Mortality information: the use of international rules for the selection of the underlying cause

A análise da mortalidade tem sido muito usada em saúde pública, e a causa básica da morte é uma variável bastante estudada. Na maioria dos países, há obrigatoriedade de o médico preencher a declaração de óbito (DO), informando às autoridades a ocorrência do evento, características do falecido e causas da morte. Quando há dois ou mais diagnósticos na declaração das causas da morte, surge a questão da seleção da causa básica. As normas para o preenchimento das causas de morte pelos médicos nas DO e as regras para a seleção da causa básica, quando mais de uma causa é declarada, estão definidas pela OMS, visando à comparabilidade internacional. O objetivo deste trabalho é avaliar se a aplicação das Regras Internacionais de Classificação da causa básica permite a seleção da real causa básica, mesmo se declarada incorretamente pelo médico. O material pertence ao "Estudo sobre a mortalidade de mulheres em idade fértil", sendo que 1.315 casos satisfizeram os requisitos de inclusão. Para cada morte foi realizada uma investigação através de entrevistas domiciliárias, consultas aos prontuários hospitalares e assemelhados. Médicos treinados e calibrados preenchiam uma DO nova, após a leitura de toda a informação, e selecionavam a "verdadeira" causa básica da morte. Esta era comparada com a causa básica da DO original, obtida por meio das Regras Internacionais. Entre as DO, em 1.192 (90,6%) houve concordância com a verdadeira causa básica obtida após a investigação. Concluiu-se que as Regras Internacionais permitem selecionar a real causa básica, mesmo quando o médico preenche inadequadamente a DOMortality analysis is often used in public health and the cause of death is an important variable. In most countries, there is a requirement for physicians to fill out a death certificate (DC) and to send it to authorities informing its occurrence, characteristics of the deceased, and causes of death. When there are two or more diagnoses in the DC as causes of death, it raises the question of how to select the underlying cause. There are International Rules for filling out medical causes of death in the DC and rules for the selection of the underlying cause when more than one cause is declared. The WHO defined and included them in the International Classification of Diseases, aiming to have international comparability. The objective is to evaluate whether the application of International Rules allows the selection of the real underlying cause, even if causes of death were poorly declared by the physician. The cases belong to the "Study on mortality of childbearing age women" from which total of 1,315 DC were selected. For each death, an investigation was conducted through household interviews, consultation to hospital records, and autopsies. Physicians were trained to fill a new DC, after reading all the information, and to select the real underlying cause. This cause selected after the investigation was compared to the corresponding cause in the original DC, obtained by means of the International Rules. Results showed that in 1,192 (90.6%) original DC there was agreement with the real cause obtained with the investigation. The conclusion was that International Rules allow a trained coder to select the real underlying cause, even when the physician fills the DC incorrectlyMinistério da Saúde - Secretaria de Atenção à Saúde. Departamento de Ações Programáticas; CNPq Processo 403087/2004-

Making sense of the sharing economy: a category formation approach

The sharing economy (SE) has drawn significant attention from several society stakeholders in the last five years. While business actors are interested in financial opportunities to meet consumer needs, new business models, academia and governmental organisations are concerned with potential unintended effects on society and the environment. Despite its notable global growth, there is still a lack of more solid ground in understanding its origins and respective mechanisms through which it has been evolving as a category. This research addresses the problematics of the origins and ascendency of the SE by examining the process by which it is arising as a new category, searching for conceptual clarification, and pinpointing the legitimacy granted by stakeholders. Our guiding research questions are: how the SE was formed and evolved as a category, and as a category, is the SE legitimate? Additionally, we attempt to identify the nature of the SE as a category. Making a historical analysis of the expression SE and its equivalents, this paper deepens the discussion about the SE’s nature by providing evidence that it has predominantly been formed by emergence processes, comprising social movement, similarity clustering, and truce components, which render the SE a particular case of category formation and allow communication, entrepreneurship, regulation, and research about what it is. Moreover, the findings reveal a generalised legitimacy granted to the SE by a vast number of stakeholders, although still lacking the consolidation of socio-political legitimation. The SE’s nature seems to fall into a metaphorical approach, notably, the notion of radial categories.info:eu-repo/semantics/publishedVersio

