[Causes of death after revascularization of the lower limbs through surgery and angioplasty in the State of Rio de Janeiro, Brazil, between 2006 and 2011]. / Causas de Morte após Revascularização dos Membros Inferiores por Cirurgia e Angioplastia no Estado do Rio de Janeiro - Brasil, de 2006 a 2011.

INTRODUCTION: The underlying cause of death is the single diagnosis to which the cause of death is attributed. Other diagnostic codes written in the death certificate are the multiple causes. The study of the multiple causes allows the identification of the diseases present in the death. OBJECTIVE: To analyze the underlying and multiple causes of death after revascularization of the lower limbs using open surgery or angioplasty. METHODS: Two databases of the Public Health System of Rio de Janeiro were used: Authorizations for Hospitalizations 2006/10, and Statements of Deaths 2006/11. Probabilistic linkage of records between databases was performed using the Stata program. RESULTS: The most frequent underlying and multiple cause of death was Diabetes mellitus. The second was the systemic atherosclerotic disease represented by peripheral arterial disease, ischemic coronary disease and cerebrovascular disease. The analysis of multiple causes revealed septicemia, iatrogenic and complications after surgery, as well as renal failure after angio- plasty. Patients submitted to lower limb revascularization procedures had a higher overall mortality rate than the population of the State of Rio de Janeiro over 50 years of age, for all causes and specific ones. CONCLUSION: The period of highest risk of death was up to 30 days after hospital discharge, demonstrating the need to improve medical and hospital care before, during and after procedures. The study of multiple causes revealed adverse events and complications that were not chosen as the underlying cause.

Objetivos: A causa básica de morte é o diagnóstico único ao qual se atribui a causa da morte. Outros códigos de diag- nóstico anotados na declaração de óbito, são as causas múltiplas. O estudo das causas múltiplas permite identificar as doenças presentes no óbito. Objetivo: Conhecer as causas básica e múltiplas de morte após revascularização dos membros inferiores por cirurgia aberta ou angioplastia. Métodos: Foram utilizadas duas bases de dados do Sistema Único de Saúde do Estado do Rio de Janeiro: Autorizações de Internação Hospitalar de 2006-10 e as Declarações de Óbito do Sistema de Informação de Mortalidade de 2006-11. Foi realizada vinculação probabilístico de registros entre os bancos de dados, com programa estatístico Stata. Resultados: A causa básica e múltipla de óbito mais freqüente foi o Diabetes mellitus. Em segundo lugar a doença ate- rosclerótica sistêmica representada pela doença arterial periférica, doença isquêmica coronariana e doença cérebro vascular. A análise das causas múltiplas revelou septicemia, iatrogenia e complicações após cirurgia, e insuficiência renal após angioplastia. Os pacientes submetidos aos procedimentos de revascularização de membros inferiores apresentaram mortalidade geral mais elevada do que a população do Estado do Rio de Janeiro acima de 50 anos, por todas as causas e pelas específicas. Conclusão: O período de maior risco de morte foi até 30 dias após a alta hospitalar revelando a necessidade de melhorar os cuidados antes, durante e após os procedimentos. O estudo das causas múltiplas revelou eventos adversos e complicações que não foram escolhidas como causa básica.

Cardiovascular mortality among a cohort of hypertensive and normotensives in Rio de Janeiro - Brazil - 1991-2009.

