Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Desigualdades socioespaciais da mortalidade prematura por doenças crônicas não transmissíveis no município de São Paulo, Brasil, 2006-2019 / Spatial inequalities of premature mortality for chronic non-transmissible diseases in the municipality of São Paulo, Brazil, 2006 to 2019

Resumo Introdução Este estudo utiliza dados de mortalidade para monitorar as desigualdades sociais em saúde. Objetivo Analisar a tendência das taxas da mortalidade prematura (30-69 anos) por grupos selecionados de DCNT em áreas de inclusão e exclusão social no Município de São Paulo (MSP), entre 2006 e 2019, e avaliar a magnitude das desigualdades nos triênios de 2006-2008 e 2017-2019. Método Utilizou-se o Índice de Exclusão/Inclusão para delimitação das áreas, regressão de Prais-Winsten para análise das tendências e Razão entre Taxas (RT) para mensurar as desigualdades. Resultados As tendências apresentaram declínios, sendo maiores na área de inclusão social, no sexo masculino, para Doenças Isquêmicas do Coração (DIC), Doenças Crônicas das Vias Respiratórias Inferiores (DCR) e Diabetes Mellitus (DM). Ocorreram aumentos significativos das RT no sexo masculino para DIC (1,62 e 2,17), DCR (1,60 e 3,00) e DM (1,81 e 2,26), enquanto no feminino não se observou ampliação. Conclusão O declínio das taxas nas áreas de exclusão social, a não ampliação da desigualdade nas mulheres, e por doenças cerebrovasculares e hipertensivas nos homens, provavelmente se devem à existência de um sistema universal de saúde. A ampliação da desigualdade entre homens requer adequação dos serviços de saúde para assegurar a integralidade desse grupo.

Abstract Background This study uses mortality data to monitor social inequalities in health. Objective To analyze the trend in premature mortality rates (30 to 69 years) by selected groups of NCDs in areas of social inclusion and exclusion in the city of São Paulo, between 2006 and 2019, and to assess the magnitude of inequalities in the years 2006-2008 and 2017-2019. Method The Exclusion/Inclusion Index was used to delimit areas, Prais-Winsten regression to analyze trends, and rate ratio (RT) to measure inequalities. Results The trends showed declines, with greater social inclusion in males for ischemic heart diseases (IHD), chronic diseases of the lower respiratory tract (DLRT) and diabetes mellitus (DM). There were significant increases in RT in males for IHD (1.62 and 2.17), DCR (1.60 and 3.00) and DM (1.81 and 2.26), while in females there was no increase. Conclusion The decline in rates in areas of social exclusion, the non-expansion of inequality in women and, due to cerebrovascular and hypertensive diseases in men, is probably due to the existence of a universal health system. The expansion of inequality between men requires adequate health services to ensure the integrality of this group.

Early death, morbidity and pharmacotherapy in extremely premature and very premature in neonatal intensive care units / Morte precoce, morbidade e farmacoterapia em prematuros extremos e muito prematuros em unidades de terapia intensiva neonatal

Abstract Objectives: to evaluate the evolution of extremely preterm and very preterm infants admitted to neonatal intensive care units, regarding the use of ventilatory support, morbidities, medication use, death, survival and viability. Methods: a non-concurrent cohort study, with 163 very premature and extreme newborns hospitalized in three neonatal intensive care units, during 2016 and 2017. A descriptive analysis of the data obtained from the medical records was performed. The outcomes studied were the use of ventilatory support, morbidities, medication use, death and causes of death. A survival curve was constructed and a viability limit was defined. Results: in the study, 28.2% were extreme and 71.8% were very premature. In this order of subgroups, the need for mechanical ventilation was higher for the extremes (65.2% and 41.0%) and the main diagnosis was early sepsis (78.6% and 82.6). Off-label (60.5% and 47.9%) and off-license (25.3% and 29.0%) medications were used. Most deaths (57.8%) occurred between the extremes, mainly due to septic shock. Survival was lower for the lowest gestational ages and the limit of viability was between 26 and 27 weeks. Conclusions: the main morbidities were from the respiratory system, with high use of off-label and unlicensed medications. Extremes had a greater demand for intensive care in addition to needing more drugs and progressing more to death.

