Thermal Comfort Conditions and Mortality in Brazil.

Conventional temperature-based approaches often overlook the intricate nature of thermal stress experienced by individuals. To address this limitation, climatologists have developed thermal indices-composite measures designed to reflect the complex interaction of meteorological factors influencing human perception of temperature. Our study focuses on Brazil, estimating the association between thermal comfort conditions and mortality related to respiratory and circulatory diseases. We examined four distinct thermal indices: the discomfort index (DI), net effective temperature (NET), humidex (H), and heat index (HI). Analyzing a comprehensive dataset of 2,872,084 deaths from 2003 to 2017, we found significant variation in relative risk (RR) based on health outcomes, exposure lag, percentile of exposure, sex/age groups, and specific thermal indices. For example, under high exposure conditions (99th percentile), we observed that the shorter lags (3, 5, 7, and 10) had the most robust effects on all-cause mortality. For example, under lag 3, the pooled national results for the overall population (all ages and sexes) indicate an increased risk of all-cause mortality, with an RR of 1.17 (95% CI: 1.13; 1.122) for DI, 1.15 (95% CI: 1.12; 1.17) for H, 1.15 (95% CI: 1.09; 1.21) for HI, and 1.18 (95% CI: 1.13; 1.22) for NET. At low exposure levels (1st percentile), all four distinct thermal indices were linked to an increase in all-cause mortality across most sex and age subgroups. Specifically, for lag 20, we observed an estimated RR of 1.19 (95% CI: 1.14; 1.23) for DI, 1.12 (95% CI: 1.08; 1.16) for H, 1.17 (95% CI: 1.12; 1.22) for HI, and 1.18 (95% CI: 1.14; 1.23) for NET. These findings have important implications for policymakers, guiding the development of measures to minimize climate change's impact on public health in Brazil.

Tendência de mortalidade prematura por doenças crônicas não transmissíveis no estado de São Paulo / Trends of premature mortality due to chronic non-communicable diseases in the state of São Paulo / Tendencia de la mortalidad prematura por enfermedades crónicas no transmisibles en el estado de São Paulo

Objetivo: analisar a tendência de óbitos prematuros relacionados às doenças crônicas não transmissíveis e sua relação com o nível de escolaridade e renda da população do estado de São Paulo. Método: estudo ecológico, utilizando dados do Departamento de Informática do Sistema Único de Saúde (DATASUS), referentes aos óbitos registrados no período de 2012 a 2019, de pessoas na faixa etária de 30 a 69 anos em decorrência de doenças cardiovasculares e respiratórias; neoplasias e diabetes mellitus. Os dados foram analisados por meio de modelo linear generalizado de distribuição binomial-negativa com função de ligação logarítmica Resultados: o coeficiente de mortalidade prematura por doenças crônicas não transmissíveis apresentou aumento, passando de 313,16 óbitos/ 100.000 habitantes no ano de 2012 para 315,08/100.000 habitantes em 2019. Conclusão: há necessidade de uma atenção especial da gestão em saúde às doenças crônicas não transmissíveis, ações para a prevenção, promoção e diagnóstico precoce, destacando-se o papel relevante dos serviços da atenção primária à saúde(AU)

Objective: to analyze the trend of premature deaths related to chronic non-communicable diseases and their relationship with the level of education and income of the population in the state of São Paulo. Method: ecological study, using data from the Department of Informatics of the Unified Health System (DATASUS), referring to deaths registered between 2012 and 2019 of people aged 30 to 69 years due to cardiovascular and respiratory diseases; neoplasms and diabetes mellitus. The data were analyzed using a generalized linear model of negative binomial distribution with a logarithmic link function. Results: the premature mortality rate due to chronic non-communicable diseases increased, from 313.16 deaths/100,000 inhabitants in 2012 to 315 .08/100,000 inhabitants in 2019. Conclusion: there is a need for special attention from health management to chronic non-communicable diseases, actions for prevention, promotion and early diagnosis, highlighting the relevant role of primary health care services(AU)

Objetivo: analizar la tendencia de muertes prematuras relacionadas con enfermedades crónicas no transmisibles y su relación con el nivel de educación y de ingresos de la población en el estado de São Paulo. Método: estudio ecológico, utilizando datos del Departamento de Informática del Sistema Único de Salud (DATASUS), relativos a muertes registradas entre 2012 y 2019 de personas de 30 a 69 años, por enfermedades cardiovasculares y respiratorias, neoplasias y diabetes mellitus. Se analizaron los datos utilizando un modelo lineal generalizado de distribución binomial negativa con una función de enlace logarítmica. Resultados: la tasa de mortalidad prematura por enfermedades crónicas no transmisibles aumentó, de 313,16 muertes/100.000 habitantes en 2012 a 315,08/100.000 habitantes en 2019. Conclusión: es necesaria una atención especial desde la gestión sanitaria a las enfermedades crónicas no transmisibles, acciones de prevención, promoción y diagnóstico temprano, destacando el papel relevante de los servicios de atención primaria de salud(AU)

Mortalidade de professores no estado de Goiás: análise de série temporal / Mortality of teachers in the state of Goiás: a time serie analysis

Análise de perfil epidemiológico e a tendência da mortalidade de professores da educação básica e do ensino superior no Estado de Goiás, no período de 2008 a 2017. Método: série temporal, com dados do Sistema de Informações sobre Mortalidade. Para a análise da tendência da mortalidade utilizou-se modelos de regressão linear e considerou-se p<0,05. Resultados: foram levantados 2.439 óbitos, maior frequência de óbitos no sexo feminino, em indivíduos de cor branca e com idade entre 50 e 69 anos. Entre as mulheres, as neoplasias malignas foram as principais causas de óbito, enquanto entre os homens destacaram-se as doenças do aparelho circulatório. Identificou-se tendência temporal de aumento dos óbitos (0,134 para as neoplasias malignas, 0,132 para as doenças do aparelho circulatório, 0,252 para as causas externas e 0,212 para as doenças do aparelho respiratório). Considerando todas as causas de óbito o incremento foi de 0,040 (p<0,000). Conclusão: há aumento de mortalidade de professores por causas evitáveis

