Evaluation of statistical process control charts for infant mortality monitoring in Brazilian cities with different population sizes.

OBJECTIVES: The control chart is a classic statistical technique in epidemiology for identifying trends, patterns, or alerts. One meaningful use is monitoring and tracking Infant Mortality Rates, which is a priority both domestically and for the World Health Organization, as it reflects the effectiveness of public policies and the progress of nations. This study aims to evaluate the applicability and performance of this technique in Brazilian cities with different population sizes using infant mortality data. RESULTS: In this article, we evaluate the effectiveness of the statistical process control chart in the context of Brazilian cities. We present three categories of city groups, divided based on population size and classified according to the quality of the analyses when subjected to the control method: consistent, interpretable, and inconsistent. In cities with a large population, the data in these contexts show a lower noise level and reliable results. However, in intermediate and small-sized cities, the technique becomes limited in detecting deviations from expected behaviors, resulting in reduced reliability of the generated patterns and alerts.

Revealing the burden of chronic kidney disease in Mexican women, 1990-2021.

BACKGROUND: Chronic kidney disease (CKD) has become a concerning public health issue, affecting people regardless of their sex, age, or socioeconomic status. We aimed to analyze the burden of female CKD in Mexico between 1990 and 2021, expressed in terms of years lived with disability (YLDs), mortality, years of life lost (YLLs), and disability-adjusted life-years (DALYs). Additionally, we evaluated the relationship between DALYs and the Socio-Demographic Index (SDI) and the Healthcare Access and Quality Index (HAQI). METHODS: Secondary data analysis from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. We used mortality, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs to analyze CKD in women between 1990 and 2021. We used a log-linear segmented regression model to analyze trends in female CKD DALY rates over time. The information was disaggregated by age groups and sub-causes nationally and across the 32 states. Age-standardized rates (ASR) were used. RESULTS: Between 1990 and 2021, the ASR mortality and ASR-DALYs due to CKD increased significantly at the national level. The DALYs are almost entirely explained by YLLs, indicating that a large proportion of women with CKD in Mexico die prematurely. Disparities in the burden of this disease were observed across different states and age groups within the country. In 2021, the highest ASR-DALY rate was recorded in Tabasco (1,972.0), while the lowest was in Sinaloa (865.1). The SDI and HAQI were associated with the CKD DALYs in most states. CONCLUSIONS: Mexican women experience a significant burden due to CKD, reflected in premature deaths and years lived with disability, while disparities between states need to be addressed to reduce inequities. Over the past 32 years, improvements in socioeconomic indicators and the quality and access to healthcare have not contributed to reducing the DALYs rate due to CKD, indicating a need to redirect policies to impact women's well-being and health positively.

Development and validation of a mobile application prototype for postoperative cardiac surgery.

OBJECTIVES: to develop and validate the content, appearance, and semantics of a prototype application for monitoring patients in the postoperative period of cardiac surgery. METHODS: this is a technological development study based on Contextualized Instructional Design. The content and appearance evaluation was conducted by a committee of specialists, and semantic validation was carried out by patients from a cardiac surgery outpatient clinic. RESULTS: the application prototype consisted of 43 screens, validated by 17 health specialists, with content validity ratio and appearance validity index results of 0.86 and 0.99, respectively. For semantic validation, 10 patients participated in data collection, with a total content validity index of 0.978. CONCLUSIONS: the prototype of the "VivaCor PósOp" application demonstrated evidence of content, appearance, and semantic validity, with the potential to stimulate self-care in patients in the postoperative period of cardiac surgery.

Polypharmacy and Therapeutic Inertia in Extreme Longevity: A Potential Clinical Ageism Scenario Secondary to Important Gaps in Clinical Evidence.

Population aging is a global health priority due to the dramatic increase in the proportion of older persons worldwide. It is also expected that both global life expectancy and disability-free life expectancy will increase, leading to a significant rise in the proportion of individuals with extreme longevity, such as non-agenarians and centenarians. The inaccuracy of clinical evidence on therapeutic interventions for this demographic could lead to biased decision-making, influenced by age-related beliefs or misperceptions about their therapeutic needs. This represents a potential clinical ageism scenario stemming from gaps in clinical evidence. Such biases can result in 2 significant issues that adversely affect the health status and prognosis of older persons: polypharmacy and therapeutic inertia. To date, documents on polypharmacy in non-agenarians and centenarians account for less than 0.35% of the overall available evidence on polypharmacy. Furthermore, evidence regarding therapeutic inertia is non-existent. The purpose of this letter is to discuss polypharmacy and therapeutic inertia as potential clinical ageism scenarios resulting from the clinical evidence gaps in extreme longevity.

