Investigating the Difference in Mortality Estimates between the Social Security Administration Trustees' Report and the Human Mortality Database

This study’s goal was to determine whether differences in data or differences in methods explain the divergence between the mortality estimates at ages 65 and older of the Social Security Administration (SSA) and the Human Mortality Database (HMD). These differences, increasing since 1968, are an issue of significant value considering the importance of SSA estimates and projections to determine the long term solvency of the Social Security Trust Funds, as well as of other government programs such as Medicare and Medicaid. The two organizations use different data and different methods to construct their estimates. In particular, the HMD relies on national statistics from the vital registration system and the Census Bureau, while the SSA uses Medicare program enrollment data. Applying the SSA methods to the HMD data showed that differences in the data, rather than in the methods, explain the entire gap in life expectancy at age 65, with the HMD indicator 0.4 years higher for 2014 than the SSA. The study also determined that the gap resulted mostly from lower mortality rates at ages 65 to 84 years (rather than at 85 and older) up to about 2005 to 2006, but that the growing divergence since then is nearly entirely due to increasingly lower mortality at ages above 85. The pattern was found to be similar for men and for women, though the gap is slightly larger for the latter. Additional investigations, with more detailed data, will be necessary to assess whether data reliability or issues of representativeness explain the difference.The U.S. Social Security Administration, RRC08098401-10, R-UM18-01https://deepblue.lib.umich.edu/bitstream/2027.42/148663/1/wp394.pdfDescription of wp394.pdf : Working pape

Mexican mortality 1990‒2016: comparison of unadjusted and adjusted estimates

Background: Vital statistics registration and census counts for Mexico may be incomplete, resulting in unreliable mortality indicators. Objective: We evaluate unadjusted mortality estimates for Mexico during 1990‒2016 and compare them with other published estimates for Mexico and with the historical mortality patterns observed among the 41 Human Mortality Database (HMD) populations. Finally, we investigate the effect of various adjustments on estimated life expectancy. Methods: We apply the HMD methodology to the official vital statistics and census counts to construct unadjusted life table series for Mexico. Then we make adjustments by substituting revised estimates for child mortality and by fitting a log-quadratic model. Results: Adjusted estimates of mortality below age 5 derived by the UN Inter-agency Group for Child Mortality Estimation (IGME) are up to 48% higher than our unadjusted estimates. Even in 2015, the IGME-adjusted estimates of child mortality remain at least 10% higher than our unadjusted estimates. Our analysis suggests that there may also be underestimation of mortality at both prime adult ages and the oldest ages. The log-quadratic model produced the lowest estimates of life expectancy at birth (3.8‒4.4 years lower than the unadjusted values in 1995). Conclusions: Unadjusted estimates are likely to underestimate mortality in Mexico, even in recent years. Adjustments may improve the accuracy of the mortality estimates, but we cannot adjudicate which set of adjusted estimates is closest to reality. Contribution: This is the first time the HMD methodology has been applied to the Mexican data

A morte no contexto da enfermagem obstétrica: uma perspectiva do cuidar

The authors intend to unveil facets of the meaning of mother’s care who has lost her baby at the end of pregnancy, in the nursery labor view. For that, they used a Qualitative Research Methodology. The phenomenological methodology of inquiry allowed them to reach the subject of the study. The data were collected from obstetric office employees that answers reveals important points linked to this mother’s care.Os autores se propõem desvelar facetas do significado do cuidado à mãe que vivencia a perda do filho ao final da gestação, aos olhos dos funcionários do Serviço de Enfermagem que cuidam dessa mãe. Para tanto, recorreram a uma Metodologia de Pesquisa Qualitativa - a investigação fenomenológica - que lhes permita o acesso a esse objeto de estudo, à sua essência. Foram coletados depoimentos de funcionários de uma Clínica Obstétrica, mediante uma questão orientadora. A análise dos depoimentos desvela facetas relevantes ligadas ao cuidado dessa mãe

Frailty at death : an examination of multiple causes of death in four low mortality countries in 2017