Resumo Objetivos: avaliar a evolução dos prematuros extremos e muito prematuros internados em unidades de terapia intensiva neonatais, quanto ao uso de suporte ventilatório e de medicamentos, óbito, sobrevida e viabilidade. Métodos: estudo de coorte não concorrente, com 163 recém-nascidos muito prematuros e extremos internados em três unidades de terapia intensiva neonatais, durante 2016 e 2017. Realizou-se análise descritiva dos dados obtidos dos prontuários. Os desfechos estudados foram o uso de suporte ventilatório, morbidades, uso de medicamentos, óbito e causas de óbito. Foi construída curva de sobrevivência e delimitado um limite de viabilidade. Resultados: no estudo, 28,2% eram extremos e 71,8% muito prematuros. Nessa ordem de subgrupos, a necessidade de ventilação mecânica foi maior para os extremos (65,2% e 41,0%) e o principal diagnóstico foi sepse precoce (78,6% e 82,6).Medicamentos off-label (60,5% e 47,9%) e sem-licença (25,3% e 29,0%) foramutilizados. A maioria dos óbitos (57,8%) ocorreu entre os extremos, principalmente por choque séptico. A sobrevivência foi menor para as menores idades gestacionais e o limite de viabilidade ficou entre 26 e 27 semanas. Conclusões: as principais morbidades foram do sistema respiratório, com alto uso de medicamentos off-label e sem licença. Extremos tiveram maior demanda de cuidados intensivos além de necessitarem de mais medicamentos e evoluírem mais ao óbito.

Años de vida saludable perdidos por diabetes mellitus en Cuba / Years of Healthy Life Lost Due to Diabetes Mellitus in Cuba

Introducción: El reciente incremento de la prevalencia de la diabetes mellitus en Cuba sucedió con mayor celeridad, y las políticas encaminadas a su control requieren de su cuantificación sistemática. Objetivo: Identificar las diferencias en Cuba, según provincia y sexo, de los años de vida saludable perdidos por la diabetes mellitus en el 2015. Métodos: En el estudio de extensión nacional se obtuvieron los años de vida saludable perdidos como resultado de la suma de los años perdidos de vida potencial por mortalidad prematura y los años de vida perdidos por morbilidad y otros indicadores para identificar la mortalidad temprana en el año 2015. Resultados: En todas las provincias los índices de años de vida saludable perdidos por morbilidad superaron los de mortalidad prematura con predominio del sexo femenino, mientras en la mayoría de las provincias, las edades de las defunciones fueron más tempranas en el masculino. Las diferencias halladas permitieron agrupar a Artemisa, La Habana, Mayabeque, Matanzas, Villa Clara, Cienfuegos, Santi Spíritus y Camagüey, con los mayores promedios de años perdidos por morbilidad y fallecimientos más tardíos, y al resto de las provincias cubanas, con los menores años perdidos por morbilidad, pero con defunciones en edades más tempranas. Conclusiones: Las pérdidas de años de vida saludable difieren según el sexo y la provincia. Este conocimiento permite la identificación de diferentes patrones de morbimortalidad útiles para orientar las acciones de prevención y control de la enfermedad para cada territorio(AU)

Introduction: The recent increase in the prevalence of diabetes mellitus in Cuba occurred more rapidly, and policies aimed at its control require systematic quantification. Objective: To identify the differences in Cuba, according to province and sex, of the years of healthy life lost due to diabetes mellitus in 2015. Methods: The national extension study collected data on the healthy years of life lost as a result of the sum of years lost from potential life due to premature mortality and years of life lost due to morbidity and other indicators to identify early mortality in 2015. Results: In all provinces, the rates of years of healthy life lost due to morbidity exceeded those of premature mortality with a predominance of women, while in most provinces, the ages of death were earlier in the male sex. The differences found allowed to group Artemisa, Havana, Mayabeque, Matanzas, Villa Clara, Cienfuegos, Santi Spíritus and Camagüey provincesn with the highest averages of years lost due to morbidity and later deaths, and the rest of the Cuban provinces, with the lowest years lost due to morbidity, but with deaths at younger ages. Conclusions: Losses of years of healthy life differ by sex and province. This knowledge allows the identification of different patterns of morbidity and mortality useful to guide the prevention and control actions of the disease for each territory(AU)

