better vaccination indicators, except for social capital and engaged society, which had no statistically significant association. The greater the gender equality, the better the vaccination indicators, such as the number of people who received all doses. CONCLUSION: Public trust in politicians, trust in others, equal distribution of resources and government that cares about the most vulnerable, starting with the implementation of programs, such as cash transfers and combating food insecurity, were factors that reduced the excess mortality due to COVID-19. Countries, especially those with limited resources and marked by social, economic, and health inequalities, must invest in strengthening social cohesion and risk communication, which are robust strategies to better cope with future pandemics.

Fatores clínicos associados à sobrevida de pacientes com COVID-19 internados em Unidade de Terapia Intensiva / Clinical factors associated with survival of patients with COVID-19 admitted to the Intensive Care Unit / Factores clínicos asociados a supervivencia de pacientes con COVID-19 ingresados a Unidad de Cuidados Intensivos

Objetivo:identificar fatores clínicos associados à sobrevida de pacientes com COVID-19 internados em Unidade de Terapia Intensiva. Método:estudo de coorte retrospectivo, por meiode análise documental de 100 prontuários de pacientes com COVID-19 internados em uma Unidade de Terapia Intensiva, no período marçoa maio de 2021. Resultados:os fatores sociodemográficos, comorbidades e fatores de risco indicaram mudança no perfil do paciente, em comparação aestudos realizados na primeira onda pandêmica. Dentre os fatores associados à sobrevida dos pacientes com COVID-19 internados em Unidade de Terapia Intensiva destacam-se a oxigenoterapia de baixo fluxo via nasal, a posição autoprona, a sedação com midazolam e o tempo de internação. Já a hemodiálise e o uso de rocurônio aumentaram o risco de óbito dos pacientes. Conclusão:os resultados podem contribuir para a tomada de decisões e melhorar o atendimento ao paciente crítico com COVID-19.

Objective:to identify clinical factors associated with the survival of patients with COVID-19 admitted to the Intensive Care Unit. Method:retrospective cohort study, through documentary analysis of 100 medical records of patients with COVID-19 admitted to an Intensive Care Unit, in the period from Marchto May 2021. Results:sociodemographic factors, comorbidities,and risk factors indicated a change in the patient's profile, compared to studies carried out in the first pandemic wave. Among the factors associated with the survival of patients with COVID-19 admitted to the Intensive Care Unit, low-flow nasal oxygen therapy, prone position, sedation with midazolam and length of stay stand out. Hemodialysis and the use of rocuronium increased the risk of death for patients. Conclusion:the results can contribute to decision-making and improve care for critical patients with COVID-19

Objetivo:identificar factores clínicos asociados a la supervivencia de pacientes con COVID-19 ingresados en la Unidad de Cuidados Intensivos. Método:estudio de cohorte retrospectivo, mediante análisis documental de 100 historias clínicas de pacientes con COVID-19 ingresados en una Unidad de Cuidados Intensivos, en el período de marzoa mayo de 2021. Resultados:factores sociodemográficos, comorbilidades y factores de riesgo indicaron un cambio en el perfil del paciente, en comparación con estudios realizados en laprimera ola pandémica. Entre los factores asociados a la supervivencia de los pacientes con COVID-19 ingresados en la Unidad de Cuidados Intensivos destacan la oxigenoterapia nasal de bajo flujo, la posición prona, la sedación con midazolam y el tiempo deestancia hospitalaria. La hemodiálisis y el uso de rocuronio aumentaron el riesgo de muerte de los pacientes. Conclusión:los resultados pueden contribuir a la toma de decisiones y mejorar la atención al paciente crítico con COVID-19

Padrão de Atividade Física "Guerreiros de Fim de Semana": Risco ou Benefício para a Saúde? / "Weekend Warriors" Physical Activity Pattern: Health Risk or Benefit?

A vida frenética, principalmente nos grandes centros urbanos, dificulta, para algumas pessoas, a realização de atividade física de forma regular (3-5 vezes por semana). Todavia, a possibilidade de realizar essas atividades em um ou dois dias da semana pode ser uma alternativa bastante interessante, uma vez que este padrão de atividade física tem sido associado a menor mortalidade por todas as causas, cardiovasculares e câncer. Nesta breve revisão narrativa, abordaremos os principais estudos científicos sobre os "Guerreiros de Fim de Semana" e sua relação com os benefícios e riscos à saúde. Certamente, a incorporação desse padrão de atividade física nas recomendações e orientações futuras promoverá melhora das condições de saúde e auxiliará o poder público a adequar as estratégias de combate ao sedentarismo.