Altres ajuts: University of California Berkeley Center for the Economics and Demography of Aging (NIH grant #P30AG012839).BACKGROUND The increasing prevalence of frailty in ageing populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process.OBJECTIVE To examine frailty-related mortality as reported on death certificates in France, Italy, Spain, and the United States in 2017. METHODS We identify frailty at death for the population aged 50 years and over in France, Italy, Spain, and the United States. We estimate the proportions of deaths by sex, age group, and country using specific frailty-related ICD-codes on the death certificate, (1) as the underlying cause of death (UC), (2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and (3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). RESULTS The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0%) followed by France (24.1%) and Spain (17.3%), and lowest in the United States (14.0%). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. CONCLUSIONS Notable cross-country differences were found in the prevalence and type of frailty-related symptoms at death, even after adjusting for differential age distributions. CONTRIBUTION Strong similarities between countries were found that warrant monitoring frailty at death in low-mortality countries to complement information on frailty prevalence in the living population

Analisadores de práticas de apoio em humanização e educação permanente em saúde

Las Políticas Nacionales de Humanización y Educación Permanente en Salud han mostrado avances y retrocesos en su proceso histórico. Algunos conceptos del marco teórico del análisis institucional pueden contribuir a estos temas, como el concepto de analizador. El objetivo de este artículo fue discutir los analizadores identificados en una investigación-intervención, con profesionales que actúan como apoyadores de la humanización y/o articuladores de la educación permanente en salud en municipios de São Paulo. El marco teórico-metodológico fue el del análisis institucional, línea socioclínica, destacándose el trabajo de los analizadores. Participaron 30 personas en los grupos de intervención. Se destacan tres analizadores: (1) el analizador histórico Covid-19; (2) el analizador de tiempo; (3) el analizador de silencio. Estos analizadores iluminan tensiones como: el lugar periférico de la atención primaria, el malestar ante el “no saber” y/o el letargo ante el no hacer impuesto y la paradoja de crear e interrumpir tanto las acciones asistenciales como de apoyo a los equipos.The National Policies of Humanization and Permanent Health Education (PHE) have shown advances and setbacks in their historical process. Some concepts from the theoretical framework of institutional analysis can contribute in these themes, such as the concept of analyzer. This article discusses the analyzers identified in an intervention research with professionals who work as supporters of humanization and/or articulators of PHE in municipalities of the state of São Paulo. The theoretical-methodological framework is the institutional analysis, socio-clinical line, focusing on the work of the analyzers.As Políticas Nacionais de Humanização e Educação Permanente em Saúde têm mostrado em seu processo histórico avanços e retrocessos. Alguns conceitos do referencial teórico da análise institucional podem contribuir nesses temas, como o conceito de analisador. O objetivo do presente estudo foi discutir os analisadores identificados em uma pesquisa-intervenção, com profissionais que exercem a função de apoiadores de humanização e/ou de articuladores de educação permanente em saúde em municípios paulistas. O quadro teórico-metodológico é a análise institucional, linha sócio-clínica, sendo destacado, o trabalho dos analisadores. Participaram 30 pessoas dos grupos de intervenção. Destacamos três analisadores: (1) o analisador histórico Covid-19; (2) o analisador tempo; (3) o analisador silêncio. Esses analisadores iluminaram tensões como: o lugar periférico da atenção básica, o desconforto frente ao “não saber” e/ou a letargia ante o não-fazer imposto e o paradoxo de criar e interromper tanto ações de cuidado, como de suporte às equipes

Frailty at death: An examination of multiple causes of death in four low mortality countries in 2017

Background: The increasing prevalence of frailty in ageing populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process. Objective: To examine frailty-related mortality as reported on death certificates in France, Italy, Spain, and the United States in 2017. Methods: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain, and the United States. We estimate the proportions of deaths by sex, age group, and country using specific frailty-related ICD-codes on the death certificate, (1) as the underlying cause of death (UC), (2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and (3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). Results: The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0Š) followed by France (24.1Š) and Spain (17.3Š), and lowest in the United States (14.0Š). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. Conclusions: Notable cross-country differences were found in the prevalence and type of frailty-related symptoms at death, even after adjusting for differential age distributions. Contribution: Strong similarities between countries were found that warrant monitoring frailty at death in low-mortality countries to complement information on frailty prevalence in the living population

Gerenciamento comunitário de recursos hídricos, uma questão de saúde: a água que temos e a água que queremos: percepção dos usuários de sociedades de água em um município rural da sub-bacia hidrográfica do Forqueta, RSCommunity management of water.....