Más allá de la cura: la necesidad de implementar un sistema de seguimiento a largo plazo para los supervivientes de cáncer infantil en Colombia / Beyond the cure: the need to implement a long-term follow-up system for childhood cancer survivors in Colombia

Resumen Con el advenimiento de tratamientos multidisciplinarios y de alta calidad, la supervivencia global a cinco años por cáncer en la población pediátrica ha mejorado considerablemente, llegando a ser hasta de 80% en países de altos ingresos. En Colombia también ha habido un aumento progresivo de la supervivencia global a 5 años, particularmente para las neoplasias hematológicas. En consecuencia, el número de supervivientes de cáncer infantil ha aumentado de forma importante en los últimos años y junto con ellos la aparición de eventos adversos tardíos relacionados con mayor morbilidad y riesgo de muerte prematura en la edad adulta. Aunque se han venido implementando estrategias de seguimiento a supervivientes de cáncer infantil en países de altos ingresos, en Colombia se han realizado pocos esfuerzos para la implementación de estas estrategias. De hecho, la práctica común en la mayoría de los centros de tratamiento consiste en dar de alta al niño que cumple 5 años de seguimiento oncológico, sin instrucciones precisas para dicho seguimiento. El objetivo del presente trabajo es argumentar sobre la necesidad de diseñar e implementar estrategias de seguimiento para supervivientes de cáncer infantil en el contexto colombiano.

Abstract With the advent of high-quality multidisciplinary treatments, the overall 5-year cancer survival in the pediatric population has improved considerably, reaching up to 80% in high-income countries. In Colombia, there has also been a progressive increase in overall 5-year survival, particularly for hematologic malignancies. Consequently, the number of childhood cancer survivors has increased significantly in recent years and, together with them, the occurrence of late adverse events related to increased morbidity and risk of premature death in adulthood. Although follow-up strategies have been implemented for childhood cancer survivors in high-income countries, few efforts have been made in Colombia to implement these strategies. In fact, the common practice in most treatment centers is to discharge children who have had 5 years of cancer follow-up, without precise instructions for long-term follow-up. This paper aims to argue about the need to design and implement follow-up strategies for survivors of childhood cancer in the Colombian context.

Estratégias para enfrentamento da mortalidade precoce por doenças crônicas não transmissíveis / Strategies for coping with early mortality from non-communicable chronic diseases

As Doenças Crônicas Não Transmissíveis (DCNTs) tendem a ser de longa duração e são o resultado de uma combinação de fatores genéticos, fisiológicos, ambientais e comportamentais. Tais agravos matam 41 milhões de pessoas a cada ano, o equivalente a 74% de todas as mortes no mundo, principalmente mortes prematuras, além de acarretar a perda de qualidade de vida, limitações e incapacidades, constituindo a maior carga de morbimortalidade. Sendo assim, esta síntese de evidências traz alguns pontos do Plano de Ações Estratégicas para o Enfrentamento das Doenças Não Transmissíveis no Brasil (2011-2022), que tem o intuito de reduzir a carga de DCNTs e evitar mortes prematuras, além de promover o desenvolvimento e a implementação de políticas públicas efetivas, integradas, sustentáveis e baseadas em evidências para a prevenção e o controle das DCNTs e seus fatores de risco e fortalecer os serviços de saúde voltados às doenças crônicas