Objective: to analyze the epidemiologic profile and the trends in mortality of teachers from basic education and higher education professors in the state of Goiás, in the period from 2008 to 2017. Method: time series, with data from the Mortality Information System. In order to analyze the trend in mortality, a linear regression model was used, considering p<0.05. Results: 2,439 deaths were recorded, with higher frequency of deaths within female sex, white and aged from 50 to 69 years. Among the women, malignant neoplasms were the main causes of death, whilst among men, circulatory system diseases stood out. It was identified a temporal trend of increase in deaths (0.134 for malignant neoplasms, 0.132 for circulatory system diseases, 0.252 for external causes and 0.212 for respiratory system diseases). Considering all the causes of death, the increase was 0.040 (p<0.000). Conclusion: there is an increase in mortality of teachers and professors due to avoidable causes

Mortality from chronic respiratory disease in Brazil: time trend and forecasts / Mortalidade por doença respiratória crônica no Brasil: tendência temporal e projeções

ABSTRACT OBJECTIVE To analyze the time trend of monthly mortality rates from chronic respiratory diseases in Brazil from 1996 to 2017, with forecasts for 2022, besides analyzing the possibility of achieving the goal of the Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil (Strategic Action Plan to Tackle Chronic Noncommunicable Diseases in Brazil) from 2011 to 2022. METHODS This is an ecological study that uses data from Sistema de Informações sobre Mortalidade (SIM - Mortality Information System), Sistema de Informações Demográficas e Socioeconômicas (Demographic and Socioeconomic Information System) and Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD Contínua - Continuous National Household Sample Survey). We established the age range between 30 and 69 years old and the evolution of the rates over time was made by autoregressive integrated moving average models in R statistical tool. RESULTS Premature mortality rates from chronic respiratory diseases are decreasing in Brazil as a whole, mostly in state capitals. There is also a trend to reach the Ministry of Health's goal in most of the country. For capitals that tend not to reach the goal, there is an association between mortality and social indicators, healthcare network and frequency of smoking. CONCLUSION This study intends to improve planning of the public health system for the control of chronic respiratory diseases.

RESUMO OBJETIVO Analisar a tendência temporal das taxas mensais de mortalidade por doenças respiratórias crônicas no Brasil de 1996 até 2017, com projeções para 2022, além de analisar a possibilidade de cumprimento da meta do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil de 2011 até 2022. MÉTODOS Trata-se de estudo ecológico que utiliza dados do Sistema de Informações sobre Mortalidade, do Sistema de Informações Demográficas e Socioeconômicas e da Pesquisa Nacional por Amostra de Domicílios Contínua. O recorte etário foi estabelecido entre 30 e 69 anos e a evolução das taxas no tempo foi feita por meio de modelos autorregressivos integrados de média móvel em plataforma estatística R. RESULTADOS As taxas de mortalidade precoce por doenças respiratórias crônicas apresentam-se decrescentes no Brasil como um todo e na maior parte das capitais, assim como, há tendência a atingir a meta do Ministério da Saúde na maior parte do país. Para capitais que tendem a não atingir a meta, verifica-se associação entre mortalidade e indicadores sociais, rede assistencial de saúde e frequência do tabagismo. CONCLUSÃO Pretende-se que o estudo possibilite um melhor planejamento do sistema público de saúde para o controle das doenças respiratórias crônicas.

Correlaciones entre el test de velocidad en 4 metros y el test de caminata en 6 min en enfermos respiratorios crónicos / Correlations between the 4 meter speed test and the 6-minute walking test in chronic respiratory patients

Resumen La prueba de velocidad de marcha en 4 metros (T4M) es considerada sustituto de la caminata en 6 min (TC6M) en EPOC. Sin embargo, no ha sido bien investigada en otras enfermedades respiratorias. Durante un año estudiamos pacientes que concurrieron a nuestra Unidad para realizar el TC6M midiendo la velocidad alcanzada en 4 metros, 2 h previo a realizar el TC6M. De 162 pacientes 99 eran mujeres. La edad media fue de 65 años, peso de 73 kg, talla de 158 cm, IMC 29,4 kg/m2. 36% tenían fibrosis pulmonar idiopática, 17% EPOC, GOLD IV,11% EPOC, GOLD III, 12% apnea de sueño y 12% otras enfermedades. No hubo diferencia para los distintos diagnósticos en ambos tests. La distancia media en TC6Mfue 368,5 m la velocidad: 1,01 m/s en T4M.Hubo una correlación positiva significativa entre ambos test: alto rendimiento en T4M es equivalente a un alto rendimiento en el TC6M. Hubo correlación negativa con la edad y positiva con la estatura. Al año de seguimiento 16 pacientes habían fallecido, siendo estos los que habían obtenido los más bajos rendimientos en ambos tests (T4M: 0,69 m/s y 248,1 m en TC6M) La posibilidad de sobrevida cayó a 20% en aquellos individuos que alcanzaron una velocidad inferior a 0,69 m/s. Es posible sustituir el TC6M por el T4M en pacientes con diferentes patologías respiratoria, podemos predecir la muerte por cualquier causa si un sujeto camina a una velocidad ≤ 0,69 m/s, T4M es barato y fácil de realizar en atención primaria, sirviendo como evaluación de riesgo para referir a un centro más complejo.