BACKGROUND: Although there is strong evidence of the benefits of antihypertensive treatment, the high prevalence of this important cardiovascular risk factor and its complications, as well as the low control rates of hypertension observed in many studies justify the investigation of these relationships in population studies. The objective was to investigate the ratio of cardiovascular disease mortality between hypertensives (non-treated, controlled and uncontrolled) and non-hypertensives in a cohort of a population sample of adults living in Ilha do Governador, Rio de Janeiro state, Brazil, who were classified in a survey conducted in 1991 and 1992 and whose death certificates were sought 19 years later. METHODS: A cohort study was performed on probabilistic linkage between data from an epidemiological study of hypertension performed in Ilha do Governador, in Rio de Janeiro, Brazil (1991 to 1992) and data from the Mortality Information System of Rio de Janeiro (1991 to 2009). The survey aimed to estimate the prevalence of hypertension and other cardiovascular risk factors in 1,270 adults aged 20 years or older selected through a probabilistic sampling of households at three economic levels (low, middle and high income). We performed a probabilistic record linkage of these databases and estimated the risk of cardiovascular death using Kaplan-Meier method to plot survival curves and Cox proportional hazards models comparing hypertensive subjects all together, and by hypertension subgroups: untreated, controlled, and uncontrolled hypertensives with non-hypertensive ones. RESULTS: A total of 170 deaths occurred, of which 31.2 % attributed to cardiovascular causes. The hazard ratio for cardiovascular death was 6.1 times higher (95 % CI 2.7 - 13.7) in uncontrolled hypertensive patients relative to non-hypertensive patients. The hazard ratios for untreated hypertensive and controlled hypertensive patients were 2.7 times (95 % CI 1.1 - 6.3) and 2.1 times (95 % CI 0.38 - 11.5) higher than for normotensive patients, respectively. CONCLUSION: The present study demonstrated a higher cardiovascular death risk among hypertensive than among non-hypertensive ones that is not associated uniquely to treatment, because uncontrolled hypertensives demonstrated a greater risk than untreated ones. Although the subgroups of hypertensive individuals were susceptible to changes in their classification over the 19 years of the study, the baseline classification was consistent with a worse prognosis in these individuals.

The Study of Cardiovascular Risk in Adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.

BACKGROUND: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA. METHODS/DESIGN: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin. DISCUSSION: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.

[Hospital Lethality Following Lower Limbs Revascularization in the State of Rio de Janeiro, Brasil, 2006/10]. / Letalidade Hospitalar após Revascularização dos Membros Inferiores no Estado Rio de Janeiro - Brasil - 2006/10.

INTRODUCTION: Ischemic peripheral arterial disease is a form of presentation of systemic atherosclerosis and can be treated by angioplasty or open vascular surgery Objective: To find in-hospital lethality after revascularization according to sex, age, procedures and hospitalization conditions. METHOD: The data comes from authorizations to hospitalize from The State of Rio De Janeiro´s Public Healthcare System from the years 2006/10. We performed a search using the International Code of Diseases tenth revision (ICD-10) to identify codes of revascularization by angioplasty or open vascular surgery. The statistical analysis was done with Stata Program of statistics. RESULTS: The procedures were performed in 41 hospitals, public, private and university medical facilities. We identified 1558 registrations, 900 (57.8%) men and 658 women (42.2%). There were 68 hospital deaths and in-hospital mortality was 3.7% for men and 5.1% for women.The lethality was 2.6% under 50 years old, 4.1% between 50-69 years and 5.3% above 70 years. We identified 846 (46.6%) open surgeries and 968 (53.4%) angioplasties with a lethality of 2.0% in angioplasties (16/809) and 7.0% (52/748) with open surgeries. Elective procedures had 4.6 % of lethality and 4.1% in urgent/emergency procedures. Elective angioplasties had a mortality of 2.6%, and 1.4% in urgent/emergency. Open surgeries had the mortality of 6.5% and 7.5%, respectively. CONCLUSION: Hospital lethality showed high levels in open vascular surgery and angioplasties. A very sensitive aspect is the mortality of angioplasties in elective patients. These results are similar to those observed in myocardial revascularization from atherosclerosis. Public hospitals had lower lethality.

[Survival analysis after open vascular surgery and angioplasty in lower limbs vascularization in Rio de Janeiro, Brazil 2006-2013]. / Sobrevida Após Cirurgia Aberta Ou Angioplastia Para Revascularização dos Membros Inferiores No Estado Do Rio De Janeiro - Brasil, 2006-13.