[Orphanhood due to COVID-19 in Argentina during 2020-2021]. / Orfandad por COVID-19 en la República Argentina durante 2020 y 2021.

INTRODUCTION: The COVID-19 pandemic has had significant impacts on society, particularly on children and adolescents, who have faced serious social, educational, and health consequences due to the loss of their primary caregivers. MATERIALS AND METHODS: Female fertility rates were analyzed, and estimates of male fertility were made to calculate the number of children under 18 years old by age group. Demographic and mortality information from COVID-19 infection was used to calculate the resulting orphanhood in Argentina during the period 2020-2021, considering the loss of one or both parents or the main caregiver grandparent. RESULTS: A total of 25161 Argentine children and adolescents lost one of their primary caregivers due to COVID-19 during the pandemic. Of these, 22729 were orphaned by mother or father during the analyzed period. The majority of cases (79.5%) were related to the father's death. Specific age groups with higher incidence of orphanhood were identified. The loss of caregiver grandparents was also significant, affecting 2432 children and adolescents. DISCUSSION: The findings underscore the need for specific policies and programs to address the comprehensive needs of children and adolescents affected by orphanhood during the pandemic. Potential long-term impacts on the physical, mental, educational, and socioeconomic health of these children and adolescents are highlighted.

Introducción: La pandemia de COVID-19 ha ejercido impactos significativos en la sociedad, particularmente en niños, niñas y adolescentes (NNA), quienes han enfrentado consecuencias sociales, educativas y de salud graves debido a la pérdida de sus cuidadores principales. Materiales y métodos: Se analizaron las tasas de fertilidad femenina y se realizaron estimaciones sobre la fertilidad masculina a fin de calcular los hijos menores de 18 años por grupo de edad. Se utilizó información demográfica y de mortalidad por infección por COVID-19 para calcular la orfandad resultante en Argentina durante el período 2020-2021, considerando la pérdida de uno o ambos progenitores o del cuidador principal abuelo/a. Resultados: Un total de 25161 NNA argentinos perdieron a uno de sus cuidadores principales por el COVID-19 durante la pandemia. De ellos, 22729 NNA quedaron huérfanos de madre o padre durante el periodo analizado. La mayoría de los casos (79.5%) estuvo relacionada con la muerte del padre. Se identificaron grupos de edad específicos con mayor incidencia de orfandad. La pérdida de abuelos cuidadores también fue significativa, afectando a 2432 NNA. Discusión: Los hallazgos subrayan la necesidad de políticas y programas específicos para abordar las necesidades integrales de los NNA afectados por la orfandad durante la pandemia. Se destacan los posibles impactos a largo plazo en la salud física, mental, educativa y socioeconómica de estos niños y adolescentes.

Health promotion of long-haul truck drivers and their families.

OBJECTIVES: to describe the development of a Health Information and Communication Technology for the health care of long-haul truck drivers and their families. METHODS: this is a description of the development of an Information and Communication Technology, developed from March to September 2023, following the systematization of the experience in five steps: 1) starting point, 2) initial questions, 3) recovery of the lived process, 4) background reflection, and 5) arrival points. RESULTS: the technology called "Work-Family Balance," electronically available, presents resources for the health care of long-haul truck drivers. It is anchored in studies on the health of long-haul truck drivers, notes from the International Labor Organization, the Strategic Action Plan for Confronting Chronic Diseases and Non-Communicable Diseases in Brazil, 2021-2030, and the Declaration by the International Association of Family Nursing. FINAL CONSIDERATIONS: the theoretical improvement of nursing can potentially improve the health care of long-haul truck drivers, prevent Chronic Non-Communicable Diseases, and promote work-life balance to achieve the goals of Agenda 2030.

Time series analysis of comprehensive maternal deaths in Brazil during the COVID-19 pandemic.

The effects of the COVID-19 pandemic on comprehensive maternal deaths in Brazil have not been fully explored. Using publicly available data from the Brazilian Mortality Information (SIM) and Information System on Live Births (SINASC) databases, we used two complementary forecasting models to predict estimates of maternal mortality ratios using maternal deaths (MMR) and comprehensive maternal deaths (MMRc) in the years 2020 and 2021 based on data from 2008 to 2019. We calculated national and regional standardized mortality ratio estimates for maternal deaths (SMR) and comprehensive maternal deaths (SMRc) for 2020 and 2021. The observed MMRc in 2021 was more than double the predicted MMRc based on the Holt-Winters and autoregressive integrated moving average models (127.12 versus 60.89 and 59.12 per 100,000 live births, respectively). We found persisting sub-national variation in comprehensive maternal mortality: SMRc ranged from 1.74 (95% confidence interval [CI] 1.64, 1.86) in the Northeast to 2.70 (95% CI 2.45, 2.96) in the South in 2021. The observed national estimates for comprehensive maternal deaths in 2021 were the highest in Brazil in the past three decades. Increased resources for prenatal care, maternal health, and postpartum care may be needed to reverse the national trend in comprehensive maternal deaths.