4-Meter Gait Speed Test (4MGST) a frailty test, is considered a surrogate for the 6-Minute Walk Test (6MWT) in COPD. However, it has not been investigated in other respiratory conditions. Over a year, we studied patients attending our Unit for evaluation with 6MWT, measuring the speed they achieved walking 4 m, 2 h before performing 6MWT. 162 patients (99 women) were studied; series' mean values were: age 65 years-old; body weight, 73 kg; height, 158 cm and BMI, 29.4 kg/m2. 36% of them had idiopathic pulmonary fibrosis, 17% GOLD IV COPD, 11% GOLD III COPD, 12% pulmonary arterial hypertension, 12% obstructive apnea-hypopnea syndrome, and 12% other conditions. ANOVA showed no difference between diagnostic categories for both test. Average score in 6MWT was 368.5 m and 1.01 m/s in 4MGST. Pearson correlation coefficient revealed significant positive correlation between results of both tests: high score in 4MGST is equivalent to high score in 6MWT. There was negative correlation with age and positive correlation with height. At one year follow-up, 16 patients had died. They obtained significantly lower scores in both tests (4MGST: 0.69 m/s and 6MWT: 248.1 m) Survival chance fell to 20% for patients walking slower than 0.69 m/s. It is possible to replace TC6M with T4M in patients with different respiratory pathologies, we can predict death for any cause if a subject walked at ≤ speed at 0.69 m/s. T4M is cheap and easy to perform in primary care, serving as a risk assessment to refer to a more complex center.

Profile of deaths from respiratory diseases in the state of Rio Grande do Sul, from 2006 to 2015 / Perfil dos óbitos por doenças respiratórias no interior do Rio Grande do Sul, 2006 a 2015 / Perfil de muertes por enfermedades respiratorias en el interior de Rio Grande do Sul, 2006 a 2015

Background and objectives: Respiratory diseases affect all age groups and pose a high demand on health services. The present study aimed to analyze the profile of patients who have died from respiratory diseases, between 2006 and 2015, from the 9th Health Coordination of Rio Grande do Sul. Methods: This is a cross-sectional and descriptive study using the database of the Informatics Department of the Unified Health System (Datasus) from the Ministry of Health in Brazil. Data collection was carried out in November 2017 and included 10 years up to 2015. The causes of death from respiratory disease were selected according to the International Classification of Diseases 10th revision, Chapter X, vital statistics, mortality from 1996 to 2015. The variables for this research were collected according to chronological distribution, gender, age and period of the year. Results: Out of a total of 1,471 deaths from respiratory diseases, 52% were men, most were older adults (61%) with up to 3 years of education (73.3%), which is possibly associated with low income. The main causes of death were chronic diseases of the lower airways and pneumonia, representing 56% and 29% of deaths, respectively. In addition, 34% of deaths occurred during winter. Conclusion: The main causes of mortality from respiratory diseases from the 9th Health Coordination were chronic diseases of the lower airways and pneumonia, with higher mortality rates in colder months, among older adults and patients with a lower level of education.(AU)

Justificativa e objetivos: As doenças respiratórias atingem todas as faixas etárias e geram grande demanda dos serviços de saúde. O presente estudo objetivou analisar o perfil dos óbitos por doenças respiratórias na 9ª Coordenadoria de Saúde do Rio Grande do Sul, entre 2006 e 2015. Métodos: Trata-se de um estudo transversal e descritivo em que se utilizou o banco de dados do Departamento de Informática do Sistema Único de Saúde (Datasus) do Ministério da Saúde do Brasil. A coleta de dados foi realizada em novembro de 2017, abrangendo os últimos 10 anos. A seleção das causas de óbitos por doenças respiratórias foi selecionada de acordo com o Código Internacional de Doenças 10ª revisão, Capítulo X, estatísticas vitais, mortalidade de 1996 a 2015. As variáveis para esta pesquisa foram coletadas de acordo com a distribuição cronológica, sexo, idade e período do ano do óbito. Resultados: Do total de 1.471 óbitos por doença respiratória, observou-se que 52% acometeram homens, na maioria idosos (61%) e com até 3 anos de estudo (73%), o que pressupõe baixa renda. As principais causas de óbitos foram as doenças crônicas das vias aéreas inferiores e pneumonia, equivalendo a 56% e 29% dos óbitos respectivamente, sendo 34% dos óbitos ocorridos durante o inverno. Conclusão: As principais causas de mortalidade por doenças respiratórias ocorridas na 9ª Coordenadoria de Saúde foram as doenças crônicas das vias aéreas inferiores e pneumonia, com maior ocorrência nos meses mais frios, acometendo mais homens idosos e com menor nível escolar.(AU)

Justificación y objetivos: Las enfermedades respiratorias afectan a todas las edades y generan gran demanda por los servicios de salud. El presente estudio objetiva analizar el perfil de las muertes por enfermedades respiratorias en la 9ª Coordinación de Salud del Rio Grande do Sul, entre 2006 y 2015. Métodos: Se trata de un estudio transversal descriptivo con base en informaciones del Departamento de Informática del Sistema Único de Salud (Datasus) del Ministerio de la Salud (Brasil). La recolección de datos se realizó en noviembre de 2017, abarcando los últimos 10 años. La selección de las causas de muertes por enfermedades respiratorias fue estimada seguido la Clasificación Internacional de Enfermedades 10ª Revisión, Capítulo X, estadísticas vitales, mortalidad de 1996 a 2015. Las variables para esta investigación fueron recolectadas de acuerdo con la distribución cronológica, sexo, edad y período del año del óbito. Resultados: De las 1.471 muertes por enfermedad respiratoria, fue observado que 52% en hombres (767), la mayoría ancianos (61%), hasta 3 años de estudio (73%,) o que presupone bajos ingresos. Las principales causas de muerte fueron las enfermedades crónicas de las vías aéreas inferiores y la neumonía, equivalente al 56% y 29% de los casos, respectivamente, el 34% de las muertes ocurrieron durante el invierno. Conclusiones: Las principales causas de mortalidad por enfermedades respiratorias ocurridas en la 9ª Coordinación de Salud en los 10 años fueron enfermedades crónicas de las vías aéreas inferiores y neumonía, con mayor ocurrencia en los meses más fríos, afectando más hombres ancianos con menor nivel escolar.(AU)

Cenário epidemiológico da Covid-19 no estado do Rio de Janeiro - 20 de fevereiro de 2021 / Epidemiological scenario of Covid-19 in the state of Rio de Janeiro - February 20, 2021

O ano de 2020 apresentou dois momentos críticos com maior intensidade de casos de Covid-19 no estado, havendo maior registro de casos no segundo momento novembro/dezembro) em relação ao primeiro (abril/maio), porém, o mesmo não aconteceu com os casos graves ou internações e com óbitos (letalidade), que tiveram redução nas demais semanas do ano quando comparados ao primeiro pico da curva de 2020. Desde 2020 até o momento, foram notificadas 72.952 internações de síndrome gripal aguda grave (SRAG) por Covid-19, equivalendo a 12,8% dos casos notificados nesse mesmo período; e o total de 32.045 óbitos de Covid-19, correspondendo a letalidade de 5,6%. A mediana semanal do percentual de internações de SRAG por Covid-19 foi de 10,6% e a letalidade de 4,4% no estado.