Objective -The aim of this study is survival analysis after lower limb revascularization according to sex, age and procedures. METHOD: Were analysed in-hospital administrative database coming from the Public Health System of Rio de Janeiro (SUS-RJ) from 2006 through 2010 and the Public Registers of death of Rio de Janeiro (SIM-RJ) from 2006 through 2013. Both groups of information had linkaged using the Stata program of statistics. Three groups of age were studied: 50 years old or less, 50 to 79 and over 70 years old. RESULTS: More than half of patients received angioplasty as procedures during the study. In both procedures, men were more frequent, except in angioplasty after 70 years of age. In the period of 30 days after discharge in both procedures the survival had an abrupt reduction and it continue reducing until 180 days after open surgery. After these the survival curves run in parallel until the fourth year and then they had the same performance. CONCLUSION: The greatest reduction in survival was registered in the first thirty days after discharge, mainly in women after open surgery. It is necessary to improve in-hospital care in order to improve the survival index on the first thirty days after discharge..

HDI, Technological and Human Resources in the Diagnosis and Treatment of Malformations of the Circulatory System in Brazil. / IDH, Recursos Tecnológicos e Humanos para Diagnóstico e Tratamento das Malformações do Aparelho Circulatório no Brasil.

BACKGROUND: In 2015, the number of infants with congenital malformations (CMs) per 100 000 live births (LBs) was 2368 (7.6%) worldwide, of whom 10.6% died in the first year of life, 43% due to malformations of the circulatory system (MCSs), a scenario similar to what occurs in Brazil. OBJECTIVE: To assess, per Brazilian macroregion, whether diagnosis of MCS at birth and death due to MCS in the first year of life associate with human development index (HDI) and with technological and human resources. METHODS: Ecological study including data available in 2000-2015. Data of LBs, deaths and availability of echocardiography devices were obtained from the DATASUS website. The HDI was obtained from the Atlas of Human Development in Brazil, while other variables were obtained from medical demographic data. Correlation measures between the variables were performed using the Kendall index. RESULTS: The CM rate was 660.8/100 000 LBs, of which 18 444 were due to MCS (diagnosis rate, 38.55/100 000 LBs). Of all Brazilian macroregions, the Southern and Southeastern regions, with the highest HDI values and resources, had the highest MCS diagnosis rates (56.94/100 000 and 62.83/100 000 LBs, respectively). The Northern and Northeastern regions, with the lowest HDI values and resources, had the lowest MCS diagnosis rates (9.77/100 000 and 13.43/100 000 LBs, respectively). The MCS diagnosis rate was 6.4-fold higher in the Southeastern region as compared to the Northern region, but mortality rates were similar in both regions. CONCLUSION: Of the CMs, the MCS accounted for the highest number of deaths in children under the age of 1 year in Brazil.

FUDAMENTO: Em 2015, foram diagnosticados 2.368 portadores de malformação congênita (MC) por 100.000 nascidos vivos (NV) no mundo, uma taxa de 7,6%, dos quais 10,6% morreram no primeiro ano de vida, sendo 43% por malformações do aparelho circulatório (MAC), à semelhança do que ocorre no Brasil. OBJETIVO: Verificar a associação de diagnóstico de MAC ao nascimento e morte por MAC no primeiro ano de vida com índice de desenvolvimento humano (IDH) e recursos tecnológicos e humanos para o diagnóstico e tratamento da MAC por macrorregião do Brasil. MÉTODOS: Estudo ecológico de dados disponíveis de 2000 a 2015. Informações sobre NV, óbitos e ecocardiógrafos foram obtidas do DATASUS, o IDH, do Atlas de Desenvolvimento Humano no Brasil, e as demais foram obtidas da demografia médica. Foram realizadas medidas de correlação entre as variáveis utilizando o índice de Kendall. RESULTADOS: A taxa de MC foi 660,8/100.000 NV, das quais, 18.444 por MAC (taxa de diagnóstico 38,55/100.000 NV). As regiões Sul e Sudeste, com maiores valores de IDH e recursos, apresentaram as maiores taxas de diagnóstico de MAC (56,94/100.000 e 62,83/100.000 NV, respectivamente). As regiões Norte e Nordeste, com os menores valores de IDH e recursos, apresentaram as menores taxas de diagnóstico de MAC (9,77/100.000 e 13,43/100.000 NV, respectivamente). Essa taxa de diagnóstico foi 6,4 vezes maior no Sudeste do que no Norte, mas as taxas de mortalidade foram similares. CONCLUSÃO: Das MC, as MAC apresentaram a maior mortalidade nos menores de 1 ano no Brasil.