Chronic Noncommunicable Diseases (NCDs) tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioral factors. Such diseases kill 41 million people each year, equivalent to 74% of all deaths in the world, mainly premature deaths, in addition to causing a loss of quality of life, limitations and disabilities, constituting the highest burden of morbidity and mortality. Therefore, this synthesis of evidence presents some points of the Strategic Action Plan for Combating Noncommunicable Diseases in Brazil (2011-2022), which aims to reduce the burden of NCDs and prevent premature deaths, in addition to promoting the development and the implementation of effective, integrated, sustainable and evidence-based public policies for the prevention and control of CNCDs and their risk factors and to strengthen health services aimed at chronic diseases

Profile of Capacity and Response to Noncommunicable Diseases and Their Risk Factors in the Region of the Americas: Country Capacity Survey Results, 2017

Noncommunicable diseases (NCDs) are the leading cause of death in the Americas, accounting for 81% of all deaths in the Region in 2016. Of the estimated 5.5 million NCD-related annual deaths, 39% of these are premature deaths (occurring between the ages of 30–70) and are largely a result of the four main NCDs: cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases. NCDs and related premature deaths can be significantly reduced through government policies that prevent, treat, and control these diseases. To monitor countries’ capacities to address NCDs, including progress and trends over time, various tools are implemented, including the World Health Organization Country Capacity Survey (WHO-CCS). The survey captures information related to NCD infrastructure, policies, surveillance, and health systems. Conducted in 2001, 2005, 2010, 2013, and in 2017, this 6th edition of the CCS incorporates new validation processes to verify country responses through the submission of official policy documents and a data comparison to global health databases. These protocols were introduced to enhance data quality and provide an accurate reflection of the country capacity to combat NCDs. It is important to recognize that for the first time in the Americas, 100% of the Member States (35 countries) and 76% of the Associate Members and Participating States (13 of 17 countries) completed the survey. As such, the 2017 CCS provides a comprehensive assessment of the entire Region and demonstrates the political commitment of the Americas to reduce the burden of NCDs. This report presents results of the 2017 CCS and offers an updated review of progress in the Region of the Americas including gaps and recommendations for improvement to strengthen countries’ capacities to address NCDs and their risk factors. While advancements have been made, without an acceleration of commitments and significant investments, it is anticipated that some countries in the Americas will not meet their global targets.

Eastern Mediterranean Health Journal [2021; Vol.27, Issue 10] / [المجلة الصحية لشرق المتوسط [2021; المجلد 27 , العدد 10

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Mortalidad prematura según causas seleccionadas en el Policlínico 5 de septiembre / Premature Mortality due to Selected Causes in 5 de Septiembre Municipality

Introducción: El conocimiento de las tendencias de mortalidad prematura en una población puede contribuir a realizar acciones que disminuyan los años de vida potencial perdidos por distintas causas. Objetivo: determinar la tendencia de mortalidad prematura por enfermedad de arterias, arteriolas y vasos, enfermedad cerebrovascular, infarto agudo del miocardio, diabetes mellitus, enfermedad pulmonar obstructiva crónica y cáncer de mama, próstata, bucal, colon y cérvix en el policlínico 5 de septiembre de Consolación del Sur. Métodos: Se realizó un estudio descriptivo retrospectivo del total de fallecidos prematuramente n = 313 por las causas seleccionadas, para ello se analizaron, a través de estadística descriptiva, los datos del Registro de Mortalidad de la Dirección Provincial de Salud Pública de Pinar del Río. Resultados: Existió correspondencia entre el incremento de la edad y el aumento de los fallecidos, los más afectados fueron el grupo etario 60-69 años, el sexo masculino y el color blanco de piel. Solo las enfermedades de arterias, arteriolas y vasos, la EPOC y la diabetes mellitus mostraron tendencia al ascenso. El mayor riesgo de morir prematuramente correspondió a los Grupos Básicos de Trabajo 2 y 4, y las causas de mayor tasa fueron la enfermedad cerebrovascular, infarto agudo de miocardio y EPOC. La población estudiada perdió 9,86 años de vida como promedio y el cáncer de cérvix fue la enfermedad que más aportó años de vida potencial perdidos. Conclusiones: Se apreció tendencia a la disminución de mortalidad prematura general por las enfermedades estudiadas(AU)

