Características de la mortalidad por tumores malignos en la provincia de Matanzas. 1990-2019 / Characteristics of mortality due to malignant tumors in the province of Matanzas. 1990-2019

RESUMEN Introducción: la mortalidad por tumores malignos se caracteriza por un incremento sostenido en el tiempo. En casi la totalidad de la provincia de Matanzas se ha observado esta tendencia en los últimos 30 años, con mayor o menor intensidad. Objetivo : describir algunas características de la mortalidad por cáncer en la provincia de Matanzas. Materiales y métodos: estudio observacional descriptivo retrospectivo de la mortalidad por tumores malignos durante 30 años (1990-2019). Se estimaron tasas crudas y ajustadas de mortalidad, globalmente, por períodos y por sexo. Se obtuvieron porcentajes y se determinó la significación estadística mediante el estadígrafo X2 y el valor de p < 0,05. Resultados: se detectaron diferencias estadísticas significativas entre sexos en cada uno de los períodos. Las tasas crudas y específicas de mortalidad experimentaron una tendencia sostenida al incremento. Cada 0,3 días (aproximadamente cada 8 horas) ocurrió una defunción por cáncer, con diferencias entre las localizaciones. Conclusiones: la tendencia al incremento sostenido de las tasas de mortalidad cruda y ajustada por edad se debe al aumento de las defunciones, pudiendo ser consecuencia, en parte, del envejecimiento poblacional y de un posible incremento de la morbilidad. El sexo masculino apareció como el más expuesto. La frecuencia de la mortalidad por cáncer fue diferente según localizaciones (AU).

ABSCRACT Introduction: Steady increase in time characterized the mortality by malignant tumors in the world as in Cuba. It was observed similar trend in the province of Matanzas in the last 30 years, almost in all body sites, showing higher or less intensity. Objective: To describe some characteristics of mortality by malignant tumors in the province of Matanzas Materials and methods: It is a descriptive observational and retrospective study of the mortality by malignant tumors for 30 years: 1990-2019. Crude and adjusted mortality rates were estimated, globally, by periods and sex. Percentages were estimated and statistical significance was determined through X2 test and p value < 0,05. Results: Statistical significant differences were detected among sexes in all periods. Crude and specific mortality rates showed an increasing steady trend. Every 0.3 days (around 8 hours) one decease took place due to malignant tumors, with differences among sites of the disease. Conclusions: The increasing steady trend of the crude & adjusted mortality rates by age could be, partly, results of the population ageing. Male sex appeared to be the most exposed. Mortality frequency by malignant tumors was different according to sites of the tumor (AU).

Hospitalization and mortality in Mexico due to breast cancer since its inclusion in the catastrophic expenditures scheme.

OBJECTIVE: To compare trends in hospital discharges and mortality due to breast cancer (BC) in Mexico from 2004 to 2012 by insurance condition before and after incorporating BC comprehensive treatment into the System of Social Protection in Health (Sistema de Protrección Social en Salud, SPSS) in 2007. MATERIALS AND METHODS: Data on BC hospital discharges and mortality reported in women aged 25 years and over were obtained from the National Health Information System. Mortality rates were adjusted by age and state. RESULTS: At the national level, a growing tendency in hospital discharges was observed, mainly for women without social security, while mortality rate remained constant. Mortality rates by state show that lower marginalization index corresponded to higher mortality. CONCLUSIONS: A differential behavior was observed among women according to insurance condition, partly due to the inclusion of BC treatment in the SPSS.

How to avoid catastrophic events on the ward.

The number and disease severity of hospitalized patients have risen steadily. At the same time, the length of stay in the hospital has decreased and there is an increasing shortage of nursing staff and physicians. In order to enable a timely treatment of serious in-house emergencies (i.e., cardiac arrest and cardiopulmonary resuscitation) and to decrease the risk of unexpected deaths, early detection and treatment of critically ill patients are of paramount importance. Therefore, patients should be monitored according to their disease severity in order to detect a critical change in vital signs. Early critical incident warning systems may play a role in this context. Currently, different rapid warning systems have been established, but data that allow a choice for a certain system are still lacking. Alarm criteria based on a single variable (single-parameter system) are a simple, but less sensitive alternative to indicate a serious adverse event. Scoring systems enable early detection of critically ill patients and may trigger early treatment by staff specially trained to handle emergency situations.