[All-cause and cardiovascular diseases mortality in three Brazilian states, 1980 to 2006]. / Mortalidade por todas as causas e por doenças cardiovasculares em três estados do Brasil, 1980 a 2006.

OBJECTIVE: to evaluate mortality from all causes, diseases of the circulatory system (DCS), ischemic heart disease (IHD), and cerebrovascular diseases (CVD) from 1980 to 2006 in Rio de Janeiro, Rio Grande do Sul, São Paulo, and their capitals, taking into consideration the impact of deaths due to ill-defined causes. METHODS: population and mortality data were obtained from the Unified Health System's Data Bank (DATASUS). Mortality from the diseases of interest and from ill-defined causes was adjusted by the direct method for adults older than 20 years of age. Since the mortality rates from ill-defined causes increased markedly after 1990, proportional mortality rates from ill-defined causes were calculated. Linear regression models were used for analysis of trends. RESULTS: a relevant decline in all-cause mortality was observed in the three states and capitals. Rio de Janeiro and its capital had the highest rates of all-cause mortality. DCS mortality declined more than all-cause mortality. Proportional mortality from ill-defined causes in Rio de Janeiro and its capital was higher than in all other states and capitals starting in 1990. CVD mortality fell in the study period, especially in Rio de Janeiro and its capital. The state of Rio de Janeiro also had the highest IHD mortality rates until 1993. Among the capitals, São Paulo presented the highest IHD mortality rates starting in 1992. CONCLUSIONS: the decline in all-cause mortality resulted mainly from the decline in DCS mortality. In turn, the decline in DCS mortality was partly due to the reduction in CVD mortality, especially in the state of Rio de Janeiro.

Inequalities in Mortality Rates from Malformations of Circulatory System Between Brazilian Macroregions in Individuals Younger Than 20 Years. / Desigualdades nas Taxas de Mortalidade por Malformações do Sistema Circulatório em Crianças Menores de 20 Anos de Idade entre Macrorregiões Brasileiras.

BACKGROUND: Deaths from malformations of the circulatory system (MCS) have a major impact on mortality reduction. given that most cases are avoidable with correct diagnosis and treatment. OBJECTIVES: To describe the distribution of mortality from MCS by sex. age. and macroregion in Brazil. in individuals under the age of 20. between 2000 and 2015. METHODS: A descriptive study of mortality rates and proportional mortality (PM) from MCS. other congenital malformations (OCM). circulatory system disease (CSD). ill-defined causes (IDC). and external causes (EC) in Brazil. RESULTS: There were 1.367.355 deaths from all causes in individuals younger than 20. 55.0% under 1 year of age. A total of 144.057 deaths were caused by congenital malformations. 39% of them by MCS. In both sexes. the annual mortality from MCS was 5.3/100.000. PM from MCS was 4.2%. CSD 2.2%. IDC 6.2% and EC 24.9%. Unspecified MCS showed the highest PM rates in both sexes and age groups. especially in the north and northeast regions (60%). Deaths from malformations occurred 5.7 times more frequently during the first year of life than in other ages (MCS: 5.0; OCM: 6.4). CONCLUSIONS: MCS was the leading cause of death among all malformations. being twice as important as CSD. mainly under 1 year of age. The frequency of misdiagnosis of MCS as cause of death was high in all ages and both sexes. especially in the north and northeast regions. These findings highlight the need for the development of public health strategies focused on correct diagnosis and early treatment of congenital cardiopathies. leading to a reduction in mortality. (Arq Bras Cardiol. 2020; 115(6):1164-1173).