Introduction: Knowledge about tendencies of premature mortality in a population can contribute to carrying out actions that reduce the number of years of potential life lost due to different causes. Objective: To determine the tendency of premature mortality due to disease of the arteries, arterioles and vessels, cerebrovascular disease, acute myocardial infarction, diabetes mellitus, chronic obstructive pulmonary disease (COPD), as well as breast, prostate, oral, colon and cervical cancer in 5 de Septiembre Polyclinic of Consolación del Sur Municipality. Methods: A retrospective and descriptive study was carried out with the total number of prematurely deceased (n=313) for the selected causes. For this purpose, the data from the Mortality Registry of the Provincial Directorate of Public Health of Pinar del Río were analyzed through descriptive statistics. Results: There was a correspondence between increase in age and increase in deaths; the most affected were those in age group 60-69 years, as well as the male sex and white skin color. Only diseases of the arteries, arterioles and vessels, COPD and diabetes mellitus showed an upward tendency. The highest risk for dying prematurely corresponded to the basic work groups 2 and 4, while the causes with the highest rate were cerebrovascular disease, acute myocardial infarction and COPD. The study population lost 9.86 years of life on average and cervical cancer was the disease that accounted for the highest amount of lost years of potential life. Conclusions: There was a tendency towards a decrease in general premature mortality due to the diseases studied(AU)

Global Diabetes Compact: Implementation in the Region of the Americas

The World Health Organization has created the Global Diabetes Compact (GDC) as a global initiative to improve diabetes prevention and care, and to contribute to the global targets to reduce premature mortality due to noncommunicable diseases by one-third by 2030. The vision of the GDC is to reduce the risk of diabetes and ensure that all people diagnosed with diabetes have access to quality care and treatment that is equitable, comprehensive, and affordable. Its overall goal is to support countries in implementing cost-effective programs for the prevention and control of diabetes. This includes reducing diabetes risk factors through multisectoral population-based health policies and strengthening primary health care for timely diabetes diagnosis and treatment, prioritizing vulnerable populations living with diabetes. This brief publication from the Pan American Health Organization examines why the GDC is needed, explores how it will be applied in the Region of the Americas, and provides a list of references to technical materials that are available to support implementation of diabetes interventions in the Region.

Pacto Mundial contra la Diabetes. Implementación en la Región de las Américas

El Pacto Mundial contra la Diabetes de la Organización Mundial de la Salud se creó como una iniciativa internacional encaminada a mejorar la prevención y la atención de la diabetes y a contribuir a las metas mundiales de reducción de la mortalidad prematura por enfermedades no transmisibles en un tercio para el 2030. La visión del Pacto Mundial es reducir el riesgo de diabetes y asegurar que todas las personas diagnosticadas tengan acceso a cuidados y tratamientos de calidad, equitativos, integrales y asequibles. Su objetivo general es prestar apoyo a los países en la aplicación de programas costoeficaces para la prevención y el control de la diabetes. Esto incluye reducir los factores de riesgo de la diabetes a través de políticas de salud multisectoriales y fortalecer la atención primaria de salud en favor de un diagnóstico y el tratamiento oportunos en los que se dé prioridad a las personas con diabetes en situación de vulnerabilidad. Este folleto de la Organización Panamericana de la Salud aborda por qué es necesario el Pacto Mundial y cómo se aplicará en la Región de las Américas, y proporciona una lista de materiales de consulta que serán de utilidad para respaldar la ejecución de las intervenciones conexas en la Región.

Carga de enfermedad por lesiones de causas externas en Bucaramanga, Colombia 2017 / Burden of disease by external causes of injury in Bucaramanga, Colombia 2017