Eliminação dos ácidos graxos trans de produção industrial: instrumento para redação de regulamentos

O consumo de ácidos graxos trans é uma das principais causas de morbidade e mortalidade em todo o mundo. Os ácidos graxos trans não têm benefícios conhecidos para a saúde e são uma das principais causas de doenças cardíacas em todo o mundo. Estima-se que os ácidos graxos trans causem cerca de 260.000 mortes a cada ano. Para reduzir efetivamente o consumo de ácidos graxos trans, a Organização Pan-Americana da Saúde/Organização Mundial da Saúde recomenda que todos os países eliminem os ácidos graxos trans produzidos industrialmente (IP-TFA) de seu abastecimento alimentar nacional, que constituem a principal fonte de ácidos graxos trans em Nutrição humana. Esta publicação foi elaborada para auxiliar agências governamentais e ministérios no desenvolvimento ou alteração de legislação ou regulamentação nacional com o objetivo de eliminar o IP-TFA do abastecimento de alimentos em seu país. Embora útil para leitores com formação jurídica, esta publicação também se destina a um público não jurídico que deseja promover a eliminação do AGT-IP por meio de regulamentação. As perguntas da árvore de decisão são usadas para ajudar os usuários desta ferramenta a preencher um regulamento de remoção de TFA-IP específico do contexto que seja consistente com as melhores práticas da OPAS/OMS. Abrange disposições importantes que devem ser consideradas no texto do regulamento, como as que dão autoridade legal para adotar um regulamento sobre ácidos graxos trans, a definição do escopo do regulamento, a criação de um quadro de fiscalização e o cumprimento de o regulamento. , e o estabelecimento de uma data de vigência. Esta publicação inclui um modelo de regulamento e oferece uma visão prática dos principais aspectos legais da remoção do AGT-IP, com foco em abordagens comprovadas, eficazes e baseadas em evidências. Ele orienta os leitores sobre como redigir regulamentos para implementar as políticas de remoção de TFA-IP recomendadas pela OPAS/OMS, bem como disposições complementares que se mostraram eficazes.

Unveiling sex-based geographical disparities in myelodysplastic syndrome mortality trends in Spain (1999-2022).

AIM: To comprehensively analyze trends in myelodysplastic neoplasm (MDS) mortality across Spain (1999-2022), examining sex and regional differences. METHODS: We analyzed nationwide death records and population data, calculating age-standardized mortality rates (ASMRs) and standardized mortality ratios (SMRs) stratified by sex and Autonomous Community (AC). Joinpoint regression identified significant shifts in trends. RESULTS: Across Spain, MDS mortality risk varied among men, with rates ranging from 1.08 to 4.38 per 100,000 across regions, while women's rates ranged from 1.23 to 2.02. Five regions had higher risks than the national average, while six had lower risks. Joinpoint analysis revealed three periods nationally: a decline until 2008, and an increase until 2017, followed by a significant decrease. Despite the overall stable national trend (-0.5% annual change), significant regional variations emerged. Andalusia stood out with a worrying increase in MDS mortality, while Aragon and Murcia demonstrated promising declines. Extremadura displayed a unique trajectory with an initial rise followed by stabilization, while Galicia exhibited a contrasting trend with an initial decline and subsequent increase. Notably, men consistently faced a higher risk of MDS mortality compared to women, with significant disparities across regions. Extremadura, in particular, showed a marked difference in risk between genders. CONCLUSION: MDS mortality trends in Spain are complex, and influenced by gender, region, and time. Further research is needed to understand regional disparities, recent national decline, and higher risk in specific demographics. Tailored interventions based on local factors and targeted research are crucial to address these complexities and improve patient outcomes.

Evolution of mortality rates among women of reproductive age in Brazilian municipalities: an ecological analysis using Global Burden of Disease estimates.

OBJECTIVES: Women's mortality at a reproductive age has been a global concern, and its decrease has been incorporated as a target of the UN Sustainable Development Goals. The aim of this study was to describe the spatial-temporal evolution of mortality rates among women of reproductive age in Brazilian municipalities by groups of causes and socioeconomic indicators from 2000 to 2018. STUDY DESIGN: Ecological analysis. METHODS: This work was an ecological, descriptive study that analyzed estimates of mortality rates among women of reproductive age (15-49 years) by main groups of causes of death from the Global Burden of Disease (GBD) study in three consecutive trienniums, T1 (2000-2002), T2 (2009-2011), and T3 (2016-2018). To quantify the temporal evolution in mortality rates, the present study calculated the percentage change for each triennium. The spatial analysis of mortality rates was carried out using Moran's index. The Pearson coefficient was used to analyze the correlation between the data. RESULTS: A significant decline in mortality rates was found for all groups of causes in all regions of the country. Despite the downward trend, the percentage change from 2009 to 2011 to 2016 to 2018 showed a decrease in the group of Noncommunicable Diseases (NCDs) and external causes. The decline in mortality rates of women due to external causes showed only a minimal change in the North and Northeast regions from T2 to T3, whereas a cluster of neighboring municipalities with high mortality rates persisted in the municipalities of the South region and in the state of Roraima. The ranking of the main causes of death in Brazilian municipalities showed an increase in neoplasms in detriment to cardiovascular diseases (CVDs). CONCLUSIONS: The main causes of death in women of reproductive age at a more local level could be used to recognize inequalities and to develop interventions aimed at tackling premature and preventable deaths.

Estimation and probabilistic projection of age- and sex-specific mortality rates across Brazilian municipalities between 2010 and 2030.