FUNDAMENTOS: Os óbitos por malformações do aparelho circulatório (MAC) em 2015 corresponderam a 43% daqueles por malformações congênitas (MC) em menores de 20 anos de idade no mundo. Os óbitos por MAC apresentam maior impacto sobre a redução da mortalidade, pelo fato de serem evitáveis na maioria das vezes, com o correto diagnóstico e tratamento. OBJETIVO: Conhecer a distribuição da mortalidade por MAC por sexo, grupos etários e macrorregiões do Brasil no período de 2000 a 2015, nos menores de 20 anos de idade. MÉTODOS: Estudo descritivo das taxas de mortalidade por 100 mil e sua mortalidade proporcional, por MAC, outras malformações congênitas (OutMC), doenças do aparelho circulatório (DAC), causas mal definidas (CMD) e causas externas (CE) no Brasil, no período de 2000 a 2015 nos menores de 20 anos. As populações foram obtidas no Instituto Brasileiro de Geografia e Estatística e os óbitos no Departamento de Informática do Sistema Único de Saúde/Ministério da Saúde. RESULTADOS: Ocorreram 1.367.355 óbitos por todas as causas nos menores de 20 anos de idade, sendo 61,7% do sexo masculino e 55,0% dos óbitos nos menores de 1 ano. Os óbitos por MC em quaisquer órgãos ou sistemas foram 144.057 e os por MAC corresponderam a 39% desses óbitos. Em ambos os sexos, a mortalidade anual por MAC foi de 5,3/100 mil habitantes e a mortalidade proporcional (MP) foi de 4,2%, por DAC 2,2%, por CMD 6,2% e por CE 24,9%. As MAC não especificadas apresentaram as maiores taxas de MP em todas as idades e sexos, notadamente nas regiões Norte e Nordeste (60%). Os óbitos por quaisquer MC ocorreram 5,7 vezes mais no primeiro ano de vida do que nas outras faixas etárias (MAC: 5,0; OutMC: 6,4). CONCLUSÃO: No Brasil, de 2000 a 2015, nos menores de 20 anos de idade, a MAC foi a principal causa de óbito dentre todas as malformações, sendo duas vezes mais importante do que as DAC, principalmente nos menores de 1 ano de idade.A frequência de diagnósticos imprecisos de óbitos por MAC ainda é elevada em todas as idades, sexos, e principalmente nas regiões Norte e Nordeste, o que requer fortalecimento das estratégias de saúde pública e maior atenção ao recém-nascido com objetivo de diagnosticar e instituir tratamento precoce das cardiopatias congênitas com consequente redução na mortalidade. (Arq Bras Cardiol. 2020; 115(6):1164-1173).

[Complexity of therapeutic regimens prescribed for elderly retirees, Belo Horizonte/MG, Brazil]. / Complexidade do regime terapêutico prescrito para idosos.

OBJECTIVE: To examine factors associated with therapeutic regimen complexity of drug prescriptions for elderly people in Belo Horizonte, Minas Gerais, Brazil. METHODS: A household survey of elderly people selected by simple random sampling from Brazil's social security register. The medication complexity index (MCI), a direct measurement of actions required to administer medication, was derived from information in the latest prescription. Univariate and bivariate analyses were performed to identify factors associated with the MCI. RESULTS: Of the 667 interviewees, 56.5% had prescriptions meeting the inclusion criteria; most (69.2%) were females aged 72.4 years (mean); 35.5% self-rated their health good or very good; and 37.4% reported five or more diseases. In the 15 days prior to interview, 1873 drugs were used (mean=5.1), of which 942 appeared on the prescriptions examined (mean=2.5). Over the same period, 22.3% of interviewees failed to use some prescribed drug. The MCI ranged from 1 to 24 (mean=6.1). Number of drugs prescribed (>2), less schooling, worse perception of health and a lower benefit payment associated positively with greater complexity (p<0.05). An association was observed between regimen complexity and failure to use some drug in the preceding 15 days (p=0.034). CONCLUSION: Elderly people in worse socio-economic and health conditions seem more likely to receive more complex therapeutic regimens, which are associated with non-compliance to the proposed treatment. This is an important consideration in the healthcare of elderly. Simplification of therapy could aid self-care among the elderly.

Fetal and maternal factors are associated with mortality due to circulatory system disorders in children.