Resumen Introducción: Las lesiones por causa externa son uno de los principales problemas de salud pública en el mundo, y la metodología estandarizada de carga de enfermedad a través de los años de vida saludable perdidos (AVISAS) permite conocer el estado de salud poblacional y priorizar acciones. Objetivo: Determinar la carga de enfermedad en términos de discapacidad y muerte como consecuencia de lesiones por causas externas en Bucaramanga, 2017. Diseño metodológico: Estudio descriptivo de carga de la enfermedad. Se estimó los AVISAS producidos por LCE utilizando las bases de datos del Departamento Administrativo Nacional de Estadísticas, Sistema de Nacional de Vigilancia en Salud Pública y Registro Individual de la Prestación de Servicios de Salud, del año 2017, de la ciudad de Bucaramanga. Resultados: Se estimó una carga global de enfermedad por LCE de 12,04 AVISAS por cada 1000 personas; 0,51 AVISAS atribuibles a discapacidad y 11,53 AVISAS, a mortalidad. Las agresiones y accidentes de tránsito (AT) son las dos principales LCE con mayor número de AVISAS. En la población de 5-59 años las agresiones y AT presentan AVISAS por mortalidad de mayor peso; los AT son la principal causa externa en la población de 60 a 79 años y la segunda en mayores de 80 años. Conclusiones: Considerando que los AT fueron la causa externa con las más altas AVISAS atribuidas a mortalidad prematura, se recomienda implementar o intensificar estrategias de alto impacto que contribuyan a disminuir los AT.

Abstract Introduction: Injuries due to external causes are one of the main worldwide public health problems. The standardized methodology to evaluate burden diseases through the disability-adjusted life years (DALYs) allows us to know the health condition in a population and prioritize actions. Objective: To determine the burden of disease in terms of disability and death as consequence of injuries due to external causes in Bucaramanga, 2017. Methodology: Descriptive study was conducted. The DALYs produced by injuries due to external causes were estimated using information from the National Administrative Department of Statistics, the National Public Health Surveillance System and the Individual Registry of Service Provision of Health databases from 2017 for the city of Bucaramanga, Colombia. Results: The global burden of diseases due to external causes was estimated at 12.04 DALYs per 1000 inhabitants; 0.51 DALYs were attributed to disability and 11.53 DALYs to mortality. Assaults and road traffic accident injuries (RTAI) were the main external causes with higher DALYs. In the population between 5 and 59 years old, assaults and RTAI had the highest DALYs attributed to mortality. RTAI were the first external cause of DALYSs in the population between 60 and 79 years old, and the second cause in the population older than 80 years. Conclusion: Considering that RTAI was the external cause with the highest DALYs attributed to premature mortality, it is recommended to implement or intensify high-impact strategies to reduce RTAI.

Trends in premature mortality in the Islamic Republic of Iran: probability of dying between ages 30 and 70 years

Background: The burden of noncommunicable diseases (NCDs) is a major challenge facing the whole world. Around 15 million premature deaths due to NCDs occur in people aged 30–70 years annually.Aims: Mortality data based on death registration systems and population data were used to estimate proposed mortality statistics in the Islamic Republic of Iran.Methods: Various criteria and methods were used to assess the quality of mortality data. The probability of dying among those aged 30–70 years for all causes and for NCDs was calculated using the life table method.Results: The mortality rate in the population aged 30–69 years was 343.12 (per 100 000 persons) in 2006 and decreased to 240.62 in 2016 in both sexes. The probability of dying due to NCDs was 21.36% in 2006 and declined to 14.95% in 2016 for both sexes.Conclusions: The number of premature deaths due to NCDs have decreased over the last decade. We predict that this reduction will continue and the country will meet the targets of the WHO NCD action plan by 2025 and also the targets of the Sustainable Development Goals for reducing premature deaths by 2030. However, the morbidity and burden of NCDs are still public health concerns in the country. Due to advancements in health care technologies and also the aging population, these concerns will impose greater costs on the health system. Hence, prevention programmes for NCDs should be an urgent priority for Iranian health policy.

STEPS: prevalence of noncommunicable disease risk factors in the Republic of Azerbaijan, 2017

Noncommunicable diseases (NCDs) are the principal cause of morbidity, disability and premature mortality in Azerbaijan. The most effective way to reduce the NCD burden is to prevent NCD development, by addressing thebehavioural risk factors underlying NCDs at the population and individual levels: smoking, alcohol use, excessive salt intake, low physical activity, overweight and obesity, and unhealthy diets. In Azerbaijan, a national survey of the prevalence of major NCD risk factors, aligned with the WHO-endorsed STEPwise approach to surveillance (STEPS) methodology, was conducted in 2017. The survey results will allow an objective view of the current situation regarding the prevalence of NCD risk factors in the adult population of the country to be formed and will determine approaches to NCD prevention and control over the coming years.