Hospitalization and mortality in Mexico due to breast cancer since its inclusion in the catastrophic expenditures scheme / Hospitalización y mortalidad en México por cáncer de mama a partir de su inclusión en el esquema de gastos catastróficos

Abstract Objective: To compare trends in hospital discharges and mortality due to breast cancer (BC) in Mexico from 2004 to 2012 by insurance condition before and after incorporating BC comprehensive treatment into the System of Social Protection in Health (Sistema de Protrección Social en Salud, SPSS) in 2007. Materials and methods: Data on BC hospital discharges and mortality reported in women aged 25 years and over were obtained from the National Health Information System. Mortality rates were adjusted by age and state. Results: At the national level, a growing tendency in hospital discharges was observed, mainly for women without social security, while mortality rate remained constant. Mortality rates by state show that lower marginalization index corresponded to higher mortality. Conclusions: A differential behavior was observed among women according to insurance condition, partly due to the inclusion of BC treatment in the SPSS.

Resumen Objetivo: Comparar las tendencias de egresos hospitalarios y mortalidad por cáncer de mama (CaMa) en México de 2004 a 2012, según esquema de aseguramiento, antes y después de la incorporación del tratamiento integral del CaMa al Sistema de Protección Social en Salud (SPSS) en 2007. Material y métodos: Los egresos hospitalarios y de mortalidad por CaMa en mujeres de 25 años o más se obtuvieron del Sistema Nacional de Información en Salud. Las tasas de mortalidad se ajustaron por edad y entidad federativa. Resultados: A nivel nacional, hubo una tendencia creciente de los egresos hospitalarios, principalmente para mujeres sin seguridad social, mientras que la tasa de mortalidad se mantuvo constante. Las tasas de mortalidad fueron mayores en estados con menor índice de marginación. Conclusiones: Se observó un comportamiento diferencial entre las mujeres según esquema de aseguramiento en salud debido, en parte, a la inclusión del tratamiento de CaMa al SPSS.

Predictors of Catastrophic Adverse Outcomes in Children With Pulmonary Hypertension Undergoing Cardiac Catheterization: A Multi-Institutional Analysis From the Pediatric Health Information Systems Database.

BACKGROUND: Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and longitudinal follow-up of children and adults with pulmonary hypertension (PH). However, the procedure is invasive and has risks associated with both the procedure and recovery period. OBJECTIVES: The purpose of this study was to identify risk factors for catastrophic adverse outcomes in children with PH undergoing cardiac catheterization. METHODS: We studied children and young adults up to 21 years of age with PH undergoing 1 or more cardiac catheterization at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between pre-specified subject- and procedure-level covariates and the risk of the composite outcome of death or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors. RESULTS: A total of 6,339 procedures performed on 4,401 patients with a diagnosis of PH from 38 of 43 centers contributing data to the Pediatric Health Information Systems database were included. The observed risk of composite outcome was 3.5%. In multivariate modeling, the adjusted risk of the composite outcome was 3.3%. Younger age at catheterization, cardiac operation in the same admission as the catheterization, pre-procedural systemic vasodilator infusion, and hemodialysis were independently associated with an increased risk of adverse outcomes. Pre-procedural use of pulmonary vasodilators was associated with reduced risk of composite outcome. CONCLUSIONS: The risk of cardiac catheterization in children and young adults with PH is high relative to previously reported risk in other pediatric populations. The risk is influenced by patient-level factors. Further research is necessary to determine whether knowledge of these factors can be translated into practices that improve outcomes for children with PH.

Predictive monitoring for early detection of subacute potentially catastrophic illnesses in critical care.

We wish to save lives of patients admitted to ICUs. Their mortality is high enough based simply on the severity of the original injury or illness, but is further raised by events during their stay. We target those events that are subacute but potentially catastrophic, such as infection. Sepsis, for example, is a bacterial infection of the bloodstream, that is common in ICU patients and has a >25% risk of death. Logically, early detection and treatment with antibiotics should improve outcomes. Our fundamental precepts are (1) some potentially catastrophic medical and surgical illnesses have subclinical phases during which early diagnosis and treatment might have life-saving effects, (2) these phases are characterized by changes in the normal highly complex but highly adaptive regulation and interaction of the nervous system and other organs such as the heart and lungs, (3) teams of clinicians and quantitative scientists can work together to identify clinically important abnormalities of monitoring data, to develop algorithms that match the clinicians' eye in detecting abnormalities, and to undertake the clinical trials to test their impact on outcomes.

Surgical peritonitis in patients on peritoneal dialysis.

In this short review we highlight the diagnostic challenge presented by surgical peritonitis in peritoneal dialysis patients, giving attention to etiology, clinical presentation, diagnosis, and management. Despite improvements in medical imaging and a reduction in overall rates of peritonitis in peritoneal dialysis, the mortality of surgical peritonitis has not changed in recent years and remains a challenge for the clinical team.