OBJECTIVE: To analyze the association of characteristics recorded at the time of birth, including weight, occurrence of asphyxia, gestation duration, maternal age and education level, with death from diseases or malformations of the circulatory system in children under 18 years of age. METHODS: The Brazilian Information System on Live Births and Information System on Mortality databases were linked and evaluated following a longitudinal cohort analysis strategy. The following independent variables were evaluated: characteristics recorded at the time of birth, including weight, occurrence of asphyxia, gestation duration, maternal age and education level. Dependent variables were death from diseases or malformations of the circulatory system in children under 18 years of age. Crude relative risks were estimated and relative risks were adjusted for the variables. RESULTS: 6,380 deaths were linked to 4,282,260 birth records, yielding 5,062 pairs considered as true. Low birth weight (RR = 2.26), asphyxia at 1 (RR = 1.72) and 5 minutes (RR = 1.51), prematurity (RR = 1.50), maternal age ≥ 40 years (RR = 2.06), and low maternal education level (RR = 1.45) increased the probability of death caused by circulatory system diseases. In the association with death by malformations of the circulatory system, the predictive variables showed the same association profile, but with greater intensity. CONCLUSIONS: Fetal and maternal factors are associated with increased mortality due to diseases and malformations of the circulatory system. Measures to control these factors and improve access to their diagnosis and treatment would contribute to reducing the number of deaths caused by diseases and malformations of the circulatory system. However, the identification of environmental influences during gestation and birth on the risk of death should be carefully considered due to being influenced by genetic factors.

Socioeconomic factors and mortality due to cerebrovascular and hypertensive disease in Brazil.

INTRODUCTION AND OBJECTIVE: Socioeconomic factors may affect mortality due to cerebrovascular diseases (CBVDs), hypertensive diseases (HYPDs), and circulatory system diseases (CSDs). This study aimed to assess the association between the Human Development Index (HDI) and the extent of supplementary health coverage and mortality due to these diseases in the Brazilian Federative Units (FUs) between 2004 and 2013. METHODS: The Municipal HDI (MHDI) scores of each FU for 2000 and 2010 were retrieved from the Atlas Brasil website, and supplementary health coverage data for the period 2004-2013 were obtained from the national regulatory agency for private health insurance. Population and mortality data were obtained from the website of the Department of Information Technology of the Unified Health System (DATASUS). Mortality rates were weighted by ill-defined causes of death and standardized by age. RESULTS: The MHDI increased between 2000 and 2010 in all FUs, in half of which it was 0.7 or higher. Supplementary health coverage increased in the country during the study period and was inversely associated with mortality due to CSDs and CBVDs between 2004 and 2013. Mortality due to CBVDs and HYPD in 2013 showed an inverse linear association with the MHDI in 2000. CONCLUSION: Mortality due to CSDs, CBVDs, and HYPDs was influenced by socioeconomic factors. There was a significant inverse association between socioeconomic factors and mortality due to CSDs, CBVDs, and HYPDs. Plans to reduce mortality due to these diseases should include measures to foster economic development and reduce inequality.

[Survey on medicine use by elderly retirees in Belo Horizonte, Southeastern Brazil]. / Inquérito sobre uso de medicamentos por idosos aposentados, Belo Horizonte,MG.

OBJECTIVE: To describe self-reported use of medicines by Brazilian elderly retirees focusing on gender differences. METHODS: Household survey conducted in a random sample comprising 667 subjects aged 60 years or more who were living in Belo Horizonte, Southeastern Brazil, in 2003. The elderly were interviewed by pharmacists, using a standardized questionnaire. The prevalence of medicine use and mean use in the 15 days previous to the interview were estimated and then stratified by gender according to sociodemographic and health variables. RESULTS: The prevalence of medicine use was 90.1%, and significantly higher among women (93.4%) than men (84.3%). Women and men took on average 4.6+/-3.2 and 3.3+/-2.6 products (p<0.001), respectively. The most frequently used drug category was cardiovascular, followed by nervous system and gastrointestinal tract and metabolism. Women showed higher use in all these drug categories, as well as higher mean number of drugs consumed, according to selected sociodemographic and health variables. CONCLUSIONS: The study identified higher use of medicines by women, making them more vulnerable to the harmful effects of polytherapy, such as drug interactions and inadequate use of medicines.

Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010. / Sobrevida em até 15 Anos de Homens e Mulheres após Intervenção Coronariana Percutânea Paga pelo Sistema Único de Saúde no Estado do Rio de Janeiro, 1999-2010.

BACKGROUND: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI's effectiveness should be conducted in a population of real-world patients. OBJECTIVES: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). METHODS: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. RESULTS: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). CONCLUSIONS: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty.

[Out-of-pocket drug expenditures by retirees and pensioners 60 years and older in Belo Horizonte, Minas Gerais, Brazil]. / Composição dos gastos privados com medicamentos utilizados por aposentados e pensionistas com idade igual ou superior a 60 anos em Belo Horizonte, Minas Gerais, Brasil.

The aim of this study was to analyze the structure of private drug expenditures by individuals 60 years and older in Belo Horizonte, Minas Gerais, Brazil. The study population consisted of a representative sample of retirees under the National Social Security Institute (INSS) in the city of Belo Horizonte, interviewed through a household survey. Monthly out-of-pocket drug expenditures were calculated, and a drug cost structure analysis was performed according to drug characteristics. 667 elders answered the survey. Mean drug expenditures per month were US$ 38.91. The therapeutic groups representing the majority of drug expenditures were: cardiovascular system (26%), nervous system (24%), and digestive/metabolic system (15%). Considering drug registration categories, brand-name drugs accounted for the majority of expenditures (54%). The results of this study can support policies to improve both access to medicines and overall health conditions for the Brazilian elderly population.

[Hospital case fatality associated with coronary angioplasty in Rio de Janeiro State, Brazil, 1999-2003]. / Letalidade hospitalar nas angioplastias coronárias no Estado do Rio de Janeiro, Brasil, 1999-2003.

This study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (PTCA) covered by the Brazilian Unified National Health System (SUS) and performed in hospitals in the State of Rio de Janeiro from 1999 to 2003. PTCA data were obtained from the State Health Department's database on Authorizations for Hospital Admissions. Case fatality rates were estimated according to age, gender, diagnosis, and hospital. Overall case fatality was 1.9% in 8,735 PTCAs. The lowest rate was associated with angina (0.8%) and the highest rates with acute myocardial infarction (6%) and other diagnoses (7%). In the 50-69-year bracket, case fatality was higher in women. In the over-70 group, it was almost three times that of the youngest group (4% versus 1.4%). There was great variability among PTCA case fatality rates in different hospitals (from 0 to 6.5%). Ongoing monitoring of PTCAs is thus necessary in clinical practice. In conclusion, PTCA performance was still unsatisfactory under the Unified National Health System.

Challenges for conducting blood collection and biochemical analysis in a large multicenter school-based study with adolescents: lessons from ERICA in Brazil.

The Study of Cardiovascular Risk in Adolescents (ERICA) is a pioneering study that aimed to assess the prevalence of cardiovascular risk factors, including metabolic syndrome components in Brazilian adolescents. This study aims to describe the methodological aspects related to blood collection as well as to report pertaining results of the preparation, transport, storage, and exams in ERICA. Exams in ERICA were performed in a single laboratory and blood samples were collected in schools in a standardized manner. Logistics involved air transportation of samples to the reference laboratory with controlled temperature since sample collection. The serum was stored in local biorepositories in four centers to be used in future analyses. During the study, 284,247 exams were performed and rate of participation in exams was 56.2%, thus involving 40,732 adolescents. From the total, 92.6% of the samples reached the reference laboratory maintaining the temperature between 0-10°C. No clinical significant changes in results due to temperature changes were identified. External quality control recorded satisfactory results in 98.7% of the evaluations. Four biorepositories with samples of 7,785 adolescents were created. Thus, we can consider that the logistics adopted in ERICA was fairly successful and description of this as well as the difficulties experienced in Brazil can inform and facilitate the planning of future studies, especially in developing countries.

[Probable cause of death after reclassification of ill-defined causes on hospital admissions forms in the Unified National Health System, Rio de Janeiro, Brazil]. / Reclassificação dos grupos de causas prováveis dos óbitos de causa mal definida, com base nas Autorizações de Internação Hospitalar no Sistema Unico de Saúde, Estado do Rio de Janeiro, Brasil.