La mortalidad entre siglos por enfermedades respiratorias en la Ciudad de Buenos Aires: ¿Las muertes por pandemias del siglo XXI las superaron?

Resulta cada vez más evidente que la duración de la vida constituye una problemática tanto de índole individual como colectiva. Los riesgos epidémicos habrían sido controlados a comienzos del siglo XX por las medidas de higiene personal, el aislamiento de los transmisores de las infecciones y, especialmente, el descubrimiento de los antibióticos y el desarrollo de las vacunas. Pero la aparición de brotes epidémicos a fines del siglo XX en algunos países donde esas enfermedades parecían erradicadas, abona las tesis más pesimistas sobre el estado de la salud de la población mundial. En este contexto, las enfermedades respiratorias reaparecen en el siglo XXI y revelan un aumento sustancial de la participación de dichas enfermedades en el total de muertes. El artículo se propone como objetivo principal analizar la evolución de las muertes por enfermedades respiratorias entre siglos en la Ciudad de Buenos Aires, mostrando la modificación de su importancia en el total de muertes y por grupo etario desde fines del siglo XIX. Asimismo, se plantea comparar su volumen con las muertes registradas en el siglo XXI por las pandemias de gripe A (H1N1) y de COVID-19. (AU)

Heterogeneidade nas causas de morte da população idosa da região Nordeste do Brasil / Heterogeneity in the causes of death among older adults in Northeastern Brazil / Heterogeneidad en las causas de muerte de ancianos en el nordeste de Brasil

Este artigo ecológico propõe-se a analisar os diferenciais na escala de prioridades das causas de morte entre a população idosa do Nordeste do Brasil, no período de 2001 a 2015, conforme três grupos etários: 60 a 69 anos (sexagenários), 70 a 79 anos (septuagenários) e 80 anos ou mais (longevos). Foram utilizados os dados do Sistema de Informações sobre Mortalidade (SIM) e as causas de óbito foram analisadas descritivamente pela mortalidade proporcional. Sendo assim, registraram-se 2.461.383 óbitos, sendo a maior parte entre longevos (44,2%), no ambiente hospitalar (55,5%), entre homens (50,8%), de cor parda (49,0%), casados (37,1%) e sem nenhum ano de estudo (34,5%). As doenças cardiovasculares representaram a maior taxa de óbitos com mais de 30% em todos os grupos. Entre os sexagenários e septuagenários, a ordem de prioridades segue com as neoplasias, causas mal definidas, doenças endócrinas, metabólicas e nutricionais e doenças do aparelho respiratório. Já entre os longevos, a escala é seguida pelas causas mal definidas, doenças do aparelho respiratório, neoplasias e doenças endócrinas, metabólicas e nutricionais. Portanto, infere-se que os idosos longevos demandam uma atenção diferenciada dos outros idosos, sobretudo quanto à prevenção e ao tratamento das doenças respiratórias, bem como uma melhor determinação da causa básica nas declarações de óbito.

This ecological study analyzes the differences in the scale of priorities of causes of death among older adults in Northeastern Brazil, from 2001 and 2015, according to three age groups: 60 to 69 years (sexagenarian), 70 to 79 years (septuagenarian), and 80 years or older (old-old). Data were collected from the Brazilian Mortality Information System (SIM) and analyzed descriptively by proportional mortality. A total of 2,461,383 deaths were recorded, most were old-old adults (44.2%), who died in the hospital environment (55.5%), men (50.8%), brown (49.0%), married (37.1%) and illiterate (34.5%). Cardiovascular diseases accounted for the highest rate of death, with more than 30% in all groups. Among the sexagenarian and septuagenarian, the order of priorities follows with neoplasms, ill-defined causes, endocrine, metabolic and nutritional diseases, and respiratory diseases. Among the old-old, the scale is followed by ill-defined causes, respiratory diseases, neoplasms and endocrine, metabolic and nutritional diseases. This suggests that the old-old adults require specific attention from the other older population, especially regarding the prevention and treatment of respiratory diseases, as well as better determination of the underlying cause in death certificates.

Este estudio ecológico se propone analizar los diferenciales en la orden de prioridades de las causas de muerte en la población anciana del Nordeste de Brasil, en el período de 2001 a 2015, según tres grupos de edad: 60 a 69 años (sexagenarios), 70 a 79 años (septuagenarios) y 80 años o más de edad (longevos). A partir de datos del Sistema de Información sobre Mortalidad (SIM), las causas de muerte fueron analizadas descriptivamente por la mortalidad proporcional. Así se registraron 2.461.383 muertes, la mayoría en personas de 80 años o más (44,2%), en ambiente hospitalario (55,5%), entre hombres (50,8%), pardos (49,0%), casados (37,1%) y sin ningún año de estudio (34,5%). Las enfermedades cardiovasculares representan la mayor tasa de muertes, con más de 30% en todos los grupos. Entre los sexagenarios y septuagenarios, el orden de prioridades sigue con las neoplasias, causas mal definidas, enfermedades endocrinas, metabólicas y nutricionales, y enfermedades del aparato respiratorio. Ya en los longevos, la escala es seguida de las causas mal definidas, enfermedades del aparato respiratorio, neoplasias y enfermedades endocrinas, metabólicas y nutricionales. Por tanto, se observa que los ancianos longevos demandan una atención diferenciada que los otros ancianos, especialmente en cuanto a la prevención y tratamiento de las enfermedades respiratorias, así como una mejor determinación de la causa básica en las declaraciones de defunción.