The challenges, opportunities and future of comparative physiology in the Global South: perspectives of early-career researchers.

Researchers in the Global South (GS, developing countries) make valuable contributions to the field of comparative physiology, but face economic and scientific disparities and several unique challenges compared with colleagues in the Global North (developed countries). This Perspective highlights some of the challenges, knowledge gaps and disparities in opportunity faced by GS researchers, especially those at early-career stages. We propose collaborative solutions to help address these issues, and advocate for promoting investment and cultural and societal change for a more inclusive research community. Additionally, we highlight the role of GS researchers in contributing expert knowledge on local biodiversity and the environment; this knowledge can help to shape the future of comparative physiology, allowing us to achieve a better understanding of the evolution of physiological mechanisms and to develop innovative solutions to environmental and biomedical challenges. With this Perspective, we hope to highlight the need to foster a more diverse, equitable and inclusive research landscape in comparative physiology; one that empowers GS scientists to address the global challenges associated with biodiversity loss, climate change and environmental pollution.

Long-Term Exposure to Particulate Matter and Mortality: An Update of the WHO Global Air Quality Guidelines Systematic Review and Meta-Analysis.

Objectives: For the development of the 2021 global air quality guidelines, the World Health Organization (WHO) commissioned a series of systematic reviews and meta-analyses to assess the association between exposure to air pollution and all-cause and cause-specific mortality. One of these reviews, which we aim to update, focused on the effects of long-term exposure to PM2.5 and PM10 on all-cause and cause-specific mortality. Methods: The protocol for this study was registered in PROSPERO (CRD42023425327). We searched the PubMed and Embase databases for studies published between September 2018 and May 2023. Study-specific effects were pooled using random-effects models. Results: We included 106 studies in the meta-analysis, 46 studies from the previous review and 60 from this update. All exposure-outcome pairs analysed showed positive and significant associations, except for PM10 and cerebrovascular mortality. The certainty of the evidence was rated as high for the majority of exposure-outcome pairs. Conclusion: We included a large number of new cohorts, and provided new concentration-response functions that will inform WHO advice on the use of this information for air pollution health risk assessments.

Maternal mortality in Brazil: an analysis of temporal trends and spatial clustering. / Mortalidade materna no Brasil: análise de tendências temporais e agrupamentos espaciais.

This article aims to analyze spatial and temporal patterns of maternal mortality in Brazil during the period 2010-2020 and identify related socioeconomic indicators. We conducted an ecological study of the maternal mortality ratio (MMR) in Brazil's municipalities using secondary data. Temporal analysis was performed using the joinpoint method. Bayesian statistics, spatial autocorrelation, the Getis Ord Gi* technique and the scan statistic were used to identify spatial clusters, and multiple non-spatial and spatial regression models were used to assess the association between factors and the MMR. There was an increase in the MMR in 2020 and an increase in deaths in the North and Southeast. Clusters were found in Amazonas, Tocantins, Piauí, Maranhão, Bahia and Mato Grosso do Sul. The following indicators were negatively associated with the MMR: cesarean section rate, Municipal Human Development Index, and per capita household income of people who are vulnerable to poverty. The MMR was stable up to 2019, followed by a sharp rise in 2020 coinciding with the onset of the Covid-19 pandemic in the country. It is essential that efforts to reduce maternal mortality in Brazil extend beyond the promotion of improvements in antenatal, childbirth and postpartum care to address the social determinants of the problem.

O objetivo do artigo é analisar o padrão espacial e temporal e identificar indicadores socioeconômicos relacionados à razão de mortalidade materna (RMM) no Brasil de 2010 a 2020. Estudo ecológico que analisou a RMM nos municípios do Brasil, utilizando dados secundários. Para análise temporal, utilizou-se o método joinpoint. Para a identificação de aglomerados espaciais, utilizou-se estatística bayesiana, autocorrelação espacial, a técnica Getis Ord Gi* e a varredura scan. Para a identificação dos fatores associados à RMM, foram adotados modelos múltiplos de regressão não espacial e espacial. Observou-se aumento da RMM de 2019 para 2020. Houve crescimento de óbitos nas regiões Norte e Sudeste. Os clusters foram encontrados no Amazonas, Tocantins, Piauí, Maranhão, Bahia e Mato Grosso do Sul. Estão negativamente relacionados à RMM os seguintes indicadores: taxa de parto cesáreo, índice de desenvolvimento humano municipal e renda domiciliar per capita dos vulneráveis à pobreza. Embora a tendência temporal tenha se mostrado constante até 2019, a RMM apresentou crescimento no ano de início da pandemia de COVID-19 no país. A redução da MM no Brasil vai além da promoção de melhorias na assistência gravídico-puerperal, sendo fundamental focar também nos determinantes sociais do problema.