Household burden of malaria in South Africa and Mozambique: is there a catastrophic impact?

OBJECTIVES: To evaluate treatment-seeking behaviour, financial impact and time lost due to malaria events, in southern Mozambique and eastern South Africa. METHODS: In-depth household surveys (828 in Mozambique and 827 in South Africa) were analysed. An asset index was calculated using principal component analysis to allow comparison across socio-economic groups. Direct costs of seeking care and the time lost due to malaria were determined. The extent of catastrophic payments was assessed using as thresholds the traditional 10% of household income and 40% of non-food income, as recently recommended by WHO. RESULTS: Poverty was highly prevalent: 70% of the South African and 95% of Mozambican households studied lived on less than $1 per capita per day. Around 97% of those with recent malaria sought healthcare, mainly in public facilities. Out-of-pocket household expenditure per malaria episode averaged $2.30 in South Africa and $6.50 in Mozambique. Analysis at the individual household level found that 32-34% of households in Mozambique, compared with 9-13% of households in South Africa, incurred catastrophic payments for malaria episodes. Results based on mean values underestimated the prevalence of catastrophic payments. Days off work/school were higher in Mozambique. CONCLUSIONS: The high rate of health seeking in public health facilities seems unusual in the African context, which bodes well for high coverage with artemisinin-based combinations, even if only deployed within the public sector. However, despite no or modest charges for public sector primary healthcare, households frequently incur catastrophic expenditure on a single malaria episode.

The clinical spectrum of catastrophic antiphospholipid syndrome in the absence and presence of lupus.

OBJECTIVE: To compare the clinical spectrum of patients with primary catastrophic antiphospholipid syndrome (P-CAPS) to those with systemic lupus erythematosus-associated CAPS (SLE-CAPS). METHODS: We used the Internet-based CAPS Registry to compare the demographic, clinical, and laboratory characteristics of 127 P-CAPS patients to 103 SLE-CAPS patients. In a logistic regression analysis, we also determined the poor prognostic factors for mortality. RESULTS: At the time of CAPS diagnosis, compared to patients with P-CAPS, those with SLE-CAPS were more likely to be female and younger; have cerebral and pancreatic involvement; receive corticosteroids and cyclophosphamide; demonstrate a lower prevalence of high titer (> or = 80 U) IgG anticardiolipin antibody; and have a higher risk for mortality after adjusting for age, sex, organ involvement, and treatment. Based on a logistic regression analysis, cyclophosphamide use was associated with increased mortality in P-CAPS but improved survival in SLE-CAPS patients. CONCLUSION: SLE is a poor prognostic factor in patients with CAPS and cyclophosphamide may be beneficial in those with SLE-CAPS.

Papel de la Atención Primaria en la asistencia pediátrica hospitalaria urgente: estudio de los pacientes derivados a un hospital de tercer nivel / No disponible

Objetivos: analizar las características de los pacientes que acuden a un servicio de urgencias hospitalario derivados desde servicios de Atención Primaria. Material y métodos: estudio analítico transversal realizado en el servicio de urgencias pediátricas del Hospital Clínico de Santiago entre noviembre de 2004 y marzo de 2005. Se seleccionó una muestra de 648 pacientes. Las variables recogidas fueron: edad, sexo, localidad, motivo de consulta, diagnóstico, tiempo de evolución del cuadro, número de consultas previas y pruebas complementarias. Resultados: el 54% de los pacientes eran varones; la edad mediana era de 3,7 (desviación cuartil de 3,6). Un 11,7% fue derivado desde la Atención Primaria. La fiebre fue el principal motivo de consulta (32,2%) y la infección respiratoria aguda de vías altas el diagnóstico más frecuente (21,5%). En la mayoría de los pacientes, los síntomas se iniciaron dentro de las primeras 24 horas (61,4%) y no hicieron consultas previas (82,3%). Mediante el análisis bivariante se comprobó que el grupo de edad más derivado es el de escolares (p = 0,006) y que el número de pruebas complementarias y el número de ingresos fueron mayores en el grupo de pacientes derivados (ambas con p < 0,001). Mediante el análisis multivariante se comprobó que las únicas variables antecedentes relacionadas con la derivación son la distancia al hospital (1,4 veces más por cada 10 kilómetros) y la presencia de antecedentes personales. Conclusiones: los diagnósticos realizados en pacientes que acuden por iniciativa propia y los que acuden a Atención Primaria son similares. Los pacientes derivados son sometidos a un mayor número de pruebas complementarias y se ingresaban con mayor frecuencia. La Atención Primaria se presenta como un filtro eficaz de las urgencias pediátricas (AU)