Os Comitês de Bacia Hidrográfica (CBH) foram criados para democratizar e descentralizar a gestão das águas, compatibilizando os usos necessários para suprir as demandas de cada setor e garantindo a qualidade do recurso para as futuras gerações. Em áreas rurais da sub-bacia do rio Forqueta, assim como em outras regiões rurais do estado do Rio Grande do Sul, o abastecimento de água para a população é realizado por associações de moradores, chamadas por eles de sociedades de água. Este estudo objetivou discutir as percepções dos presidentes das sociedades de água sobre a gestão dos recursos hídricos, principalmente sobre aspectos quali-quantitativos locais. As informações foram coletadas a partir de entrevistas individuais e de rodas de conversa, realizadas com os presidentes das sociedades de água do município de Marques de Souza/RS e do acompanhamento das reuniões do Comitê Taquari-Antas. A pesquisa classifica-se como exploratória, observacional, qualitativa. Como potencialidades, os entrevistados apontam que as sociedades de água facilitaram o acesso à água, mas há uma desvalorização do recurso, retratada pelo desperdício e pela poluição, podendo impactar a saúde das comunidades. Para enfrentar esses fatores, foi sugerido o tratamento de esgoto, a preservação da mata ciliar, a limitação do uso da água e campanhas de educação quanto ao seu uso e preservação. Destaca-se que a população não está ciente dos dados qualitativos dos recursos hídricos da bacia hidrográfica, nem mesmo da possível contaminação de seus poços por agrotóxicos, aponta o que a necessidade de estratégias de educação ambiental. A falta de comunicação entre os etrevistados e o Comitê de Bacia ao qual pertencem é outro elemento que necessita ser trabalhado.Abstract The hydrographic Basin Monitoring Committees were created to democratize and decentralize water management, harmonizing the uses needed to meet the demands of each sector and ensuring the quality of the resource for future generations. In rural areas of the sub-basin of the Forqueta River as well as in other rural regions of the state of Rio Grande do Sul, the water supply for the population is carried out by local residents’ associations who call themselves “water societies”. This study aimed to discuss the perceptions of the presidents of the “water societies” on the management of water resources, mainly on local qualitative and quantitative aspects. Data were collected from individual interviews and conversation circles, carried out with the presidents of the “water societies” in the municipality of Marques de Souza/Rio Grande do Sul and from the follow-up meetings with the Taquari-Antas Committee. The research is classified as exploratory, observational and qualitative. The results show that the respondents point out that the “water societies” facilitated access to water, however there is a depreciation of the resource, evidenced by the waste and pollution, which can impact on the health of the communities. Thus, it was suggested sewage treatment, the preservation of riparian vegetation, water use restrictions and educational campaigns, focusing on the use and preservation of water. It is noteworthy that the population is not aware about the qualitative data of the water resources of the basin, but they also ignore about the possible contamination of their wells by pesticides, indicating the need for environmental education strategies. The lack of communication between the “water societies” and the Basin Monitoring Committee to which they belong is another element that needs to be worked

A análise de implicação profissional como um dispositivo de educação permanente em saúde