Death and its epidemiological investigation: considerations about some relevant aspects

O artigo aborda questões relativas ao óbito e sua investigação como elementos importantes para a Epidemiologia e a Saúde Pública. Ressalta aspectos ligados à melhoria da sua qualidade e da vigilância, bem como da pesquisa científica/epidemiológica nessa área, vistos sob a óptica da legislação e das normas éticas existentes no Brasil. Discute o problema relativo, a saber, "a quem pertence a informação em saúde e quais os limites de sua utilização", tratando, inclusive, da possibilidade do uso de bancos de dados identificados. Conclui sugerindo meios hábeis, como "Termo de Responsabilidade e Confidencialidade" por parte do pesquisador, para que a pesquisa científica/epidemiológica possa ter continuidade no país, com agilidade e oportunidade.This article addresses death and issues related to its investigation, as important components for Epidemiology/Public Health. It highlights aspects linked to the improvement of quality of investigation and surveillance of death, as well as the advance of scientific/epidemiological research in this area, analyzed in view of current legislation and ethical principles in Brazil. We discuss the problem related to knowing "whom the health information belongs to and which are the limits of its utilization", considering also the possibility of using identified databases. At the end, we suggest competent ways, as a "Term of Responsibility/Confidentiality" signed by the researcher in order to enable scientific/epidemiological research to continue in the country, in a more opportune and agile manner

Análise de declarações de óbito dos casos investigados pelo comitê de mortalidade materna do estado de Santa Catarina nos anos de 2006 e 2007.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Tocoginecologia

Decline in cardiovascular disease mortality in the city of S.Paulo, Brazil, 1970 to 1983

Mortality from all causes as well as from the great groups of cardiovascular diseases for the residents of the city of S.Paulo, Brazil, of the ages-group 40-69, for the years 1970 to 1983, has been analysed by means of the specific death rates. During this period a statistically significant decline was observed (28% on the average for ischemic heart diseases and 16% for cerebrovascular diseases). The death rates for the group 40-69 years old for both sexes were age-standardized and compared with those of 27 industrialized countries. The S.Paulo standardized death rates ranked almost always very high in the comparisons.Foi analisada a mortalidade por todas as causas e por grandes grupos de doenças cardiovasculares de residentes da cidade de São Paulo, SP, Brasil, nas idades de 40 a 69 anos, para os anos de 1970 a 1983, mediante os coeficientes específicos de mortalidade. No período observado houve um declínio (28% em média para as doenças isquêmicas do coração e 16% para as doenças cerebrovasculares), estatisticamente significativo. Os coeficientes de mortalidade de 40 a 69 anos, de ambos os sexos, foram ajustados por idade e comparados com os de 27 países industrializados, observando-se alto risco de morrer de doenças cardiovasculares