Mortalidad infantil en la Cuenca Matanza Riachuelo. Comparación con la Ciudad de Buenos Aires, la provincia de Buenos Aires y la Argentina (de 2010 a 2017)Infant mortality in the Matanza-Riachuelo / River Basin. Comparison with the Autonomous City of Buenos Aires, the province of Buenos Aires, and Argentina (2010-2017)

Introducción. La tasa de mortalidad infantil (TMI) es un indicador de salud y de condiciones socioeconómicas, ambientales y sanitarias. Basurales a cielo abierto y desechos cloacales e industriales hacen de la Cuenca Matanza Riachuelo (CMR) la más contaminada de Argentina.Objetivo. Analizar la mortalidad infantil (MI) en la CMR en comparación con Argentina, provincia de Buenos Aires (PBA) y Ciudad Autónoma de Buenos Aires (CABA), y la evolución entre los años 2010 y 2017.Población y métodos. Estudio descriptivo a partir de datos del Ministerio de Salud de la Nación.Resultados. En 2017, la TMI en la CMR fue del 9,4 ‰; en Argentina, del 9,3 ‰; en PBA, del 9,4 ‰, y, en CABA, del 6,9 ‰. Entre 2010 y 2017, se observó una disminución de la TMI en la CMR del 20,6 %, similar a PBA y Argentina. En CABA, no hubo descenso.En las 4 jurisdicciones, las afecciones perinatales representaron la primera causa de muerte, seguidas por las malformaciones congénitas y las enfermedades respiratorias. Solo para enfermedad respiratoria, en la CMR, el riesgo fue 4 veces mayor que en CABA (riesgo relativo: 3,9; intervalo de confianza del 95 %: 1,4-10,7).Conclusión. La estructura de causas, la evolución y el riesgo de MI en la CMR, Argentina y PBA fueron similares entre 2010 y 2017. CABA presentó una TMI menor que CMR, pero no mostró descensos. El riesgo de MI en la CMR fue mayor que en CABA a expensas del mayor riesgo por enfermedad respiratori

Introduction. Infant mortality rate (IMR) is an indicator of health and socioeconomic, environmental, and health care conditions. Open dumps and sewage and industrial waste make the Matanza-Riachuelo River Basin the most polluted in Argentina.Objective. To analyze infant mortality (IM) in the Matanza-Riachuelo River Basin compared to Argentina, the province of Buenos Aires (PBA), and the Autonomous City of Buenos Aires (CABA), and its evolution between 2010 and 2017.Population and methods. Descriptive study based on data from Argentina's Ministry of Health.Results. In 2017, the IMR was 9.4 ‰ in the Matanza-Riachuelo River Basin; 9.3 ‰ in Argentina; 9.4 ‰ in PBA; and 6.9 ‰ in CABA. Between 2010 and 2017, the IMR in the Matanza-Riachuelo River Basin decreased by 20.6 %, similar to PBA and Argentina. No reduction was observed in CABA.In the 4 jurisdictions, perinatal conditions were the leading cause of death, followed by congenital malformations and respiratory diseases. For respiratory diseases only, the risk in the Matanza-Riachuelo River Basin was 4 times higher than in CABA (relative risk: 3.9; 95 % confidence interval: 1.4-10.7).Conclusion. The structure of causes, evolution, and risk of IM in the Matanza-Riachuelo River Basin, Argentina, and PBA was similar between 2010 and 2017. IMR was lower in CABA than in the Matanza-Riachuelo River Basin, but no reduction was observed in the former. The risk of IM was higher in the Matanza-Riachuelo River Basin than in CABA, at the expense of the increased risk of respiratory disease

Association between coal and firewood combustion and hospital admissions and mortality in Chile 2015 - An ecological approach.

INTRODUCTION AND OBJECTIVE: Burning coal and firewood generates toxic emissions that are associated with respiratory illness, cardiovascular disease, and even death. The aim of the study is to evaluate the association between county-level prevalence of household coal and firewood use and health outcomes, including total, respiratory, and cardiovascular mortality, as well as total and respiratory hospitalization rates. MATERIAL AND METHODS: The ecological study included data on the use of household coal and firewood in 139 counties obtained from the 2015 Chilean National Socio-economic Characterization Survey. Total, respiratory, and cardiovascular mortality, as well as total and respiratory hospitalization rates, were obtained from the Department of Health Statistics. Poisson models with robust error variance, Pearson linear correlation coefficients, and scatterplots were used to explore associations between household coal and firewood use and morbidity-mortality, stratifying by geographic zone. RESULTS: Total, respiratory, and cardiovascular mortality and total and respiratory hospitalization rates were 5.7 per 1,000, 552 per 100,000, 157 per 100,000, 92.5 per 1000, and 8.8 per 1000 inhabitants, respectively. The median prevalence of coal use for residential cooking, heating, or water heating was 3.64%, while the median prevalence of firewood combustion was 12%. In southern counties, age- and gender-adjusted respiratory mortality increased 2.02 (95% CI: 1.17-3.50), 1.5 (95% CI: 1.11-1.89), and 1.76-fold (95% CI: 1.19-2.60) for each percentage increase in household coal and firewood use for heating, cooking and heating water, respectively. CONCLUSIONS: The prevalence of household coal and firewood used for heating and cooking was positively correlated with respiratory mortality and hospitalization in southern zone counties.

Infant mortality in the Matanza-Riachuelo River Basin. Comparison with the Autonomous City of Buenos Aires, the province of Buenos Aires, and Argentina (2010-2017). / Mortalidad infantil en la Cuenca Matanza Riachuelo. Comparación con la Ciudad de Buenos Aires, la provincia de Buenos Aires y la Argentina (de 2010 a 2017).