Физическая активность: информационный бюллетень. Цели в области устойчивого развития: задачи в области здравоохранения

Информационные бюллетени о задачах ЦУР в области здравоохранения раскрывают основные факты и цифры, текущие обязательства, стратегические рекомендации для осуществления действий и индикаторы для мониторинга прогресса – в контексте Европейского региона ВОЗ. Особое внимание в них уделяется тому, как ЕРБ ВОЗ содействует государствам-членам в достижении этих целевых ориентиров, а также ключевым аспектам ЦУР, таким как справедливость, партнерское взаимодействие и межсекторальное сотрудничество.

Mortalidade prematura por doenças crônicas não transmissíveis e cobertura da atenção básica: análise dos indicadores / Mortalidad prematura por enfermedades crónicas no transmisibles y cobertura de atención: análisis de los indicadores / Premature mortality from chronic non-communicable diseases and coverage of primary care: analysis of indicators

Objetivo: avaliar a taxa de mortalidade prematura por doenças crônicas não transmissíveis (DCNT) e sua associação com a cobertura populacional pelas equipes de Atenção Básica nos municípios de Santa Catarina. Método: estudo transversal que utilizou dados secundários do banco de dados oficiais do Estado. Os indicadores mortalidade prematura por DCNT e cobertura populacional pelas equipes de Atenção Básica nos anos 2017 e 2018, foram coletados em 2019. Os dados foram analisados no Statistical Package for the Social Sciences versão 25.0, para estatística descritiva e apresentados por média e desvio padrão. Utilizou-se teste de correlação de Spearman para as variáveis em estudo. Resultados: houve aumento nas taxas de mortalidade prematura por DCNT e redução na cobertura populacional pelas equipes de Atenção Básica, sem associação significativa entre esses indicadores. Conclusão: o aumento da mortalidade prematura por DCNT e o não cumprimento das metas pactuadas requerem avaliação das ações realizadas na Atenção Básica.

Objective: to evaluate the rate of premature mortality due to chronic noncommunicable diseases (CNCD) and its association with population Coverage of Primary Care teams in Santa Catarina municipalities. Method: cross-sectional study that used secondary data from the official state database. The indicators premature Mortality due to CNCD and population Coverage of Primary Care teams in the years 2017 and 2018 were collected in 2019. The data were analyzed in the Statistical Package for the Social Sciences version 25.0, for descriptive statistics and presented by mean and standard deviation. Spearman correlation test was used for the variables under study. Results: there was an increase in the rates of premature Mortality due to CNCD and a reduction in population Coverage of Primary Care teams, with no significant association between these indicators. Conclusion: the increase in premature mortality due to CNCD and the non-compliance with the agreed goals require evaluation of the actions performed in Primary Care.

Objetivo: evaluar la tasa de mortalidad prematura por enfermedades crónicas no transmisibles (ECNT) y su asociación con la cobertura poblacional por parte de los equipos de atención primaria en los municipios de Santa Catarina. Método: estudio transversal que utilizó datos secundarios de la base de datos oficial del estado. Los indicadores Mortalidad prematura por ECNT y cobertura poblacional por parte de los equipos de atención primaria en los años 2017 y 2018 se recogieron en 2019. Los datos fueron analizados en el Statistical Package for the Social Sciences versión 25.0, para estadística descriptiva y presentados por media y desviación estándar. La prueba de correlación de Spearman se utilizó para las variables en estudio. Resultados: hubo aumento en las tasas de mortalidad prematura debido a la ECNT y reducción en la cobertura poblacional por parte de los equipos de atención primaria, sin una asociación significativa entre estos indicadores. Conclusión: el aumento de la Mortalidad prematura por ECNT y el incumplimiento de las metas acordadas requiere evaluación de las acciones realizadas en Atención Primaria.