Objectives: To analyze the characteristics of the patients attended in a hospital emergency department referred from Primary Care. Patients and methods: Cross-sectional analytical study made in the Paediatrics Emergency Department of The Clinic Hospital of Santiago de Compostela between November 2004 and March 2005. We analyzed 648 episodes. The variables recorded were: age, sex, locality, reasons of consultation, diagnosis, time of evolution, number of consultations and further tests. Results: 54% of the patients were males, and the median age was 3,7 years (deviation quartile 3,6). 11,7% were referred from Primary Care. Fever was the main reason of consultation (32,2%) and upper respiratory tract infection the most common diagnosis. In most cases the symptoms had appeared in the last 24 hours (61,4%) and they hadn’t go previously to Primary Care (82,3%). In the bivariate analysis we proved that the school age children were the most frequently referred (p = 0,006), moreover the number of further tests and the number of admissions were bigger in the referred patients (both, p < 0,001). In the multivariate analysis we proved that only variables influencing the referrals were the distance to hospital and the personal history of the patient. Conclusions: The diagnosis in patients who seek medial care at a hospital are the same that the diagnosis in patients who go to Primary Care. The referred patients were submitted more frequently to further tests and they were frequently admitted into hospital. Primary care is an effective filter of hospital emergencies (AU)

Mortality in the catastrophic antiphospholipid syndrome: causes of death and prognostic factors in a series of 250 patients.

OBJECTIVE: To assess the main causes of death and the prognostic factors that influence mortality in patients with the catastrophic antiphospholipid syndrome (CAPS). METHODS: We analyzed the case reports of 250 patients included in the CAPS Registry up to February 2005. To identify prognostic factors for CAPS, we compared the main clinical and immunologic features and the types of treatment in the patients who died with those features in the patients who survived. RESULTS: Recovery occurred in 56% of the episodes of CAPS and death occurred in 44%. Cerebral involvement, consisting mainly of stroke, cerebral hemorrhage, and encephalopathy, was considered the main cause of death, being present in 27.2% of patients, followed by cardiac involvement (19.8%) and infection (19.8%). The only factor we identified that was prognostic of a higher mortality rate was the presence of systemic lupus erythematosus (SLE). A higher recovery rate was associated with combined treatment with anticoagulants (ACs) plus corticosteroids (CS) plus plasma exchange (PE) (77.8%), followed by ACs plus CS plus PE and/or intravenous immunoglobulins (69%). In contrast, concomitant treatment with cyclophosphamide did not demonstrate additional benefit. CONCLUSION: Cerebral involvement (mainly consisting of stroke), cardiac involvement, and infections were considered the main causes of death in patients with CAPS. The presence of SLE was related to a higher mortality rate. According to the results of the present study, ACs plus CS plus PE should be the first line of therapy in patients with CAPS.

The role of therapeutic plasma exchange in the catastrophic antiphospholipid syndrome.

The catastrophic antiphospholipid syndrome (CAPS) is a life-threatening sub-entity of the antiphospholipid syndrome (APS) resulting in multiorgan failure and a mortality rate that may reach 50%. The optimal treatment regimen for CAPS is unknown. To evaluate the benefit of therapeutic plasma exchange (TPE) therapy in CAPS, we undertook a computer-assisted (MEDLINE, National Library of Medicine, Bethesda, MD) search of the literature to locate all cases of CAPS (case reports and reviews) treated with TPE. In view of the published literature so far, TPE has shown reasonable therapeutic benefits and improved survival for patients with CAPS. The use of this technique, along with anticoagulation and if needed pharmacological immunosuppression, should be considered for the acute management of patients who present with this life-threatening condition.

Abdominal catastrophe revisited: the risk and outcome of enteric peritoneal contamination.