Introduction: Infant mortality rate (IMR) is an indicator of health and socioeconomic, environmental, and health care conditions. Open dumps and sewage and industrial waste make the Matanza-Riachuelo River Basin the most polluted in Argentina. Objective: To analyze infant mortality (IM) in the Matanza-Riachuelo River Basin compared to Argentina, the province of Buenos Aires (PBA), and the Autonomous City of Buenos Aires (CABA), and its evolution between 2010 and 2017. Population and methods. Descriptive study based on data from Argentina's Ministry of Health. Results: In 2017, the IMR was 9.4 ‰ in the Matanza-Riachuelo River Basin; 9.3 ‰ in Argentina; 9.4 ‰ in PBA; and 6.9 ‰ in CABA. Between 2010 and 2017, the IMR in the Matanza- Riachuelo River Basin decreased by 20.6 %, similar to PBA and Argentina. No reduction was observed in CABA. In the 4 jurisdictions, perinatal conditions were the leading cause of death, followed by congenital malformations and respiratory diseases. For respiratory diseases only, the risk in the Matanza- Riachuelo River Basin was 4 times higher than in CABA (relative risk: 3.9; 95 % confidence interval: 1.4-10.7). Conclusion: The structure of causes, evolution, and risk of IM in the Matanza-Riachuelo River Basin, Argentina, and PBA was similar between 2010 and 2017. IMR was lower in CABA than in the Matanza-Riachuelo River Basin, but no reduction was observed in the former. The risk of IM was higher in the Matanza-Riachuelo River Basin than in CABA, at the expense of the increased risk of respiratory disease.

Introducción. La tasa de mortalidad infantil (TMI) es un indicador de salud y de condiciones socioeconómicas, ambientales y sanitarias. Basurales a cielo abierto y desechos cloacales e industriales hacen de la Cuenca Matanza Riachuelo (CMR) la más contaminada de Argentina. Objetivo. Analizar la mortalidad infantil (MI) en la CMR en comparación con Argentina, provincia de Buenos Aires (PBA) y Ciudad Autónoma de Buenos Aires (CABA), y la evolución entre los años 2010 y 2017. Población y métodos. Estudio descriptivo a partir de datos del Ministerio de Salud de la Nación. Resultados. En 2017, la TMI en la CMR fue del 9,4 ‰; en Argentina, del 9,3 ‰; en PBA, del 9,4 ‰, y, en CABA, del 6,9 ‰. Entre 2010 y 2017, se observó una disminución de la TMI en la CMR del 20,6 %, similar a PBA y Argentina. En CABA, no hubo descenso. En las 4 jurisdicciones, las afecciones perinatales representaron la primera causa de muerte, seguidas por las malformaciones congénitas y las enfermedades respiratorias. Solo para enfermedad respiratoria, en la CMR, el riesgo fue 4 veces mayor que en CABA (riesgo relativo: 3,9; intervalo de confianza del 95 %: 1,4-10,7). Conclusión. La estructura de causas, la evolución y el riesgo de MI en la CMR, Argentina y PBA fueron similares entre 2010 y 2017. CABA presentó una TMI menor que CMR, pero no mostró descensos. El riesgo de MI en la CMR fue mayor que en CABA a expensas del mayor riesgo por enfermedad respiratoria.

PM2.5 exposure on daily cardio-respiratory mortality in Lima, Peru, from 2010 to 2016.

BACKGROUND: There have been no studies of air pollution and mortality in Lima, Peru. We evaluate whether daily environmental PM2.5 exposure is associated to respiratory and cardiovascular mortality in Lima during 2010 to 2016. METHODS: We analyzed 86,970 deaths from respiratory and cardiovascular diseases in Lima from 2010 to 2016. Estimated daily PM2.5 was assigned based on district of residence. Poisson regression was used to estimate associations between daily district-level PM2.5 exposures and daily counts of deaths. RESULTS: An increase in 10 µg/m3 PM2.5 on the day before was significantly associated with daily cardiorespiratory mortality (RR 1.029; 95% CI: 1.01-1.05) across all ages and in the age group over 65 (RR 1.04; 95% CI: 1.005-1.09) which included 74% of all deaths. We also observed associations with circulatory deaths for all age groups (RR 1.06; 95% CI: 1.01-1.11), and those over 65 (RR 1.06; 95% CI 1.00-1.12). A borderline significant trend was seen (RR 1.05; 95% CI 0.99-1.06; p = 0.10) for respiratory deaths in persons aged over 65. Trends were driven by the highest quintile of exposure. CONCLUSIONS: PM2.5 exposure is associated with daily cardiorespiratory mortality in Lima, especially for older people. Our data suggest that the existing limits on air pollution exposure are too high.

Revisión de la bibliografía. Coronavirus (COVID-19) y Sistema Nervioso Central. Un panorama para analizar en una situación de pandemia. Consideraciones sobre el neurotrofismo del Coronavirus / Literature review. Coronavirus (COVID-19) and Nervous System Central. A panorama to analyze in a pandemic situation. Considerations on coronavirus neurotrophy

En humanos, las infecciones virales del tracto respiratorio son una causa principal de morbilidad y mortalidad en todo el mundo. Varios agentes virales respiratorios reconocidos tienen una capacidad neuroinvasiva, ya que pueden propagarse desde el tracto respiratorio hasta el sistema nervioso central (SNC). Una vez allí, la infección de las células del SNC (neurotropismo) podría conducir a problemas de salud humana, como encefalitis y enfermedades neurológicas a largo plazo. Los coronavirus (HCoV) generalmente infectan el tracto respiratorio superior, donde se asocian principalmente con resfriados comunes. Sin embargo, en las poblaciones más vulnerables, como los recién nacidos, los bebés, los ancianos y las personas inmunocomprometidas, también pueden afectar el tracto respiratorio inferior y provocar neumonía, exacerbaciones del asma, síndrome de dificultad respiratoria o incluso síndrome respiratorio agudo severo (SRAS) . Se ha establecido claramente la afectación respiratoria del VHC desde la década de 1960. Además, durante casi tres décadas, la literatura científica también ha demostrado que los HCoV son neuroinvasivos y neurotrópicos y podrían inducir una activación excesiva del sistema inmune.