Muertes prematuras y años de vida potenciales perdidos, ¿qué ha cambiado en Colombia durante la pandemia por COVID-19? / Premature deaths and years of potential life lost, what has changed in Colombia during the COVID-19 pandemic?

Resumen Introducción: La pandemia por COVID-19 es uno de los mayores desafíos globales de la época. Para la mayor comprensión de sus efectos poblacionales es necesario analizar medidas complentarias a la mortalidad. Objetivos: Estimar los años de vida potenciales perdidos en Colombia debido a muertes prematuras por todas las causas de defunción y por COVID-19 en el periodo marzo-julio entre los años 2015 y 2020. Materiales y métodos: Estudio ecológico, longitudinal y retrospectivo, basado en fuentes de información secundaria. Se calcularon los años de vida potencialmente perdidos según sexo y grupo de edad, utilizando la esperanza de vida y las tablas actuariales del DANE. Resultados: Entre marzo y julio de 2020 se perdieron 2 356 420 años por muertes prematuras, para una tasa de 46,8 años perdidos por cada mil habitantes de Colombia, un resultado superior en un 4,8 % respecto a la media de los últimos cinco años. Debido al COVID-19 se dejaron de vivir 237 725,5 años -con mayor pérdida entre los hombres- y un aporte porcentual del 10,5 % al total de años potenciales perdidos en Colombia. Conclusiones: Durante la pandemia se ha presentado un ligero incremento en los años de vida potenciales perdidos en Colombia. Si bien la pérdida de años atribuibles a las muertes confirmadas por COVID-19 no son los responsables directos de la mayor parte de la pérdida total, los cambios sociales y las condiciones de vida durante el confinamiento sí podrían haber incidido en las variaciones de la mortalidad y su distribución entre subgrupos poblacionales.

Abstract Introduction: The COVID-19 pandemic is one of the greatest global challenges of the time. For a better understanding of its population effects, it is necessary to analyze complementary measures to mortality. Objetive: To estimate the potential years of life lost in Colombia due to premature deaths from all causes and from COVID-19 in the March-July period between 2015 and 2020. Materials and methods: We carried out an ecological, longitudinal and retrospective study, based on secondary sources. Years of life potentially lost were calculated according to sex and age group, using life expectancy and the DANE actuarial tables. Results: Between March and July 2020, 2 356 420 years were lost due to premature deaths, for a rate of 46.8 years lost per thousand inhabitants of Colombia, a result that is 4.8% higher than the average of the last five years. Due to COVID-19, 237 725.5 years were lost -with the greatest loss among men- and a percentage contribution of 10.5% to the total potential years of life lost in Colombia. Conclusions: During the pandemic there has been a slight increase in the potential years of life lost in Colombia. Although the loss of years attributable to deaths confirmed by COVID-19 are not directly responsible for most of the total loss, social changes and living conditions during confinement could have had an impact on variations in mortality and its distribution among population subgroups.

Analysis of life expectancy across countries using a decision tree

Background: It is important to identify variables that influence life expectancy in order to develop strategies to improve health care systems and thereby increase life expectancy. Aims: In this study, a decision tree was built using a chi-square automatic interaction detector technique in order to identify variables influencing life expectancy at birth. Methods: Data were taken from the databases of the World Bank, World Health Organization and World Life Expectancy. Data from 166 countries for the year 2013 were extracted for 25 selected input variables related to mortality, health and the environment, child health, economy and demography in order to build the decision tree.Results: Of the 25 variables, nine had a significant influence on life expectancy: percentage of the population using improved sanitation facilities; death rates per 100 000 population for HIV/AIDS, liver disease, stroke and coronary heart disease; percentage of the urban population using improved drinking-water sources; total fertility rate (births per woman); public health expenditure (percent of government expenditure); and health expenditure per capita. Conclusions: Improving these variables may result in significant increases in life expectancy and quality of life. At the country level, appropriate strategies can be developed to improve the quality and performance of health care systems