BACKGROUND: Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We estimated age- and sex-specific mortality rates for all 5,565 Brazilian municipalities in 2010 and forecasted probabilistic mortality rates and life expectancy between 2010 and 2030. METHODS: We used a combination of the Tool for Projecting Age-Specific Rates Using Linear Splines (TOPALS), Bayesian Model, Spatial Smoothing Model and an ad-hoc procedure to estimate age- and sex-specific mortality rates for all Brazilian municipalities for 2010. Then we adapted the Lee-Carter model to forecast mortality rates by age and sex in all municipalities between 2010 and 2030. RESULTS: The adjusted sex- and age-specific mortality rates for all Brazilian municipalities in 2010 reveal a distinct regional pattern, showcasing a decrease in life expectancy in less socioeconomically developed municipalities when compared to estimates without adjustments. The forecasted mortality rates indicate varying regional improvements, leading to a convergence in life expectancy at birth among small areas in Brazil. Consequently, a reduction in the variability of age at death across Brazil's municipalities was observed, with a persistent sex differential. CONCLUSION: Mortality rates at a small-area level were successfully estimated and forecasted, with associated uncertainty estimates also generated for future life tables. Our approach could be applied across countries with data quality issues to improve public policy planning.

[Tuberculosis mortality trends and the correlation with the socio-demographic index in Brazil between 2010 and 2019]. / Tendência da mortalidade por tuberculose e relação com o índice sóciodemográfico no Brasil entre 2005-2019.

The scope of this article is to analyze the trend of the standardized mortality rate (SMR) for tuberculosis and its correlation with the developmental status in Brazil. An ecological time series study was conducted to analyze data of deaths from tuberculosis reported between 2005 and 2019 in all states. Data were extracted from the Mortality Information System, the Brazilian Institute of Geography and Statistics, and the Global Burden of Disease study. The temporal trend was analyzed using Prais-Winsten regression. Spearman's correlation analysis between SMR and Socio-Demographic Index (SDI) was also performed. From 2005 to 2019, 68,879 deaths from tuberculosis were recorded in Brazil. The average mortality rate was 2.3 deaths per 100,000 inhabitants. The decreasing trend of SMR due to tuberculosis was observed in Brazil and in all regions. There was a significant negative correlation between SDI and TMP. TMP due to tuberculosis revealed a decreasing trend in Brazil and in all regions. Most states showed a decreasing trend and none of them had an increasing trend. An inverse relationship was found between developmental status and mortality due to tuberculosis.

O objetivo do artigo é analisar a tendência da taxa de mortalidade padronizada (TMP) por tuberculose e sua correlação com o status de desenvolvimento no Brasil. Estudo ecológico de séries temporais que analisou dados de óbitos por tuberculose notificados entre 2005 e 2019 de todos os estados. Os dados foram extraídos do Sistema de Informação sobre Mortalidade, do Instituto Brasileiro de Geografia e Estatística e do estudo da Carga Global de Doenças. A tendência temporal foi analisada pela regressão de Prais-Winsten. A análise da correlação de Spearman entre a TMP e o índice sociodemográfico (socio-demographic index - SDI) também foi realizada. De 2005 a 2019, foram registrados 68.879 óbitos por tuberculose no Brasil. A taxa média de mortalidade foi de 2,3 óbitos por 100.000 habitantes. A tendência decrescente da TMP por tuberculose foi observada no Brasil e em todas as regiões. Verificou-se correlação negativa significativa entre o SDI e a TMP. A maioria dos estados apresentou tendência decrescente e nenhum deles teve tendência crescente. Uma relação inversa foi verificada entre o SDI e a mortalidade por tuberculose.

Mortality and years of life lost related to adverse drug events in Brazil.

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

Mortality trends and sociodemographic factors associated with early death in sickle cell disease patients in the state of São Paulo.

OBJECTIVE: To estimate trends in mortality rate and average age of death, and identify sociodemographic factors associated with early death in patients with sickle cell disease (SCD). METHODS: An ecological and cross-sectional study was conducted using data from the Mortality Information System. All deaths of patients residing in the state of São Paulo from 1996 to 2015 with at least one International Disease Code for SCD in any field of the death certificate were included. Simple linear regression was used to estimate trends. The Log-rank test and multiple Cox regression were used to identify factors associated with early death. RESULTS: The age-standardized mortality rate per million inhabitants increased by 0.080 per year (R2=0.761; p<0.001). When the events were stratified by age at death, the increase was 0.108 per year for those occurring at age 20 years or older, (R2=0.789; p<0.001) and 0.023 per year for those occurring before age 20 years old (R2=0.188; p=0.056). The average age at death increased by 0.617 years (7.4 months) per year (R2=0.835; p<0.001). Sociodemographic factors associated with early death identified were male gender (hazard ratio - HR=1.30), white race (HR=1.16), death occurring in the hospital (HR=1.29), and living in the Greater São Paulo (HR=1.13). CONCLUSIONS: The mortality rate and the average age of death in patients with SCD have increased over the last two decades. Sociodemographic factors such as gender, race, place of occurrence, and residence were found to be associated with early death.