Objetivo: analizar la implicación profesional con los colaboradores de humanización y los articuladores de educación permanente en salud como un dispositivo de Educación Permanente en Salud. Método: investigación-intervención, de abordaje cualitativo, fundamentado en el referencial teórico del Análisis Institucional. Participaron de la investigación 35 colaboradores de humanización y/o articuladores de educación permanente. Fueron realizadas encuestas semiestructuradas, encuentros mensuales, encuentros de restitución y el diario de investigación como instrumentos para la producción de los datos. El análisis del material fue hecho según los principios del referencial del estudio y los resultados fueron presentados según las dimensiones ideológica, organizacional y libidinal de la implicación profesional. Resultados: fueron identificadas: la contradicción en pensarse en un perfil profesional para el desarrollo del apoyo y de la articulación; los sentimientos de desánimo, pesimismo y optimismo en el desarrollo de esas funciones; los atravesamientos que la profesión de enfermería ejerce en el hacer apoyo y articulación; el tiempo de ejercicio profesional; y la ausencia/presencia del deseo en el desarrollo de las mismas. Conclusion: el análisis de implicación profesional consistió en un potente dispositivo generador de procesos formativos. Ella posibilitó el aprendizaje y la reflexión de la práctica por medio del análisis de las acciones que fueron ejecutadas por los profesionales, generando transformaciones de la concepción del trabajo en salud.Objective: analyze professional implication with the support of humanization and articulators of permanent education in health as a tool of Permanent Education in Health. Method: this is an interventional study of qualitative approach, based on the theoretical reference of Institutional Analysis. Thirty-five humanization supporters and/or permanent education articulators participated in this study. Semi-structured interviews, monthly meetings, restitution meetings and a daily logbook were used as tools for data production. The material was analyzed according to the principles of the study reference and the results were presented according to the ideological, organizational and libidinal dimensions of professional implication. Results: this study identified a contradiction when finding a professional profile for the development of support and articulation; feelings of discouragement, pessimism and optimism in the development of these roles; influences of the nursing profession on the development of support and articulation; length of professional service; and the absence/presence of desire in such development. Conclusion: the analysis of professional implication consisted of a powerful tool generating training processes. It allowed learning and reflection of the practice through analysis of the actions performed by the professionals, generating changes in the conception of work in health.Objetivo: analisar a implicação profissional com os apoiadores de humanização e os articuladores de educação permanente em saúde como um dispositivo de Educação Permanente em Saúde. Método: pesquisa-intervenção, de abordagem qualitativa, fundamentada no referencial teórico da Análise Institucional. Participaram da pesquisa 35 apoiadores de humanização e/ou articuladores de educação permanente. Foram utilizadas entrevistas semiestruturadas, encontros mensais, encontros de restituição e o diário de pesquisa como instrumentos para a produção dos dados. A análise do material foi feita segundo os princípios do referencial do estudo e os resultados foram apresentados conforme as dimensões ideológica, organizacional e libidinal da implicação profissional. Resultados: foram identificadas: a contradição em se pensar em um perfil profissional para o desenvolvimento do apoio e da articulação; os sentimentos de desânimo, pessimismo e otimismo no desenvolvimento dessas funções; os atravessamentos que a profissão de enfermagem exerce no fazer apoio e articulação; o tempo de exercício profissional; e a ausência/presença do desejo no desenvolvimento das mesmas. Conclusão: a análise de implicação profissional consistiu em um potente dispositivo gerador de processos formativos. Ela possibilitou o aprendizado e a reflexão da prática por meio da análise das ações executadas pelos profissionais, gerando transformações da concepção do trabalho em saúde

The short-term mortality fluctuation data series, monitoring mortality shocks across time and space.

The COVID-19 pandemic has revealed substantial coverage and quality gaps in existing international and national statistical monitoring systems. It is striking that obtaining timely, accurate, and comparable across countries data in order to adequately respond to unexpected epidemiological threats is very challenging. The most robust and reliable approach to quantify the mortality burden due to short-term risk factors is based on estimating weekly excess deaths. This approach is more reliable than monitoring deaths with COVID-19 diagnosis or calculating incidence or fatality rates affected by numerous problems such as testing coverage and comparability of diagnostic approaches. In response to the emerging data challenges, a new data resource on weekly mortality has been established. The Short-term Mortality Fluctuations (STMF, available at www.mortality.org ) data series is the first international database providing open-access harmonized, uniform, and fully documented data on weekly all-cause mortality. The STMF online vizualisation tool provides an opportunity to perform a quick assessment of the excess weekly mortality in one or several countries by means of an interactive graphical interface