In humans, viral infections of the respiratory tract are a leading cause of morbidity and mortality worldwide. Several recognized respiratory viral agents have a neuroinvasive capacity since they can spread from the respiratory tract to the central nervous system (CNS). Once there, infection of CNS cells (neurotropism) could lead to human health problems, such as encephalitis and long-term neurological diseases. Coronaviruses (HCoV) usually infect the upper respiratory tract, where they are mainly associated with common colds. However, in more vulnerable populations, such as newborns, infants, the elderly and immune-compromised individuals, can also affect the lower respiratory tract, leading to pneumonia, exacerbations of asthma, respiratory distress syndrome, or even severe acute respiratory syndrome (SARS). It has been clearly established the respiratory involvement of HCoV since the 1960s. In addition, for almost three decades now, the scientific literature has also demonstrated that HCoV are neuroinvasive and neurotropic and could induce an over activation of the immune system

Deaths Attributable to High Body Mass in Brazil.

Our study estimated the proportion of deaths from major noncommunicable diseases (NCDs) that could be prevented in Brazil by reducing population-wide body mass index (BMI) to different counterfactual (optimally theoretical) scenarios. We calculated population-attributable fractions by using BMI data from a representative national survey and relative risks from a published meta-analysis. Reductions in population-wide BMI could prevent 30,715 to 168,431 deaths from NCDs per year in Brazil. Cardiovascular diseases were the most preventable causes of death (5.8%-31.5% deaths prevented). Policies are needed to reduce population-wide BMI in Brazil.

Boletim Epidemiológico: mortalidade por doenças crônicas não-transmissíveis em Goiás, 2006 a 2016 / Epidemiological Bulletin: Mortality from non-communicable chronic diseases in Goiás, 2006 to 2016

As doenças crônicas não transmissíveis (DCNTs), como as doenças cardiovasculares, doenças respiratórias crônicas (bronquite, asma, DPOC, rinite), hipertensão, câncer e doenças metabólicas (obesidade, diabetes, dislipidemia), podem levar a incapacidades, ocasionando sofrimentos e custos materiais diretos aos pacientes e suas famílias, sem esquecer os custos intangíveis, como os efeitos adversos na qualidade de vida das pessoas afetadas. Produzem custos indiretos significativos para a sociedade e o governo em função da redução da produtividade, perda de dias trabalhados e prejuízos para o setor produtivo

Chronic non-communicable diseases (NCDs), such as cardiovascular diseases, chronic respiratory diseases (bronchitis, asthma, COPD, rhinitis), hypertension, cancer and metabolic diseases (obesity, diabetes, dyslipidemia), can lead to disabilities, causing suffering and costs. direct materials to patients and their families, without forgetting the intangible costs, such as adverse effects on the quality of life of those affected. They produce significant indirect costs for society and the government due to reduced productivity, lost days worked and losses for the productive sector

Mortalidad estandarizada según causas, edad y género en una comuna minera del norte de Chile entre 2006 y 2015 / Standardized mortality according to cauSe of death, age, and gender in a mining community in Northern Chile, 2006-2015

INTRODUCCIÓN: La comuna de Andacollo fue declarada Zona Saturada por material particulado en el año 2009, desconociéndose si dicha contaminación afecta la salud de sus habitantes o aumenta el riesgo de morir de su población. OBJETIVO: Comparar la mortalidad general y por causas cardiovasculares, respiratorias y neoplasias, según edad y género, de la comuna Andacollo con las tasas nacionales, entre 2006 y 2015. MATERIALES Y MÉTODOS: Con registros oficiales de defunciones y población, se calcularon tasas de mortalidad general, por causas específicas y según género. Se estandarizó con ajuste directo por edad las tasas comunales, para compararlas con las del país. RESULTADOS: Las tasas de mortalidad ajustadas de Andacollo tienden a ser, en promedio, 20% superiores a las nacionales, durante toda la década. Esta diferencia está dada principalmente por un mayor riesgo de morir en hombres, que es 35% mayor para neoplasias, 40% más para enfermedades cardiovasculares y 50% mayor para las enfermedades respiratorias. Estas diferencias de riesgo de morir es mucho menor para las mujeres (promedio 9%) y no se observan en la población joven (20-59 años). CONCLUSIONES: Las tasas de mortalidad general y específicas de Andacollo son significativamente superiores a las nacionales, pudiendo descartarse influencia de las condiciones ambientales en el riesgo de morir de su población, dada la heterogencidad presentada en los riesgos de morir por sexo. El exceso de riesgo de fallecer en hombres mayores podría explicarse por exposiciones laborales antiguas.

INTRODUCTION: The Chilean municipality of Andacollo was declared to be a Saturated Zone due to air pollution in 2009. It is unknown if this contamination affects the health of its inha-bitants. OBJECTIVE: To compare the general mortality and specific cardiovascular, respiratory, and neoplastic mortality rates in Andacollo with the national mortality rates between the years 2006 and 2015. MATERIALS AND METHODS: General and specific mortality rates, by gender, were calculated using official death and population registries. The Andacollo mortality rates were directly standardized by age and then compared with the national rates. RESULTS: The adjus-ted mortality rates of Andacollo tend to be, on average, 20% higher than the national ones, throughout the decade. This difference is mainly due to an increased risk of dying among men, which is 35% higher for cancers, 40% higher for cardiovascular diseases, and 50% higher for respiratory diseases. These differences in risk of dying are much lower for women (average 9%) and are not observed in the younger population (20-59 years of age). CONCLUSIONS: An-dacollo's general and specific mortality rates are significantly higher than national ones, and the influence of environmental conditions on the population's risk of dying can be ruled out, given the heterogeneity presented by sex. The excess risk of death among older men could be explained by previous occupational exposures.