Fiscal austerity and municipal health spending: an interrupted time series study.

OBJECTIVE: To analyze the impact of the fiscal austerity policy (PAF) on health spending in Brazilian municipalities, considering population size and source of funds. METHODS: The interrupted time series method was used to analyze the effect of the PAF on total expenditure, resources transferred by the Federal Government, and own/state per capita resources allocated to health in the municipalities. The time series analyzed covered the period from 2010 to 2019, every six months. The first semester of 2015 was adopted as the start date of the intervention. The municipalities were grouped into small (up to 100,000 inhabitants), medium (101,000 to 400,000 inhabitants), and large (over 400,000 inhabitants). The data was obtained from the Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budget). RESULTS: The results for the national average of municipalities show that the PAF had a negative impact on the level of total expenditure and own/state resources allocated to health in the first half of 2015, without causing statically significant changes in the trends of any of the indicators analyzed in the period after 2015. Small municipalities saw a drop in total expenditure, while large municipalities saw a drop in own/state resources, and medium-sized municipalities saw a drop in both variables. There was no statistically significant drop in the volume of funds transferred by the Federal Government in the immediate aftermath of the implementation of the PAF in any of the municipal groups analyzed. In the medium-term, the PAF only had a negative impact on the large municipalities, which saw significant reductions in the trends of own/state resources and those transferred by the Union for health. CONCLUSION: In general, the impact of the PAF on health financing in municipalities was immediate and based on the decrease in own/state resources allocated to health. In large municipalities, however, the impact lasted from 2015 to 2019, mainly affecting health expenditure from federal funds.

Factors associated with preventable infant mortality in 2020: a Brazilian population-based study.

OBJECTIVES: to identify factors associated with preventable infant deaths, classified as neonatal and post-neonatal. METHODS: this is an epidemiological and population-based study relating to 2020. Data from the Mortality Information System (MIS) and the preventability classification proposed in the Brazilian Health System List of Causes of Deaths Preventable by Interventions were used. RESULTS: prematurity, living in the North and Northeast regions and the occurrence of the event at home were associated with preventable neonatal deaths. To the avoidable post-neonatal component, death outside the hospital, low maternal education and children of brown or yellow color/race were associated. CONCLUSIONS: the main risk factor associated with preventable deaths was prematurity, in the case of neonatal death. Low maternal education and occurrence outside the hospital were associated with post-neonatal deaths.

Healthy Aging in Colombia 2018 and Its Variation in Relation to Social Conditions.

The population aging in the region is occurring under scenarios of inequality, raising concerns about how the increase in life expectancy is experienced and what factors affect the quality of life of older adults. This research quantified the differentials of healthy aging in Colombia in 2018 and its association with social indicators through a cross-sectional, descriptive, and correlational observational study. Healthy aging was quantified using the Disability-Free Life Expectancy (DFLE) indicator and later correlated with social indicators and subjected to a Multiple Factor Analysis (MFA). The results showed a healthy life expectancy of 71.5 years for women and 66.9 years for men, with a disability expectancy of 8.3 and 6.4 years, respectively. Negative associations emerged with health problems, disability, lack of medical care, illiteracy, school absenteeism, and poverty, while higher education levels and retirement showed positive associations. The factor analysis by area of residence highlighted urban areas as conducive to healthy aging. In conclusion, the accelerated aging of the Colombian population faces health disparities that policies must address by improving education, economic security, and health services, especially for women and rural areas.

Update on the Epimed Monitor Adult ICU Database: 15 years of its use in national registries, quality improvement initiatives and clinical research.

In recent decades, several databases of critically ill patients have become available in both low-, middle-, and high-income countries from all continents. These databases are also rich sources of data for the surveillance of emerging diseases, intensive care unit performance evaluation and benchmarking, quality improvement projects and clinical research. The Epimed Monitor database is turning 15 years old in 2024 and has become one of the largest of these databases. In recent years, there has been rapid geographical expansion, an increase in the number of participating intensive care units and hospitals, and the addition of several new variables and scores, allowing a more complete characterization of patients to facilitate multicenter clinical studies. As of December 2023, the database was being used regularly for 23,852 beds in 1,723 intensive care units and 763 hospitals from ten countries, totaling more than 5.6 million admissions. In addition, critical care societies have adopted the system and its database to establish national registries and international collaborations. In the present review, we provide an updated description of the database; report experiences of its use in critical care for quality improvement initiatives, national registries and clinical research; and explore other potential future perspectives and developments.