Mortalidade materna por hemorragia no Brasil

OBJETIVO: analizar las tasas de mortalidad materna debida a hemorragia, identificadas en Brasil durante el periodo de 1997 a 2009. MÉTODOS: fueron examinados los datos de series temporales y de población del Ministerio de la Salud de Brasil, del Sistema de Información de Mortalidad y del Sistema de Información de Nacidos Vivos. Del Sistema de Información de Mortalidad, inicialmente seleccionamos todos los informes sobre muerte de mujeres con edad entre 10 y 49 años, que ocurrieron entre el 01 de enero de 1997 y el 31 de diciembre de 2009, en Brasil, clasificadas como "muertes maternas". RESULTADOS: durante el periodo de investigación, fueron identificadas 22.281 muertes maternas, entre las cuales 3.179 se debieron a hemorragia, siendo responsables por 14,26% del total de muertes. La tasa más alta de mortalidad materna fue encontrada en las regiones Norte y Noreste de Brasil. CONCLUSIONES: el escenario brasileño muestra desigualdades regionales en lo que se refiere a mortalidad materna; este presenta la hemorragia como un síntoma y no como la causa de la muerte.OBJECTIVE: to analyze the rates of maternal mortality due to hemorrhage identified in Brazil from 1997 to 2009. Methods: the time series and population data from the Brazilian Health Ministry, Mortality Information System and Live Birth Information System were examined. From the Mortality Information System, we initially selected all reported deaths of women between 10 and 49 years old, which occurred from January 1, 1997 to December 31, 2009 in Brazil, recorded as a "maternal death". RESULTS: during the research period, 22,281 maternal deaths were identified, among which 3,179 were due to hemorrhage, accounting for 14.26% of the total deaths. The highest rates of maternal mortality were found in the North and Northeast areas of Brazil. CONCLUSIONS: the Brazilian scenario shows regional inequalities regarding maternal mortality. It presents hemorrhaging as a symptom and not as a cause of death.OBJETIVO: analisar a razão de mortalidade materna devido a hemorragia identificada no Brasil, durante o período de 1997 a 2009. MÉTODO: análise de dados populacionais com série temporal. Os dados foram obtidos nos Sistemas de Informações de Mortalidade e Nascidos Vivos do Ministério da Saúde do Brasil. Foi selecionado, para análise, o total de óbitos de mulheres com idade compreendida entre 10 e 49 anos, que ocorreram no período de 1997 a 2009, e que foram registrados como "morte materna". RESULTADOS: durante o período de pesquisa, 22.281 mortes maternas foram identificadas no Sistema de Mortalidade e, dessas, 3.179 foram devido a hemorragia, respondendo por 14,26%. A razão de mortalidade materna esteve mais elevada nas Regiões Norte e Nordeste do Brasil. CONCLUSÕES: o cenário brasileiro mostra desigualdades regionais em relação à mortalidade materna. A hemorragia é apresentada como um sintoma, e não como uma causa de morte

Reliability of reported underlying causes of neonatal death : implications for the study of preventable mortality

Analisam-se as principais causas de morte neonatal, a confiabilidade da causa básica constante nas declarações de óbito e o impacto dos problemas de confiabilidade na análise de morte prevenível. A informação constante nas declarações de óbito de urna amostra de 15% dos óbitos neonatais, ocorridos entre maio de 1986 e abril de 1987, na Região Metropolitana do Rio de Janeiro, Brasil, é comparada com a dos prontuários hospitalares de 452 crianças falecidas. Identificou-se no prontuário o diagnóstico, denominado "causa básica modificada", considerada mais correta segundo as regras de classificação de doenças. A grande maioria dos óbitos foram devidos às causas perinatais (87%). A concordância simples entre a causa básica original e a modificada foi baixa - 38% para 3 dígitos da Classificação Internacional de Doenças e 33% para 4 dígitos. As causas básicas modificadas mostram maior peso das afecções e complicações maternas, com aumento de 12,8 vezes, e das complicações relacionadas com a placenta, cordão, trabalho de parto ou parto, que aumentaram 6,2 vezes em relação as causas originalmente declaradas. A utilização da causa básica modificada elevou consideravelmente (58%) o percentual de óbitos considerados "reduzíveis" pela classificação de mortalidade neonatal proposta pela Fundação Sistema Estadual de Análise de Dados. Do total dos óbitos, 75% foram considerados reduzíveis ou parcialmente reduzíveis. Foram identificados 107 (24%) óbitos em crianças com adequado peso ao nascer, 60% dos quais foram considerados como reduzível ou parcialmente reduzível, bem como 4 óbitos por sífilis congênita, 3 por doença hemolítica perinatal, e 21 crianças que vieram a morrer no domicílio. Em conclusão, foram constatados importantes problemas na confiabilidade da declaração da causa básica de óbitos neonatais, cuja correção tende a elevar a proporção considerada reduzível ou prevenível. Fica evidente o potencial de utilização do atestado de óbito para o monitoramento de qualidade, entretanto sendo necessário um aprimoramento da qualidade do seu preenchimento. _________________________________________________________________________________ ABSTRACTThe main causes of neonatal mortality, the reliability of the underlying cause of death registered in the death certificate, and the impact of problems of reliability on the analysis of preventable death were studied. The information on death certificates from a 15% sample of neonatal deaths between May 1986 and April 1987 in the Greater Metropolitan Region of Rio de Janeiro was compared to the information in the hospital records of the 452 deceased infants. A "modified underlying cause" considered most correct according to disease classification rules was identified from the records. The great majority of deaths (87%) were due to perinatal causes. Agreement between the originally declared and modified underlying causes of death was poor: 38% for 3 digits of the International Classification of Diseases Codes (CID-9) and 33% for 4 digits. The modified underlying causes are more weighted towards maternal conditions and complications, which increased by a factor of 12.8, and towards complications of the placenta, umbilical cord, labour and delivery, which rose by a factor of 6.2 in relation to the original causes. The utilization of the "modified" underlying cause elevated considerably (58%) the proportion of deaths considered reducible by the classification of neonatal death proposed by the SEADE Foundation. Seventy-five percent (75%) of deaths were considered reducible or partially reducible. One hundred and seven (24%) of the deaths of them being in infants of normal birthweight, of which 60% considered preventable. Four (4) deaths from congenital syphilis, 3 from perinatal hemolytic diseases, and 21 unattended home deaths of infants were also identified. In summary, important problems were identified in the reliability of the declaration of the underlying causes of neonatal death, whose correction tends to elevate the proportion considered reducible or preventable. The potential for the use of death certificate data for the monitoring of quality is evident, nonetheless improvements are needed in the quality of these data