This article describes the clinical and socio-demographic characteristics of deaths from ill-defined causes in the State of Rio de Janeiro, Brazil, in 1998, and reclassifies the groups of probable causes based on data from death certificates in the Mortality Information System and the Hospital Information System of the Unified National Health System (SIH-SUS) for 1997-98. Reclassification required a random sample of defined causes from the SIH-SUS. The technique used was probabilistic relationship of records. As compared to deaths with defined causes, in those with ill-defined causes the individuals were predominantly non-white, had less schooling, had died in Greater Metropolitan Rio de Janeiro, were less likely to have been hospitalized in the SUS, and were more likely to have died at home and without medical care. It was possible to reclassify 20% of deaths with ill-defined causes. Reclassification had a minor impact on proportional mortality, due to the size of this group (10% of the deaths). However, if the results could be applied to all deaths with ill-defined causes, the impact might be greater on proportional mortality.

[Use of medications by elderly Brazilian retirees: 1--methodology and response rates of a multicenter survey]. / Utilização de medicamentos por aposentados brasileiros: 1--metodologia e resultados de cobertura de inquérito multicêntrico.

This paper reports methodological aspects and response rates of a survey with the main objective of describing the drug utilization profile of retirees of the Institute of National Social Security of Brazil, 60 years of age or older, in three simple random samples: Brazil (countrywide), Belo Horizonte municipality, and Rio de Janeiro municipality. This cross-sectional study employed two approaches: mail (self-report questionnaires) and home interviews (questionnaires completed by interviewers). This strategy allowed evaluation of response agreement between the mail and home interview approaches. In the national sample of 3,000 individuals, 1,025 only responded to the self-report questionnaire. Despite this the low response rate, there was reasonable resemblance between respondents and non-respondents, suggesting that this sample is representative of the target population. In Belo Horizonte and Rio de Janeiro the initial samples of 800 individuals were replicated for both approaches, mail and home interview. The response rates to the mail surveys were 46.8% and 34.4% in Belo Horizonte and Rio de Janeiro, respectively. The response rates to the home interviews were 80.3% and 70.7% in Belo Horizonte and Rio de Janeiro, respectively, after unavoidable attrition.

[Ischemic heart disease lethalities in the state of Rio de Janeiro between 1999 and 2003]. / Letalidade por doenças isquêmicas do coração no Estado do Rio de Janeiro no período de 1999 a 2003.

OBJECTIVE: To estimate the lethality rate of acute and chronic ischemic heart disease (IHD) procedures, coronary artery bypass graft (CABG) procedures and percutaneous transluminal coronary angioplasty (PTCA) procedures in the hospitals that are registered as service providers for the Hospital Information System/Single Healthcare System (SIH/SUS) plan in the state of Rio de Janeiro (RJ) between 1999 and 2003. METHODS: The procedures considered as CABGs and PTCAs were provided by Datasus (SUS databank). The rates were standardized in accordance with gender, age, and disease severity. The common factors among these procedures are that they are highly complex cardiovascular procedures performed in RJ in the year 2000. The IHD groups are: angina, acute myocardial infarction, other acute IHDs and chronic IHDs. RESULTS: Lethality rates for angina, acute myocardial infarction (AMI), other acute and chronic IHDs were 2.8%, 16.2%, 2.9% and 3.9%, respectively, in the RJ. The lethality rates for CABG and PTCA, adjusted by age, sex and diagnostic groups, were elevated ranging from 1.9% to 12.8% for CABG procedures and as high as 3.2% for PTCA. When medical therapy was performed the rates were 2.3% for CABG and 11.1% for PTCA. CONCLUSION: There has been a progressive increase in the number of CABG and PTCA procedures to treat IHDs in the RJ. Lethality rates were above the desirable level, mainly for chronic IHD hospital admissions (5.4% and 1.7%, respectively). Optimized medical therapy appears to be a worthwhile therapeutic option, reserving CABG and PTCA procedures for the cases with the worst prognoses. Lethality rates for AMI with medical therapy was comparable to current rates when thrombolytics were not used (16.7%).