Trends and multiple causes of death due to chronic renal failure in a municipality in the Brazilian Amazon. / Tendência e causa múltipla de óbito por insuficiência renal crônica em município da Amazônia brasileira.

This study examined the mortality trend due to chronic renal failure (CRF) and verified the underlying and associated causes for this trend in the capital of the state of Acre in the Brazilian Amazon. This ecological study used data provided by DATASUS related to mortality due to CRF, which occurred between 1986 and 2012 for male and female residents of the city of Rio Branco, Acre, Brazil. The estimated annual percentage chance (EAPC) was calculated by using Poisson log-linear regression and utilizing the Joinpoint program. The results showed that the adjusted mortality rates due to CRF, with correction, ranged from 15.4 per 100,000 inhabitants in 1986 to 4.0 per 100,000 inhabitants in 2012. The EAPC was -3.5% from 1986- 2012. Deaths by CRF presented associated causes such as respiratory diseases, pneumonia and pulmonary edema, septicemias and poorly defined signs and symptoms. When CRF was analyzed as an associated cause of death, the main primary causes of death were hypertensive diseases and diabetes. Thus, there was a decrease in mortality due to CRF as an underlying cause during the period studied; however, preventive and heath care measures should be maintained.

O presente estudo buscou observar a tendência de mortalidade por insuficiência renal crônica (IRC) e verificar as causas básicas e associadas na capital do Acre, Amazônia brasileira. Para tanto, foi realizado um estudo ecológico com dados de óbitos por IRC do DATASUS ocorridos entre 1986 e 2012, em ambos os sexos de residentes em Rio Branco, Acre. Estimou-se a variação anual percentual (Estimated Annual Percentage Chance ­ EAPC) com a técnica de regressão log-linear de Poisson do programa Joinpoint. Os resultados demonstraram que as taxas de mortalidade ajustadas da IRC com correção variaram de 15,4 por 100.000 hab., em 1986, para 4,0 por 100.000 hab., em 2012. A EAPC foi de -3,5%, de 1986 a 2012. Os óbitos pela IRC apresentaram como causas associadas às doenças respiratórias, pneumonia e edema pulmonar, às septicemias e aos sinais e sintomas mal definidos. Quando analisada a IRC como causa associada, as principais causas básicas do óbito foram as doenças hipertensivas e o diabetes. Assim, houve redução da mortalidade por insuficiência renal crônica como causa básica no período observado, contudo medidas de prevenção e assistência em saúde devem ser mantidas.

Age at natural menopause and mortality: A survival analysis of elderly residents of São Paulo, Brazil.

OBJECTIVE: To conduct a survival analysis according to age at natural menopause (NM) in a representative sample of elderly women from the municipality of São Paulo, Brazil. STUDY DESIGN: We analyzed data from the Health, Well-Being and Aging study (SABE), a cohort that started in 2000. Mortality data up to September 2016 were obtained by linkage from the Program for Mortality Information of São Paulo (PRO-AIM). MAIN OUTCOME MEASURES: We used Cox regression to analyze all-cause and cause-specific mortality rates for cardiovascular diseases, respiratory diseases and cancer, according to age at menopause, categorized as <40, 41-44, 45-49, 50-54 (reference) and ≥55. RESULTS: After 16 years of follow-up, there were 444 deaths, of which 199 were from cardiovascular diseases, 73 from respiratory diseases and 65 from cancer. After adjustment for socioeconomic, reproductive and lifestyle factors, having an early menopause (at age 41-44) was associated with an increased risk of all-cause mortality (HR = 1.48, 95% IC: 1.03, 2.14) relative to NM at 50-54 years. Women aged 41-44 and 45-49 at NM had twice the risk of cancer mortality of the reference group. We did not find significant associations between age at NM and cause-specific mortality for respiratory and cardiovascular diseases. CONCLUSIONS: Our findings suggest that early menopause is associated with all-cause mortality in the largest city of Latin America. In addition, earlier age at NM was associated with cancer mortality. These results suggest that age at NM may be a biomarker for mortality, irrespective of country of residence.

Climate change, heat, and mortality in the tropical urban area of San Juan, Puerto Rico.

Extreme heat episodes are becoming more common worldwide, including in tropical areas of Australia, India, and Puerto Rico. Higher frequency, duration, and intensity of extreme heat episodes are triggering public health issues in most mid-latitude and continental cities. With urbanization, land use and land cover have affected local climate directly and indirectly encouraging the Urban Heat Island effect with potential impacts on heat-related morbidity and mortality among urban populations. However, this association is not completely understood in tropical islands such as Puerto Rico. The present study examines the effects of heat in two municipalities (San Juan and Bayamón) within the San Juan metropolitan area on overall and cause-specific mortality among the population between 2009 and 2013. The number of daily deaths attributed to selected causes (cardiovascular disease, hypertension, diabetes, stroke, chronic lower respiratory disease, pneumonia, and kidney disease) coded and classified according to the Tenth Revision of the International Classification of Diseases was analyzed. The relations between elevated air surface temperatures on cause-specific mortality were modeled. Separate Poisson regression models were fitted to explain the total number of deaths as a function of daily maximum and minimum temperatures, while adjusting for seasonal patterns. Results show a significant increase in the effect of high temperatures on mortality, during the summers of 2012 and 2013. Stroke (relative risk = 16.80, 95% CI 6.81-41.4) and cardiovascular diseases (relative risk = 16.63, 95% CI 10.47-26.42) were the primary causes of death most associated with elevated summer temperatures. Better understanding of how these heat events affect the health of the population will provide a useful tool for decision makers to address and mitigate the effects of the increasing temperatures on public health. The enhanced temperature forecast may be a crucial component in decision making during the National Weather Service Heat Watches, Advisories, and Warning process.