Perinatal mortality in hospitals of the state of São Paulo: methodological aspects and some characteristics of mothers and conceptuses

Objective: to verify perinatal mortality and its associated components in an investigation about the history of gestations/deliveries. Method: the study was carried out at six maternity hospitals in the State of São Paulo that were interested in participating in the research. The population was composed of 7,058 women, of whom 6,530 gave birth, the number of conceptuses was 6,602: 56 stillbirths and 6,546 live births, of which 28 died in the first week of life. Variables related to the mother, the pregnancy, the delivery and the conceptus were studied. Results: the perinatal mortality coefficient was 12.7 per 1,000 births, 66.7% of the conceptuses were stillbirths and 33.3% were live births who died aged less than 7 days at the same hospital where they were born. Approximately 27% of the conceptuses were children of adolescent mothers and 44% of the mothers were primigravidae. Prenatal assistance was attended by 92% of the women, type of pregnancy showed 67.8% of preterm gestations with similar proportions for each one of the components. The coefficient for twin gestations was more than four times higher than the coefficient for mothers of singleton gestations. Regarding type of delivery, Cesarean sections corresponded to 31.1% of the total, and it is important to notice that there was a non-negligible amount of surgical deliveries in mothers whose product was a stillbirth. The coefficient according to sex was higher for males (1.8: 1), and as for birth weight, the highest proportion occurred among those who weighed less than 2,500g (67.9%). Conclusions: there was a relationship of the proportion of neonatal deaths in the first hours of life and the proportion of fetal deaths to the quality of the care offered in the women’s pregnancy-puerperal cycle

NUMBERS OF MORTALITY IN THE STATE OF MARANHÃO, BRAZIL

Death is defined by the World Health Organization as the cessation of vital signs at any time after birth, with no possibility of resuscitation. The objective of this study was to analyze the temporal dynamics of mortality in the State of Maranhão using data from the Mortality Information System (SIM) of the National Department of Health. For this, it was used information on the mortality rate of all municipalities in the State in the years 2000, 2010 and 2014. Data were initially analyzed through descriptive statistics to determine the main statistical moments. The statistical analysis demonstrated that data presented high coefficient of variation value and did not show normal frequency distribution. Through the maps generated it is possible to verify that only the city of São Luís had more than 1000 deaths in the three years analyzed. In addition to the growth in the total number of deaths in the state, accompanying the population increase