OBJECTIVE: Peritonitis from a visceral source is associated with striking morbidity and mortality in patients treated with peritoneal dialysis (PD). Surgical intervention for both diagnosis and repair is definitive. However, because the antecedents of enteric injury leading to peritonitis are unpredictable, no preventive strategy has been proposed or adopted. The goal of this study was to examine risk factors influencing the occurrence and outcome of anatomically documented peritonitis of enteric origin. DESIGN: Retrospective chart and database review. SETTING: Peritoneal dialysis unit in tertiary-care referral hospital. PATIENTS: 330 patients treated with PD for end-stage renal disease between 1988 and 2000. MAIN OUTCOME MEASURES: Prevalence of peritonitis of anatomically documented enteric origin over two consecutive time periods within the study interval: period 1, from 1 January 1988 through 30 June 1996; period 2, from 1 July 1996 through 30 June 2000. RESULTS: At least 1 episode of peritonitis occurred in 202 of 330 patients during the entire study period of 12.5 years (600.74 patient-years of care). There were 543 episodes of peritonitis. Anatomically documented visceral Injury caused bacterial peritonitis in 41 patients with a total of 63 discrete episodes, an incidence rate of 0.1048 per patient-year. Peritonitis-free survival was compared between the two periods using Kaplan-Meier analysis. The curve representing risk distribution for anatomically documented visceral peritonitis remained constant over the two periods, in contrast to improvements found in all other types of peritonitis, taken as a group (p= 0.044). Logistic regression modeling showed that the only risk factor associated with development of anatomically documented visceral peritonitis was older age. There was no influence of race, sex, time on PD, and underlying disease etiology. 31 deaths were attributed to peritonitis during the study period. The mortality rate from enteric peritonitis due to visceral injury was 46.3% (19/41 cases), compared to 7.5% for all other peritonitis taken as a group (12/161 cases, p < 0.0001). CONCLUSIONS: The experience at University Hospitals of Cleveland suggests that abdominal catastrophe occurs in approximately 10% of all patients treated with PD, and is associated with high mortality, which has not changed over time. Therefore, peritonitis due to spontaneous visceral injury presents a great diagnostic and therapeutic challenge. It is important to develop a research strategy to understand this devastating complication.

Progressive versus catastrophic loss of the ability to walk: implications for the prevention of mobility loss.

OBJECTIVES: Loss of mobility is an important functional outcome that can have devastating effects on quality of life and the ability of older persons to remain independent in the community. Although a large amount of research has been done on risk factors for disability onset, little work has focused on the pace of disability progression. This study characterizes the development of severe walking disability over time and evaluates risk factors and subsequent mortality as they relate to mobility disability with progressive or catastrophic onset. DESIGN: Population-based prospective cohort study with annual follow-up assessments for up to 7 years SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: There were 5,355 persons not disabled at baseline and the first follow-up who had adequate data available to classify mobility disability during subsequent follow-ups. MEASUREMENTS: Severe mobility disability was defined as the need for help from a person to walk across a room or inability to walk across a room. Those developing severe mobility disability were classified as having progressive mobility disability if they had been unable to walk half a mile in either of the prior 2 years. They were classified as having catastrophic mobility disability if they reported having been able to walk half a mile in two previous annual interviews. RESULTS: The overall incidence of severe mobility disability was 11.6 cases/1,000 person years. Those age 85 and older or having three or more chronic conditions at baseline were significantly more likely to develop progressive disability than catastrophic disability. Stroke, hip fracture, and cancer occurring during follow-up were associated with very high risk of severe mobility disability. For stroke and hip fracture, the risk was twice as high for catastrophic disability as for progressive disability, but this difference did not reach statistical significance. Risk for catastrophic disability from cancer was significantly greater than for progressive disability. Half of catastrophic disability subjects had stroke, hip fracture, or cancer in the year immediately preceding this disability. Incident heart attack did not predict severe mobility disability. Among those who developed severe mobility disability, type of disability did not influence subsequent survival for the first 3 years, but beyond 3 years those with catastrophic disability had a relative risk of death of 0.4 (95% confidence interval 0.2-0.9) compared with those with progressive disability. CONCLUSION: The observation that risk factors and mortality outcomes were both different for progressive and catastrophic mobility disability supports the value of ascertaining the pace of disability development as a useful characterization of disability. Further progress in developing prevention and treatment strategies may be made by taking the pace of disability development into account.

Resource allocation, equity and public risk: dying one at a time vs dying all together.

This paper focuses on the evaluation, from an individual and societal perspective, of risk in terms of possible loss of life due to an exposure to two different types of events over a period of time. The two types are: risk of death from a catastrophic event (a sudden death of many people in a disaster at a yet unknown point in time) expected to occur during a planning period, or risk of death from another event (e.g. disease, road accident, etc) which claims fewer lives each year, but for which the expected total number of deaths over the planning period is equal to the expected number of deaths from the catastrophic event. Our analysis considers the extreme case in which these two types of events have the same probabilities of death every year and the same expected number of fatalities over the planning period. The individual's decision problem is described using a von-Neumann Morgenstern (vNM) utility function. The model suggests that the choice between these types of events depends on the value of the following variables: the probability of death over the planning period, the length of the planning period, the individual's time preference pattern, and the utility of being in different anxiety states. Stochastic extensions that may direct the public decision making process (involving aggregated preferences) are discussed. We also discuss issues of implementation.